Diastolic Blood Flow Velocity Research Articles

Instant Detection of Cerebral Blood Flow Changes in Infants with Congenital Heart Disease during Transcatheter Interventions.

Background: Transcatheter interventions are increasingly used in children with congenital heart disease. However, these interventions can affect cardiac output and cerebral circulation. In this pilot study, we aimed to investigate the use of NeoDoppler, a continuous transfontanellar cerebral Doppler monitoring system, to evaluate the impact of transcatheter interventions on cerebral circulation. Methods: Nineteen participants under one year of age (mean age 3.5 months) undergoing transcatheter cardiac interventions were prospectively included. Transfontanellar cerebral Doppler monitoring with the NeoDoppler system was initiated after intubation and continued until the end of the procedure. Results: Instant detection of changes in cerebral blood flow were observed across a spectrum of transcatheter interventions. Balloon aortic valvuloplasty demonstrated temporary cessation of cerebral blood flow during balloon inflation. Increase in cerebral diastolic blood flow velocity and decreased pulsatility were observed during patent ductus arteriosus occlusion. Changes in cerebral blood flow patterns were detected in two patients who encountered complications during their transcatheter interventions. There was no significant change in Doppler parameters before and after the interventions for the entire patient group. High quality recordings were achieved in 87.3% of the monitoring period. Conclusions: Continuous transfontanellar cerebral Doppler is feasible in monitoring cerebral hemodynamic trends and shows instantaneous changes associated with interventions and complications. It could become a useful monitoring tool during transcatheter interventions in infants.

Ultrasound predictors of outcome of traumatic brain injury

Objective. To evaluate the possibility of ultrasound monitoring of optic nerve sheath diameter and blood flow velocity in cerebral arteries as predictors of craniocerebral trauma outcome. Materials and methods. 35 patients with traumatic brain injury (TBI) were produced ultrasound monitoring of the optic nerve sheath diameter (ONSD) and blood flow velocity (BFV) in the middle cerebral artery (AMC) before surgery and for 10 days after craniotomy. A comparative analysis of blood flow in the A MC and ONSD was carried out between groups of patients with a favorable (group 1) and unfavorable (group 2) outcome of TBI. Results. Between the groups of patients with different outcome`s TBI, significant differences were revealed in the diameter of the optic nerve sheaths at the preoperative period and in the diastolic blood flow velocity in the MCA on the 9th day after surgery. In group 1, the ONSD was 4.7 [4.5; 5.1] mm, and in group 2 – 5.6 [5.4; 6] mm, p=0.003. On the 9th day after surgery, BFV at diastole in group 1 was 43.9 [38.7; 49.4] cm/sec, in group 2 – 28.7 [24.8; 36.7] cm/sec, p = 0.001. For ONSD in the preoperative period as a predictor of unfavorable outcome of TBI AUC=0.83, Se=88.8%, Sp=61.2%. For diastolic BFV in the AMC on the 9th day after surgery – AUC = 0.84, Se=93%, Sp = 52 %. Conclusion. In patients with traumatic brain injury, ultrasound examination shows that the diameter of the optic membranes before surgery is ≥5.6 mm and the blood flow velocity in the middle cerebral artery in diastole ≤28.7 cm/sec can be considered as predictors of an unfavorable outcome of TBI.

Prediction of neurocritical care intensity through automated infrared pupillometry and transcranial doppler in blunt traumatic brain injury: the NOPE study.

This pilot study aimed to determine the capacity of automated infrared pupillometry (AIP) alone and in combination with transcranial doppler (TCD) on admission to rule out need for intense neuroAQ2 critical care (INCC) in severe traumatic brain injury (TBI). In this observational pilot study clinicians performed AIP and TCD measurements on admission in blunt TBI patients with a Glasgow Coma Score (GCS) < 9 and/or motor score < 6. A Neurological Pupil index (NPi) < 3, Pulsatility Index (PI) > 1,4 or diastolic blood flow velocity (dV) of < 20 cm/s were used to rule out the need for INCC (exceeding the tier 0 Seattle Consensus Conference). The primary outcome was the negative likelihood ratio (nLR) of NPi < 3 alone or in combination with TCD to detect need for INCC. A total of 69 TBI patients were included from May 2019 to September 2020. Of those, 52/69 (75%) median age was 45 [28-67], median prehospital GCS of 7 [5-8], median Injury Severity Scale of 13.0 [6.5-25.5], median Marshall Score of 4 [3-5], the median Glasgow Outcome Scale at discharge was 3 [1-5]. NPi < 3 was an independent predictor of INCC. NPi demonstrated a nLR of 0,6 (95%CI 0.4-0.9; AUROC, 0.65, 95% CI 0.51-0.79), a combination of NPi and TCD showed a nLR of 0.6 (95% CI 0.4-1.0; AUROC 0.67 95% CI 0.52-0.83) to predict INCC. This pilot study suggests a possible useful contribution of NPi to determine the need for INCC in severe blunt TBI patients on admission.

