Ghent University

We compared the cerebrovascular response to various cognitive tasks of cardiovascular patients and healthy controls by using transcranial Doppler ultrasonography (TCD). Cognitive task-induced cerebral blood flow velocity (BFV) changes in 66 candidates for coronary artery bypass graft surgery (mean age 59.4±7.5) were compared with the functional BFV measurement of 60 healthy controls (mean age 58±7). Absolute BFV values during baseline and activation were monitored with TCD. Relative increase of the BFV was calculated from the immediately preceding rest period to the following activation. A MANOVA with group (patients vs controls) as between-subjects factor showed no differences in absolute BFV during the rest period. For absolute BFV during activation, a significant difference between the two groups was found. Although for each test the percentage change was smaller in the cardiac group, the difference just failed to reach significance. An explorative multivariate linear regression analysis with the absolute activation and percentage change as dependent variables and coronary risk factors as independent variables revealed no significant predictors. Using functional TCD we found that BFV values during activation were significantly lower in cardiac patients compared to healthy controls. Future research should focus on the possible explanations of this phenomenon.

[1]  Jarl Risberg,et al.  Observations on the functional significance of regional cerebral blood flow in “resting” normal subjects , 1980, Neuropsychologia.

[2]  R. Aaslid,et al.  Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. , 1982, Journal of neurosurgery.

[3]  T. Treasure,et al.  CEREBRAL CONSEQUENCES OF CARDIOPULMONARY BYPASS , 1986, The Lancet.

[4]  J. French,et al.  Early intellectual dysfunction following coronary bypass surgery. , 1986, The Quarterly journal of medicine.

[5]  J. French,et al.  Long-term intellectual dysfunction following coronary artery bypass graft surgery: a six month follow-up study. , 1987, The Quarterly journal of medicine.

[6]  J. Blass,et al.  Unrecognized Cognitive Impairment in Cardiac Rehabilitation Patients , 1988, Journal of the American Geriatrics Society.

[7]  A. Harders,et al.  A transcranial Doppler study of blood flow velocity in the middle cerebral arteries performed at rest and during mental activities. , 1989, Stroke.

[8]  N. Ochner.  World Literature Today: A Literary Quarterly of the University of Oklahoma , 1989 .

[9]  E B Ringelstein,et al.  Transcranial Doppler sonography: anatomical landmarks and normal velocity values. , 1990, Ultrasound in medicine & biology.

[10]  T. Benke,et al.  Neuropsychological deficits in asymptomatic carotid artery stenosis , 1991, Acta neurologica Scandinavica.

[11]  J. van der Linden,et al.  When do cerebral emboli appear during open heart operations? A transcranial Doppler study. , 1991, The Annals of thoracic surgery.

[12]  B. G. Rule,et al.  The Impact of Pacemaker Implantation on Cognitive Functioning in Elderly Patients , 1992, Journal of the American Geriatrics Society.

[13]  J. Murkin.  Neurologic dysfunction after CAB or valvular surgery: is the medium the miscreant? , 1993, Anesthesia and analgesia.

[14]  S. Nakamura,et al.  Selective removal of beta 2-microglobulin from plasma specimens of long-term hemodialysis patients by high-performance immunoaffinity chromatography. , 1993, Clinical chemistry.

[15]  C Caltagirone,et al.  Bilateral Simultaneous Assessment of Cerebral Flow Velocity during Mental Activity , 1994, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[16]  E. Ringelstein,et al.  Transcranial Doppler ultrasonic assessment of middle cerebral artery blood flow velocity changes during verbal and visuospatial cognitive tasks , 1994, Neuropsychologia.

[17]  J. J. Claus,et al.  Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam study , 1994, BMJ.

[18]  H. Seo,et al.  Involvement of beta 2-microglobulin modified with advanced glycation end products in the pathogenesis of hemodialysis-associated amyloidosis. Induction of human monocyte chemotaxis and macrophage secretion of tumor necrosis factor-alpha and interleukin-1. , 1994, The Journal of clinical investigation.

[19]  C. Naylor,et al.  Cardiopulmonary bypass, temperature, and central nervous system dysfunction. , 1994, Circulation.

