Aortic Doppler Research Articles

Assessing Fetal Circulatory Changes in Gestational Diabetes via Aortic Isthmus Doppler

Background: Gestational diabetes mellitus (GDM) is a common complication during pregnancy that can negatively impact fetal heart function and structure. This study aimed to investigate the hemodynamic characteristics of the fetal aortic isthmus in patients with GDM using Doppler ultrasound parameters. Methods:This was a cross-sectional observational study including 47 pregnant patients with GDM and 47 healthy pregnant patients as controls. Fetal biometric measurements and umbilical artery Doppler values were obtained. Aortic isthmus Doppler was used to measure systolic and diastolic flow velocity time integrals (S and D), peak systolic velocity (PSV), and systolic nadir (Ns) to calculate the isthmus flow index (IFI) = (S + D)/S and isthmus systolic index (ISI) = Ns/PSV. A generalized additive model was used to analyze the relationship between IFI, ISI and gestational age. Results: Compared to controls, the GDM group had significantly lower D (2.39 cm vs. 2.76 cm), Ns (11.48 cm/s vs. 14.06 cm/s), IFI (1.24 vs. 1.27) and ISI (0.14 vs. 0.16). Curve fitting showed IFI was lower in the GDM group for most gestational weeks and decreased with advancing weeks, while ISI remained constantly lower and decreased linearly. Conclusions: Fetal aortic isthmus Doppler parameters IFI and ISI were altered in GDM pregnancies, suggesting earlier changes in aortic arch hemodynamics compared to the umbilical artery. Combining IFI and ISI may provide more comprehensive assessment of fetal circulatory changes in GDM. These findings could enhance our understanding of the pathophysiologic impacts of maternal diabetes.

Unfolding Mystery of Aortic Transcatheter Valve Doppler Gradient and Clinical Outcomes.

Unfolding Mystery of Aortic Transcatheter Valve Doppler Gradient and Clinical Outcomes.

High- versus low-gradient aortic stenosis: Is our evaluation limited by aorto-mitral angle on cardiovascular CT?

BackgroundAccurate assessment of aortic valve (AV) stenosis (AS) on transthoracic echocardiogram is crucial for appropriate clinical management. However, discordance between aortic valve area (AVA) and Doppler can complicate the diagnosis of severe AS in low-gradient (LG) AS phenotypes. MethodsWe reviewed 220 consecutive patients with suspected severe AS and AVA ≤1.0 cm2 on transthoracic echocardiogram who were evaluated for transcatheter AV replacement (TAVR) within a large health system from 2015 to 2019. We compared AV calcium score and aorto-mitral angle (AMA) on 3-chamber views from ECG-gated cardiovascular CT among patients with high-gradient (HG) AS (N = 19), paradoxical low-flow low-gradient (PLFLG) AS (N = 24) and normal-flow low-gradient (NFLG) AS (N = 14). ResultsAll groups had comparable age, comorbidities, and AV calcium scores. Compared to patients with HG AS (mean AMA 120 ± 10°), those with PLFLG AS (104 ± 12°; p < 0.001) and NFLG AS (106 ± 13°; p = 0.008) had narrower mean AMA values on cardiovascular CT. ConclusionLG AS patients have significantly narrower AMA than HG AS patients on cardiovascular CT. Due to difficulty obtaining parallel Doppler alignment, narrower AMA may contribute to AVA-Doppler discordance on echocardiogram. These findings emphasize the need for additional information in the setting of LG AS.

Hemodynamically Significant Patent Ducts Arteriosus: Impact of Ductal Size on Left Output and Aortic Doppler Velocimetry

Hemodynamically Significant Patent Ducts Arteriosus: Impact of Ductal Size on Left Output and Aortic Doppler Velocimetry

Trifid or double-notched aortic Doppler: an aortic ‘Trishula’ sign

Trifid or double-notched aortic Doppler: an aortic ‘Trishula’ sign

Fetal Aortic and Umbilical Doppler Flow Velocity Waveforms in Pregnancy: The Concept of Aortoumbilical Column.