Effects of lung resection on heart structure and function: A tissue Doppler ultrasound survey of 43cases.

Changes in heart structure and function after lung resection in patients with lung cancer are challenging to manage. Therefore, a non-invasive and reliable measurement tool to gauge such changes is critical. The purpose of the present study was to compare cardiological changes before and after lung resection using tissue Doppler imaging (TDI). A total of 43 patients (19 men and 24 women) with primary non-small cell lung cancer (n=37) and metastatic cancer in the lungs (n=6) were enrolled in the study.nTDI was used to determine the thickness of the ascending aorta, the open size of the ascending valve, the anterior-oposterior diameters of the left atrium and left ventricle, and the thickness of the ventricular septum and right ventricle before and after lung resection. Left ventricular (LV) ejection fraction (EF), pulmonary valve flow rate, tricuspid annular or mitral leaflet tip early (E) peak/late (A) diastolic blood flow velocities, tricuspid regurgitation flow, the lateral mitral annulus early (e') diastolic velocity and mitral E/e' ratio were used to determine LV filling pressure. Results revealed no significant differences between male and female patients in terms of the open size of the ascending valve, the anterior-posterior diameter of the left ventricle and the mitral E/e' ratio. Significant differences were found in the width of the ascending aorta, anterior-posterior diameter of the left atrium, width of the LV septum and right ventricular (RV) diameter before and after lung resection. Finally, there were significantchanges in EF and tricuspid pressure. The results indicated that TDI was useful as a non-invasive method for assessing left and right heart function following lung resection. The LV and RV dimensions were affected, but LV filling pressure was preserved after lobectomy.

Correlations of PCSK9 and LDLR Gene Polymorphisms and Serum PCSK9 Levels With Atherosclerosis and Lipid Metabolism in Patients on Maintenance Hemodialysis.

This study is aimed at investigating the correlations of PCSK9 and LDLR gene polymorphisms as well as serum proprotein convertase subtilisin/kexin type 9 (PCSK9) levels with atherosclerosis and lipid metabolism in patients on maintenance hemodialysis (HD). A single nucleotide polymorphism at the E670G locus of the PCSK9 gene and the rs688 locus of the LDLR gene was analyzed by polymerase chain reaction-restriction fragment length polymorphism. All study subjects' blood lipid (triglyceride [TG], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], and low-density lipoprotein cholesterol [LDL-C]) concentrations and lipoprotein(a) and PCSK9 levels were measured. The differences in blood lipid levels between different genotypes of the E670G locus of the PCSK9 gene and the rs688 locus of the LDLR gene in patients on maintenance HD with atherosclerosis were compared. Patients on maintenance HD with atherosclerosis at the E670G locus of the PCSK9 gene AG+GG genotype had higher levels of TG, TC, LDL-C, and lipoprotein(a) than the AA genotype, and lower levels of HDL-C than the AA genotype. Patients on maintenance HD with atherosclerosis at the rs688 locus of the LDLR gene CT+TT genotype had higher levels of TG, TC, LDL-C, and lipoprotein(a) than the CC genotype, and lower levels of HDL-C than the CC genotype. Serum PCSK9 contents in patients on maintenance HD with atherosclerosis were positively correlated with lipid indices (TG, TC, LDL-C, and lipoprotein(a)) and carotid ultrasound indices (intima-media thickness and resistance index), and negatively correlated with HDL-C, maximum systolic blood flow velocity, and minimum diastolic blood flow velocity (all P < .05).

Comparative effect of laser therapy and Fufang xueshuantong capsules in patients with diabetic retinopathy and ocular hemodynamic characteristics

Purpose: To investigate the therapeutic effect of combined administration of laser and Fufang xueshuantong capsules in patients with diabetic retinopathy, and its influence on ocular hemodynamics.Methods: A total of 193 patients with diabetic retinopathy in the Ophthalmology Department of Hebei University Affiliated Hospital from October 2020 to April 2022 were retrospectively analyzed. The patients were divided into two groups: study group (127 patients) and control group (66 patients). Control group received laser therapy in the fundus while the study group was administered 3 capsules (i.e., 1.5 g) of Fufang xueshuantong thrice daily for 7 days. Changes in the fundus and visual acuity, hemodynamic indices of the ophthalmic artery, and changes in macular edema diameter, and adverse reactions in both groups were recorded.Results: In the study group, after treatment, eyeground changes were especially effective (67.37 %), effective (30.51 %), or ineffective (2.12 %). Visual acuity improved (58.90 %), (unchanged at 38.56 %), or decreased (2.54 %). In the control group, laser treatment was especially effective (42.61 %), effective (44.35 %), or ineffective (13.04 %); however, visual acuity increased (36.52 %), unchanged (47.83 %), or decreased (15.65 %). The changes were significant (p &lt; 0.05). There was no significant difference in ophthalmic artery hemodynamics between the two groups before treatment (p &gt; 0.05). After treatment, however, peak systolic velocity (Psv), end diastolic blood flow velocity (Edv), mean velocity (Vm), resistance index (RI), and pulsatile index (PI) in the study group were significantly different from those of the control group (p &lt; 0.05); There was also no significant difference between the two groups before and 1 day after the operation (p &gt; 0.05), neither was there a significant difference in adverse reactions between the two groups (p &lt; 0.05).Conclusion: Fufang xueshuantong capsule is effective in the treatment of diabetic retinopathy, and significantly improves ophthalmic artery hemodynamics. Further clinical trials, however, are required for the validation of the findings of this study.

