Aortic Peak Systolic Velocity Research Articles

Impact of Breathing Control Training Program on sonographic quantification of abdominal vasculature.

To compare vascular scanning parameters (vessel diameter, peak systolic velocity, end-diastolic velocity, and resistive index) and scanning time before and after breathing control training program for selected abdominal vessels. This study was pre and post quasi-experimental. The researchers designed a breathing training program that gives participants instructions through a video describing breathing maneuvers. Data were collected at the ultrasound laboratory/College of Health and Rehabilitation Sciences in Princess Nourah bint Abdul Rahman University, Riyadh, Saudi Arabia from January 2023 to November 2023. About 49 volunteers at the university participated in the study. Scanning was performed two times for the right renal artery, upper abdominal aorta, inferior vena cava, and superior mesenteric artery. Scanning time was measured before and after the program as well. A paired sample t-test was used to compare the parameters means and time before and after the program. The program had a significant effect on the following parameters: right renal artery peak systolic velocity (p=0.042), upper abdominal aortic peak systolic velocity, and resistive index (p=0.014, p=0.014 respectively), superior mesenteric artery and inferior vena cava diameters (p=0.010 and p=0.020). The scanning time was reduced significantly (p<0.001). The breathing training program saves time and improves ultrasound measurement quality. Hospitals and health centers should consider the importance of breathing control training programs before abdominal scanning.

Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging.

This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated. A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening. Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) - 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) - 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) - 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = -0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (-0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (-0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (-0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (-0.128, p = 0.045) and CRL (-0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010). Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.

Abnormal Shape and Size of the Cardiac Ventricles Are Associated with a Higher Risk of Neonatal Death in Fetuses with Isolated Left Congenital Diaphragmatic Hernia

Introduction: The objective of this study was to evaluate the association between fetal cardiac deformation analysis (CDA) and cardiac function with severe adverse perinatal outcomes in fetuses with isolated left congenital diaphragmatic hernia (CDH). Methods: CDA in each ventricle (contractility, size, and shape), evaluated by speckle tracking and novel FetalHQ software, and markers of cardiac function (E/A ratios, pulmonary and aortic peak systolic velocities, and sigmoid annular valve diameters), were evaluated in fetuses with isolated left CDH. Two evaluations were performed: at referral (CDA and function) and within 3 weeks of delivery (CDA). Severe adverse neonatal outcomes were considered neonatal death (ND) or survival with CDH-associated pulmonary hypertension (CDH-PH). Differences and associations between CDA, cardiac function, and severe adverse outcomes were estimated. Results: Fifty fetuses were included, and seventeen (34%) had severe adverse neonatal outcomes (11 ND and 6 survivors with CDH-PH). At first evaluation, the prevalence of a small left ventricle was 34% (17/50) with a higher prevalence among neonates presenting severe adverse outcomes (58.8 [10/17] vs. 21.2% [7/33]; p = 0.01; OR, 5.03 [1.4–19.1; p = 0.01]) and among those presenting with neonatal mortality (8/11 [72.7] vs. 9/39 [23.0%]; p = 0.03; OR, 8.9 [1.9–40.7; p = 0.005]). No differences in cardiac function or strain were noted between fetuses with or without severe adverse outcomes. Within 3 weeks of delivery, the prevalence of small left ventricle was higher (19/34; 55.8%) with a more globular shape (reduced transverse/longitudinal ratio). A globular right ventricle was significantly associated with ND or survival with CDH-PH (OR, 14.2 [1.5–138.3]; p = 0.02). Conclusion: Fetuses with isolated CDH at risk of perinatal death or survival with CDH-PH had a higher prevalence of a small left ventricle and abnormal shape of the right ventricle.