Low impedance within the uteroplacental circulation is crucial for fetal development. Flow velocity waveforms (FVW) have been established for the aortic and umbilical arteries in low-risk pregnancies during the second half of pregnancy, but data regarding early gestation is limited. Both vascular territories exhibit higher impedance patterns in pregnancies complicated by fetal growth restriction (FGR), hypertensive disorders, fetal anemia, and chromosomal abnormalities. Early identification of these complications is critical in obstetric practice, to reduce perinatal morbidity and mortality through prevention and close antenatal surveillance. Available data suggest that aortic and umbilical impedances follow the same variation pattern as pregnancy progresses. This observation implies that both vessels may be considered as a single artery, referred to as the "aortoumbilical column". Our hypothesis posits that changes in the hemodynamic pattern of this column could identify high-risk pregnancies, particularly those complicated by preeclampsia, FGR, intrauterine fetal demise, fetal aneuploidies, and fetal anemia. Understanding vascular embryogenesis and the FVWs of the aortic and umbilical arteries enables comprehension of impedance changes throughout normal pregnancies. The continuous variation in impedance along a single vessel supports our concept of the aortoumbilical column. Deviations from the regular pattern could assist in identifying compromised fetuses during early pregnancy. Further research on normal aortoumbilical column FVW and the development of reference charts is necessary to consider this arterial column as a screening tool in clinical practice.

Protective role of CXCR7 activation in neonatal hyperoxia-induced systemic vascular remodeling and cardiovascular dysfunction in juvenile rats

Neonatal hyperoxia induces long-term systemic vascular stiffness and cardiovascular remodeling, but the mechanisms are unclear. Chemokine receptor 7 (CXCR7) represents a key regulator of vascular homeostasis and repair by modulating TGF-β1 signaling. This study investigated whether pharmacological CXCR7 agonism prevents neonatal hyperoxia-induced systemic vascular stiffness and cardiac dysfunction in juvenile rats. Newborn Sprague Dawley rat pups assigned to room air or hyperoxia (85% oxygen), received CXCR7 agonist, TC14012 or placebo for 3 weeks. These rat pups were maintained in room air until 6 weeks when aortic pulse wave velocity doppler, cardiac echocardiography, aortic and left ventricular (LV) fibrosis were assessed. Neonatal hyperoxia induced systemic vascular stiffness and cardiac dysfunction in 6-week-old rats. This was associated with decreased aortic and LV CXCR7 expression. Early treatment with TC14012, partially protected against neonatal hyperoxia-induced systemic vascular stiffness and improved LV dysfunction and fibrosis in juvenile rats by decreasing TGF-β1 expression. In vitro, hyperoxia-exposed human umbilical arterial endothelial cells and coronary artery endothelial cells had increased TGF-β1 levels. However, treatment with TC14012 significantly reduced the TGF-β1 levels. These results suggest that dysregulation of endothelial CXCR7 signaling may contribute to neonatal hyperoxia-induced systemic vascular stiffness and cardiac dysfunction.

Machine learning for the generation of personalized image analysis protocol in echocardiography: a pilot study in arterial hypertension

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Agence National de la Recherche Europian Union-NextGenerationEU. Background Current workflow in cardiac imaging is based on protocols meant to capture a set of predefined images for a certain condition [1]. Although standardized, such approaches are not personalized, and are often time- and resource-ineffective. Reinforcement learning (RL), a subfield of machine learning that addresses decision making [2], can be used to incorporate complex, whole cardiac cycle imaging data, while optimizing costs associated to data acquisition and processing – including economy, patient safety/comfort and examination time. Our aim is to demonstrate the viability of RL to create a personalized, resource-effective data analysis routine from echocardiography to separate remodelling in arterial hypertension from normal cardiac function. Methods An echo study was performed in 189 clinically managed hypertensive (HTN) patients, and 60 non-hypertensive healthy control subjects [3]. Speckle-tracking analysis of the left ventricle was performed and deformation curves extracted. Aortic and mitral flow pulsed-wave (PW) Doppler and septal basal tissue PW Doppler velocity profiles were obtained. These whole cardiac cycle deformation and velocity curves were used as input data to the RL algorithm. RL optimized the required image analysis sequence to maximize the probability of obtaining a correct diagnosis while reducing the number of analysed images. Results The RL-generated protocol identified three separate image analysis groups to determine cardiac remodelling (Figure 1). The proposed protocol starts with the analysis of the mitral PW, and based on its velocity pattern, assigns each individual to one of the three groups. In Group 1 (G1, n=158) analysing the mitral PW acquisition was sufficient to determine disease status. HTN patients were separated based on a pattern of an inversed E/A ratio and EA fusion reflecting signs of diastolic dysfunction. In G2 (n=56), mitral flow showed a slightly decreased E/A ratio and longer E deacceleration time, and adding aortic PW was required to determine remodelling: HTN had higher aortic peak velocity and shorter peak acceleration time due to higher systemic afterload. Finally, G3 (n=19) required global longitudinal strain, which showed pathological early systolic stretching, reflecting the change in the timing of cardiac events in arterial hypertension. Fifteen (6%) participants did not match any of the groups, requiring the acquisition of remaining sequences (TDI, regional strain) to secure a correct diagnosis. In average, the protocol analysed 1.44 images per patient, out of the four available. Conclusion Through a pilot study utilizing a limited set of imaging sequences, we demonstrate a template for automated generation of efficient, tailored image analysis protocols, that minimimize the number of analyzed images to determinine patient phenotypes. RL is a promising tool to reduce analysis time, potentially saving costs in preventive screening programs.

