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The Capital Region of Denmark - a part of Copenhagen University Hospital
E-pub ahead of print

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 (CMRO2 ) reflects oxygen supply and consumption so may be more insightful than flow-based CVR measures for ischemic risk in SCD. We hypothesized that adults with SCD have impaired CMRO2 at rest and that a vasodilatory challenge with acetazolamide would improve CMRO2 . CMRO2 was calculated from CBF and oxygen extraction fraction (OEF), measured with arterial spin labeling and T2 -prepared tissue relaxation with inversion recovery (T2 -TRIR) MRI. We studied 36 adults with SCD without a clinical history of overt stroke and 9 healthy controls. As expected, CBF was higher in patients with SCD versus controls (mean ± standard deviation: 74±16 vs 46±5 mL/100g/min, P<.001), resulting in similar oxygen delivery (SCD: 377±67 vs controls: 368±42 μmol O2 /100g/min, P=.69). OEF was lower in patients versus controls (27±4 vs 35±4 %, P<.001), resulting in lower CMRO2 in patients versus controls (102±24 vs 127±20 μmol O2 /100g/min, P=.002). After acetazolamide, CMRO2 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 CMRO2 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. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalAmerican Journal of Hematology
ISSN0361-8609
DOIs
Publication statusE-pub ahead of print - 9 Jan 2020

ID: 59013068