Features of Ocular Blood Flow in Malignant Arterial Hypertension of Renal Origin

Color Doppler imaging allows a detailed non-invasive assessment of the state of blood flow in the retrobulbar vessels in patients with various vascular pathologies. Malignant hypertension (MH) is a clinical syndrome characterized by severe diastolic arterial hypertension (140 mm Hg or more), leading to ischemic damage to various organs — kidneys, heart, brain, eyes. Patients with MH often present with thrombotic microangiopathy (TMA), a rare life-threatening condition characterized by multiple systemic thromboses of the microvasculature.Purpose: to assess the state of blood flow in retrobulbar vessels by color Doppler imaging in TMA associated with MH.Methods: 10 patients (20 eyes) (age 43.5 ± 6.2 years) with TMA associated with MH underwent a study of the state of blood flow in the vessels of the retrobulbar space by color Doppler imaging. Qualitative and quantitative analyzes of retinal and choroidal circulation were assessed.Results. Analysis of the Doppler spectrum of blood flow in TMA associated with MH revealed a statistically significant increase in maximum systolic (Vsyst) and finale diastolic blood flow velocity (Vdiast) in the ophthalmic artery (OA), as well as Vsyst in the medial short posterior ciliary arteries (SPCA), compared with the control group (p &lt; 0.05). In 2 patients (20 %) of the study group, a significant bilateral decrease in the diastolic component of the spectrum was found up to the isoline (Vdiast = 0) and a maximum increase in the peripheral resistance index (RI = 1.0). Statistically significant correlations were found between some laboratory parameters of blood serum (hemoglobin, lactate dehydrogenase, creatinine), as well as the estimated glomerular filtration rate and hemodynamic parameters in the central retinal artery (CRA), lateral (SPCA) and OA (p &lt; 0.05).Conclusion. The results of the study of ocular hemodynamics using color Doppler imaging in TMA associated with MH are presented for the first time. TMA associated with MH is characterized by a statistically significant increase in the maximum systolic blood flow velocity in the OA and SPCA with the development of an ischemic state in the retinal and choroidal microcirculation in some patients. An increase in TMA activity in MH leads to a change in the microcirculation of the retina and choroid of an ischemic nature. An increase in blood creatinine in patients with TMA with MH is statistically significantly associated with a decrease in systolic blood flow velocity in the CRA.

Doppler ocular ultrasound in patients with type 2 diabetes mellitus

Purpose: To determine ocular blood flow parameters by Doppler ultrasound scanning in type 2 diabetic patients with different stages of diabetic retinopathy. Material and Methods: In this prospective study, forty-five patients (90 eyes) with type 2 diabetes mellitus were divided into three groups of 15 patients each: no diabetic retinopathy group (DR0), non-proliferative retinopathy (NPDR), and proliferative retinopathy (PDR) groups. Doppler indices such as systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), time-averaged maximum velocity (TAMXV), pulsatility index (PI) and resistivity index (RI) in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) were determined. ANOVA was used for quantitative comparisons between the three groups. Results: There was a significant (р less 0.05) decrease in (a) the Vs from 71.1 +- 20.6 cm/s in the DR0 group to 59.9 +- 16.7 cm/s in the NPDR group and 47.4 +- 16.4 cm/s in the PDR group, (b) Vd from 22.1 +- 6.9 cm/s to 17.0 +- 6.6 cm/s and 12.3 +- 5.9 cm/s, respectively; and (c) TAMXV from 37.2 +- 11.3 cm/s to 31.9 +- 9.1 cm/s and 25.3 +- 9.7 cm/s, respectively, and an increase in the RI from 0.69 +- 0.06 cm/s to 0.71 +- 0.09 cm/s and 0.75 +- 0.08 cm/s, respectively, in the OA. In addition, there was a significant decrease in the Vd from 9.9 +- 5.4 cm/s in the DR0 group to 8.1 +- 3.8 cm/s in the NPDR group and 5.5 +- 3.1 cm/s in the PDR group, and an increase in the PI from 1.34 +- 0.16 cm/s to 1.46 +- 0.28 cm/s and 1.54 +- 0.24 cm/s, respectively, and in the RI from 0.71 +- 0.06 cm/s to 0.75 +- 0.07 cm/s and 0.80 +- 0.05 cm/s, respectively, in the CRA. Moreover, there was a significant decrease in the Vd from 4.3 +- 1.6 cm/s in the DR0 group to 3.2 +- 2.0 cm/s in the NPDR group and 3.1 +- 2.2 cm/s in the PDR group, and an increase in the PI from 1.32 +- 0.21 cm/s to 1.37 +- 0.24 cm/s and 1.54 +- 0.26 cm/s, respectively, and in the RI from 0.76 +- 0.04 cm/s to 0.82 +- 0.06 cm/s and 0.82 +- 0.06 cm/s, respectively, in the SPCA. Conclusion: We found that the arteries examined in patients with diabetic retinopathy tended to have decreased blood flow velocities and increased resistivity and pulsatility indices, with the greatest changes observed in patients with PDR. In addition, the difference in mean values of most Doppler indices between the PDR and NPDR groups was larger than that between the NPDR and DR0 groups.