The role of different Doppler parameters in predicting adverse neonatal outcomes in fetuses with late-onset fetal growth restriction.

The aim of this study is to clarify the role of different Doppler parameters such as umbilicocerebral ratio (UCR), cerebroplacentouterine ratio (CPUR), aortic isthmus, renal artery, and umbilical vein flow Doppler in predicting adverse neonatal outcomes in fetuses with late -onset fetal growth restriction. The study included all patients diagnosed with fetal growth restriction at 32-39 weeks' gestation between 01/02/2020 and 01/02/2022 and treated at the Department of Obstetrics and Gynecology, Inonu University School of Medicine. Patients included in the study had a median gestational week at delivery of 37 (minimum 33+0-maximum 39+0), median CPR of 1.42 (minimum-maximum 0.43-3.57), and median UCR of 0.7 (minimum-maximum 0.28-2.3). Receiver operating characteristic analysis was performed to determine the performance of the measured obstetric Doppler parameters in predicting the development of adverse neonatal outcomes. Umbilical venous blood flow showed the best performance in predicting adverse neonatal outcomes [area under the curve 0.952, 95% confidence interval (CI) 0.902-0.981, p<0.001]. Multivariate logistic regression analysis showed that fetuses with abnormal CPUR had a 4.5-fold (95% CI 0.084-0.583, p=0.02) increased risk of adverse neonatal outcome, whereas fetuses with abnormal umbilical venous flow had a 1.07-fold (95% CI 0.903-0.968, p<0.001) increased risk of adverse neonatal outcome. The results of this study demonstrate that the use of UCR, CPUR, umbilical venous flow, and aortic isthmus PI Doppler parameters along with umbilical artery PI and CPR are effective in predicting adverse neonatal outcomes in fetuses with late -onset fetal growth restriction.

Fetal Doppler in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome and selective in utero growth restriction

BackgroundMonochorionic (MC) twin pregnancies may be complicated by placental pathologies that impact fetal cardiac function, such as twin-twin transfusion syndrome (TTTS) and selective intrauterine growth-restriction (sIUGR). In the TTTS, the unbalanced blood flow through placental anastomoses lead a recipient volume overload, hypertension and hypertrophic cardiomyopathy and the donor twin experiences hypovolemia and hypertension due to increased placental resistance and poor renal perfusion. When MC pregnancies were complicated by sIUGR, the increase of placental resistances lead to complex fetal compensatory mechanisms with redistribution of cardiac output to vital organs. Increased placental vascular resistances, hypoxia and hemodynamic compensation mechanisms lead to higher pre and/or afterload for both ventricles, right cardiac failure and eventually left cardiac failure observed just before fetal death. ObjectivesThe purpose of this study was to describe the anomalies of umbilical, ductal and aortic isthmic Doppler as well as left and right myocardial performance index (MPI) across various clinical phenotypes of MC twin pregnancies, uncomplicated or complicated by TTTS or sIUGR, in order to help differentiating these conditions and to improve the understanding of TTTS and sIUGR pathophysiology. Study designAortic isthmic systolic index (ISI), umbilical artery pulsatility index (UAPI), ductus venosus pulsatility index (DVPI), and MPI were studied in uncomplicated MC twins (control group) and cases of sIUGR or TTTS. ResultsThe measurements were obtained in 113 pregnancies (24 uncomplicated, 22 sIUGR, 51 TTTS). In comparison with controls, the sIUGR smaller twin sets had lower ISI and higher UAPI, and the larger twin had higher ISI. The TTTS donor and recipient had lower ISI, higher UAPI and DVPI. Compared to the co-twin, the ISI values were lower in the sIUGR smaller twin and the TTTS donor had lower ISI and MPI. Comparing TTTS and sIUGR, the recipient had higher DVPI and MPI than the sIUGR larger twin. ConclusionsThe Doppler anomalies observed in the smaller twin reflected increased placental blood flow resistance, presumably due to abnormal feto-fetal transfusion in TTTS and to unequal placental sharing in sIUGR. Early hemodynamic changes suggestive of cardiac overload in the recipient twin may help to differentiate TTTS and sIUGR.

