Changes In Peak Systolic Velocity Research Articles

Microbubble-enhanced functional changes in arteries induced by pulsed high-intensity focused ultrasound exposure

The purpose of this study is to investigate the dose-dependent effects of ultrasound contrast agent (UCA) on the changes of peak systolic velocity (PSV) and pulsatility index (PI) in the arteries of 24 male Sprague-Dawley rats. The rats were sonicated with 1.0-MHz pulsed high-intensity focused ultrasound (HIFU) at two acoustic powers, 15W and 30W, with UCA present at four concentrations (0, 150, 300, and 450μL/kg). Ultrasound imaging was used to localize and to monitor the pulsed-HIFU exposure. The mean PSV of blood flow, as measured by Doppler ultrasound imaging, increased immediately in the arteries where UCA has been administrated at all four doses after pulsed-HIFU at 15W. However, the normalized PSV change decreased with each injected dose of UCA at 30W. Furthermore, the normalized pulsatility index changes increased as the injected dose of UCA increased at two acoustic powers. No obvious changes were found in terms of histological structures and temperature rise at the vessel wall. Our results demonstrated that the response of the artery to pulsed-HIFU was dependent on UCA dose at the same acoustic power. The value of normalized PSV change was minimal and the normalized PI change reached a maximum when the UCA dose was at the highest dose of UCA (450μL/kg) with the two acoustic powers.

51 Low-dose sodium nitrite relieves myocardial ischaemia in patients with coronary artery disease: a targeted no-donor effect

Introduction Sodium nitrite (NaNO 2 ) became a popular means of treating angina in the 19th century, as its stable chemical structure allowed for cheap preparation and easy storage. However, the effects were slow and unpredictable and so it fell out of favour as more potent and faster-acting agents became available, (eg, organic nitrates). Recent in vitro evidence shows that nitrite (NO 2 - ) exhibits an enhanced vasodilator effect in hypoxia; an environmental modification which encourages its reduction to nitric oxide (NO). Therefore NaNO 2 could potentially be an anti-ischaemic agent at much lower doses than those used historically, and be without the adverse side effects associated with organic nitrates (eg, systemic hypotension and tachyphylaxis). Method A double-blind, placebo-controlled, cross-over study was performed in 10 subjects with proven myocardial ischaemia documented by exercise tolerance testing and coronary angiography. Two dobutamine stress echocardiography (DSE) studies were performed on each subject: one with 0.9% saline and one with NaNO 2 , 1.5 μmol/min for 20 min. This dose of NaNO 2 has previously been shown to be inert in normoxia but to vasodilate hypoxic tissue. Myocardial ischaemia was identified by the peak systolic velocity (PSV) response during DSE in a six basal-wall segment model of the left ventricle. Using placebo study data-set, walls were classified into tertiles: the lowest tertile of responders of PSV to an increase in heart rate (ΔHR) labelled ischaemia (n=18) and the upper tertile control (n=18). Data was divided into four groups according to the study-infusion received and the myocardial-wall examined: saline/ischaemia , NO 2 - /ischaemia , saline/control and NO 2 - /control . Results Data from each stage of each DSE was plotted on a scatter plot graph with change in (ΔHR) on the x-axis and corresponding change in PSV (ΔPSV) on the y-axis (increase in both values compared to baseline), see Abstract 51 figures 1 and 2. Linear regression analysis of the saline/ischaemia group was lower than the NO 2 - /ischaemia group, with no overlap in their 95% CI, see Abstract 51 figure 1. In addition, the linear regression gradient of the NO 2 - /ischaemia group was similar to the saline/control and the NO 2 - /control gradient, see Abstract 51 figure 2. The peak-dose dobutamine values of ΔPSV/ΔHR were different in the saline/ischaemia group compared to the three other groups (ie, saline/ischaemia =3.7±0.6 cm/s/s, NO 2 - /ischaemia =8.2±1.0 cm/s/s, saline/control =10.5±1.1 cm/s/s, NO 2 - /control =8.4±0.7 cm/s/s; p Conclusions Low-dose NaNO 2 delivers a therapeutic effect to ischaemic myocardial tissue in the absence of a vasodilator effect on normoxic tissue. This is the first study in patients to demonstrate a targeted vasodilator effect of NO 2 - to tissues in need only.