Abdominal perfusion in canine patients with pyometra and sepsis evaluated by Doppler and contrast-enhanced ultrasound

BackgroundSepsis is a condition characterized by organic dysfunction, leading to hemodynamic instability and high morbidity and mortality rates in humans and animals. Early identification of perfusion changes and appropriate management of sepsis are crucial for improving patient prognosis. Currently, the Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) scores are widely studied for sepsis identification and evaluation of organ dysfunction. However, these scores do not assess gastrointestinal involvement, which is common in this condition. Contrast-enhanced ultrasound (CEUS) and Doppler have been considered promising diagnostic techniques for detecting changes in vascularization and microcirculation in a non-invasive and safe manner, particularly in the gastrointestinal system. This study aimed to evaluate duodenal perfusion using CEUS, as well as abdominal aortic and cranial mesenteric artery blood flow using Doppler ultrasound, and systolic arterial pressure (SAP) in 17 bitches with pyometra and in 10 healthy animals.ResultsThe variables were compared between the pyometra and control groups, as well between patients with and without sepsis determined by the SOFA or SIRS scores. Pyometra was found to cause a reduction in abdominal aortic blood flow volume, aortic peak systolic velocity, and resistivity index as evaluated by Doppler ultrasound. Patients with sepsis according to the SOFA criteria only presented lower SAP. In contrast, sepsis animals identified by the SIRS score exhibited lower SAP, aortic peak systolic velocity, aortic blood flow volume, and aortic resistivity index and additionally, higher peak intensity of contrast in the duodenal wall.ConclusionsPyometra causes a reduction in abdominal aortic blood flow, which is more pronounced in animals with sepsis identified by the SIRS criteria. These animals also exhibited a decrease in systolic blood pressure and an increase in duodenal perfusion, as evident by CEUS. However, these changes were not observed in patients with sepsis identified by the SOFA criteria. The alterations in intestinal perfusion observed in animals with sepsis indicate the presence of inflammation or dysfunction. In this regard, CEUS proves to be a valuable technique for detecting subtle changes in tissue hemodynamics that may not be apparent in conventional exams.

Four‐Dimensional flow Magnetic Resonance Imaging for Assessment of Pediatric Coarctation of the Aorta

4D Pathline Images Comparing Flow Patterns and Maximum Intensity Projections (MIPS) of Aortic Peak Systolic Velocities in the Ascending Aorta (AAO), Transverse Arch (ARCH), and Descending Aorta (DAO) by Desai et al. (200-208)

Fetal and Neonatal Modified Myocardial Performance Indices in Preeclamptic versus Normotensive Pregnancies: A Prospective Cohort Study.

ObjectiveTo compare fetal and neonatal cardiac functions in terms of global, systolic, and diastolic function between the preeclampsia and normotensive blood pressure of pregnancies.MethodsA prospective cohort study was conducted at a university hospital in Northeast Thailand. Twenty-nine pregnancies diagnosed as preeclampsia with or without severe features were compared with 29 normotensive pregnancies. Global cardiac, systolic, and diastolic function were assessed at prenatal and postnatal periods, by a professionally trained obstetrician and pediatric cardiologist, respectively.ResultsThe fetal left modified myocardium performance index (Mod-MPI) in preeclampsia and normotensive blood pressure were 0.60±0.08 and 0.59±0.08 (p-value=0.341), respectively, while fetal right Mod-MPI were 0.57±0.16 and 0.54±0.21 (p-value=0.861), respectively. There were no statistically significant differences in terms of fetal isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ejection time (ET), aortic peak systolic velocity (Ao PSV), pulmonary artery peak systolic velocity (PA PSV), mitral valve (MV) E:A ratio, or tricuspid valve (TV) E:A ratios between the two groups. Neonatal mitral valve E peak systolic velocity (MV-E PV) in preeclamptic and normotensive blood pressure groups were significantly different at 51.1±8.02 cm/s and 43.56±5.21cm/s (p-value=0.036), respectively, whereas neonatal left Mod-MPI, mitral valve A peak systolic velocity (MV-A PV), MV E:A ratio, and Ao PSV were not significantly different (p-value=0.436, 0.119, 0.379, and 0.709), respectively.ConclusionNeonatal MV-E PV of the preeclampsia group was significantly higher than the normotensive blood pressure group, while there were no statistically significant differences in terms of global cardiac and diastolic functions during the fetal period between two groups.

Fetal myocardial performance index in pregnancies with idiopathic mildly increased amniotic fluid volume.