One-year clinical and echocardiographic outcomes of transcatheter aortic valve replacement with SAPIEN 3 Ultra versus SAPIEN 3.

The newest-generation balloon-expandable valve, SAPIEN 3 Ultra (S3U), is expected to function well with the enhanced sealing skirt compared with SAPIEN 3 (S3). However, current literature on the comparison between these two valves is limited to short-term follow-ups. Therefore, we aimed to evaluate the 1-year outcomes and echocardiographic changes of S3U compared with S3. We retrospectively identified patients who underwent transfemoral-transcatheter aortic valve replacement with S3U or S3 (20/23/26 mm) at our institution in 2018-2020. Outcomes were 1-year clinical events and echocardiographic parameters, and were compared between S3U and S3 after adjustment with inverse probability of treatment weighting. The S3U and S3 groups included 297 (25.7%) and 858 (74.3%) patients, respectively. There were no significant differences between the two groups in clinical events (death 5.8% vs. 5.5%, hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.81-1.90; death or heart failure hospitalization 10.3% vs. 10.1%, HR 1.04, 95% CI 0.67-1.62). The S3U group had a lower prevalence of mild paravalvular leakage (PVL) (13.7% vs. 22.3%, p = 0.044), with similar moderate PVL (0.7% vs. 1.2%, p > 0.99). No significant differences were observed in aortic valve mean gradient and Doppler velocity index at 1 year. However, the S3U group had a larger increase in mean gradient from implantation to 1 year (median +4.70 vs. +1.63 mmHg, p < 0.001). S3U and S3 carried similarly favorable clinical event risks. Nonetheless, S3U was associated with less frequent mild PVL but a larger increase in transprosthetic gradient. Further studies are needed to determine the prognostic impact of these hemodynamic differences.

Doppler alternans in pediatric emergency: correlation between clinical, Doppler waveforms and silent ventricular dysfunction by POCUS echo

Pulsus alternans (PA), reported in nineteenth century, is a subtle abnormality, often missed in emergency situations. However, the significance lies in its association with severe ventricular dysfunction. This case reports an 8-year-old child presenting with heart failure in emergency department. Abdominal aortic Doppler displayed pulsus/Doppler alternans. Step by step investigation of Doppler clue unearthed severe left ventricular dysfunction secondary to systemic arterial hypertension.

Abstract 12304: Right Ventricular Hemodynamics in COVID Patients With Shock

Introduction: Patients with serious COVID infections frequently develop shock. Their right-sided hemodynamic profiles have not been well characterized. Methods: In a prospectively collected database including 1997 patients hospitalized for COVID pneumonia from March 2020 to March 2021, 368 had shock requiring vasopressors. 327 had echocardiography to assess ventricular function and stroke volume based on clinical indications. LVEF (LV ejection fraction) and RVFAC (RV fractional area change) were measured using Simpson’s rule, stroke volume (SV) by aortic Doppler, and RVSP (RV systolic pressure) from tricuspid regurgitation velocity; 187 had evaluable data on all parameters. Patients were divided into groups with low or preserved RVFAC ( RVFAC L or RVFAC P , cutoff &amp;lte35%), and low or normal cardiac index, (CI, CI L or CI N , cutoff &amp;lte2.2 L/min/m 2 ). Results: Mean age: 65±12, LVEF 59.5±12.8, RVFAC 35.3±10.6, CI 2.41±0.89. Overall hospital mortality in this cohort with shock was 80%. Mean RVSP was 38.8±12.2, PEEP 11.0±3.7. 43% of patients had low RVFAC (&amp;lt35%), and RVFAC correlated with other measures of RV function such as tricuspid annular peak systolic excursion (TAPSE) and lateral tricuspid annulus peak systolic velocity (S’). Higher RVSP correlated with lower CI (r=0.134, p= 0.016) but not with PEEP (r=0.03, p=0.70). Mortality did not differ significantly among groups, (p=0.19 by ANOVA) but was highest in the group with low RVFAC and low CI. ( Figure ) Conclusion: RV dysfunction is common in patients with severe COVID-19 and shock. Although RV dysfunction is probably associated with a worse prognosis, outcome in COVID may be tied to pulmonary recovery. Whether treatment targeted at RV dysfunction will improve outcome remains uncertain.

