Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis

Figures

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  Figure 1. Individual results from studies reporting cerebrovascular reactivity as a continuous exposure measure. Forest plot illustrating the individual effect sizes for each study reporting continuous cerebrovascular reactivity in relation to cerebral small vessel disease burden. IV indicates inverse‐variance; and OR, odds ratio.

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  Figure 2. Odds ratio results from pooled studies reporting cerebrovascular reactivity as a dichotomous exposure variable. Forest plot illustrating the effect sizes reported for dichotomous cerebrovascular reactivity in relation to cSVD burden. There was a borderline significant association between impaired cerebrovascular reactivity and a greater cSVD burden (OR, 2.26 [95% CI, 0.99–5.14]). cSVD indicates cerebral small vessel disease; IV, inverse‐variance; OR, odds ratio.

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  Figure 3. Individual results from studies reporting cerebral autoregulation as a dichotomous exposure measure. Forest plot illustrating the individual effect sizes for each study reporting dichotomous cerebral autoregulation in relation to cerebral small vessel disease burden. IV indicates inverse‐variance; and OR, odds ratio.

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  Figure 4. Odds ratio results from pooled studies reporting arterial stiffness as a continuous exposure variable. Forest plot illustrating the effect sizes for studies reporting continuous arterial stiffness in relation to cSVD burden. Effect sizes are reported per 1‐SD increase. The overall effect favored a greater presence of cSVD as arterial stiffness increases (OR, 1.24 [95% CI, 1.15–1.33]). cSVD indicates cerebral small vessel disease; IV, inverse‐variance; and OR, odds ratio.

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  Figure 5. Odds ratio results from pooled studies reporting arterial stiffness as a dichotomous exposure variable. Forest plot illustrating the effect sizes for studies reporting dichotomous arterial stiffness in relation to cSVD burden. Effect sizes are reported per 1‐SD increase. The overall effect suggested a greater arterial stiffness was associated with a greater presence of cSVD (OR, 1.86 [95% CI, 1.41–2.45]). cSVD indicates cerebral small vessel disease; IV, inverse‐variance; and OR, odds ratio.

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  Figure 6. Characterization of arterial stiffness and cerebrovascular regulation in relation to cSVD. A, Cerebrovascular reactivity is an aspect of the chemo‐regulation of cerebral blood flow, where a healthy cerebrovascular system should demonstrate a positive relationship between cerebral blood flow and arterial carbon dioxide content (arterial CO2). B, Cerebral autoregulation is the regulatory process by which the cerebral circulation maintains relatively stable perfusion through a range of arterial blood pressures. C, In vivo measurements of arterial stiffness capture incremental stress–strain relationships, describing the overall impact that arterial structural and functional components have on arterial elasticity, buffering of pulsatile pressures, etc. Examples of MRI images depicting the 5 primary radiological markers of cSVD are shown. Created with BioRender.com. MRI images adapted from Bennett et al 206 used under CC BY 4.0. cSVD indicates cerebral small vessel disease; and MRI, magnetic resonance imaging.