RETRACTED ARTICLE: Effects of Dapagliflozin on myocardial remodeling, inflammatory factors, and cardiac events in heart failure with preserved ejection fraction.

To investigate the effects of Dapagliflozin on myocardial remodeling, inflammatory factors, and cardiac events in the treatment of heart failure with preserved ejection fraction (HFpEF). Ninety-two patients with HFpEF treated in our hospital from August 2021 to March 2022 were retrospectively picked as study subjects. These subjects were randomized as the study group and control group following the random number table, with 46 cases in each group. Patients in the control group adopted standard anti-heart failure (HF) treatment, including diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists β receptor blockers, and digitalis. Patients in the study group received Dapagliflozin on the basis of the control group. Changes in myocardial remodeling-related parameters [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), the ratio of early diastolic blood flow velocity to late diastolic blood flow velocity (E/A), plasma N-terminal B-type brain natriuretic peptide precursor (NT-proBNP), and cardiac troponin I (CTnI)] were assessed by echocardiography before and 12months after the intervention. The content of inflammatory factors [interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)] in serum was measured by enzyme-linked immunosorbent assay. The factors affecting the clinical efficacy of Dapagliflozin were analyzed by the multivariate logistic regression. The incidence of cardiac events was compared between the two groups. The effective rate of 95.65% in the study group was much higher than 80.43% in the control group (P < 0.05). After the intervention, the study group had an especially higher content of LVEF and E/A and sharply lower content of LVEDD, NT-proBNP, and CTnI than the control group (P < 0.001). After the intervention, IL-1β, TNF-α, and IL-6 levels were markedly lower in the study group than in the control group (P < 0.001). The incidence of cardiac events, including arrhythmias, recurrent angina, heart failure rehospitalization, cardiogenic death, and all-cause mortality, was 8.70% in the study group and 26.09% in the control group, which was much lower in the study group (P < 0.05). The results of multivariate logistic regression analysis showed that LVEF and E/A were independent protective factors affecting the ineffectiveness of Dapagliflozin (P < 0.05), and LVEDD, NT-proBNP, CTnI, IL-1β, TNF-α, and IL-6 were independent risk factors affecting the ineffectiveness of Dapagliflozin (P < 0.05). In conclusion, Dapagliflozin could effectively improve myocardial remodeling, inhibit inflammatory reaction, and play a more active role in the treatment of patients with HFpEF, providing a certain clinical basis for the treatment of patients.

Влияние употребления кофе на гемодинамику глаза в режиме цветного допплеровского картирования

The most common methods for studying ocular blood flow include the method of color Doppler imaging (CDI). Purpose. To evaluate the effect of drinking coffee on the indicators of retrobulbar blood flow in healthy people using color doppler and to predict the possible impact of this factor on the results of the study of ocular blood flow in pathology of the organ of vision. Material and methods. The total number of observations is 16: 8 healthy people (8 eyes) before drinking coffee and an hour after drinking it, 8 healthy people (8 eyes) of the control group. The age of the subjects was 28 ± 2 years. As a control feature, a cup of made coffee (150 ml) was used, which was drunk one hour before the examination. The control group included persons who underwent a study of retrobulbar blood flow with an hour interval without drinking coffee. The calculations were carried out using the STATISTICA 13.0 software. Results. Analyzing the dynamics of the CDI indicators, there was an increase in the diastolic blood flow velocity and the average blood flow velocity in the ophthalmic artery one hour after drinking coffee (p &lt; 0.05) compared with the control group. When assessing the indicators of the resistance index and the pulse index, their increase was found, but these changes turned out to be reliably insignificant, which indicates a change in blood flow in a certain period of cardiac output, but does not affect the total blood flow in the ophthalmic artery. Conclusion. Thus, the data obtained during the CDI indicate a change in ocular blood flow in the ophthalmic artery to a certain cardiac output one hour after drinking coffee, without affecting the true blood flow velocity and peripheral resistance in the ophthalmic artery. The CDI values in the central retinal artery did not change. Keywords: ophthalmic artery, central retinal artery, color Doppler imaging, drinking coffee

