Impaired Cerebrovascular Function in Coronary Artery Disease Patients and Recovery Following Cardiac Rehabilitation

Udunna C Anazodo; J K Shoemaker; Neville Suskin; Tracy Ssali; Danny J J Wang; Keith S St Lawrence

doi:10.3389/fnagi.2015.00224

Impaired Cerebrovascular Function in Coronary Artery Disease Patients and Recovery Following Cardiac Rehabilitation

Front Aging Neurosci. 2016 Jan 5:7:224. doi: 10.3389/fnagi.2015.00224. eCollection 2015.

Authors

Udunna C Anazodo¹, J K Shoemaker², Neville Suskin³, Tracy Ssali⁴, Danny J J Wang⁵, Keith S St Lawrence⁴

Affiliations

¹ Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada.
² Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada.
³ London Health Sciences Cardiology Rehabilitation Program, London ON, Canada.
⁴ Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada.
⁵ Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles CA, USA.

Abstract

Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV) images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.

Keywords: aerobic exercise; arterial spin labeling (ASL); cardiac rehabilitation; cerebral blood flow (CBF); cerebral vascular reactivity (CVR); coronary artery disease.