Ultrasound analysis of the vertebral artery during non-thrust cervical translatoric spinal manipulation

Objective: Cervical translatoric spinal manipulation (TSM) techniques have been suggested as a safer alternative to cervical thrust rotatory techniques. The objective of this study was to determine the effect of three C5–C6 non-thrust TSM techniques on vertebral artery (VA) lumen diameter (LD) and two blood flow velocity parameters. The two-tailed research hypothesis was that the TSM techniques would result in a significant change (increase or decrease) in blood flow velocity and arterial LD at the C5–C6 intertransverse portion of the VA.Methods: In a sample of 30 subjects representative of a clinical population, color-coded duplex Doppler diagnostic ultrasound imaging was used to collect data on LD, peak systolic velocity (PSV), and end diastolic velocity with the cervical spine positioned in neutral and in three different manipulation positions. Pair-wise mean differences between measurements at baseline (neutral position) and in all three manipulation positions were analyzed using two-tailed paired t-tests with alpha set at 0·05.Results: Of the 18 paired comparisons, there were four statistically significant differences between measurements in the neutral position and a manipulation position, three concerning LD and one PSV.Discussion: The three significant differences in LD ranged from 4·6 to 3·2% and were not associated with changes in blood flow velocity. The one significant change in PSV was only 6·6 cm/s. A value that still greatly exceeded the end diastolic velocity. No subject experienced symptoms associated with VA compromise. This study has provided evidence for the safety of the three lower cervical non-thrust TSM techniques on the current population studied. Further study is required on thrust versus non-thrust TSM techniques and on levels other than C5–C6.

Penile haemodynamic changes in post-radical cystectomy patients

The aim of this study was to assess the penile vascular changes in post-radical cystectomy patients. A prospective assessment took place between January 2003 and January 2005 of 45 potent men who underwent radical cystectomy and diversion for invasive bladder cancer. Nerve sparing (NS) technique was applied in 21 cases, while others were not subjected to NS (non-nerve sparing group; NNS = 24 cases). All patients were comparable in preoperative clinical and pathological parameters. A control arm was the preoperative normal indices of the same patients. Preoperative penile duplex ultrasounds (PDU) for all cases were carried out, and then follow-up 2, 6 and 12 months thereafter. On first postoperative visit, none of NS cases showed any arterial insufficiency, while two cases of NNS (8.3%) had peak systolic velocity (PSV) < 30 cm/sec. Moreover, all cases of both groups showed early increase of end diastolic velocity (EDV) > 5 cm/sec. In NS cystectomy group, the PSV showed statistically insignificant change [p > 0.05 (mean: 53.6, cm/sec)]. Shortly after surgery, the EDV values increased, followed by gradually significant improvement (decrease in EDV values) in comparison with control state (mean: 5.9 cm/sec). On the other hand, the NNS cases showed statistically insignificant changes in PSV (mean: 49.3 cm/sec), with deterioration in EDV that did not improve with time, in contrast to NS cases (mean: 13.15 cm/sec). The main significant penile vascular changes were in EDV (venogenic mechanism) in post-cystectomy patients. There was a gradual progressive improvement in venogenic competence mechanism in NS cases with insignificant deterioration of arteriogenic mechanism in both groups (NS/NNS).

Brachial artery flow mediated assessment: A tool to predict the response to chronic PDE5 inhibition with tadalafil in patients with erectile dysfunction

