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Cerebral Oxygen Metabolism in Adults with Sickle Cell Disease

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  • Lena VáclavŮ
  • Jan Petr
  • Esben Thade Petersen
  • Henri Jmm Mutsaerts
  • Charles Bl Majoie
  • John C Wood
  • Ed VanBavel
  • Aart J Nederveen
  • Bart J Biemond
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In sickle cell disease (SCD), oxygen delivery is impaired due to anemia, especially during times of increased metabolic demand, and cerebral blood flow (CBF) must increase to meet changing physiologic needs. But hyperemia limits cerebrovascular reserve (CVR) and ischemic risk prevails despite elevated CBF. The cerebral metabolic rate of oxygen (CMRO 2) directly reflects oxygen supply and consumption and may therefore be more insightful than flow-based CVR measures for ischemic risk in SCD. We hypothesized that adults with SCD have impaired CMRO 2 at rest and that a vasodilatory challenge with acetazolamide would improve CMRO 2. CMRO 2 was calculated from CBF and oxygen extraction fraction (OEF), measured with arterial spin labeling and T 2-prepared tissue relaxation with inversion recovery (T 2-TRIR) MRI. We studied 36 adults with SCD without a clinical history of overt stroke, and nine healthy controls. As expected, CBF was higher in patients with SCD versus controls (mean ± SD: 74 ± 16 versus 46 ± 5 mL/100 g/min, P <.001), resulting in similar oxygen delivery (SCD: 377 ± 67 versus controls: 368 ± 42 μmol O 2/100g/min, P =.69). OEF was lower in patients versus controls (27 ± 4 versus 35 ± 4%, P <.001), resulting in lower CMRO 2 in patients versus controls (102 ± 24 versus 127 ± 20 μmol O 2/100g/min, P =.002). After acetazolamide, CMRO 2 declined further in patients (P <.01) and did not decline significantly in controls (P =.78), indicating that forcing higher CBF worsened oxygen utilization in SCD patients. This lower CMRO 2 could reflect variation between healthy and unhealthy vascular beds in terms of dilatory capacity and resistance whereby dysfunctional vessels become more oxygen-deprived, hence increasing the risk of localized ischemia.

Original languageEnglish
JournalAmerican Journal of Hematology
Volume95
Issue number4
Pages (from-to)401-412
Number of pages12
ISSN0361-8609
DOIs
Publication statusPublished - Apr 2020

Bibliographical note

© 2020 The Authors. American Journal of Hematology published by Wiley Periodicals, Inc.

ID: 59013068