Investigation of in vivo measurement of cerebral cytochrome-c-oxidase redox changes using near-infrared spectroscopy in patients with orthostatic hypotension
We have previously used a continuous four wavelength near infrared spectrometer to measure changes in the cerebral concentrations of oxy- (Δ[HbO2] and deoxy- haemoglobin (Δ[HHb]) during head-up tilt in patients with primary autonomic failure. The measured changes in light attenuation also allow calculation of changes in the concentration of oxidised cytochrome c oxidase (Δ[oxCCO]), and this paper analyses the Δ[oxCCO] during the severe episodes of orthostatic hypotension produced by this experimental protocol. We studied 12 patients during a passive change in position from supine to a 60º head-up tilt. The challenge caused a reduction in mean blood pressure of 59.93 (±26.12) mmHg (Mean (±SD), p<0.0001), which was associated with a reduction in the total concentration of haemoglobin (Δ[HbT]= Δ[HbO2]+Δ[HHb]) of 5.02 (±3.81) μM (p<0.0001) and a reduction in the haemoglobin difference concentration (Δ[Hbdiff]= Δ[HbO2]-Δ[HHb]) of 14.4 (±6.73) μM (p<0.0001). We observed a wide range of responses in Δ[oxCCO]. 6 patients demonstrated a drop in Δ[oxCCO] (0.17 ±0.15μM ); 4 patients demonstrated no change (0.01 ±0.12 μM ) and 2 patients showed an increase in Δ[oxCCO] (0.21 ±0.01 μM ). Investigation of the association between the changes in concentrations of haemoglobin species and the Δ[oxCCO] for each patient show a range of relationships. This suggests that a simple mechanism for crosstalk, which might produce artefactual changes in [oxCCO], is not present between the haemoglobin and the oxCCO NIRS signals. Further investigation is required to determine the clinical significance of the changes in [oxCCO]