To evaluate modified myocardial performance index (MPI), or Tei index, in fetuses of pregnancies with idiopathic mildly increased amniotic fluid index (AFI). We studied 25 cases (24-40 weeks) with idiopathic mildly increased AFI, and 25 gestational age- and fetal gender-matched healthy controls. Fetal echocardiographic variables and Doppler-derived indices were recorded, including left and right MPI, left isovolumetric contraction time (IVCT), left ejection time (ET), left isovolumetric relaxation time (IVRT), aortic and pulmonary arterial peak systolic velocity (PSV), left and right E/A ratios, middle cerebral artery (MCA) pulsatility index (PI), and umbilical artery (UA) PI. The mean left MPI (0.52 vs 0.41, P < .0001) and right MPI (0.50 vs 0.42, P < .001) were higher, and mean IVCT (37.7 vs 25.9, P < .0001) was longer in cases than in controls. However, there were no significant differences between the two groups in IVRT (45.2 vs 43.2, P = .381), ET (160.2 vs 170.0, P = .079), aortic PSV (P = .073), left E/A (P = .080), pulmonary artery PSV (P = .061), right E/A (P = .054), MCA PI (P = .259), UA PI (P = .685), and cerebroplacental ratio (P = .645). Pregnancies with idiopathic mildly increased AFI were associated with a significant increase in the fetal MPI of both left and right ventricles.

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

Surrogate indices of aortic peak systolic velocity variation to monitor fluid responsiveness in pediatric non-cardiac surgery: a prospective observational study.

Aortic peak systolic velocity variation (ΔVpeakAo) is a reliable dynamic indicator of preload in mechanically ventilated children. However, easily measurable alternative parameters like carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakSs) are not well evaluated in children. The aim of the study was to find correlation between ΔVpeakCa and ΔVpeakSs to ΔVpeakAo, as potential surrogate markers of fluid responsiveness. 52 children, 1-12years old, undergoing major non-cardiac surgeries under general endotracheal anaesthesia were recruited for this single-centre prospective observational study. ΔVpeakAo, ΔVpeakCa and ΔVpeakSs were measured by pulsed wave Doppler in appropriate windows, measuring maximum and minimum peak flow velocity over a single respiratory cycle. Calculated parameters were compared by a repeated measures study design. Correlation coefficients were 0.82 between ΔVpeakAo and ΔVpeakSs and 0.73 between ΔVpeakAo and ΔVpeakCa. Bland-Altman analysis showed minimal bias of 1.86 percentage points with limits of agreement of 11.21 to - 7.49 (ΔVpeakAo and ΔVpeakSs) and 3.93 percentage points with limits of agreement of 14.04 to - 6.18 (ΔVpeakAo and ΔVpeakCa). ΔVpeakSs and ΔVpeakCa also showed good discrimination to predict ΔVpeakAo (lying in previously validated fluid responsive zones) with sensitivities and specificities of 82.25% and 85% with cut-off of 11% for ΔVpeakSs, and 88.52% and 70% with cut-off of 8.6% for ΔVpeakCa. Carotid peak systolic velocity variation (ΔVpeakCa) and suprasternal peak systolic velocity variation (ΔVpeakCa) can be potential surrogate markers for Aortic peak systolic velocity variation (ΔVpeakAo) in assessing fluid responsiveness in mechanically ventilated children.Study registration: Clinicaltrials.gov ID NCT03155555.

Influence of renal function and demographic data on intrarenal Doppler ultrasonography.

Intrarenal Doppler ultrasonography is a non-invasive method to evaluate the renal blood flow in patients with renal arterial stenosis as well as chronic kidney diseases (CKD). Until recently, the relationship between ultrasonography findings and CKD stage has not been fully understood. Overall, 162 patients with CKD without apparent renal arterial stenosis were included in this study, and the pulsed-wave Doppler ultrasonography findings were evaluated in terms of the following parameters: peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) at the renal arterial trunk, hilum, segmental, and interlobar regions. Age showed a significant negative correlation with the estimated glomerular filtration rate (eGFR), kidney size, and aortic PSV. Additionally, age showed a significant positive correlation with RI in all 4 regions. The eGFR showed a positive correlation with the aortic PSV and kidney size, but a negative correlation with RI. Both age and eGFR were found to be independently associated with aortic blood flow. On the intrarenal ultrasound, EDV and RI showed stronger correlations with eGFR than PSV, suggesting that the former indices would be better markers of renal function. In particular, the interlobar EDV was found to be the best index that reflects renal function. Although the RI is also a good marker of renal function, it is confounded by age; thus, its utility would be weaker than that of the EDV. In conclusion, intrarenal pulsed-wave Doppler ultrasonography is a useful tool to estimate and evaluate the renal function; the interlobar EDV may be the best index to estimate the effective perfusion and filtration of the kidneys.

