Doppler Peak Systolic Velocity Research Articles

Comparison of Doppler ultrasound indices of uterine artery and sub endometrial blood supply in frozen embryo transfer with and without repeated implantation failure: A cross-sectional study.

Background: Uterine blood supply has been identified as a potential factor in implantation failure. Objective: This study aimed to investigate Doppler indices in the uterine artery, including vascular flow and resistance, as well as the amount of sub-endometrial blood supply in women with a history of repeated implantation failure (RIF) compared to the non-RIF group. Materials and Methods: This cross-sectional study was conducted with 139 women candidates for frozen embryo transfer in Yazd Reproductive Sciences Institute, Yazd, Iran from February to July 2023. Group A (n = 68) included women with a history of more than 2 RIF, and group B (n = 71) included women candidates for implantation for the first time without RIF. Doppler ultrasound indices of uterine artery and sub-endometrium, including sub-endometrial flow, uterine artery flow, uterine artery resistance, and peak systolic velocity, were recorded. Results: No significant differences were observed in uterine artery Doppler pulsatility index and peak systolic velocity between groups, but the uterine artery resistance index was significantly higher in the A group (p 0.001). A significant difference was observed in the perfusion area between groups. 60/68 women in the group A had endometrial perfusion in areas 2 and 3 (p 0.001). Conclusion: Our study revealed that women with RIF exhibited higher resistance index in sub-endometrial arteries compared to the non-RIF group.

Prediction of adverse outcome by ophthalmic artery Doppler and angiogenic markers in pregnancies with new onset hypertension

ObjectivesTo compare the ophthalmic artery Doppler peak systolic velocity ratio (OA PSV-ratio) and soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF ratio) in predicting adverse maternal and perinatal outcomes in women presenting with new onset hypertension. Study designProspective cohort study in a specialist hypertension clinic, within a tertiary referral centre. Main outcome measuresComparison between the OA PSV-ratio and sFlt-1/PlGF ratio in predicting delivery within one week from presentation and adverse maternal and perinatal outcomes e.g. severe hypertension, neonatal unit admission, small for gestational age. ResultsWomen who delivered within one week, compared to those who did not, had a higher OA PSV-ratio (0.82 vs 0.71, p < 0.01) and sFlt-1/PlGF ratio (93.3 vs 40.5, p = 0.08). Independent predictors of the OA PSV-ratio included mean arterial pressure and maternal weight and predictors of the sFlt-1/PlGF ratio included diastolic blood pressure and use of antihypertensive medications. Prediction of adverse outcomes with both ratios were similar and only modest e.g. AUROC for predicting delivery within one week for OA PSV-ratio was 0.57 (95% CI 0.47–0.67) and for sFlt-1/PlGF ratio was 0.61 (95% CI 0.52–0.70) (p = 0.53). ConclusionsIn women presenting with new onset hypertension, the OA PSV-ratio and sFlt-1/PlGF ratio have similar and modest performance in predicting adverse outcomes.

Effect of Internal Carotid Artery Doppler Peak-Systolic Velocity Thresholds for Classifying Ipsilateral Ischemic Stroke Due to Large Artery Atherosclerosis According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) System for CME Credit September 2023

Effect of Internal Carotid Artery Doppler Peak-Systolic Velocity Thresholds for Classifying Ipsilateral Ischemic Stroke Due to Large Artery Atherosclerosis According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) System for CME Credit September 2023

Effect of Internal Carotid Artery Doppler Peak Systolic Velocity Thresholds for Classifying Ipsilateral Ischemic Stroke Due to Large Artery Atherosclerosis According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) System