[20]  C. Dougherty,et al.  Longitudinal recovery following sudden cardiac arrest and internal cardioverter defibrillator implantation: survivors and their families. , 1994, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[21]  T. Treasure,et al.  The Impact of Microemboli During Cardiopulmonary Bypass on Neuropsychological Functioning , 1994, Stroke.

[22]  C. Blauth,et al.  Macroemboli and microemboli during cardiopulmonary bypass. , 1995, The Annals of thoracic surgery.

[23]  W. White,et al.  Predictors of cognitive decline after cardiac operation. , 1995, The Annals of thoracic surgery.

[24]  M. Harrison,et al.  Neurologic complications of coronary artery bypass grafting: diffuse or focal ischemia? , 1995, The Annals of thoracic surgery.

[25]  Y. Juliano,et al.  Neurological outcome in coronary artery surgery with and without cardiomlmonarv bypass , 1995, Acta neurologica Scandinavica.

[26]  C. Mazer,et al.  Cerebral microemboli during coronary artery bypass using different cardioplegia techniques. , 1995, The Annals of thoracic surgery.

[27]  R. E. Clark,et al.  Microemboli during coronary artery bypass grafting. Genesis and effect on outcome. , 1995, The Journal of thoracic and cardiovascular surgery.

[28]  M. Kaps,et al.  Is there a hemispheric side preference of cardiac valvular emboli? , 1995, Ultrasound in medicine & biology.

[29]  W D White,et al.  Defining neuropsychological dysfunction after coronary artery bypass grafting. , 1996, The Annals of thoracic surgery.

[30]  J. Gold,et al.  Comparison of transcranial Doppler ultrasonography and transesophageal echocardiography to monitor emboli during coronary artery bypass surgery. , 1996, Stroke.

[31]  K. Fox,et al.  Chronic memory impairment after cardiac arrest outside hospital , 1996, BMJ.

[32]  W. Skreczek,et al.  Hemispheric asymmetry of arterial blood flow velocity changes during verbal and visuospatial tasks , 1996, Neuropsychologia.

[33]  J. Hammon,et al.  Cerebral emboli and cognitive outcome after cardiac surgery. , 1996, Journal of cardiothoracic and vascular anesthesia.

[34]  G. Vingerhoets,et al.  Prospective evaluation of verbal memory performance after cardiopulmonary bypass surgery. , 1996, Journal of clinical and experimental neuropsychology.

[35]  J. Gold,et al.  Impact of embolization during coronary artery bypass grafting on outcome and length of stay. , 1997, The Annals of thoracic surgery.

[36]  J. Svennevig,et al.  Cerebral microembolic signals during cardiopulmonary bypass surgery. Frequency, time of occurrence, and association with patient and surgical characteristics. , 1997, Stroke.

[37]  G. Vingerhoets,et al.  Neuropsychological impairment in candidates for cardiac surgery , 1997, Journal of the International Neuropsychological Society.

[38]  A. Cope,et al.  Shedding kinetics of soluble tumor necrosis factor (TNF) receptors after systemic TNF leaking during isolated limb perfusion. Relevance to the pathophysiology of septic shock. , 1998, The Journal of clinical investigation.

[39]  S. Newman,et al.  Cerebral functional changes following cardiac surgery: Neuropsychological and EEG assessment. , 1998, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[40]  P. Halligan,et al.  Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations? , 1999, The Journal of thoracic and cardiovascular surgery.

[41]  W. Boyd,et al.  Beating heart surgery: why expect less central nervous system morbidity? , 1999, The Annals of thoracic surgery.

[42]  GuyVingerhoets,et al.  Lateralization of Cerebral Blood Flow Velocity Changes During Cognitive Tasks , 1999 .

[43]  M. Borger,et al.  Cerebral microemboli during cardiopulmonary bypass: increased emboli during perfusionist interventions. , 1999, The Annals of thoracic surgery.

[44]  S. Wan,et al.  Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury. , 1999, The Annals of thoracic surgery.

[45]  R. Petersen,et al.  Cost-effectiveness of minimally invasive coronary artery bypass surgery. , 1999, The Annals of thoracic surgery.

[46]  T. Ikizler,et al.  Transforming growth factor-beta is involved in the pathogenesis of dialysis-related amyloidosis. , 2000, Kidney international.

[47]  G. Angelini,et al.  Reduced cerebral embolic signals in beating heart coronary surgery detected by transcranial Doppler ultrasound. , 2000, British journal of anaesthesia.