Subjects, n 26 11 15 Age, years 60.9±9.6 59.4±10.7 62.0±8.9 BMI 26,5±3,5 26±3,5 26,9±3,5 HB1c 6,8±1,7 5,6±0,3 7,6±1,9 Smoking history 11/26 2/11 9/15 Comorbidities Diabetes, % 6/26 0/11 6/15 Hypertension, % 3/26 0/11 3/15 Diabetes+hypertension 6/26 0/11 6/15 ⁎ Corresponding author. Andrology, San Paolo Hospital, University of Milano, Via A. di Rudini, 8 20142 Milano, Italy. E-mail address: mancinis178@msn.com (M. Mancini). Impairment of cavernosal arteries responsiveness is the most common cause of erectile dysfunction (ED) whose pathogenesis primarily depends on vascular endothelial dysfunction [1]. Atherosclerotic risk factors increase the rate of ED and most male patients with angiographically documented coronary artery disease (CAD) exhibit ED [2]. Endothelial injury is a basic step in the development of artheriosclerosis and its in-vivo evaluation by brachial artery flow mediated dilatation (BAD) technique provides relevant clinical and prognostic information [3]. Phosphodiesterase 5 inhibition (PDE5i) is an effective strategy for ED improvement which improves BAD response in both ED and non-ED patients [4,5]. It is undefined whether different pretreatment endothelial BAD patterns may predict the ED response to chronic PDE5i therapy. 26 impotent patients with no previous cardiovascular events diagnosed by IIEF questionnaire (questions 1, 2, 3, 4, 5, and 15) were enrolled and grouped according to absence (group A; n=11) or coexistence of hypertension and diabetes comorbidities (group B; n=15, n=6 with diabetes n=3 with hypertension, n=6 with diabetes and hypertension). All underwent brachial artery flowmediated evaluation (high resolution ultrasound Philips 11 MHz linear-array transducer) with measures of BAD and hyperemic (HYP) response [6], penile Duplex Ultrasound (DS) cavernosal peak systolic velocity (PSV) measure [7], and IIEF questionnaire evaluation before and after PDE5i treatment with tadalafil 10 mg on alternate days for 30 days. Differenceswithin group A and between group A and Bwere tested by ANOVA analysis and paired and unpaired Student t-test when appropriate. Linear regression analysis with least square method was used to correlate delta PSV with delta BAD and HYP. Populations were similar in terms of age, BMI, HB1c, and smoking history (Table 1). In all patients, a trend but not statistically significant increase in PSV (p=0.08) after tadalafil was observed while IIEF increased significantly (pb0.01) (Table 2). Significant differences in the BAD response were observed between group A and group B before and after treatment, even though tadalafil did not cause significant BAD improvement in both populations. Conversely, group A exhibited a significantly greater HYP response both at preand post-tadalafil treatment (Table 3). Post-tadalafil HYP response was significantly increased just in group A. After disease distribution a significant correlation between delta PSV and delta HYP was found in group A unless group B (Fig. 1A and B, r=0.677; p=0.022 and r=0.24; p=NS). The major finding of our study is that BAD may be a helpful screening technique in the identification of impotent patients that very likely may or may not get a hemodynamic advantage from midterm PDE5i treatment with tadalafil at current doses. Our observation provides a rationale for systematically using PSV evaluation in combination with BAD in the management of ED patients. In populations with variable degrees of cardiovascular risk, brachial ultrasound assessment has emerged as a strong and independent predictor of cardiovascular morbidity and mortality [3]. In this regard, changes in arterial diameter are considered more reliable than changes in flow. This because variations in flow reflect those in forearm microcirculation and brachial artery occlusion may still induce some degree of responsiveness to post-ischemic reperfusion stimuli even when the lumen of brachial conduit artery does not change significantly. In the present study no correlation was observed between changes in BAD and PSV. Conversely, brachial artery HYP response correlated with changes in PSV, at least in ED patients without hypertension and/ or diabetes. Remarkably, this seems to reflect a behavior similar to that observed at penile microcirculatory level and support the idea that in the initial stages of a penile arterial disease, a reduced PSVmay arise from an impaired microcirculation reactivity rather than from a real atherosclerotic process. Major study limitations are the small number of patients investigated, especially when considering the subset with comorbid conditions such as diabetes or hypertension and the lack of a followup period with PDE5i drug withdrawal. In conclusion, a preserved reactivity at brachial artery level in the absence of comorbid conditions predicts a favorable response at penile microcirculatory level to standard doses of PDE5i treatment. This study was supported by funds provided by the Monzino Foundation, Milano-Italy. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [8].

Can Doppler Sonography Discern Between Hemodynamically Significant and Insignificant Portal Vein Stenosis After Adult Liver Transplantation?

The purpose of our study was to determine whether Doppler sonography, using a strict reference standard, can specifically identify hemodynamically significant portal vein anastomotic stenosis after liver transplantation in adults. The duplex and color Doppler examinations of 13 consecutive adult patients who underwent portal venography for suspected portal vein stenosis after liver transplantation were retrospectively examined. Peak systolic velocity (PSV) and change in PSV (ΔPSV) along the portal vein were correlated with portal venography. Stenoses above 50% on the basis of strict venographic criteria were considered hemodynamically significant. The Doppler studies before and after intervention were also assessed. Fourteen randomly chosen subjects with transplants without suspicion of portal anastomotic stenosis acted as controls. Six patients had significant portal vein stenosis (> 50%) and seven had stenosis below 50%. PSV and ΔPSV were significantly greater for patients with > 50% stenosis in comparison with those with ≤ 50% stenosis and control subjects. Optimal threshold values for PSV and ΔPSV were 80 and 60 cm/s, respectively, with either value alone yielding sensitivity of 100% and specificity of 84% for significant stenosis. Threshold values also included cases of stenosis below 50%. Five of six patients with > 50% stenosis underwent stenting, with poststent PSV and ΔPSV significantly declining to match that of control subjects. Three of seven with stenosis below 50% had stents placed but no significant change in the Doppler examination. Doppler threshold criteria reliably exclude those without posttransplantation portal vein stenosis and have high sensitivity for detecting portal stenosis. However, these criteria cannot discern the extent of stenosis.