Transcranial Doppler as an early predictor of neurological outcome in mild and moderate traumatic brain injury: An observational study

Background: Traumatic brain injury (TBI) is a major cause of disability and mortality globaly. The transcranial Doppler (TCD) method may show low diastolic blood flow velocity (FVd) and high pulsatility index (PI) measurements brought on by high vascular bed resistance. This study aimed to assess the usefulness of the TCD-PI for the early detection of secondary neurological deterioration (SND) in mild and moderate TBI. Materials and Methods: This prospective study was carried out on 105 mild and moderate TBI patients, who had TCD measurements within 12 h of the initial trauma, and initial computerized tomography (CT) showed mild lesion or no detected abnormality. Results: Primary end point was assessed (SND) within 1st week post trauma. Of the 105 patients with mild and moderate TBI, 29 (27.6%) showed SND. We evaluated the value of our intervention (TCD) to predict SND after mild and moderate TBI in 1st week. PI could predict SND at cutoff 1.21 with good sensitivity of 96.5% and specificity of 94.7%, area under curve (AUC) value of 0.98, negative predictive value (NPV) of 98.6%, and positive predictive value (PPV) of 87.5%. To amplify our finding, we measured FVd, and at 25 cm/s it showed good sensitivity 86.2% and specificity 89.5% when AUC 0.93, NPV 94.4%, and PPV 75.8%. Conclusion: TCD on admission may provide a valuable tool of early prediction of neurological outcome for mild and moderate TBI patients. Closing the gap in poor prediction of commonly used evaluation by CT especially with mild lesion.

Predictive Model for the Type of Active Retinopathy of Prematurity Based on Data from Angiological Studies

The purpose — to develop a prognostic model of the type of active retinopathy of prematurity (ROP) based on informative prognostic parameters of optical coherence tomography of the retina in angio-mode (OCT-A) and color duplex scanning (CDS) for a reliable choice of patient management tactics.Patients and methods. 30 premature infants (30 eyes) with favorable and unfavorable types of 1–3 stages of active ROP were performed with optical coherence tomography of the retina in angio-mode. Children were born at a gestational age of 25–34 weeks. The birth weight of children was 680–2030 g. 55 premature infants (55 eyes) with active ROP were performed with CDS in modes of color Doppler mapping and pulsed Doppler sonography. Children were born at a gestational age of 25–32 weeks. The birth weight of children was 680–1760 g. ROC analysis was used to estimate the prognostic information content of the quantitative indicators of OCT-A and CDS in relation to the type of active ROP. The discriminant analysis was used to estimate the contribution of the studied quantitative indicators to the intergroup differences in the type of active ROP. A regression model was built to obtain a prediction of a favorable or unfavorable type of disease. The assessment of the acceptability of the model as a whole was carried out according to the index of determination and the level of significance of the resulting model (p &lt; 0.05).Results. The most informative prognostic indicators of the type of active ROP were determined, according to OCT in angio-mode: the area of the foveal avascular zone — and, according to CDS: maximum systolic and end diastolic blood flow velocity in the ophthalmic artery, maximum systolic blood flow velocity in the posterior short ciliary arteries, minimum velocity blood flow in the central retinal vein. On the basis of informative indicators, a reliable prognostic model of the type of active ROP was built, which has two independent variables: the area of the foveal avascular zone and the end diastolic blood flow velocity in the ophthalmic artery. The dependent variable can take values close to 0, which determine the favorable type of the disease, or close to 1, which determines the unfavorable type of the disease.Conclusion. The introduction of the obtained model into clinical practice will allow to objectively determine the unfavorable course of the pathological process at the earliest stages, as well as to carry out early treatment of active ROP.