[48]  V Falk,et al.  Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. , 2000, The Annals of thoracic surgery.

[49]  J. Hammon,et al.  Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli. , 2000, Stroke.

[50]  K V Arom,et al.  Safety and efficacy of off-pump coronary artery bypass grafting. , 2000, The Annals of thoracic surgery.

[51]  M. Galiñanes,et al.  Off-pump bypass graft operation significantly reduces oxidative stress and inflammation. , 2000, The Annals of thoracic surgery.

[52]  B. Soller,et al.  Off-pump versus on-pump coronary artery bypass surgery: a case-matched comparison of clinical outcomes and costs. , 2000, The heart surgery forum.

[53]  Bénédicte Ledent.  A Fictional and Cultural Labyrinth: Caryl Phillip's "The Nature of Blood" , 2001 .

[54]  C. Peniston,et al.  Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions. , 2001, The Journal of thoracic and cardiovascular surgery.

[55]  C. Consani,et al.  Reappraisal of serum beta2-microglobulin as marker of GFR. , 2001, Renal failure.

[56]  D. Stump,et al.  Does off-pump coronary artery bypass surgery reduce the risk of brain injury? , 2001, The heart surgery forum.

[57]  M. Czerny,et al.  Cardiopulmonary bypass affects cognitive brain function after coronary artery bypass grafting. , 2001, The Annals of thoracic surgery.

[58]  J. D. Lee,et al.  Coronary artery bypass performed without the use of cardiopulmonary bypass is associated with reduced cerebral microemboli and improved clinical results. , 2001, Chest.

[59]  W. Owen,et al.  beta(2)-Microglobulin modified with advanced glycation end products delays monocyte apoptosis. , 2001, Kidney international.

[60]  Lars Eckstein.  The Insistence of Voices: An Interview with Caryl Phillips , 2001 .

[61]  D Moshman,et al.  Conceptual constraints on thinking about genocide , 2001, Journal of genocide research.

[62]  S. Moe,et al.  beta(2)-Microglobulin increases the expression of vascular cell adhesion molecule on human synovial fibroblasts. , 2001, Kidney international.

[63]  G. Vingerhoets,et al.  Short-term and long-term neurocognitive outcome in on-pump versus off-pump CABG. , 2002, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[64]  N. Chen,et al.  Signal transduction of beta2m-induced expression of VCAM-1 and COX-2 in synovial fibroblasts. , 2002, Kidney international.

[65]  A. Moses.  Conceptual blockages and definitional dilemmas in the 'racial century': genocides of indigenous peoples and the Holocaust , 2002 .

[66]  L. Rasmussen,et al.  Cerebral blood flow and cognitive dysfunction after coronary surgery. , 2002, The Annals of thoracic surgery.

[67]  R. Brucher,et al.  Online Automatic Discrimination Between Solid and Gaseous Cerebral Microemboli With the First Multifrequency Transcranial Doppler , 2002, Stroke.

[68]  P. Smethurst.  Postmodern Blackness and Unbelonging in the Works of Caryl Phillips , 2002 .

[69]  J. Cavaillon,et al.  Structural and functional analyses of bacterial lipopolysaccharides. , 2002, Microbes and infection.

[70]  Raymond Vanholder,et al.  Review on uremic toxins: classification, concentration, and interindividual variability. , 2003, Kidney international.

[71]  Ping-yan Chen,et al.  Enhanced expression of receptor for advanced glycation end products in chronic kidney disease. , 2004, Journal of the American Society of Nephrology : JASN.

[72]  Guy Vingerhoets,et al.  Transcranial Doppler Ultrasonography Monitoring of Cerebral Hemodynamics During Performance of Cognitive Tasks: A Review , 2000, Neuropsychology Review.

[73]  Wendy Zierler.  "My Holocaust Is Not Your Holocaust": "Facing" Black and Jewish Experience in The Pawnbroker, Higher Ground, and The Nature of Blood , 2004 .

[74]  J. Manson,et al.  Kidney dysfunction, inflammation, and coronary events: a prospective study. , 2004, Journal of the American Society of Nephrology : JASN.

[75]  P. D. De Deyn,et al.  In vitro study of the potential role of guanidines in leukocyte functions related to atherogenesis and infection. , 2004, Kidney international.