Postoperative Middle Cerebral Artery Peak Systolic Velocity Changes Confirm Physiological Principles of the Sequential Laser Technique for Twin-Twin Transfusion Syndrome

Introduction: Treatment of the twin-twin transfusion syndrome (TTTS) via sequential selective laser photocoagulation of communicating vessels (SQLPCV) mandates ablation of donor-to-recipient arteriovenous anastomoses first. It is hypothesized that SQLPCV facilitates intraoperative transfusion to the donor, thereby minimizing donor hypovolemia and anemia. We sought to determine if postoperative changes in fetal middle cerebral artery-peak systolic velocities (MCA-PSV) support this hypothesis. Materials and Methods: Patients undergoing preferential SQLPCV for TTTS had MCA-PSV measured 1 day before surgery and on postoperative day 1 (POD-1). Fetal anemia was defined as an MCA-PSV ≧1.5 multiples of the median (MoM). Exclusions included: POD-1 demise, missing MCA-PSV data, or gestational age <18 weeks. Results: Study criteria were met by 139 patients. Mean MCA-PSV in recipients increased from 0.97 to 1.15 MoM postoperatively (p < 0.0001). Donor mean MCA-PSV remained stable at 1.00 MoM preoperatively and 0.98 MoM postoperatively (p = 0.272). Nine fetuses, 6 donors and 3 recipients, had preoperative anemia; SQLPCV was not attempted in the 3 anemic recipients. Postoperatively, the proportion of donors with anemia remained stable (increase 3.6%, p = 0.419), and the proportion of recipients with anemia increased (increase 12.2%, p = 0.009). Discussion: Our findings confirm the presumed physiological basis for the SQLPCV treatment of TTTS.

Changes in blood flow velocity in the radial artery during 1‐hour ultrasound monitoring with a 2‐MHz transcranial probe—A pilot study

Multiple biologic effects of ultrasound on the human body have been described. Our aim was to monitor changes in blood flow velocities in the radial artery during continuous pulsed wave Doppler monitoring (DM). Fifteen healthy volunteers (8 males; mean age 55 ± 17 years) underwent two 1-hour sessions of left radial artery DM using a diagnostic transcranial 2-MHz pulsed-wave transducer. Blood flow velocities were recorded twice at 2-minute intervals, for the measurement of peak systolic velocity, end-diastolic velocity, and mean flow velocity, and the calculation of pulsatility index, and resistance index. Insonation was either intermittent (by periods <10 seconds) or continuous during the first session, and conversely during the second session 2 weeks later. Blood flow velocities and indices fluctuated during both sessions. These changes were symmetrical during the intermittent DM session. In contrast, end-diastolic velocity increased while pulsatility index and resistance index decreased significantly during the continuous DM session (p < 0.05 for all three parameters). The changes in peak systolic velocity and mean flow velocity did not differ between sessions. One-hour sonographic Doppler monitoring using a 2-MHz diagnostic transcranial PW Doppler probe may induce peripheral vasorelaxation in humans.

Natural history and progression of atherosclerotic renal vascular stenosis

Date written: December 2008Final submission: October 2009

Assessment of cerebrovascular reactivity during major depression and after remission of disease

Background:There are a growing number of studies suggesting that depression may increase the risk of stroke. Impaired autoregulation of vascular tone may contribute to a higher risk of developing cerebrovascular diseases. Cerebrovascular reactivity (CVR) reflects the compensatory dilatory capacity of cerebral arterioles to a dilatory stimulus and is an important mechanism that ensures constant cerebral blood flow. There is a hypothesis that CVR is reduced in major depression, which would explain the association between depression and stroke.Objectives:The aim of this study was to investigate the effect of depression on CVR in cerebral vessels by comparing CVR during the depression phase with that during remission.Material and Methods:Using the apnea test, we assessed CVR in 16 patients with unipolar depression during disease and after remission of disease by calculating the increase in cerebral blood flow velocity after breath-holding (the apnea test). Blood flow velocities were measured by transcranial Doppler ultrasound (TCD).Results:CVR was significantly reduced in the depression phase in comparison to that in the remission phase. However, this change was not seen in all the patients.Conclusion:CVR was reduced in most of the depressed patients. The decreased CVR, as indicated by the changes in peak systolic velocity (PSV) and mean flow velocity (MFV) of the middle cerebral artery, in depressed patients was more marked on the right side, which could point to a vascular basis for some kinds of depression. We recommend that other studies, with larger samples, be done; future studies should assess whether the changes in the CVR varies with the severity and type of depression.