Aortic valve morphology and the double envelope phenomenon in continuous Doppler echocardiography of aortic stenosis: a computerized model

Abstract Introduction Visualization of a double envelope (DE) is a relatively common issue in aortic transvalvular continuous-wave Doppler (CW) traces. In 1997, Song et al proposed that velocity time integral (VTI) measured at the edge of the inner envelope (IE) might equal that of the left ventricular outflow tract (LVOT). This surrogate measurement would be especially interesting in patients with irregular heart rhythms, as both LVOT and valvular VTIs could be obtained from the same beat, thus avoiding inter-beat variability when assessing aortic valve area (AVA) with continuity equation. In contrast, based on clinical data and 3D-printed models, they raised concern that DE method in dome-shaped valves could lead to significant overestimation of LVOT velocities (about 40%). Later studies, including a Partner trial subanalysis, question the validity of this measurement. Purpose We created a computerized aortic valve model to reproduce the CW tracing, and analysed how valve morphology may lead to a valid, well defined inner envelope or, by contrast, produce overestimation of LVOT velocities. Methods The simulation code was created using Python (v3.9.6) along with NumPy and Matplotlib libraries. For each simulation, an aortic valve scheme was created (LVOT diameter: 2 cm; TSVI length: 1 cm; LVOT peak velocity 1.1 m/s; varying morphologies and lengths of the aortic cusps). The longitudinal axis between LVOT base and valve tip was divided in sections or levels (at least 300 per emulation). To recreate the CW trace, for each level, luminal diameter and peak velocity (according to continuity equation) were calculated, and an array of points was generated representing the aortic waveform during the entire systole. Slight random dispersion (standard deviation 0.05 times original values) was added to produce a more realistic image. Data points were represented as scatter plot over black background with transparency, simulating CW tracings (Figure 1) Results Figure 2 represents the plots of various aortic valve configurations (1st row AVA 1.6 cm2; 2nd: 1.2 cm2; 3rd: 0.8 cm2). Note that the innermost portion of the trace results in hollow space, as these velocities are produced in portions of ventricle and aorta which are not included in the simulation. Pink dashed line represents actual LVOT velocities. In a short-length flat valve (A), the IE is well defined and shows good correlation with LVOT velocity. In a cone-shaped 6mm length valve (B), there is a progressive brightness reduction, with no recognizable contour. With long (6 mm) dome-shaped valves, an ill-defined IE is produced at higher velocities than LVOT, which could result in overestimation. Conclusion DE method could accurately assess LVOT velocities when a sharp-defined IE is present and a dome-shaped valve can be excluded (e.g. rheumatic or some bicuspid valves). Measurements in a blurred DE or in a dome-shaped valve would produce overestimation of LVOT velocities and AVA. Funding Acknowledgement Type of funding sources: None.

Role of Aortic Isthmus Doppler Ultrasound in Fetuses with Intrauterine Growth Restriction

Role of Aortic Isthmus Doppler Ultrasound in Fetuses with Intrauterine Growth Restriction

Clinical utility of aortic isthmus Doppler in the prediction of perinatal outcomes