Hematocrit: another important factor in systemic neonatal cardiovascular adaptation

Background: Global cardiovascular adaptation of normal healthy term newborns is rarely studied from a multiorgan and hematological point of view.Aims: To evaluate comprehensive neonatal cardiovascular adaptation during the first days of life with echocardiography and renal-cerebral echo color-Doppler and to correlate it with hematocrit (Ht) changes.Study design: A prospective observational study was conducted on 35 healthy term neonates with a mean ± SD gestational age and birth weight of 39.5 ± 1.1 weeks and 3,400 ± 330 g, respectively. All infants underwent serial echocardiograms at 15 ± 4 hours (day 1) and 72 ± 4 hours (day 3) of age. At the same time, cerebral and renal Doppler parameters were acquired and Ht was sampled.Results: The weight and Ht declined by 220 g (189-251) and 8.1% (6.7-9.5), respectively. Systolic and diastolic diameters of the right ventricle and diastolic left ventricle posterior wall thickness showed a reduction, while the diastolic diameter of the left ventricle showed a small increase. The Doppler cardiac evaluation showed an increase in the mitral E/A ratio and pulmonary acceleration time, a reduction of late transmitral flow peak velocity, aortic peak systolic velocity (PSV), aortic peak systolic pressure gradient, aortic velocity-time integral, aortic mean pressure gradient and pulmonary mean acceleration. We also found a reduction of cerebral resistance parameters and an increase in PSV, end-diastolic velocity, and time-averaged velocity. Other measured parameters remained unchanged.Conclusion: Systemic cardiovascular evaluation about changes in Ht is an essential approach to study newborns, especially during the first days of life when Ht shows a significant decrease. Knowledge of the laws of physics related to the effect of Ht changes on vascular parameters is another important factor in understanding the pathophysiology of neonatal disease states. Further studies are useful to help physicians make evidence-based decisions in the management of newborns in Neonatal Intensive Care Units (NICUs).

Two-Minute k-Space and Time-accelerated Aortic Four-dimensional Flow MRI: Dual-Center Study of Feasibility and Impact on Velocity and Wall Shear Stress Quantification.

To investigate the two-center feasibility of highly k-space and time (k-t)-accelerated 2-minute aortic four-dimensional (4D) flow MRI and to evaluate its performance for the quantification of velocities and wall shear stress (WSS). This cross-sectional study prospectively included 68 participants (center 1, 11 healthy volunteers [mean age ± standard deviation, 61 years ± 15] and 16 patients with aortic disease [mean age, 60 years ± 10]; center 2, 14 healthy volunteers [mean age, 38 years ± 13] and 27 patients with aortic or cardiac disease [mean age, 78 years ± 18]). Each participant underwent highly accelerated 4D flow MRI (k-t acceleration, acceleration factor of 5) of the thoracic aorta. For comparison, conventional 4D flow MRI (acceleration factor of 2) was acquired in the participants at center 1 (n = 27). Regional aortic peak systolic velocities and three-dimensional WSS were quantified. k-t-accelerated scan times (center 1, 2:03 minutes ± 0:29; center 2, 2:06 minutes ± 0:20) were significantly reduced compared with conventional 4D flow MRI (center 1, 12:38 minutes ± 2:25; P < .0001). Overall good agreement was found between the two techniques (absolute differences ≤15%), but proximal aortic WSS was significantly underestimated in patients by using k-t-accelerated 4D flow when compared with conventional 4D flow (P ≤ .03). k-t-accelerated 4D flow MRI was reproducible (intra- and interobserver intraclass correlation coefficient ≥0.98) and identified significantly increased peak velocities and WSS in patients with stenotic (P ≤ .003) or bicuspid (P ≤ .04) aortic valves compared with healthy volunteers. In addition, k-t-accelerated 4D flow MRI-derived velocities and WSS were inversely related to age (r ≥-0.53; P ≤ .03) over all healthy volunteers. k-t-accelerated aortic 4D flow MRI providing 2-minute scan times was feasible and reproducible at two centers. Although consistent healthy aging- and disease-related changes in aortic hemodynamics were observed, care should be taken when considering WSS, which can be underestimated in patients.© RSNA, 2019See also the commentary by François in this issue.