285: Postoperative middle cerebral artery peak systolic velocity changes confirm physiological principles of the sequential laser technique for twin-twin transfusion syndrome

285: Postoperative middle cerebral artery peak systolic velocity changes confirm physiological principles of the sequential laser technique for twin-twin transfusion syndrome

The ischemic preconditioning effect of adenosine in patients with ischemic heart disease

IntroductionIn vivo and in vitro evidence suggests that adenosine and its agonists play key roles in the process of ischemic preconditioning. The effects of low-dose adenosine infusion on ischemic preconditioning have not been thoroughly studied in humans.AimsWe hypothesised that a low-dose adenosine infusion could reduce the ischemic burden evoked by physical exercise and improve the regional left ventricular (LV) systolic function.Materials and methodsWe studied nine severely symptomatic male patients with severe coronary artery disease. Myocardial ischemia was induced by exercise on two separate occasions and quantified by Tissue Doppler Echocardiography. Prior to the exercise test, intravenous low-dose adenosine or placebo was infused over ten minutes according to a randomized, double blind, cross-over protocol. The LV walls were defined as ischemic if a reduction, no increment, or an increment of < 15% in peak systolic velocity (PSV) was observed during maximal exercise compared to the baseline values observed prior to placebo-infusion. Otherwise, the LV walls were defined as non-ischemic.ResultsPSV increased from baseline to maximal exercise in non-ischemic walls both during placebo (P = 0.0001) and low-dose adenosine infusion (P = 0.0009). However, in the ischemic walls, PSV increased only during low-dose adenosine infusion (P = 0.001), while no changes in PSV occurred during placebo infusion (P = NS).ConclusionLow-dose adenosine infusion reduced the ischemic burden and improved LV regional systolic function in the ischemic walls of patients with exercise-induced myocardial ischemia, confirming that adenosine is a potential preconditioning agent in humans.

Carotid Duplex Ultrasound Velocity Measurements Versus Intravascular Ultrasound in Detecting Carotid In-Stent Restenosis

Duplex ultrasonography criteria for assessing the severity of carotid artery (CA) in-stent restenosis are not well established. We analyzed 39 patients (40 CAs) who underwent CA stenting with baseline and 6-month follow-up carotid duplex ultrasonography and intravascular ultrasound. Intravascular ultrasound measurements included minimum luminal diameter, percent diameter, and lumen area stenosis. Duplex ultrasonography measurements included peak systolic velocity (PSV), percentage change in PSV, end-diastolic velocity (EDV), and internal-to-common CA PSV ratio (ICA/CCA). Receiver operating characteristic curves assessed each duplex measurement to detect >or=50% diameter, >or=75% lumen area stenosis, and minimum luminal diameter <3 mm at follow-up. At 6-month intravascular ultrasound follow-up, >or=50% diameter and >or=75% lumen area CA in-stent restenosis occurred in 20% and 25%, respectively; minimum luminal diameter <3 cm occurred in 48%. Area under receiver operating characteristic curves for PSV, EDV, and ICA/CCA were 0.85, 0.96, and 0.89 for >or=50% diameter stenosis and 0.89, 0.93, and 0.88 for >or=75% lumen area stenosis, respectively. Optimal PSV, EDV, and ICA/CCA criteria to detect >or=50% diameter and >or=75% lumen area CA in-stent restenosis were greater compared with those for native CA. A >98% increase in PSV had the highest specificity, whereas the combination of EDV >41 cm/s and ICA/CCA >2 had the highest sensitivity in detecting >or=75% lumen area CA in-stent restenosis. PSV, EDV, and ICA/CCA PSV ratio were good discriminators for detecting significant diameter and lumen area greater compared with those for native CA. The combination of duplex velocity criteria increases diagnostic accuracy.

Disparities in Fistula Maturation Persist Despite Preoperative Vascular Mapping

Failure to mature (primary failure) of new fistulas remains a major obstacle to increasing the proportion of dialysis patients with fistulas. This failure rate is higher in women than in men, higher in older than in younger patients, and higher in forearm than in upper arm fistulas. These disparities in the frequency of failure to mature may be due in part to marginal vessels in the high-risk groups and should be reduced by routine preoperative vascular mapping. A prospective, computerized database was queried retrospectively to evaluate the frequency of primary fistula failure in 205 hemodialysis patients for whom preoperative mapping was obtained. The association between clinical characteristics and risk for primary fistula failure was analyzed by univariate and multiple variable regression analysis. The overall primary fistula failure rate was 40% (82 of 205 patients). On multiple variable logistic regression, three clinical factors were associated with an increased risk for failure to mature among patients who underwent preoperative vascular mapping: Female gender, age > or =65 yr, and forearm location. The primary fistula failure rate varied from 22% in younger men with an upper arm fistula to 78% in older women with a forearm fistula. Dynamic preoperative vascular measurements (change in peak systolic velocity and resistive index after tight fist clenching) did not differ between patients with mature and immature forearm fistulas. Disparities in fistula maturation persist despite the use of routine preoperative vascular mapping.