Background: A Doppler peak systolic velocity (PSV) of 125 cm/s has been used to indicate an internal carotid artery 50% stenosis, a marker of large artery atherosclerosis (LAA) when classifying ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Shifting this cut point to 180 cm/s might affect the classification of ischemic stroke. Methods: Color Doppler–assisted measurements of PSV were performed at the baseline visit of a large longitudinal cohort study in the United States: the Cardiovascular Health Study (CHS). Incident ischemic stroke within the following 6 years was ascertained by adjudicated review of medical records. The side of ischemic stroke was recorded. Incidence rates and odds ratios (logistic regression models) were estimated at the respective 125 cm/s and 180 cm/s cut points. Results: Mean age was 72.8 years with 57.6% women. A total of 11 425 bifurcations had PSV measurements. Of the 514 carotid bifurcations with PSV above 125 cm/s, 20 ipsilateral incident strokes were seen, whereas 6 strokes occurred among the 126 bifurcations with PSV above 180 cm/s. Shifting the cut point decreased categorizing ischemic stroke as due to LAA by 70% (14/20). The odds ratio (1.75; 95% confidence interval, 1.01-3.02) of incident stroke for a PSV between 125 cm/s and 180 cm/s was significant ( P &lt; .05) when compared with a PSV &lt;125 cm/s. Conclusion: Shifting the PSV cut point for a 50% carotid stenosis from 125 cm/s to 180 cm/s would have significant implications when categorizing ischemic stroke as being associated with LAA.

How should right ventricle remodeling be assessed in women and men with chronic mitral regurgitation?

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Haukeland University Hospital Introduction Right ventricular (RV) dysfunction has a negative impact in patients with mitral regurgitation (MR), yet its assessment by two-dimensional (2D) echocardiography remains challenging. It is unclear which echocardiographic parameter best reflects RV remodeling in chronic MR. Purpose To assess 2D and three-dimensional (3D) measures of RV size and function in relation to MR severity. Methods Patients in the 3D-PRIME (3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation) study with moderate or severe MR by combined transthoracic/transesophageal assessment and no other severe valve disease were examined at our heart valve clinic between 2020–2022. RV remodeling was assessed in 2D by the basal diameter, tissue Doppler peak systolic velocity at the lateral tricuspid ring (RV s´), tricuspid annular plane systolic excursion (TAPSE), and RV free wall longitudinal strain (RV FWS); and in 3D by end-diastolic volume (3D RVEDV), end-systolic volume (3D RVESV), ejection fraction (3D RVEF) and fractional area change (3D RVFAC). Results 100 patients with moderate or severe MR (54 with degenerative MR; 26 with atrial functional MR; 20 with ventricular functional MR) were included. Women (n=38) had smaller MR regurgitation volumes and RV size, similar TAPSE and RV s´, but higher 3D RVEF, 3D RVFAC and RV strain normalized for 3D RVEDV (all p &amp;lt;0.05). More severe RV remodeling with larger volumes, and lower 3D RVFAC (all p &amp;lt;0.05), and 3D RVEF (p = 0.05) was detected in severe MR by 3D, but not by 2D RV measures (Figure). In ROC analyses, 3D RVESV was strongest associated with severe MR (area under curve 0.68, p &amp;lt;0.01, Figure). In linear regression analysis, increasing 3D RVESV was associated with higher body mass index, larger MR regurgitation volume, male sex, and larger 3D left atrial volumes (R2 0.48, p &amp;lt;0.001). Conclusion RV remodeling in severe MR is detected by 3D, but not by routine 2D echocardiography. The 3D RV end-systolic size best reflects MR severity.

Abstract 10045: Higher Renal Vascular Resistance is Associated With Greater Body Mass Index in Children