Ascending aortic blood flow velocity is increased in children with primary snoring/mild sleep-disordered breathing and associated with an increase in CD8 + T cells expressing TNFα and IFNγ.

Sleep-disordered breathing (SDB) is associated with cardiovascular disease and systemic inflammation in adults but this remains to be explored in children, especially in children with the most common form of SDB, i.e. primary snoring/mild SDB. This pilot study investigated the relationship between the cardiovascular function and inflammation in children with mild SDB. Nineteen participants aged 5-14years underwent overnight polysomnography, cardiac magnetic resonance imaging (aortic blood flow velocity and left and right ventricular systolic function) and assessment for inflammatory markers (intracellular cytokine analysis of T cells by flow cytometry). Parents also completed the Sleep Disturbances Scale for Children (SDSC). Children with mild SDB exhibited increased ascending aortic peak systolic velocity compared to controls (SDB 119.95m/s vs. control 101.49m/s, p<0.05). No significant group differences were observed for left and right ventricular ejection fraction or mean aortic blood flow velocity from either the ascending aorta or pulmonary artery. Children with mild SDB had increased inflammatory markers as demonstrated by elevated T cell interferon gamma (IFNγ) (SDB 52±4% vs. control 25±3% positive cells, p<0.005) and tumour necrosis factor alpha (TNFα) (SDB 39±4% vs. control 20±2% positive cells, p<0.005) expression from CD8+ cells. A strong positive correlation was observed between ascending aorta peak blood flow velocity and both TNFα and IFNγ (TNFα, r=0.54, p<0.03; IFNγ, r=0.63, p<0.005, respectively). Polysomnography revealed that oxygen saturation (SaO2) nadir was significantly lower in children with mild SDB compared to controls (SDB 92.3±2.7% vs. control 94.4±1.6%, p<0.05). A lower SaO2 nadir was associated with an increased ascending aorta peak systolic velocity (r=-0.48, p<0.05). As well, both a lower SaO2 nadir and an increased ascending aorta peak systolic velocity were associated with higher SDSC Sleep-Disordered Breathing and Disorder of Initiating and Maintaining Sleep subscale scores but not the polysomnographic-derived Obstructive Apnea-Hypopnea Index. The finding of elevated ascending aortic peak systolic blood flow velocity and its association with increased inflammatory markers suggests that the profile of cardiovascular changes noted in adult SDB may also occur in children with mild SDB.

Longitudinal Evaluation of Aortic Hemodynamics in Marfan Syndrome: New Insights from a 4D Flow Cardiovascular Magnetic Resonance Multi-Year Follow-Up Study

BackgroundThe aim of this 4D flow cardiovascular magnetic resonance (CMR) follow-up study was to investigate longitudinal changes in aortic hemodynamics in adolescent patients with Marfan syndrome (MFS).Methods4D flow CMR for the assessment of in-vivo 3D blood flow with full coverage of the thoracic aorta was performed twice (baseline scan t1/follow-up scan t2) in 19 adolescent MFS patients (age at t1: 12.7 ± 3.6 years, t2: 16.2 ± 4.3 years) with a mean follow-up duration of 3.5 ± 1.2 years. Ten healthy volunteers (24 ± 3.8 years) served as a control group. Data analysis included aortic blood flow visualization by color-coded 3D pathlines, and grading of flow patterns (helices/vortices) on a 3-point scale (none, moderate, severe; blinded reading, 2 observers). Regional aortic peak systolic velocities and systolic 3D wall shear stress (WSS) along the entire aortic wall were quantified. Z-Scores of the aortic root and proximal descending aorta (DAo) were assessed.ResultsRegional systolic WSS was stable over the follow-up duration, except for a significant decrease in the proximal inner DAo segment (p = 0.02) between t1 and t2. MFS patients revealed significant lower mean systolic WSS in the proximal inner DAo compared with volunteers (0.78 ± 0.15 N/m2) at baseline t1 (0.60 ± 0.18 N/m2; p = 0.01) and follow-up t2 (0.55 ± 0.16 N/m2; p = 0.001). There were significant relationships (p < 0.01) between the segmental WSS in the proximal inner DAo, DAo Z-scores (r = −0.64) and helix/vortex pattern grading (r = −0.55) at both t1 and t2. The interobserver agreement for secondary flow patterns assessment was excellent (Cohen’s k = 0.71).ConclusionsMFS patients have lower segmental WSS in the inner proximal DAo segment which correlates with increased localized aberrant vortex/helix flow patterns and an enlarged diameter at one of the most critical sites for aortic dissection. General aortic hemodynamics are stable but these subtle localized DAo changes are already present at young age and tend to be more pronounced in the course of time.