The state of ocular arterial blood flow in active retinopathy of prematurity

Purpose: to study the state of blood flow in the ocular arteries of patients with various forms, stages and course types of active retinopathy of prematurity (ROP). Material and methods. Colour duplex scanning was performed by colour Doppler mapping and pulsed Doppler sonography for 55 premature babies (55 eyes) with active ROP and 8 premature babies (8 eyes) without ROP signs. The children’s gestation age was 25 to 32 weeks, and the body weight at birth was 680 to1760 g. Blood flow was examined in the ophthalmic artery (OA), the central retinal artery (CRA) and the medial and lateral posterior short ciliary arteries (PSCA). Results. The ophthalmic artery revealed no significant differences between the children with ROP and without ROP, except for a significant increase in the peak systolic velocity (Vsyst) in an unfavorable course of stage III of ROP. The development of aggressive posterior ROP is accompanied by a statistically insignificant decrease in blood flow velocity of OA. Hemodynamic parameters of CRA indicate an increase in peripheral vascular resistance in children with an unfavorable course of ROP. A significant increase of Vsyst in the posterior short ciliary arteries was revealed in children with an unfavorable course of stages I–III of ROP and Vsyst, and Vdiast (diastolic blood flow velocity) in children with aggressive posterior ROP as compared with children without ROP. A pronounced impact of the ROP course (favorable or unfavorable) on the Vsyst, Vdiast, and PI indicators in the posterior short ciliary arteries was revealed. The most informative hemodynamic parameters in predicting the course of active ROP are Vsyst and Vdiast values in the ophthalmic artery and Vsyst in the posterior short ciliary arteries. The least informative were the hemodynamic parameters of the central retinal artery. Conclusion. The assessment of hemodynamic changes in eye arteries may be used as an additional diagnostic criterion in the early diagnosis of ROP.

Correlation analysis of the triglyceride glucose index and heart failure with preserved ejection fraction in essential hypertensive patients.

BackgroundTriglyceride glucose index (TyG index) is a novel marker of insulin resistance. Studies have shown that TyG index is closely associated with the occurrence of hypertension and cardiovascular disease. However, little is known about the correlation between TyG index and the occurrence of heart failure with preserved ejection fraction (HFpEF) in hypertensive patients.HypothesisOur study assumes that TyG index strongly correlates with occurence of HFpEF in hypertensive patients.MethodsThis research enrolled 559 hypertensive patients (273 patients with HFpEF and 286 without HFpEF) admitted to the Department of Cardiology of Jiading Branch of Shanghai General Hospital from 2020 to 2021 as the study subjects. Gender, age, diastolic blood pressure, systolic blood pressure (SBP), and heart rate (HR) were recorded at admission. Medication history and fasting blood samples were harvested after admission to detect laboratory index. Cardiac function and ventricular structure index were measured by echocardiography. Pearson correlation analysis was conducted to identify the correlation of TyG index with cardiac function and ventricular structure. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of TyG index in HFpEF with hypertension.ResultsHFpEF patients had higher diuretic use frequencies, fasting plasma glucose, NT‐proBNP, triglycerides, TyG index, left atrial diameter (LAD), left ventricular mass index (LVMI), the ratio of peak E‐velocity of mitral orifice to peak velocity of early diastolic mitral annulus (E/e′), and SBP but lower ratio of peak E of early diastolic maximum blood flow velocity to peak A of late diastolic maximum blood flow velocity of mitral orifice (E/A) and average e′ than non‐HFpEF patients. Moreover, TyG index was correlated with LAD, left ventricular ejection fraction (LVEF), LVMI, average e′, E/e′, and NT‐proBNP. The multivariate regression analysis suggested that TyG index, E/e′, and NT‐proBNP were independent risk factors for HFpEF in hypertensive patients. Compared with E/e′ and NT‐proBNP, the area under the ROC curve (0.778 [95% confidence interval: 0.707–0.849]) was the largest for TyG index.ConclusionTyG index is higher in HFpEF patients than in non‐HFpEF patients and related to cardiac diastolic function, which strongly correlates with occurrence of HFpEF in hypertensive patients.

Two-Dimensional Ultrasound and Triplane Tissue Doppler Ultrasound of Patients with Severe Preeclampsia.