Background: Obesity is associated with increased risk for cardiovascular and renal diseases, however, there has been little focus on renal vascular function. The purpose of this study is to assess renal vascular flow regulation and investigate their relation to cardiovascular risk factors in obese children. Methods: Noninvasive ultrasonographic measurements were made in 108 overweight/obese children aged 7 to 13 years (body mass index 18 to 33kg/m 2 ). Using color Doppler sonography, peak systolic (PSV), end-diastolic (EDV), and average peak flow (APV) velocities of renal artery were measured. Pulsatility index as a parameter of vascular resistance was calculated. Pulsatility index was defined as (PSV-EDV)/APV. Quantitative B-mode ultrasound scans were used to measure intima-media thickness and diameters of the common carotid artery. Plasma lipid concentrations, uric acid, homeostasis model assessment of insulin resistance, and high sensitivity C-reactive protein were assessed in the obese children. Results: Compared with overweight children with body mass index &lt;25 kg/m 2 , pulsatility index in obese children with body mass index≥25 kg/m 2 was significantly higher (1.24 ±0.13 vs. 1.13 ±0.14 cm/sec, p &lt; 0.01), because APV and EDV were significantly lower (35 ±3 vs. 38 ±7 cm/sec and 21± 3 vs. 25 ±5 cm/sec, p &lt;0.05, respectively), although PSV was not significantly different. Pulsatility index correlated significantly with body mass index (r =0.58, p &lt; 0.01), insulin (r = 0.24, p &lt; 0.05), homeostasis model assessment of insulin resistance (r =0.25, p &lt; 0.01), triglycerides (r = 0.26, p &lt; 0.01), uric acid (r = 0.22, p &lt; 0.05), systolic blood pressure (r = 0.31, p &lt; 0.01), and carotid intima-media thickness (r = 0.36, p&lt;0.01). Renal blood flow velocities did not correlate with high sensitivity C-reactive protein. Conclusions: The present study indicates that obesity can adversely affect renal vascular flow and resistance in children. Obesity-related insulin resistance may be a main risk factor for renal vascular flow changes. Obesity not only is a risk factor for later cardiovascular disease, but also is associated with significant impairment of renal arterial flow dynamics.

Effect of a standardized maternal meal on fetal middle cerebral artery Doppler indices: A single-blinded crossover study.

ObjectiveMeasures of Doppler blood flow velocity profiles are an integral part of monitoring fetal well-being during pregnancy. These examinations are performed at different times of the day and at different maternal meal states. In uncomplicated pregnancies, we assessed the effect of a standardized maternal meal on middle cerebral artery (MCA) and umbilical artery (UA) Doppler blood flow velocity pulsatility indices (PIs) and MCA peak systolic velocity (PSV).MethodsIn this prospective single-blinded crossover study 25 healthy women were examined at 36 weeks of pregnancy. The first examination was performed in the morning following overnight fast, and repeated after extended fast (state A), and after a standard breakfast meal (state B).ResultsIrrespective of maternal prandial status, the MCA-PI values were lower in the 2nd compared to the 1st examination (-0.187; p = 0.071, and -0.113; p = 0.099, state A and B, respectively). Compared to the values in the 1st examination, the UA-PI values, were higher after extended fast (0.014; p = 0.436), and lower post-prandially (-0.036; p = 0.070). The difference (state B minus state A) between the meal states were not significant (0.074; p = 0.487 and -0.050; p = 0.058, for MCA-PI and UA-PI, respectively). Adjusting for the possible influence of fetal heart rate on MCA-PI and UA-PI, the differences between meal states remained non-significant (p = 0.179, p = 0.064, respectively). The MCA-PSV values increased after the meal (6.812; p = 0.035), whereas no increase was observed following extended fast (0.140; p = 0.951). The difference in MCA-PSV values between the two meal states was not significant (6.672; p = 0.055).ConclusionOur results demonstrate possible diurnal variations in MCA-PI and UA-PI, with and without adjustment for fetal heart rate, that seem to be unaffected by maternal meal intake in healthy pregnancies.

Effect of food intake on echocardiographic measurements in healthy elderly

This study evaluates whether food intake affects systolic and diastolic echocardiographic measurements in healthy seniors. Thirty healthy subjects 65-70 years of age were investigated with echocardiography, at fasting and then 30, 90, and 180 min after a meal. After 30 min the biggest changes were seen in left ventricular wall stress and myocardial performance index with a decrease of 45% and 33%, respectively, compared to fasting values. Significant (p<.05) increases also were seen in left ventricular stroke volume, left ventricular cardiac output, left ventricular cardiac index, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, the E/A ratio, pulsed tissue Doppler peak systolic (s') and early (e') and late (a') diastolic velocities, pulmonary vein peak velocities in systole (S) and diastole (D), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and global longitudinal strain (GLS) (increases ranging 6%-19%). After 90 min there remained a decrease in wall stress and myocardial performance index of 31% and 17%, respectively, and smaller, but still significant, changes could be seen in left ventricular stroke volume, left ventricular outflow velocity-time integral, MAPSE (lateral), TAPSE, GLS, and a few pulsed tissue Doppler peak systolic velocities and late diastolic velocities. An increase also could be seen in deceleration time of E-wave (DT). After 180 min, all variables except DT were back at baseline or below. No significant changes were seen in S/D ratio, lateral early diastolic velocity (e' lateral) and E/e'ratio. This study shows that food intake affects commonly used echocardiographic parameters, both systolic and diastolic, in healthy seniors. With a few exceptions, the changes seen in the older population were less pronounced than previous studies in younger subjects.