The impact of intrahepatic cholestasis of pregnancy on fetal cardiac and peripheral circulation.

The aim of this study was to evaluate changes in fetal cardiac and peripheral circulation in pregnancies complicated with intrahepatic cholestasis. The Doppler examination results of 22 pregnant subjects complicated with intrahepatic cholestasis of pregnancy (ICP) and 44 healthy controls were compared. The parameters of fetal cardiac circulation were pulmonary artery and aortic (Ao) peak systolic velocity (PSV), pulmonary vein (Pv), peak velocity index (PVI) and pulsatility index (PI), mitral valve (MV) and tricuspid valve (TV), early diastole (E)- and atrial contraction (A)-wave peak velocity ratio (E/A), and isthmus aortic peak systolic velocity (IAo PSV). The parameters of fetal peripheral circulation were middle cerebral artery (MCA) and umbilical artery (UA) PI, resistance index (RI), systolic/diastolic (S/D) ratio. Fetal obstetric Doppler monitoring was conducted weekly before 36 weeks and biweekly after that, and the results were compared with the normal reference values for gestational age. The Doppler parameters of fetal cardiac and peripheral circulation did not significantly differ between the two groups. S/D ratio readings in the ICP group were significantly above 2 SD before 35 weeks of gestation. Women with ICP had increased risks of preterm delivery, neonatal unit admission, and meconium-stained amniotic fluid compared with those in the controls. Fetuses of pregnant women with ICP showed no differences in the evaluation of cardiac and peripheral Doppler measurements compared with fetuses of healthy mothers. The Doppler investigation of the umbilical artery may be useful in monitoring of pregnancies complicated by early onset intrahepatic cholestasis.

When early life growth restriction in rats is followed by attenuated postnatal growth: effects on cardiac function in adulthood.

Epidemiological and experimental studies demonstrate that intrauterine growth restriction (IUGR) followed by accelerated postnatal growth leads to increased risk of developing cardiac disease in adulthood. The aim of this study was to examine the effect of early life growth restriction on cardiac structure and function in young adult rats. IUGR was induced in Wistar Kyoto dams through administration of a low protein diet (LPD; 8.7% casein) during pregnancy and lactation; controls received a normal protein diet (NPD; 20% casein). Cardiac function and structure were assessed in female NPD (n = 7) and LPD (n = 7) offspring at 18 weeks of age by echocardiography and pressure-volume techniques, and systolic blood pressure by tail-cuff sphygmomanometry. LPD offspring remained significantly smaller throughout life compared to controls. There were no differences in the levels of systolic blood pressure, left ventricular cardiac dimensions, heart rate, ejection fraction and fractional shortening of the cardiac muscle between the investigated groups. Aortic peak systolic velocity was significantly reduced in the LPD group (P = 0.02). Our findings support the idea that the programming of adult cardiovascular disease can be prevented or delayed in IUGR offspring when postnatal growth trajectory resembles that of in utero.

Crohn's disease activity assessed by doppler sonography: the role of aortic flow parameters