[76]  A. Dawson.  ‘To remember too much is indeed a form of madness’: Caryl Phillips's the nature of blood and the modalities of European racism , 2004 .

[77]  L. Deecke,et al.  Distribution of ischemic cerebrovascular events in cardiac embolism , 1991, Klinische Wochenschrift.

[78]  Y. Saijo,et al.  Relationship of β2-Microglobulin to Arterial Stiffness in Japanese Subjects , 2005, Hypertension Research.

[79]  Z. Massy,et al.  Chronic kidney disease as cause of cardiovascular morbidity and mortality. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[80]  M. Haberal,et al.  Cardiac troponin I and beta 2 microglobulin as risk factors for early‐onset atherosclerosis in patients on haemodialysis , 2005, Nephrology.

[81]  Jürgen Zimmerer.  The birth of the Ostland out of the spirit of colonialism: a postcolonial perspective on the Nazi policy of conquest and extermination , 2005 .

[82]  A. Fokkema.  Identity, trauma and exile: Caryl Phillips on surviving , 2005, European Review.

[83]  T. Mayadas,et al.  Renal cell-expressed TNF receptor 2, not receptor 1, is essential for the development of glomerulonephritis. , 2005, The Journal of clinical investigation.

[84]  R. Saunders,et al.  Introduction: Mourning and Memory , 2005 .

[85]  B. Palmer.  History in Transit: Experience, Identity. Critical Theory , 2005 .

[86]  William Clark,et al.  Serum beta-2 microglobulin levels predict mortality in dialysis patients: results of the HEMO study. , 2006, Journal of the American Society of Nephrology : JASN.

[87]  J. Jankowski,et al.  Review on uraemic toxins III: recommendations for handling uraemic retention solutes in vitro--towards a standardized approach for research on uraemia. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[88]  R. Vanholder,et al.  P-cresylsulphate, the main in vivo metabolite of p-cresol, activates leucocyte free radical production. , 2006, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[89]  J. Griffith,et al.  The Framingham predictive instrument in chronic kidney disease. , 2007, Journal of the American College of Cardiology.

[90]  E. Fung,et al.  Beta2-microglobulin as a biomarker in peripheral arterial disease: proteomic profiling and clinical studies. , 2007, Circulation.

[91]  T. Mayadas,et al.  Functions of TNF and its receptors in renal disease: distinct roles in inflammatory tissue injury and immune regulation. , 2007, Seminars in nephrology.

[92]  R. Vanholder,et al.  The middle-molecule hypothesis 30 years after: lost and rediscovered in the universe of uremic toxicity? , 2008, Journal of nephrology.

[93]  S. Craps.  Linking Legacies of Loss: Traumatic Histories and Cross-Cultural Empathy in Caryl Phillips’s Higher Ground and The Nature of Blood , 2008 .

[94]  W. Dehaen,et al.  Removal of the uremic retention solute p-cresol using fractionated plasma separation and adsorption. , 2007, Artificial organs.

[95]  S. Sprague,et al.  Beta2-microglobulin stimulates osteoclast formation. , 2008, Kidney international.

[96]  M. Inaba,et al.  Serum beta2-microglobulin level is a significant predictor of mortality in maintenance haemodialysis patients. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[97]  R. Vanholder,et al.  Role of symmetric dimethylarginine in vascular damage by increasing ROS via store-operated calcium influx in monocytes. , 2009, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[98]  N. Heegaard.  beta(2)-microglobulin: from physiology to amyloidosis. , 2009, Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis.

[99]  J. Manson,et al.  Novel proteins associated with risk for coronary heart disease or stroke among postmenopausal women identified by in-depth plasma proteome profiling , 2010, Genome Medicine.

[100]  K. Hirata,et al.  Serum beta2-microglobulin concentration as a novel marker to distinguish levels of risk in acute heart failure patients. , 2010, Journal of cardiology.

[101]  J. Jankowski,et al.  Dinucleoside polyphosphates: newly detected uraemic compounds with an impact on leucocyte oxidative burst. , 2010, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[102]  N. Tentolouris,et al.  β2-Microglobulin, Pulse Pressure and Metabolic Alterations in Hemodialysis Patients , 2010, Nephron Clinical Practice.