This study was to investigate the cardiac function characteristics under two-dimensional ultrasound and triplane tissue Doppler imaging (TDI) of patients with severe preeclampsia (SPE). 28 SPE patients with singleton pregnancy from January 2018 to December 2020 were included in the SPE group. 25 healthy nonpregnant women of reproductive age were taken as the control group (Ctrl group), and 26 normal pregnant women with singleton pregnancy were selected as the normal group (Norm group); all the research objects underwent ultrasonography. The morphological and functional indexes of left and right ventricles were compared among the cases in different groups. The results showed that the left ventricular end-diastolic period diameter (LVEDd), left ventricular relative wall thickness (LV-RWT), left ventricular mass index (LVMi), left anterior descending (LAd), left ventricular E/e and e/a values, right ventricular diameter (RV-D), right ventricular anterior wall thickness (RVAW), a value, right atrial septum (RA-S), pulmonary artery systolic pressure (PASP), left ventricular end-systolic period diameter (LVEds), interventricular septal thickness (IVSd), posterior wall thickness (PWd), end-diastolic period volume (EVD), end-systolic period volume (ESV), relative wall thickness (RWT), sphericity index (SpI), left atrium volume index (LAVi), and E/e value of patients in the SPE group were higher than those in the Ctrl group and the Norm group (P < 0.05). The mitral annular plane systolic excursion (MAPSE), s value, tricuspid annual plane systolic excursion (TAPSE), ratio of early diastolic blood flow velocity to late diastolic blood flow velocity (E/A), ratio of peak early diastolic velocity to peak late diastolic velocity (e/a), peak early diastolic velocity (e), and ejection fraction (EF) of the SPE group were lower than those of the Ctrl group and the Norm group (P < 0.05). The ratio of mitral valve early diastolic blood flow velocity to peak early diastolic velocity (E/e) of the Norm group was higher than that of the Ctrl group (P < 0.05). In two-dimensional ultrasound of the SPE group, the maximum difference in time from the start to the peak of systole (Ts) of the right ventricle between the basal and middle segments of the lateral wall and that of interventricular septum (RV-Ts-max) was 31.56 ± 0.39%. The maximum difference in time to peak of early diastole (Te) under the same condition (RV-Te-max) was 47.16 ± 0.19%. Left ventricular LV-Ts-max and LV-Te-max were 9.83 ± 0.80% and 8.37 ± 0.68%, respectively, in triplane TDI, which were considerably higher than those in the Ctrl and Norm groups (P < 0.05). It suggested that two-dimensional ultrasound and triplane TDI could reflect the ventricular morphology as well as diastolic and systolic function injury in patients, which offered a reference basis for the diagnosis of SPE.

ДИАГНОСТИЧЕСКАЯ ЭФФЕКТИВНОСТЬ НОВОГО МЕТОДА ОПРЕДЕЛЕНИЯ ПОВРЕЖДЕНИЯ ПОЧЕК ПРИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

Objectives. To evaluate diagnostic effectiveness of a complex ultrasound method for determining kidney damage in patients with chronic heart failure (CHF). Material and methods. In 2017-2021 on the basis of the Healthcare Institution «1st City Clinical Hospital» in Minsk, a clinical and instrumental study was performed on 203 patients aged 66 (59; 75) years, of which 111 (54.7%) were women and 92 (45.3%) men. Dynamic ultrasound investigation of the kidneys was carried out in 80 patients with CHF after ≥3 months. Inclusion criteria: sinus rhythm in patients; essential (primary) arterial hypertension; chronic ischemic heart disease; congestive heart failure; informed voluntary consent of the patient to participate in the study. Exclusion criteria: glomerular, tubulointerstitial kidney disease, obstructive uropathy, renal artery stenosis, congenital kidney diseases, history of renal malignancy. Results. The method for determining kidney damage in CHF is based on the concept of establishing a complex of ultrasound signs. It includes an assessment of the total volume of the kidneys, parenchymal thickness, end diastolic blood flow velocity, pulsation index, resistance index in segmental renal arteries, and characterizes kidney damage in patients with normal or slightly reduced glomerular filtration rate (GFR) (categories C1 - C2), chronic kidney disease (CKD) with categories of GFR C3A - C4 and CHF. Conclusions. The method has a high accuracy - 98.3%, which makes it possible to recommend its use when establishing CKD in patients with CHF.

Scale-Invariant Feature Transform (SIFT) Algorithm-Based Detection of Cardiac Insufficiency in Sepsis Patients with Echocardiography

This research aimed to explore the application of cardiac ultrasound imaging (CUI) in the examination and diagnosis of sepsis patients with cardiac insufficiency under a speckle tracking algorithm (STA). Scale-invariant feature transform (SIFT) algorithm was introduced to process images of CUI through STA under feature points of cardiac ultrasonic images. 90 patients with sepsis who were admitted to the hospital were selected and randomly divided into a sound cardiac function group (n = 62) (group A) and a cardiac insufficient group (n = 28) (group B) under whether they had cardiac insufficiency, and 20 healthy people were selected as a control group. Sepsis patients were examined on the seventh day after diagnosis including laboratory-related indicators, echocardiography, and echocardiographic data. The results showed that there were differences in cardiac ultrasound, cardiac marker, and laboratory examinations of subjects in the three groups ( P &lt; 0.05). Creatine kinase isoenzyme-MB (CK-MB), glycogen phosphorylase isoenzyme BB (GPBB), and heart-type fatty acid-binding protein (H-FABP) of subjects in the three groups showed statistically marked differences ( P &lt; 0.05). The other results indicated tricuspid late diastolic blood flow velocity (A′) value was greater than stroke volume (SV) and isovolumetric relaxation time (IVRT) value, followed by left ventricular ejection fraction (EF) and cardiac output per minute output (CO), and EF and CO values were over peak velocity of right ventricular free wall tricuspid valve systolic movement (SM) and left ventricular fractional shortening (FS) value, and left ventricular end-diastolic volume (EDV) value came next. The analysis of CUI based on STA could help doctors to judge sepsis patients with cardiac function. In addition, sepsis patients with sound cardiac function and sepsis patients with cardiac insufficiency could be distinguished by CUI, which had certain guiding significance for clinical diagnosis.