Comparison of Middle Cerebral Artery Doppler and Cord Blood Hemoglobin in the Diagnosis of Fetal Anemia among Rh-negative Pregnant Women

Background: Most prevalent cause of fetal anemia is Rh incompatibility between the mother's and the fetus's blood types, where antibodies from the mother damage the fetus's red blood cells causing fetal hemolytic anemia. Objective: To compare the Doppler of the middle cerebral artery of the fetus and cord blood hemoglobin to diagnose fetal anemia among Rh-negative women in the last trimester of pregnancy. Methodology: This was a cross-sectional study conducted at the Gynecology &amp; Obstetrics Department, Mercy Teaching Hospital Peshawar, from February 2020 to May 2021. A total of 126 Rh-negative blood group women were included who were in the last trimester of the pregnancy. Ethical approval was obtained from Ethics Committee and informed written consent was taken from the study participants. Middle cerebral artery Doppler peak systolic velocity was checked at 28th, 32nd, and 34th week of gestation. If middle cerebral artery Doppler peak systolic velocity changes were present, then patients were closely monitored and managed appropriately for post-delivery assessment of cord blood fetal anemia. A pre-designed structured proforma was used to collect patient details. Results: Mean age of 126 pregnant mothers was 28±7 years, and the mean parity was 4.57±2. The overall frequency of fetal anemia among Rh-negative women predicted by middle cerebral artery Doppler peak systolic velocity was 59 (46.8%), while anemia on cord blood sampling after delivery was found in 43 (34.1%) of babies. No anemia was found in 83 (65.8%) study participants. The sensitivity and specificity of middle cerebral artery Doppler were 100% and 84% respectively. Conclusion: Middle cerebral artery Doppler can be a simple noninvasive method to detect fetal anemia before the development of hydrops fetalis with high sensitivity and specificity.

Subclinical right ventricular dysfunction in patients with mitral stenosis.

Right ventricular (RV) dysfunction is a strong predictor of poor outcomes of patients with mitral stenosis (MS). The aim of this study was to detect a subclinical right ventricular dysfunction in patients with MS. We conducted a prospective study from January 2015 to June 2019 in 104 asymptomatic patients with MS (mean age: 46.1 ± 4.27years), and compared to a group of 52 age and sex matched healthy subjects. Standard and speckle tracking echocardiography were performed; parameters of RV function were measured and compared. Although they were in normal range, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler and pulsed wave Doppler RV myocardial performance index (MPI) and peak systolic velocity (S') were decreased in patients with MS (p < 0.05). The global RV longitudinal strain (LSGRV) and the longitudinal strain of the free wall of the right ventricular (LSFRV) were lower in patients with MS (p, respectively, at 0.001 and < 0.001), 53.5% (n = 47) of patients had LSFRV < -20%. A significant difference was noted between LSFRV and 2D strain of the septal wall (p = 0.002). No difference was found between patients with severe MS and moderate MS regarding LSFRV and LSGRV. No correlation between LSFRV and FAC (p = 0.85), MPI (p = 0.62), TAPSE (p = 0.31) and S' (p = 0.78) was found. Our study showed the presence of subclinical systolic dysfunction of the right ventricle in patients with MS.

Performance of middle cerebral artery doppler for prediction of recurrent fetal anemia