[103]  R. Vanholder,et al.  New uremic toxins - which solutes should be removed? , 2011, Contributions to nephrology.

[104]  C. Guo,et al.  Plasma aluminum is a risk factor for oxidative stress and inflammation status in hemodialysis patients. , 2011, Clinical biochemistry.

[105]  F. Locatelli,et al.  What We Know About Oxidative Stress in Patients with Chronic Kidney Disease on Dialysis—Clinical Effects, Potential Treatment, and Prevention , 2011, Seminars in dialysis.

[106]  Z. Massy,et al.  Symmetric dimethylarginine as a proinflammatory agent in chronic kidney disease. , 2011, Clinical journal of the American Society of Nephrology : CJASN.

[107]  J. Kals,et al.  β2-microglobulin, a novel biomarker of peripheral arterial disease, independently predicts aortic stiffness in these patients , 2011, Scandinavian journal of clinical and laboratory investigation.

[108]  O. Wagner,et al.  Beta 2 Microglobulin and the Risk for Cardiovascular Events in Patients With Asymptomatic Carotid Atherosclerosis , 2011, Stroke.

[109]  N. Levin,et al.  Clearance of p-Cresol Sulfate and &bgr;-2-Microglobulin from Dialysate by Commercially Available Sorbent Technology , 2011, ASAIO journal.

[110]  O. Wagner,et al.  Renal function and long-term mortality in patients with asymptomatic carotid atherosclerosis , 2011, Thrombosis and Haemostasis.

[111]  R. Vanholder,et al.  Novel method for simultaneous determination of p-cresylsulphate and p-cresylglucuronide: clinical data and pathophysiological implications. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[112]  A. Cueto-Manzano,et al.  Pentoxifylline decreases serum levels of tumor necrosis factor alpha, interleukin 6 and C-reactive protein in hemodialysis patients: results of a randomized double-blind, controlled clinical trial. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[113]  T. Mayadas,et al.  Circulating TNF receptors 1 and 2 predict ESRD in type 2 diabetes. , 2012, Journal of the American Society of Nephrology : JASN.

[114]  Raymond Vanholder,et al.  Normal and pathologic concentrations of uremic toxins. , 2012, Journal of the American Society of Nephrology : JASN.

[115]  Z. Massy,et al.  Plasma beta-2 microglobulin is associated with cardiovascular disease in uremic patients. , 2012, Kidney international.

[116]  B. Astor,et al.  Novel markers of kidney function as predictors of ESRD, cardiovascular disease, and mortality in the general population. , 2012, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[117]  Z. Massy,et al.  Estimated Glomerular Filtration Rate Is a Poor Predictor of the Concentration of Middle Molecular Weight Uremic Solutes in Chronic Kidney Disease , 2012, PloS one.

[118]  T. Mayadas,et al.  Circulating TNF receptors 1 and 2 predict stage 3 CKD in type 1 diabetes. , 2012, Journal of the American Society of Nephrology : JASN.

[119]  R. Sacco,et al.  Tumour necrosis factor receptor 1 and mortality in a multi-ethnic cohort: the Northern Manhattan Study. , 2013, Age and ageing.

[120]  J. Murabito,et al.  Multiple Inflammatory Biomarkers in Relation to Cardiovascular Events and Mortality in the Community , 2013, Arteriosclerosis, thrombosis, and vascular biology.

[121]  M. Lindenmeyer,et al.  Distinct Contributions of TNF Receptor 1 and 2 to TNF-Induced Glomerular Inflammation in Mice , 2013, PloS one.

[122]  A. Martínez‐Castelao,et al.  High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. , 2013, Journal of the American Society of Nephrology : JASN.

[123]  D. Stamatialis,et al.  Mixed matrix hollow fiber membranes for removal of protein-bound toxins from human plasma. , 2013, Biomaterials.

[124]  V. Rigalleau,et al.  Association of Serum Concentration of TNFR1 With All-Cause Mortality in Patients With Type 2 Diabetes and Chronic Kidney Disease: Follow-up of the SURDIAGENE Cohort , 2014, Diabetes Care.

[125]  H. Schiffl.  Impact of advanced dialysis technology on the prevalence of dialysis‐related amyloidosis in long‐term maintenance dialysis patients , 2014, Hemodialysis international. International Symposium on Home Hemodialysis.