Tissue Velocity Imaging with Dobutamine Stress Echocardiography–A Quantitative Technique for Identification of Coronary Artery Disease in Patients with Left Bundle Branch Block

Patients with left bundle branch block (LBBB) exhibit abnormal septal motion that may limit the interpretation of stress echocardiograms and persuade the results of myocardial scintigraphy. We sought to analyze whether the use of tissue velocity imaging during graded dobutamine infusion is useful to identify and predict coronary artery disease (CAD) in patients with complete LBBB. In all, 62 patients with LBBB (mean age 62 years, 34 men) with suggested CAD underwent dobutamine stress-tissue Doppler echocardiography within 6 weeks before coronary arteriography. Dobutamine infusion started at 5 micro/kg/min and increased up to 40 micro/kg/min with additional atropine during submaximal heart rate responses. In addition to wall-motion analysis, pulsed wave tissue Doppler sampling of mitral annulus at 5 corners was performed at rest in the apical 4-chamber plus aorta and 2-chamber apical views. The measurements were repeated at low dose (10-15 micro/kg/min) and at peak stress. Tissue Doppler echocardiography measurements included early peak systolic velocity (PSV), postsystolic shortening (PSS) velocity, peak early diastolic velocity (Ve), and peak late diastolic velocity. The results were compared with 20 healthy subjects as a control group. Patients were classified into two groups according to angiographic results: LBBB with CAD (n = 32) and LBBB without CAD (n = 30). There was no significant difference between LBBB groups in global wall-motion score index at rest; the delta changes in each group were almost similar during peak stress test (P > .05). In the LBBB with CAD group, PSV increased during peak stress to a smaller extent (6.3 +/- 1.1-7.2 +/- 2.0 cm/s, approximately 24% P < .03) than in non-CAD group (6.8 +/- 1.0-9.6 +/- 2.7 cm/s, approximately 46% P < .01). Similarly, Ve increased to a lesser extent in CAD group (deltaVe 1.6 +/- 1.7 vs 2.8 +/- 1.7 cm/s, approximately 25% vs 42% P < .0001). There were no significant difference in delta late diastolic velocity between LBBB and control groups or between each of them. PSS could be recorded at rest in 24 of 32 patients (75%) in CAD group and 17 of 30 patients (57%) in non-CAD group. In LBBB with CAD group, PSS was developed and significantly augmented from 4.7 +/- 3.1 to 6.3 +/- 3.4 cm/s (P < .001) during stress. Increment less than 2.5 cm/s in PSV and Ve during peak stress identified CAD with 88% sensitivity (for each) and 90% and 87% specificity, respectively. The cut-off values of PSS velocity greater than 4 cm/s at peak stress have strong diagnostic power for prediction of obstructive CAD in patients with LBBB (82% accuracy). Tissue Doppler echocardiography with dobutamine stress allows a diagnostic benefit in the detection of CAD in patients with LBBB. The magnitude of change of PSV and Ve in addition to PSS are quantitative parameters to identify CAD in patients with LBBB where subjective wall-motion analysis failed.

Changes in peak systolic velocity induced by chronic therapy with phosphodiesterase type-5 inhibitor

The aim of this study was to assess the influence of chronic therapy with phosphodiesterase type-5 inhibitor on penile haemodynamics at colour Doppler ultrasound. Thirty patients affected by erectile dysfunction (ED) of different aetiology tested with the International Index of Erectile Function (IIEF-5) were evaluated with penile colour Doppler ultrasound during basic and dynamic phases (10 microg PGE1) before and after chronic self-administration of sildenafil citrate (dosage: 100 mg as required, two to three times a week) for a period of 5-20 months (mean: 12.3). Treatment was interrupted 14-21 days before the second ultrasound evaluation. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were recorded by means of colour Doppler; cut off values were 25 and 5 cm s(-1) respectively. Data were compared by nonparametric tests. Twenty-two of the 30 patients showed normal pre-treatment PSV, while eight of 30 had an insufficient arterial flow. Mean pre-treatment EDV was 4.7 +/- 0.5. After chronic therapy with sildenafil, a global improvement of 10.5% on PSV was seen (P < 0.001), without any statistical difference between patients with normal pre-treatment peak and those with a borderline one. No statistically significant changes were found for EDV (P = 0.98). It is concluded that chronic therapy with phosphodiesterase-5 inhibitor results in a significant improvement in PSV values, probably due to a penile chronic vasoactive enhancement.

A comparison of Doppler waveform parameters versus flow-mediated vascular dilation of the brachial artery in preeclamptic and normotensive women

