Cardiac-cerebrovascular crosstalk: Cardiac rhythms reveal maladaptive cerebral blood flow velocity and constrained ventilatory status

In brain-heart interactions, several pathways have been proposed to mediate feedback loops between systems. Among these, cerebrovascular dynamics operate at their interface. However, how cardiovascular control, ventilation mechanisms, and cerebral autoregulation interact is not well characterized, especially in ageing and post-stroke conditions, where perfusion can be compromised. In a cohort of 57 elderly participants, including 30 stroke survivors, we investigated the relationship between cardiac sympathetic activity and both, cerebral blood flow regulation and ventilatory status. Sympathetic reflexes, assessed via cardiac sympathetic index (CSI) during sit-to-stand transitions, were preserved across all participants, with marginal group differences between stroke and non-stroke populations. However, among individuals with constrained ventilation, indexed by reduced end-tidal CO2 at baseline, we identified a more elevated CSI following postural change, scaling with the degree of CO2 dysregulation. Furthermore, transcranial Doppler measurements revealed exaggerated changes in mean flow velocity (MFV) within the right middle cerebral artery in most participants. These MFV shifts significantly correlated with the magnitude of cardiac sympathetic change under orthostatic stress, suggesting that CSI can capture maladaptive cerebrovascular responses. Together, these findings highlight a distinct cardiac-cerebrovascular crosstalk in elderly individuals, revealing patterns consistent with compensatory or maladaptive sympathetic overactivation under conditions of impaired cerebrovascular control.