Doppler studies of uteroplacental-fetal circulation have been proven useful in diagnosing fetal growth restriction, appropriately timing delivery, and improving perinatal morbidity and mortality. There has been an extensive search for the ideal means to identify fetuses between the compensatory and acidemic phase (ie, the "preacidemic phase"), and the aortic isthmus Doppler seems to show promise. This study aimed to investigate: (1) the prevalence of abnormal aortic isthmus Dopplers in a cohort of small-for-gestational-age fetuses and their correlation with other conventional Doppler abnormalities, and (2) the predictive ability of abnormal aortic isthmus Dopplers with regard to short-term adverse neonatal outcomes. Fetuses diagnosed as small-for-gestational-age at ≥24 weeks' gestation were included. Management was as per the standard protocol. Aortic isthmus Doppler was performed within a week of delivery with other conventional Dopplers. The adverse perinatal outcomes studied were: requirement of neonatal resuscitation at birth, Apgar score at 5 minutes <7, cord blood pH <7, presence of bronchopulmonary dysplasia, hypoxic-ischemic encephalopathy, grade III/IV intraventricular hemorrhage, necrotizing enterocolitis, sepsis, neonatal intensive care unit stay longer than 14 days, and stillbirth or neonatal death. Among 121 small-for-gestational-age fetuses, 67 showed Doppler abnormalities in ≥1 vessels. The prevalence of abnormal aortic isthmus Doppler was 14.87%. Analysis was between group 1 with 103 normal aortic isthmus and group 2 with 18 abnormal aortic isthmus fetuses; 41 cases had some form of adverse perinatal outcome, the frequency of which was comparable between the groups. Abnormal aortic isthmus Doppler had a significant correlation with low cerebroplacental ratio, absent or reversed end-diastolic flow in the umbilical artery, and high pulsatility index in the ductus venosus. The positive likelihood ratio for predicting composite adverse perinatal outcome was 10.2 for absent or reversed end-diastolic flow in the umbilical artery, 9.6 for low cerebroplacental ratio, 2.28 for absent or retrograde flow in the aortic isthmus, and 2 for abnormal ductus venosus. Predelivery abnormal aortic isthmus Dopplers performed worse than other conventional Dopplers in predicting abnormal perinatal outcomes.

Diastolic Function and Left Atrial Strain in Young Patients with History of Aortic Coarctation Repair.

Aortic coarctation (AoCo) leads to long-term sequelae that may impair heart function. Data regarding new echocardiographic function parameters such as atrial strain, in affected patients, are scarce. This study aims to describe these parameters in AoCo patients and define their association with severity measures. 53 AoCo patients and 31 healthy controls, aged 12-40years, were evaluated. Effectively corrected AoCo (cAoCo) was defined as aortic trans-isthmic corrected Doppler gradient (Dgrad) ≤ 20mmHg (n = 36), and recoarctation (rAoCo) as Dgrad > 20mmHg (n = 17). Dependent variables were: E/E'; atrial reservoir strain (Ares); and atrial conduit strain (Acd). T-tests/Mann-Whitney U tests were used to compare these among groups. Multivariable regression was used to test correlation with systolic blood pressure (SBP), indexed LV mass (ILVM), Dgrad, and the ratio between the narrowest diameter of aortic arch and aorta at diaphragm level (Aoratio). In cAoCo and rAoCo patients, E/E' was higher (p < 0.001), Ares, and Acd were lower (p < 0.001 for both) comparing with controls. Acd was higher in cAoCo than rAoCo (p = 0.045). Higher Ares was associated with higher Aoratio (p = 0.002), and lower Acd with higher Dgrad (0.014). EF and GLS were not different among groups. Young patients with effectively corrected aortic coarctation have persistent changes in diastolic function parameters (E/E' and atrial strain), and these are affected by anatomical sequelae. These patients' physiology is closer to patients with recoarctation, than to healthy individuals. This provides rationale for a stronger prevention, and treatment, of arterial dysfunction and high left ventricular afterload in these patients.

Excess pressure but not pulse wave velocity is associated with cognitive function impairment: a community-based study.

