Moderate correlation between breath-holding and CO 2 inhalation/hyperventilation methods for transcranial doppler evaluation of cerebral vasoreactivity

Diogo C. Haussen, Michael Katsnelson, Abiezer Rodriguez, Nelly Campo, Iszet Campo-Bustillo, Jose G. Romano, Sebastian Koch

Research output: Contribution to journalArticle

5 Scopus citations


Background: Both CO 2 inhalation followed by hyperventilation and breath-holding have been utilized to measure cerebral vasomotor reactivity (VMR) but their correlation has been poorly studied and understood. Methods: A retrospective study was conducted in 143 subjects (62.6 ± 15.8 years old, 64% men) with transcranial Doppler ultrasonography measurement of mean flow velocity (MFV) at baseline, after 30 seconds of breath-holding, and after CO 2 inhalation followed by hyperventilation, in the left and right middle cerebral artery. Breath-holding index (BHI) was calculated as the percentage of MFV increase from baseline per second of apnea. CO 2 inhalation/hyperventilation index (CO 2/HV) was calculated as the percentage of MFV difference between CO 2 inhalation and hyperventilation. Results: There were 75 carotid arteries with >70% stenosis or occlusion, and 18 middle cerebral arteries with >50% stenosis or occlusion. The mean BHI was 0.93 ± 0.7 and 0.89 ± 0.6, whereas the mean CO 2/HV was 61 ± 26% and 60 ± 26%, respectively, on the right and left sides. The correlation between BHI and CO 2/HV was moderate on the right (r = 0.33; p < 0.01) and left sides (r = 0.38; p < 0.01). Multivariate linear regression analysis indicated that age (p = 0.01) and history of stroke (p = 0.007) were associated independently with an impaired VMR on the right as measured by CO 2/HV. No predictors for impaired VMR by CO 2/HV on the left and by BHI on either side were found. Conclusions: CO 2/HV and BHI are only moderately correlated. Further studies are necessary to determine which method more accurately predicts clinical morbidity.

Original languageEnglish (US)
Pages (from-to)554-558
Number of pages5
JournalJournal of Clinical Ultrasound
Issue number9
StatePublished - Nov 1 2012



  • Carbon dioxide
  • Cerebrovascular reactivity
  • Hypercapnia
  • Hypocapnia
  • Transcranial Doppler

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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