OBJECTIVES:Intestinal neovascularization and abnormal abdominal arterial flow rates have been reported in Crohn's disease. The aim of this study was to evaluate Doppler sonography as a method for assessing Crohn's disease activity based on changes in splanchnic hemodynamics.METHODS:Forty-eight patients with Crohn's disease, 22 healthy volunteers and 12 patients with irritable bowel syndrome were evaluated by Doppler ultrasound for flow parameters of the aorta and superior mesenteric artery. This evaluation included the cross-sectional area, maximum flow volume, peak systolic velocity, end diastolic velocity, resistance and the pulsatility index. Disease activity was classified according to the Crohn's disease activity index.RESULTS:Most measurements in the aorta and superior mesenteric artery were significantly different between Crohn's disease patients and both control groups. Only the aortic maximum flow volume (CC = 0.37, p = 0.009) and aortic peak systolic velocity (CC = 0.30, p = 0.035) showed a significant positive correlation with the Crohn's disease activity index. The determination of cut-off points for the aortic maximum flow volume and peak systolic velocity measurements increased the sensitivity (80 and 75% for flow volume and velocity, respectively), specificity (57 and 75%), accuracy (67 and 75%) and positive (57 and 68%) and negative (80 and 81%) predictive values. These cut-off values permitted the correct classification of most of the patients with Crohn's disease with respect to disease activity. None of the superior mesenteric artery measurements were able to discriminate patients in relation to disease activity.CONCLUSION:The aortic maximum flow volume and peak systolic velocity levels estimated by Doppler sonography reflected disease activity in Crohn's disease. Doppler sonography of the aorta is therefore a novel noninvasive adjunct method that may be useful in the clinical follow-up of patients with Crohn's disease.

Modified myocardial performance index for evaluation of fetal cardiac function in pre‐eclampsia

To assess cardiac function by means of the modified myocardial performance index (Mod-MPI) in fetuses of pre-eclamptic mothers without intrauterine growth restriction and to compare this with values from normal controls. A cross-sectional study was conducted including a total of 72 fetuses at between 26 and 40 weeks' gestation. Forty fetuses of healthy mothers were assigned as the control group (Group I) while 15 fetuses of mildly pre-eclamptic mothers constituted Group II and 17 fetuses of severely pre-eclamptic mothers constituted Group III. Two-dimensional gray-scale and Doppler fetal echocardiography was used to exclude cardiac anomalies and calculate the Mod-MPI. The mean+/-SD Mod-MPI values of Groups I, II and III were 0.43+/-0.045, 0.44+/-0.064 and 0.44+/-0.064, respectively (P=0.680). The mean aortic peak systolic velocity (PSV), the mean mitral valve early ventricular filling (E-wave) and active atrial filling (A-wave) peak velocities were significantly lower in fetuses of severely pre-eclamptic mothers than in fetuses of mildly pre-eclamptic mothers and control fetuses. The fetal global myocardial function assessed by Mod-MPI does not seem to change in mild or severe pre-eclampsia. The lower mitral E-wave and A-wave peak velocities and the lower aortic PSV seem to reflect the increased cardiac afterload against which the fetal heart has to work, rather than systolic or diastolic cardiac dysfunction, in the fetuses of severely pre-eclamptic mothers.

First-Trimester Fetal Cardiac Function

The purpose of this study was to establish normal values for fetal heart function in the first trimester. This was a prospective observational study with institutional ethics approval and written maternal consent. Thirty-two healthy pregnant women were recruited, and transabdominal fetal echocardiography was performed between 12 and 14 completed weeks' gestation. Myocardial function was assessed with the myocardial performance index to assess combined systolic and diastolic function, isovolumetric contraction time to assess systolic function, and isovolumetric relaxation time to assess diastolic function. Mitral and tricuspid inflows were also assessed by determining the ratio between passive and active ventricular filling. The ventricular outflows were also assessed by peak systolic velocities (PSVs) and time velocity integrals (TVIs). The mean gestational age at the time of echocardiography was 13 weeks, and the mean crown-rump length was 79 mm. All fetuses had a normal nuchal translucency measurement (mean, 1.5 mm). The myocardial performance index was the same in the left and right sides of the heart, 0.5. The mean isovolumetric relaxation time and isovolumetric contraction time on the left side of the heart were 41 and 36 milliseconds, respectively. The mean passive/active ventricular filling ratio was 0.6 at both the mitral and tricuspid valves. The mean aortic PSV was 26 cm/s, and mean pulmonary artery PSV was 32 cm/s. The mean aortic outflow TVI was 3.6 cm, and the mean pulmonary outflow TVI was 4.1 cm. This study establishes normal values for cardiac function at 12 to 14 weeks' gestation. These values may assist in assessment of fetal health in early pregnancy.