Objective To assess the predictive value of middle cerebral artery Doppler peak systolic velocity (MCA-PSV) for moderate-severe fetal anemia following one intrauterine transfusion (IUT) and test the performance of alternate cutoffs to the recommended threshold ≥1.69 multiples of the median (MoM). Methods This was a retrospective cohort study of patients with pregnancies affected by alloimmunization who underwent percutaneous umbilical blood sampling (PUBS) procedures from 2000 to 2020. An MCA-PSV ≥1.69 MoM was the indication for the second IUT. The primary outcome was recurrent moderate-severe fetal anemia. Receiver-operating characteristic (ROC) curves assessed the predictive ability of MCA-PSV for the primary outcome and the Youden index identified the “optimal” cutoff value. Predictive characteristics of MCA-PSV ≥1.69 MoM and the “optimal” cutoff were compared. Results Of the 58 patients who underwent IUT during the study period, 36 (62%) did not meet inclusion criteria. Of the remaining 22 patients who underwent a second PUBS, 12 (54.6%) fetuses had moderate or severe anemia. Following one IUT, the AUC for MCA-PSV was 0.86 (95% CI 0.70–1.00) for the primary outcome. The “optimal” cutoff MCA-PSV value was 1.74 MoM, which had a greater specificity than ≥1.69 MoM (90 vs. 50%, p = .05), but was not statistically significant. The sensitivity was similar between the two cutoff values of ≥1.69 and ≥1.74 MoM (83.3 vs. 75.0%, p = .65) (Table 2). Conclusion Raising the recommended MCA-PSV cutoff to ≥1.74 MoM for recurrent moderate-severe fetal anemia after one IUT would decrease the number of unnecessary procedures without significantly changing the sensitivity of this screening test.

Evaluation of testicular hemodynamics following gonadotropin-releasing hormone administration with the aid of pulse wave Doppler in rams and their relation to hormonal response

Vascularization of the testis through testicular artery is of great importance to maintain its normal function. Vascular disruption due to inadequate arterial blood flow of the testis negatively affects testicular function and semen quality. This study aimed to determine the efficacy of gonadotropin-releasing hormone (GnRH) administration on testicular vascularity in relation to testosterone hormonal response. Five clinically healthy adult ossimi rams 18- to 30-months-old were used. Testicular arteries Doppler examination, blood sampling following GnRH administration and testosterone hormonal assay were conducted. Both pulsatility index (PI) and resistance index (RI) significantly decreased in all treated rams starting from 1 hr till 120 hrs after single GnRH administration, both Doppler indices returned to their pre-treatment values at 144 hours after GnRH administration. Doppler peak systolic velocity (PSV) did not change in response to GnRH administration. Testosterone hormone concentrations negatively correlated with PI and RI but not PSV. In conclusion, GnRH would be useful a beneficial therapy for treatment of testicular dysfunction in rams by increasing testosterone concentrations and testicular blood flow. And pulse wave Doppler ultrasonography would be a useful non-invasive clinical tool for evaluation of the efficacy of novel therapeutic treatments in rams.

The Effects of Spironolactone and Eplerenone on Left Ventricular Function Using Echocardiography in Symptomatic Patients With New-Onset Systolic Heart Failure: A Comparative Randomised Controlled Trial

Heart failure (HF), as a serious health condition, is characterised by the decreasing ability of the heart to pump enough blood around the body. This study compared the effects of spironolactone and eplerenone on the echocardiographic variables of the left ventricular (LV) function in symptomatic patients diagnosed with new-onset systolic HF. This study was a randomised controlled trial, including 85 symptomatic patients with new-onset systolic HF (namely, dilated cardiomyopathy). The patients were then randomly assigned to two groups in a 1:1 ratio and received either spironolactone or eplerenone in addition to optimal HF therapy for 6 months. Echocardiography was performed to visualise alterations in two-dimensional, pulse Doppler, tissue Doppler, and deformation indices of LV function. The results revealed that the group receiving eplerenone had a significantly greater increase in LV ejection fraction (LVEF) and a decrease in end-systolic LV internal diameter compared with the group receiving spironolactone (intergroup p=0.002 and p=0.006, respectively). There was a significant reduction in the end-diastolic LV internal diameter and the left atrial diameter, and a significant rise in tissue Doppler peak systolic mitral annular velocity in the group taking eplerenone; there were no significant changes in these variables in the group receiving spironolactone (intergroup p=0.006 and p=0.049, respectively). Accordingly, eplerenone had greater favourable effects on LVEF and the global longitudinal strain than spironolactone (B=5.207 [p<0.001] and B= -2.072 [p=0.044]), respectively. This study established that adding eplerenone to optimal HF therapy might be associated with more improvements in echocardiographic variables of LV function than spironolactone in symptomatic patients with new-onset systolic HF.

