Abstract T MP113: Symptoms During Carotid Sinus Massage, but Not the Magnitude of Haemodynamic Change, are Associated with White Matter Lesions in Later Life
Introduction: White matter hyperintensities (WMH) on MRI are common in older people and are associated with cognitive impairment, falls and depression. They are believed to represent cerebrovascular small vessel disease but as frank infarction is not always seen it is suggested that WMH represent damage resulting from hypoperfusion. Carotid sinus hypersensitivity (CSH) is an exaggerated fall in blood pressure (BP) or heart rate (HR) in response to stimulation of the carotid sinus. It is defined as a ≥50 mmHg drop in systolic BP & / or ≥3 second asystole in response to carotid sinus massage (CSM). CSH, is often associated with syncope & presyncope, thought to indicate cerebral hypoperfusion.
Aim: To examine, over a ten year follow-up, if CSH is associated with WMH volume.
Method: In 2002, 274 people age ≥65 underwent CSM. BP & HR response were recorded using beat to beat monitoring. Symptoms suggestive of cerebral hypoperfusion e.g. syncope or presyncope were recorded. In 2012, 53 of these participants underwent MRI. Volume of WMH was calculated using a validated quantitative method.
Results: Of the 53 participants who underwent MRI, 17 had CSH. Presence of CSH was not associated with WMH volume. Mean BP response was 46.5 mmHg (SD 20.4) and mean HR response was 2.5s (SD 1.9). Change in BP or HR were not associated with WMH volume.
Eight of the 53 participants had syncope or presyncope during CSM. These symptoms were significantly associated with greater total WMH volume (P=0.004) & greater periventricular WMH volumes (P=0.001). Findings remained significant after adjusting for age, sex & history of hypertension, [total WMH R2 0.29 (p=0.006) & periventricular WMH R2 0.34 (P=0.002)].
Conclusion: Presyncope or syncope during CSM, rather than hemodynamic response, predict volume of WMH. These findings suggest clinical symptoms of cerebral hypoperfusion rather than hemodynamic changes are a better indicator of patients at risk of WMH.
Author Disclosures: C. McDonald: Research Grant; Significant; Research into Ageing, British Geriatric Society, NIHR Biomedical Research Unit. M. Firbank: None. I. Lewis: None. M. Pearce: None. S. Kerr: None. A. Blamire: None. J. Newton: None.
- © 2014 by American Heart Association, Inc.