ULTRASOUND DOPPLER TECHNIQUE AND THE RENAL ARTERIES: DIAGNOSTIC IMPACT OF THE ECHO ENHANCER SH U 508A AND A NEW RENAL‐HILIAR VELOCITIES INDEX

Introduction: Renal vascular hypertension (RVH) accounts for 1–5% of the total population of patients with high blood pressure. In addition, the prevalence between patients with coronary and peripheral vascular disease usually is greater to 40%. Several noninvasive methods for diagnosis have been used in hypertensive patients with a suspicion of renal arteries stenosis, such as color Doppler ultrasound. The incorporation of echo enhancers (EE) to the echographic technique has had a significant impact for the yield of the study. Objective: To analyze the feasibility of total visualization of main renal artery with and without EE. To determine the sensitivity and diagnostic specificity of the conventional color Doppler parameters for the diagnosis of RVH: renal peak systolic velocity (RePSV), renal aortic ratio (RAR): RePSV/peak systolic velocity at the abdominal aorta (AoPSV), with and without EE. A new index of velocities was also proposed: the renal‐hiliar index (ReHi‐Index): RePSV/renal hilum peak systolic velocity (ReHiPSV), and was compared with conventional parameters in terms of sensitivity and specificity, using angiography as the gold standard method. Materials and Methods: 77 patients were included (45 males, 32 females, mean age 54 years) between July 1998 and April 2003. Echo‐Doppler analysis was made with and without EE, comparing the feasibility of visualization of the renal arteries in all their passage: proximal, medium, and distal. Three different echo machines were used: Ving Med CFM 800 (2,5 MHz and 3,5 MHz transducer), Toshiba SSH 140‐A (2,5 MHz and 3,75 MHz transducer) and Hewlett Packard Image Point HX (2,5 MHz and 4,0 MHz transducer). An EE composed of 999 mg of galactose and 1 mgof palmitic acid by each gram of grains was used with 300 mg/mL concentration. The direct parameters measured in the main renal artery were the following: (1) RePSV: as the highest Doppler velocity measured in systole in the main renal artery. (2) RAR: as the rate between renal peak systolic velocity, RePSV, divided by aortic peak systolic velocity, AoPSV, measured at the abdominal aorta. (3) ReHi Index: the rate between RePSV and renal hilum peak systolic velocity, ReHiPSV, measured at the hilum in its extrarenal section. Stenosis was considered significant when RePSV &gt; 200 cm/s, RAR &gt; 3.5 and new renal‐hiliar Index &gt;2.7. Renal angiography was performed in 16 patients with echographic diagnosis of renal artery stenosis. Statistical analyses included specificity, sensibility, and relative risk calculations on the three mentioned direct parameters. The Mantel‐Haenszel chisquare test was applied to analyze statistically significant differences between the discrete parameters. Results: 77 patients were examined with conventional color echo Doppler technique with and without EE. All 151 of 151 the renal arteries segments, proximal, medium and distal, were observed with EE, (100% feasibility) and 137 of 151 without EE (91% feasibility) (p &lt; 0.001). Renal angiography revealed severe stenosis in 16 arteries (&gt;60%), 3 with moderate obstruction (40–59%), 10 normal, 2 occluded, and one absent.The diagnostic accuracy of the direct parameters for the diagnosis of severe renal stenosis was as follows: (1) RePSV &gt; 200 cm/s; 94% sensibility, 77% specificity, RR 9.17 (p &lt; 0.001). (2) RAR &gt; 3.5: 69% sensibility, 100% specificity, RR 3.6 (p&lt; 0.001). (3) New ReHi‐Index &gt; 2.7: 94% sensibility, 92% specificity, RR 12.24 (p&lt; 0.001). The values of urea and creatinine in blood before and after the intravenous administration of EE were similar (p&lt;0.72), showing EE as a well‐tolerated product. Conclusions: (1) The visualization feasibility of renal arteries improved significantly with the EE use, increasing from 91% to 100% (p &lt; 0.001). (2) A new renal‐hiliar index (ReHi Index) was introduced, with improved sensitivity and very acceptable specificity in relation to conventional direct parameters like RePSV &gt; 200 cm/s and RAR &gt; 3.5 (p&lt; 0.0001). (3) EE showed an excellent security profile in terms of renal tolerance, also allowing its use in patients with deterioration of the renal function.