Предикторы и ранняя диагностика хронической болезни почек у детей

Early diagnosis of progressive forms of chronic kidney disease (CKD), prevention of chronic kidney disease (CKD) in childhood, prevention of the development of complications and life-threatening conditions associated with impaired renal function still remain an unresolved problem in pediatrics and nephrology. The lack of informative clinical and paraclinical markers for predicting the course of CKD makes it difficult to diagnose the early stages of the disease, and the methods used in pediatrics for diagnosing kidney damage to assess the preclinical stages of structural and functional kidney damage are insufficienly informative. Determination of pathogenetic predictors of the course of chronic kidney diseases and biomarkers of early stages of kidney damage is prospective for solving this problem. Prognostic markers are factors or a group of factors that lead to the development and progression of the disease with an outcome in nephrosclerosis, the identification of which will improve the efficiency of CKD early diagnosis. We have scientifically substantiated that in children the leading criteria for the formation and progression of CKD are: an increase in the level of markers of endothelial dysfunction (endothelin-1, homocysteine, ADMA, serum cystatin) cytokine imbalance (increased pro-inflammatory IL-6, TNFά), combined with a decrease in GFR and parameters of intrarenal hemodynamics (diastolic blood flow velocity).

Role of noninvasive imaging techniques as outcome predictors in traumatic brain injury

ObjectivesWe aimed to assess the predictive value of early transcranial Doppler (TCD) in patients with traumatic brain injury (TBI) in terms of secondary neurological insult and to establish the comparison between TCD and other diagnostic methods as predictors of outcome in those patients.BackgroundPatients with mild to moderate TBI are at risk of grave neurologic outcomes. Early use of TCD for these patients could be a good predictor.Patients and methodsThis prospective cohort study enrolled adult patients with mild and moderate TBI. Early TCD was done, and the peak systolic velocities, end-diastolic velocity, and time-averaged mean velocity in the middle cerebral artery were recorded. The pulsatility index and the resistance index were calculated. Secondary neurological deterioration (SND) was assessed on the seventh day from injury. Prognosis was also assessed by the Glasgow outcome scale (GOS) on the 28th day of admission.ResultsIn all, 120 patients were enrolled. Of these, 78 patients had SND, and 44 patients developed bad 28-day GOS. Age and severity of trauma (mild and moderate TBI) were significantly associated with both SND and bad GOS. TCD measurements were good predictors to detect patients at risk of SND and the 28-day GOS. Using receiver-operating characteristic analysis, the best threshold limit was found to be 25 cm/s for diastolic cerebral blood flow velocity and 1.2 for pulsatility index. Combination cutoffs of TCD parameters could be good predictors of SND.ConclusionEarly TCD measurements after mild to moderate TBI could predict patients at risk of SND and bad neurological outcome.

Improvement of Pulsatility index and Minimum Diastolic Blood Flow Velocity by low Dose Mannitol in Cases of Traumatic Brain Injury: a Cross-Sectional Study

Aim: To investigate the impact of low-dose mannitol on the pulsatility index (PI) and minimum diastolic blood flow velocity (FV-min (-1)) in the middle cerebral artery in cases of traumatic brain injury (TBI). Study design: A cross-sectional study Place and duration: From October 2018 to September 2020, the Department of Neurosurgery at Riyadh Care Hospital Methodology: A total of 80 patients with traumatic brain injury (TBI) were considered in the study. The participants had diffused TBI and their GCS was less than 8. All patients were administered the low-dose mannitol (0.3g kg). PI and FV-min were monitored by Transcranial Doppler (TCD) ultrasonography. The TCD ultrasonography was done before the administration of low-dose mannitol (0.3g kg), immediately after its administration, after 1 hour, 2 hours, and 3 hours. Result: The values taken before the administration of the low-dose mannitol were pathological (PI&gt;1.5 and FV-min &lt;20cm s (-1)). It was observed that administration of low-dose mannitol brought a significant change in the values of PI (F=8.967, p &lt; 0.001) and FV-min (F=8.642, p &lt;0.0001). Conclusion: Low-dose mannitol helps to improve the indicators of disturbance of circulation in a patient with TBI. It increased FV-min and decreased the PI. The most improved results in PI were noticed one hour after the administration and it was 11.1%. Similarly, the maximum effect of low-dose mannitol (0.3g kg) on FV-min was also noticed after one hour and it was a 30.2% increase as compared to the values taken in the beginning. The values were significantly different after 2 hours of administration. Keywords: Traumatic brain injury, low-dose mannitol, pulsatility index, minimum diastolic blood flow velocity