Assessment of the accuracy of testicular dysfunction detection in male donkey (Equus asinus) with the aid of colour‐spectral Doppler in relation to plasma testosterone and serum nitric oxide levels

This study aimed to determine the usefulness of colour and pulsed Doppler modes for the accurate diagnosis of donkeys suffering from subfertility to determine whether testicular vascularity assessment could be an indicator for sperm functionality. The study sample was composed of 10 male donkeys with normospermia (control group) and 10 donkeys with hypospermia. Animals underwent scrotal circumference measurement, testicular Doppler examination, seminal evaluation, blood sampling and hormonal assay. Semen volume and concentration were significantly (p≤.05) lower in the subfertile group (30.25±1.22ml and 89.44±2.55×106 /ml) as compared with the control group (82.76±1.65ml and 452.78±1.25×106 /ml), and total sperm/ejaculation was significantly (p≤.05) higher in the normal donkeys (28.30±2.32×109 /total ejaculated) as compared with the subfertile group. Intratesticular coloured area showed a marked decline in the hypospermic males. There was no significant difference between the two groups in testosterone level, although the normal group showed an increase in nitric oxide metabolites. Both Doppler indices of the three branches of the testicular artery were elevated significantly (p≤.05) in abnormal donkeys, whereas Doppler peak systolic and end-diastolic velocities were increased in the normal group. Male donkeys with subfertility demonstrated lower arterial vascularity parameters in the form of intratesticular coloured area and blood flow rate; therefore, the most optimal parameters for differentiating subfertile hypospermic from normospermic donkeys were found to be the two Doppler indices, velocities parameters, testicular blood flow rate and nitric oxide levels.

Acute pharmacodynamic effects of pimobendan in client-owned cats with subclinical hypertrophic cardiomyopathy

BackgroundPrior studies have suggested that pimobendan is associated with several positive effects in cats, including improved survival in cats with congestive heart failure and improved left atrial function in research colony cats with hypertrophic cardiomyopathy (HCM) and normal cats. However, there is still a paucity of pharmacodynamic data refuting or supporting the use of pimobendan in a clinical cat population. This clinical trial aimed to evaluate the pharmacodynamic effects and tolerability of a single dose of pimobendan in cats with HCM. Echocardiograms and Doppler-derived systolic blood pressures were performed in 21 client-owned cats with subclinical HCM at baseline and 90-min after oral administration of 1.25 mg of pimobendan (Vetmedin). Seven additional cats were evaluated post-placebo administration to account for intra-day variability.ResultsHeart rate, systolic blood pressure, and murmur grade were not significantly different between baseline and post-pimobendan evaluations. Left auricular blood flow velocity, left atrial size, and left ventricular fractional shortening were not significantly different between baseline and post-pimobendan evaluations.Mean (± standard deviation) tissue Doppler peak systolic velocity of the mitral annulus was significantly higher following pimobendan (7.4 cm/s ± 1.5 vs 8.5 ± 1.6; p = 0.02). Median (min, max) left-ventricular outflow tract maximum velocity was significantly higher following pimobendan [1.9 m/sec (1.5, 3.4) vs 2.6 m/sec (2.0, 4.0); p = 0.01]. Mean right-ventricular outflow tract maximum velocity was also significantly higher following pimobendan (1.5 m/s ± 0.51 vs 2.0 ± 0.53; p = 0.004). Mean left atrial fractional shortening was significantly higher following pimobendan (28% ± 6 vs 32% ± 7; p = 0.02).No adverse events were observed following pimobendan administration.Right ventricular outflow tract velocity was significantly higher following placebo in control cats (1.02 ± 0.21 versus 1.31 ± 0.31; p = 0.01). No other significant differences were detected.ConclusionsIn client-owned cats with HCM, pimobendan acutely increased left atrial function and mildly increased left ventricular systolic function. Left ventricular outflow tract velocity was increased after pimobendan. Pimobendan was well tolerated in the acute setting in cats with HCM. The findings of this prospective, acute-dosing study confirm previous findings in research animals and retrospective analyses and suggest that chronic dosing studies are safe and warranted.

