Key result
Baroreflex sensitivity shows complex, bidirectional temporal links with cerebrovascular reactivity across patients.
Why the study?
Recent literature indicates autonomic dysfunction may drive impaired cerebrovascular reactivity in moderate/severe TBI, but the physiological relationship between continuous cerebrovascular reactivity and autonomic variables remains poorly understood.
Does autonomic function display a temporal and causal relationship with cerebrovascular reactivity in patients with moderate/severe traumatic brain injury?
Observational (n=47)
No
Does autonomic function display a temporal and causal relationship with cerebrovascular reactivity in patients with moderate/severe traumatic brain injury?
Autonomic dysfunction, specifically systemic sympathetic responses, exhibits a complex bidirectional influence on cerebrovascular reactivity in traumatic brain injury, suggesting overlapping secondary injury pathways.
There has been little change in morbidity and mortality in traumatic brain injury (TBI) in the last 25 years. However, literature has emerged linking impaired cerebrovascular reactivity (a surrogate of cerebral autoregulation) with poor outcomes post-injury. Thus, cerebrovascular reactivity (derived through the pressure reactivity index; PRx) is emerging as an important continuous measure. Furthermore, recent literature indicates that autonomic dysfunction may drive impaired cerebrovascular reactivity in moderate/severe TBI. Thus, to improve our understanding of this association, we assessed the physiological relationship between PRx and the autonomic variables of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) using time-series statistical methodologies. These methodologies include vector autoregressive integrative moving average (VARIMA) impulse response function analysis, Granger causality, and hierarchical clustering. Granger causality testing displayed inconclusive results, where PRx and the autonomic variables had varying bidirectional relationships. Evaluating the temporal profile of the impulse response function plots demonstrated that the autonomic variables of BRS, ratio of low/high frequency of HRV and very low frequency HRV all had a strong relation to PRx, indicating that the sympathetic autonomic response may be more closely linked to cerebrovascular reactivity, then other variables. Finally, BRS was consistently associated with PRx, possibly demonstrating a deeper relationship to PRx than other autonomic measures. Taken together, cerebrovascular reactivity and autonomic response are interlinked, with a bidirectional impact between cerebrovascular reactivity and circulatory autonomics. However, this work is exploratory and preliminary, with further study required to extract and confirm any underlying relationships.
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Froese et al. (2022) conducted an observational in Moderate to severe traumatic brain injury (n=47). Autonomic response variables (heart rate variability, blood pressure variability, baroreflex sensitivity) was evaluated on Temporal and causal physiological relationship between cerebrovascular reactivity (PRx) and autonomic variables (HRV, BPV, BRS) using VARIMA and Granger causality. Autonomic response variables, particularly baroreflex sensitivity, demonstrated a complex, bidirectional temporal relationship with cerebrovascular reactivity, with significant patient-level heterogeneity.
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