Carotid-femoral pulse wave velocity (cf-PWV), an index of mainly distal aortic stiffness, has been inconsistently associated with cognitive function. Excess pressure, derived from the arterial reservoir-excess pressure analysis, may integrate the pulsatile load of the proximal aorta. The present study examined whether increased excess pressure is associated with cognitive function impairment in community adults. A total of 992 community participants (69.5% females; mean age: 67.3 years; education 13.6 years) without cerebrovascular disease or dementia received the Montreal Cognitive Assessment (MoCA) to evaluate global cognition. Arterial reservoir and excess pressure, arterial stiffness, and wave reflections were assessed, using carotid tonometry and aortic Doppler flowmetry. Excess pressure integral (XSPI), percentage XSPI, cf-PWV, characteristic impedance (Zc), and forward and backward pressure amplitude (Pf, Pb, respectively) were significantly higher in 197 participants (19.9%) with a low MoCA score (<26 or <25, depending on level of education). In multivariable analyses, XSPI (standardized odds ratio, 95% confidence interval, 1.30, 1.06-1.59), and percentage XSPI (1.27, 1.06-1.52) but not cf-PWV (1.04, 0.85-1.26) were significantly associated with a low MoCA. Further analysis revealed that Pf and Zc were the major determinants of XSPI (partial R2: Pf = 0.656, Zc = 0.467) and percentage XSPI (Pf = 0.459, Zc = 0.371). In contrast, age, instead of Pf and Zc, was the major determinant of cf-PWV (partial R2: age = 0.187). Excess pressure (XSPI/percentage XSPI), mainly determined by the pulsatile hemodynamics of the proximal aorta, was significantly associated with cognitive function impairment in middle-aged and elderly community adults.

Machine Learning-Based Feature Selection and Classification for the Experimental Diagnosis of Trypanosoma cruzi

Chagas disease, caused by the Trypanosoma cruzi (T. cruzi) parasite, is the third most common parasitosis worldwide. Most of the infected subjects can remain asymptomatic without an opportune and early detection or an objective diagnostic is not conducted. Frequently, the disease manifests itself after a long time, accompanied by severe heart disease or by sudden death. Thus, the diagnosis is a complex and challenging process where several factors must be considered. In this paper, a novel pipeline is presented integrating temporal data from four modalities (electrocardiography signals, echocardiography images, Doppler spectrum, and ELISA antibody titers), multiple features selection analyses by a univariate analysis and a machine learning-based selection. The method includes an automatic dichotomous classification of animal status (control vs. infected) based on Random Forest, Extremely Randomized Trees, Decision Trees, and Support Vector Machine. The most relevant multimodal attributes found were ELISA (IgGT, IgG1, IgG2a), electrocardiography (SR mean, QT and ST intervals), ascending aorta Doppler signals, and echocardiography (left ventricle diameter during diastole). Concerning automatic classification from selected features, the best accuracy of control vs. acute infection groups was 93.3 ± 13.3% for cross-validation and 100% in the final test; for control vs. chronic infection groups, it was 100% and 100%, respectively. We conclude that the proposed machine learning-based approach can be of help to obtain a robust and objective diagnosis in early T. cruzi infection stages.

Multisystem inflammatory syndrome in children: Salient echocardiogram findings in the acute phase and longitudinal follow-up

BackgroundCoronary artery (CA) abnormalities and left ventricular (LV) systolic dysfunction have been reported in multisystem inflammatory syndrome in children (MIS-C); however, a thorough review of all findings on transthoracic echocardiogram (TTE) with long term follow-up is lacking. ObjectivesComprehensively describe the findings on TTE during the acute phase of MIS-C and how those findings change on serial follow-up 6 months after diagnosis. MethodsPediatric patients meeting CDC criteria for MIS-C were included, with data collected from acute phase (T0), outpatient follow-up at 2 weeks (T1), 6–8 weeks (T2), and 6 months (T3), including TTE findings of descending aorta Doppler profile, CA abnormalities, valvar regurgitation, LV systolic function, and pericardial effusion. ResultsFifty patients (52% male) were included; 45 (90%) were SARS-CoV-2 IgG antibody positive, 13 (26%) PCR positive, and 8 (16%) positive for both. Mean age was 8.3 years (range 9 months - 17 years). Holodiastolic flow reversal in descending aorta was seen in 72% at T0, in 6% at T1, with complete resolution in all by T2. CA abnormalities were seen in 52% at T0, 31% at T1, 13% at T2, and none at T3. Mitral regurgitation was present in 84% at T0, 40% at T1, 36% at T2, and 24% by T3. LV systolic dysfunction (ejection fraction <55%) occurred in 52% at T0, with resolution by discharge in 69%, and complete resolution by T2. Trivial to small pericardial effusion was present in 48% at T0, 13% at T1, 3% at T2 and 4% by T3. ConclusionIn addition to CA abnormalities and LV systolic dysfunction, holodiastolic flow reversal in the descending aorta, valvar regurgitation, and pericardial effusion are prominent findings in MIS-C. Longitudinal follow-up shows improvement in all.