VASCULAR DILATION OF THE BRACHIAL ARTERY IN PREECLAMPTIC AND NORMOTENSIVE WOMEN INNA LANDRES, MARIA SMALL, ADESH SIRJUSINGH, SAMUEL RAMSAWAK, KEITH WILLIAMS, Yale University, Obstetrics & Gynecology, New Haven, Connecticut, Yale University, OB/GYN, New Haven, Connecticut, University of the West Indies, Mount Hope, Port of Spain, Trinidad and Tobago OBJECTIVE: Flow mediated dilation of the Brachial artery is impaired with endothelial dysfunction. We previously identified that brachial artery waveforms were changed in preeclamptic women. We therefore sought to compare Doppler waveform analysis with Flow Mediated Vascular Dilation (FMVD) measurements in Preeclamptic and Normotenstive women. STUDY DESIGN: We conducted a nestled case-control of 12 preeclamptic vs 20 normotensive women, matched for gestational age, maternal age and ethnicity. Research was conducted at three hospitals and two geographic settings; (1) YaleNew Haven Hospital in New Haven CT, (2) Mount Hope Maternity and (3) Port of Spain General Hospital in, Trinidad. Brachial artery doppler waveform measurements were done at baseline and 90s post cuff-release. From the doppler waveforms we assessed % change in Peak Systolic Velocity, systolic acceleration and acceleration time and compared them with % change in (FMVD). Statistical analysis using student t tests, chi squared analysis and correlation coefficient was done as necessary. RESULTS: The % change PSV at 90s in normotensives vs preeclamptics was (13.5% G 22.7 vs 20.5% G 27.8) (P = .432). The % change in mean FMVD in the normotensives vs the preeclamptics was (4.3% G 4.7 vs -0.52% G 2.2) (P = .031). Correlation between the % change in the doppler waveform parameters and % change in mean FMVD identified only % change in peak systolic velocity (P = .040) as significant. CONCLUSION: FMVD remains the gold standard for assessment of endothelial dysfunction .A correlation was observed between the doppler measured % change in Peak Systolic Velocity and flow mediated vascular dilation. Although % change in the other doppler waveforms parameters did not correlate with flow mediated dilation they were done at 90 s and may need to be more appropriately measured earlier, corresponding to the peak of flow mediated vascular dilation. 111 A RANDOMIZED PLACEBO-CONTROLLED TRIAL OF PROLONGED PREDNISOLONE ADMINISTRATION TO PATIENTS WITH HELLP SYNDROME REMOTE FROM TERM: MATERNAL AND NEONATAL COMPLICATIONS P.J. VAN RUNNARD HEIMEL, A. J. M. HUISJES, A. FRANX, C. KOOPMAN, M. L. BOTS, H. W. BRUINSE, University Medical Center Utrecht, Obstetrics and Gynaecology, Utrecht, The Netherlands, Netherlands, Gelre Ziekenhuizen Apeldoorn, Obstetrics and Gynaecology, Apeldoorn, The Netherlands, Netherlands, Erasmus University Medical Centre Rotterdam, Obstetrics and Gynaecology, Rotterdam, The Netherlands, Netherlands, University Medical Center Utrecht, Neonatology, Utrecht, The Netherlands, Netherlands, University Medical Center Utrecht, Julius Center for Health Science and Primary Care, Utrecht, The Netherlands, Netherlands OBJECTIVE: Several reports have shown a beneficial effect of corticosteroids on HELLP syndrome. However, there is a lack of RCTs of corticosteroids in HELLP syndrome in the antepartum period for more than 48 hours. Prednisolone is a glucocorticoid with limited transplacental passage. This randomized, double-blind, placebo-controlled study was undertaken to evaluate the effect of prolonged administration of high-dose prednisolone on maternal, perinatal and neonatal outcome in patients suffering early onset HELLP syndrome. STUDY DESIGN: 31 pregnant women were included suffering HELLP syndrome with an onset prior to 30 weeks gestation. Prior to inclusion all women received 2 intramuscular doses of betamethasone 11.4 mg 24 hours apart to promote fetal lung maturation. Patients received either prednisolone (n = 15) or placebo (n = 16) 50 mg intravenously twice a day. Maternal outcome measures were presence of liver hematoma and rupture, pulmonary oedema, renal failure and placental abruption. Perinatal outcome measures were gestational age at delivery, occurrence of perinatal death, birth weight and Apgar score. Neonatal outcome measures were occurrence of neonatal complications during admission at the neonatal intensive care unit (NICU) and the duration of admission at the NICU. Long-term neonatal follow-up was also performed at 6, 15 and 24 months. RESULTS: In the placebo group two liver hematomas and one liver rupture occurred, the latter resulting in maternal death. In both treatment groups a placental abruption occurred. Four perinatal deaths occurred in the placebo group versus three neonatal deaths in the prednisolone group. No further differences were found in perinatal and neonatal outcome measures. At longterm neonatal follow-up no differences could be demonstrated. CONCLUSION: Although administration of prednisolone to patients suffering early onset HELLP syndrome did not significantly improve maternal, perinatal and neonatal outcome measures, a trend towards a beneficial effect on the occurrence of maternal complications could be shown.