1129 How useful is assessment of amniotic fluid volume in antenatal surveillance of fetal growth restriction?

Maximum vertical pocket (MVP) is commonly assessed for surveillance of fetal growth restriction (FGR) and small for gestational age (SGA). It is theorized that MVP becomes compromised when blood flow to the brain is prioritized. Our objectives are to evaluate the relationships among FGR and SGA, MVP, and perfusion parameters. This is a retrospective study of the last ultrasound prior to delivery of 105 fetuses with an estimated fetal weight <10th percentile. Data include biometry, MVP, middle cerebral artery Doppler peak systolic velocities (MCA-PI), and cardiac size, shape, and right-to-left disproportion. Fetuses were classified as FGR or SGA by International Society of Ultrasound in Obstetrics and Gynecology criteria. MCA-PI <10th percentile for gestational age was abnormal. Relationships between dichotomized and continuous variables were analyzed using Fisher’s exact tests and linear regressions respectively. Mean gestational age at time of ultrasound assessment was 36 +/- 2 weeks. A total of 61 (58%) and 44 (42%) fetuses met criteria for FGR and SGA respectively. Five fetuses (5%) had low or low-normal MVPs (≤3cm). MVP ≤3cm did not correspond to increased rate of FGR or abnormal MCA-PI (p=0.39 and 0.31 respectively). The risk ratio (RR) of FGR for MVP ≤3cm compared to MVP >3cm is 1.40 [95% confidence interval (CI) 0.88, 2.25], and the RR of MCA <10th percentile for MVP ≤3cm compared to MVP >3cm is 1.89 [CI 0.60, 5.89]. Cardiac deformation was present in all fetuses with MVP ≤3cm (table). In our series, MVP ≤3cm was found infrequently in fetuses with FGR. There were no differences in MVP between fetuses with FGR v. SGA. Low MVP was not associated with abnormal MCA-PI, contrary to the theorized competitive relationship between amniotic fluid production and fetal brain sparing. However, this pilot study suggests that MVP ≤3cm is associated with fetal cardiac deformation, indicating possible compromise of renal perfusion in the setting of cardiac remodeling; further research is needed to validate this relationship.

965 Accuracy of middle cerebral artery doppler ultrasound for fetal anemia prior to 24 weeks gestation

Fetal middle cerebral artery (MCA) peak systolic velocity of Doppler ultrasound varies with gestational age, and it is unclear if established reference ranges are applicable to pregnancies less than 24 weeks. We aimed to estimate the positive predictive value and false positive rate of MCA Doppler ultrasound for assessment of fetal anemia at gestational ages less than 24 weeks. A retrospective cohort study was performed in a single healthcare system over a 10-year period. All fetuses at risk of alloimmunization less than 24 weeks gestation who had MCA Doppler ultrasounds were identified. Non-immune causes of fetal anemia were excluded. Peak MCA systolic velocity > 1.5 multiples of the median (MoM) were considered positive and periumbilical blood sampling was considered. Pregnancy and neonatal outcomes were reviewed for all patients. The positive predictive value of MCA Doppler peak systolic velocity for fetal anemia prior to 24 weeks was estimated with 95% confidence intervals based on the binomial exact method. 126 pregnancies at risk for fetal anemia due to maternal alloimmunization had MCA Doppler ultrasound assessments prior to 24 weeks gestation. Of these, eleven had MCA peak systolic velocity > 1.5 MoM. Seven of the eleven were confirmed to have fetal anemia on percutaneous umbilical sampling while four were false positives, corresponding to a positive predictive value of 7/11 (64%, 95% CI 31%, 89%) and a false positive rate of 4/11 (36%, 95% CI 11%, 69%). MCA Doppler assessment performed at less than 24 weeks gestation had a positive predictive value of 64% for identification of fetal anemia, suggesting that 1 in 3 are false positives. This must be taken into account when considering percutaneous umbilical sampling in patients were positive fetal MCA Dopplers before 24 weeks.

Intraoperative vascular Doppler ultrasound blood flow and peak systolic velocity predict early patency in hemodialysis arteriovenous fistula.

