Aortic Pulsatility Propagates Intracranially and Correlates with Dilated Perivascular Spaces and Small Vessel Compliance

Introduction: To test the hypotheses that changes in the aortic pulse-wave produced by arterial stiffening are (1) propagated into cerebral small vessels, (2) associated with reduced compliance of small cerebral arterial vessels, and (3) associated with the presence of dilated perivascular spaces (PVS). Methods: Fifteen volunteers and 19 patients with late-onset depression (LOD) were prospectively recruited, of which 6 fulfilled the criteria for treatment-resistant depression (TRD). Aortic pulse-wave velocity (PWV) was determined using Carotid-Femoral Doppler. Pulse-wave analysis (PWA) was performed using a SphygmoCor system. White-matter lesion load and PVS were scored on established MRI scales. Cerebral arterial and aqueductal cerebrospinal fluid (CSF) flow patterns were studied using quantitative phase-contrast angiography. Results: Depressed patients had more PVS (P <.05) and prolongation of the width of the arterial systolic pulse-wave in the carotid arteries (P <.01). There was no significant group difference for any PWV or PWA measurement. TRD patients showed more PVS than other LOD patients (P <.05). The fractional width of the arterial systolic peak correlated significantly with augmentation index (AIx) and heart rate-corrected augmentation index (AIx75; R ² = 0.302, P <.01and R ² = 0.363, P <.01 respectively). Arterial–aqueductal delay showed a negative correlation with estimated aortic systolic pressure (PWVsys; R ² = 0.293; P <.01), AIx (R ² = −0.491; P <.01) and AIx75 (R ² = −0.310; P <.01). PVS scores correlated with AIx (R ² = 0.485; P <.01) and AIx75 (R ² = −0.292; P <.01). Conclusion: Our findings support the hypothesis that increased arterial pulsatility resulting from central arterial stiffness propagates directly into cerebral vessels and is associated with the development of microvascular angiopathy, characterized by dilated PVS and decreased compliance of small arterial vessels.