TY - JOUR
T1 - The effect of endovascular baroreflex amplification on central sympathetic nerve circuits and cerebral blood flow in patients with resistant hypertension
T2 - A functional MRI study
AU - Groenland, Eline H
AU - van Kleef, Monique E A M
AU - Hendrikse, Jeroen
AU - Spiering, Wilko
AU - Siero, Jeroen C W
N1 - Copyright © 2022 Groenland, van Kleef, Hendrikse, Spiering and Siero.
PY - 2022/7/25
Y1 - 2022/7/25
N2 - BACKGROUND: Endovascular baroreflex amplification (EVBA) by implantation of the MobiusHD is hypothesized to lower blood pressure by decreasing sympathetic activity through the mechanism of the baroreflex. In the present exploratory study we investigated the impact of MobiusHD implantation on central sympathetic nerve circuits and cerebral blood flow (CBF) in patients with resistant hypertension.MATERIALS AND METHODS: In thirteen patients, we performed blood oxygenation level-dependent functional magnetic resonance imaging (BOLD fMRI) at rest and during Valsalva maneuvers, before and 3 months after EVBA. Data were analyzed using a whole-brain approach and a brainstem-specific analysis. CBF was assessed using arterial spin labeling MRI.RESULTS: Resting-state fMRI analysis did not reveal significant differences in functional connectivity at 3 months after EVBA. For the Valsalva maneuver data, the whole-brain fMRI analysis revealed significantly increased activation in the posterior and anterior cingulate, the insular cortex, the precuneus, the left thalamus and the anterior cerebellum. The brainstem-specific fMRI analysis showed a significant increase in BOLD activity in the right midbrain 3 months after EVBA. Mean gray matter CBF (partial volume corrected) decreased significantly from 48.9 (9.9) ml/100 gr/min at baseline to 43.4 (13.0) ml/100 gr/min (
p = 0.02) at 3 months.
CONCLUSIONS: This first fMRI pilot study in patients with resistant hypertension treated with EVBA showed a significant increase in BOLD activity during the Valsalva maneuver in brain regions related to sympathetic activity. No notable signal intensity changes were observed in brain areas involved in the baroreflex circuit. Future randomized controlled studies are needed to investigate whether the observed changes are directly caused by EVBA.CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, identifier: NCT02827032.
AB - BACKGROUND: Endovascular baroreflex amplification (EVBA) by implantation of the MobiusHD is hypothesized to lower blood pressure by decreasing sympathetic activity through the mechanism of the baroreflex. In the present exploratory study we investigated the impact of MobiusHD implantation on central sympathetic nerve circuits and cerebral blood flow (CBF) in patients with resistant hypertension.MATERIALS AND METHODS: In thirteen patients, we performed blood oxygenation level-dependent functional magnetic resonance imaging (BOLD fMRI) at rest and during Valsalva maneuvers, before and 3 months after EVBA. Data were analyzed using a whole-brain approach and a brainstem-specific analysis. CBF was assessed using arterial spin labeling MRI.RESULTS: Resting-state fMRI analysis did not reveal significant differences in functional connectivity at 3 months after EVBA. For the Valsalva maneuver data, the whole-brain fMRI analysis revealed significantly increased activation in the posterior and anterior cingulate, the insular cortex, the precuneus, the left thalamus and the anterior cerebellum. The brainstem-specific fMRI analysis showed a significant increase in BOLD activity in the right midbrain 3 months after EVBA. Mean gray matter CBF (partial volume corrected) decreased significantly from 48.9 (9.9) ml/100 gr/min at baseline to 43.4 (13.0) ml/100 gr/min (
p = 0.02) at 3 months.
CONCLUSIONS: This first fMRI pilot study in patients with resistant hypertension treated with EVBA showed a significant increase in BOLD activity during the Valsalva maneuver in brain regions related to sympathetic activity. No notable signal intensity changes were observed in brain areas involved in the baroreflex circuit. Future randomized controlled studies are needed to investigate whether the observed changes are directly caused by EVBA.CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov, identifier: NCT02827032.
KW - endovascular baroreflex amplification
KW - hypertension
KW - blood oxygenation leveldependent
KW - functional magnetic resonance imaging (fMRI)
KW - cerebral blood flow (CBF)
U2 - 10.3389/fnimg.2022.924724
DO - 10.3389/fnimg.2022.924724
M3 - Article
C2 - 37555165
SN - 2813-1193
VL - 1
JO - Frontiers in neuroimaging
JF - Frontiers in neuroimaging
M1 - 924724
ER -