BackgroundChronic kidney disease is a major public health problem. Hemodialysis is the most common renal replacement therapy. Arteriovenous fistulas (AVF) are a possible access option, but early failure rates remain high.Objectivesto investigate the value of intraoperative vascular Doppler ultrasound for predicting early AVF patency.MethodsProspective observational study. Consecutive patients undergoing AVF were assessed with vascular Doppler ultrasonography intraoperatively and on days 1, 7, 30, and 60. Patients were divided into groups according to presence or absence of primary and secondary patency. Blood flow (BF) and peak systolic velocity (PSV) were compared. ROC curves were plotted and used to define the PSV and BF values that yielded greatest sensitivity (Sens) and specificity (Spec).Results47 patients met the inclusion criteria and were analyzed. Higher intraoperative PSV and BF values were observed in patients who had primary and secondary patency than in patients with access failure. The values with greatest sensitivity and specificity for predicting 30-day primary patency were 106 cm/s for venous PSV (Sens: 75% and Spec: 71.4%) and 290.5 ml/min for arterial blood flow (Sens: 80.6% and Spec 85.7%). Values for 30-day secondary patency were 106 cm/s for arterial PSV (Sens: 72.7%, Spec: 100%) and 230 ml/min for venous blood flow (Sens: 86.4%, Spec100%). Values for 60-day primary patency were 106 cm/s for venous PSV (Sens: 74.4%, Spec: 62.5%) and 290.5 ml/min for arterial blood flow (Sens: 80%, Spec: 75%).ConclusionsPeak systolic velocity and blood flow measured using intraoperative vascular Doppler ultrasound can predict early patency of hemodialysis arteriovenous fistulas.

Difference between near-field and far-field of middle cerebral artery doppler pulsatility index and peak systolic velocity: a prospective study

Objective: We purposed to investigate the difference between near-field and far-field of PI (pulsatility index) and peak systolic velocity (PSV) of the middle cerebral artery (MCA) that are important in the management of fetal growth restriction and fetal anemia. Methods: This prospective study was conducted with 130 single uncomplicated pregnancies. Doppler was applied to near-and far-field of proximal MCA while PSV and PI were recorded and compared between two sides as well as according to body mass index (BMI) and gestational weeks of participants. Results: There was no statistically significant difference between near and far-fields of MCA PI (P = 0.75). However, a statistically significant difference in PSV was observed (P = 0.03), and this was especially noticeable in women with normal BMI (P = 0.009). On the other hand, there was no difference between MCA PI or PSV in women with a BMI higher than 25. Also, no significant difference was observed between groups, which were subcategorized according to gestational weeks. Conclusions: Our data suggest that the far-field PSV values may be higher than near-field MCA PSV values; sonographers should bear in mind that while far and near-field PSV can differ, conversely MCA PI can safely be assessed from both the near and far-fields of MCA in case of technical difficulty.

Age-Dependent Echocardiographic and Pathologic Findings in a Rat Model with Duchenne Muscular Dystrophy Generated by CRISPR/Cas9 Genome Editing.

Duchenne muscular dystrophy (DMD) is X-linked recessive myopathy caused by mutations in the dystrophin gene. Although conventional treatments have improved their prognosis, inevitable progressive cardiomyopathy is still the leading cause of death in patients with DMD. To explore novel therapeutic options, a suitable animal model with heart involvement has been warranted.We have generated a rat model with an out-of-frame mutation in the dystrophin gene using CRISPR/Cas9 genome editing (DMD rats). The aim of this study was to evaluate their cardiac functions and pathologies to provide baseline data for future experiments developing treatment options for DMD.In comparison with age-matched wild rats, 6-month-old DMD rats showed no significant differences by echocardiographic evaluations. However, 10-month-old DMD rats showed significant deterioration in left ventricular (LV) fractional shortening (P = 0.024), and in tissue Doppler peak systolic velocity (Sa) at the LV lateral wall (P = 0.041) as well as at the right ventricular (RV) free-wall (P = 0.004). These functional findings were consistent with the fibrotic distributions by histological analysis.Although the cardiac phenotype was milder than anticipated, DMD rats showed similar distributions and progression of heart involvement to those of patients with DMD. This animal may be a useful model with which to develop effective drugs and to understand the underlying mechanisms of progressive heart failure in patients with DMD.