Uteroplacental Hemodynamics during Early Human Pregnancy: A Longitudinal Study

Background: To determine normal physiologic changes in the uteroplacental hemodynamics during early placental development in the first trimester of pregnancy. Methods: Sixteen normal singleton pregnancies were included in this longitudinal study. Transvaginal Doppler ultrasonographic examinations of uterine, arcuate, radial and spiral arteries were performed at the 5th, 7th, 8th and 10th completed gestational weeks. Peak systolic velocity (PSV), time-averaged maximum velocity (TAMXV) and the pulsatility index (PI) were measured. Results: Uterine artery PSV, TAMXV and PI remained unchanged from the 5th to the 8th week of gestation. From the 8th to the 10th week, PSV (p = 0.02) and TAMXV (p = 0.005) increased and PI decreased (p = 0.006). Changes in the arcuate arteries were similar to those in uterine arteries. No significant changes in PSV, TAMXV or PI of the radial artery were noticed. Spiral artery PSV (p = 0.02) and TAMXV (p = 0.02) increased from the 5th to the 7th week. Thereafter they remained unchanged. Spiral artery PI decreased from the 5th to the 10th week, (p = 0.004). Throughout the study period, the PSV, TAMXV and PI values were significantly higher in the uterine artery than in the arcuate artery, and in the arcuate artery compared with the radial artery. At the 5th gestational week, no differences in PSV and TAMXV were found between radial and spiral arteries. From the 7th gestational week onwards, PSV and TAMXV were significantly lower in the radial artery than in the spiral artery. However, the PI values in the radial artery were significantly higher compared with those in the spiral artery during the whole study period. Conclusions: Spiral artery impedance decreases and blood flow velocities increase as early as between the 5th and the 7th weeks of gestation. During that period, the uterine and arcuate artery hemodynamics remain unchanged. In the uterine and arcuate arteries, decreases in impedance and increases in absolute velocities are detected after the 8th week of gestation. This delay between the changes in the spiral and uterine arteries may represent the magnitude of the increase of placental volume and spiral arterial involvement which is needed to affect uterine hemodynamics.

Colour Doppler ultrasound predicts chemotherapy response, but not survival in paediatric osteosarcoma.

Histological response to chemotherapy is an important prognostic factor in osteosarcoma, influencing therapeutic considerations. It would be advantageous to be able to assess chemotherapy response, and predict survival, prior to tumour resection. Colour Doppler US (CDUS) is non-invasive, non-demanding for the patient, and easy to plan. This makes the method especially suitable for children, who comprise the majority of patients. To establish the value of CDUS for pre-operative prediction of chemotherapy response and survival, using widely available US equipment. CDUS was performed in 21 consecutive patients before and after chemotherapy. Peak systolic velocity (PSV) in the soft-tissue component of the tumour and quotient of resistive index (QRI) of the feeding artery and contralateral control were calculated. A pathologist, unaware of CDUS results, assessed the response to chemotherapy after resection. QRI change after chemotherapy was significantly higher in histological responders. No correlation of QRI change with survival was found. There was no significant difference in PSV change comparing any subgroup. CDUS appeared useful in predicting chemotherapy response (sensitivity 83%, specificity 86%), especially for negative response (predictive value 92%). Survival could not be predicted accurately. CDUS can predict chemotherapy response, but not survival. The method could be useful in planning treatment prior to definitive surgery.

Preoperative sonographic radial artery evaluation and correlation with subsequent radiocephalic fistula outcome.

Primary failure of forearm radiocephalic dialysis fistulas is common even when preoperative vascular mapping is used. Previous studies have suggested that low peak systolic velocity of the radial artery predicts subsequent fistula failure. The study goal was to evaluate whether preoperative spectral Doppler assessment of radial artery inflow can improve forearm fistula outcome prediction. Forearm fistulas were placed in 112 patients after preoperative sonographic mapping. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. Fistula flow rates were determined 6 to 12 weeks postoperatively in a subset of patients. Failed and successful fistulas were similar in their preoperative arterial and vein diameters, resistive index, and peak systolic velocity during fist clenching and after fist relaxation. Specifically, there was no difference in fistula success with radial artery peak systolic velocity lower than 50 cm/s versus peak systolic velocity of 50 cm/s or higher. The change in peak systolic velocity after fist relaxation was highly predictive of subsequent fistula outcome among female patients in ad hoc analysis. Fistula adequacy for dialysis in women was 11% when the change in peak systolic velocity was lower than 0 cm/s and 50% when the change was 0 cm/sec or higher (P = .02). The postoperative fistula flow rates were lower when the preoperative change in peak systolic velocity was lower than 0 cm/s than when it was 0 cm/s or higher (316 +/- 46 versus 781 +/- 150 mL/min; P = .003). There was no difference in the preoperative peak systolic velocity or the resistive index of successful and failed fistulas. Measurement of the radial artery peak systolic velocity change after release of fist clenching was not useful in predicting outcomes in male patients but identified a subset of female patients with a very low likelihood of success. This criterion may merit further investigation in future trials.