Higher Pulsatility Index Values Research Articles

Transit time flow measurement in off-pump surgery: is it a functional index of the biological graft integrity?

Transit-time flow measurement (TTFM) represents a valid tool in the assessment of the quality of the anastomosis during coronary artery bypass graft (CABG). Nevertheless, a high variability limits its standardized use, lacking univocally accepted cut-off flow values. Our study analyzes TTFM data collected from a study population that underwent off-pump CABG (OP-CABG), with the aim to differentiate into subgroups according to the presence of diabetes mellitus. Patients referred to the Cardiovascular Unit of S. Michele Hospital (Caserta, Italy) for coronary artery disease (CAD) and underwent OP-CABG between January 2015 and December 2019 were enrolled, and intraoperative TTFMs data were recruited and evaluated. Mean graft flow (MGF) and pulsatility index (PI) values were collected and analyzed. The study population was composed of 342 patients who underwent OP-CABG with TTFM data regarding 824 grafts. Diabetic patients shared a higher cardiovascular risk profile. The TTFM assessment showed better results for the use of the arterial grafts in diabetic patients, especially for those insulin-dependent; conversely, venous grafts showed worse data with lower MGF and higher PI values. In particular, the anastomoses of the saphenous vein graft with marginal obtuse (MO) coronary artery showed worse MGF results in the insulin-dependent rather than normoglycemic subgroup (28.66 vs. 38.44, p=0.003). Diabetic patients, especially in the insulin-dependent subgroups, have demonstrated lower MGF and higher PI values collected from venous anastomoses with, conversely, inverse results from the arterial one. These results might be correlated to an altered biological adaptability caused by the effects of the diabetic endocrine disorder.

Different Predictive Factors for Early Neurological Deterioration Based on the Location of Single Subcortical Infarction: Early Prognosis in Single Subcortical Infarction.

Patients with single subcortical infarctions (SSIs) have relatively a favorable prognosis, but they often experience early neurological deterioration (END). In this study, we compared the predictors for END in patients with SSI according to the location of the lesion. We included consecutive patients with SSIs within 72 hours of symptom onset presenting between 2010 and 2016. END was defined as an increase of ≥2 in the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 in the motor NIHSS score within the first 72 hours of admission. Along with the analysis of all patients with SSI, we also analyzed the predictors for END in proximal/distal SSI patients and anterior/posterior circulation SSI patients. A total of 438 patients with SSI were evaluated. In multivariable analysis, initial NIHSS score (adjusted odds ratio, 1.36 [95% CI, 1.15–1.60]), pulsatility index (adjusted odds ratio, 1.25 [95% CI, 1.03–1.52]), parent artery disease (adjusted odds ratio, 2.14 [95% CI, 1.06–4.33]), and neutrophil-to-lymphocyte ratio (adjusted odds ratio, 1.24 [95% CI, 1.04–1.49]) were positively associated with END. In patients with proximal SSI, initial NIHSS score, pulsatility index, parent artery disease, and neutrophil-to-lymphocyte ratio showed positive associations with END. Meanwhile, no variable related to END was found in the distal SSI group. When we compared the predictors for END based on the involved vascular territory, higher initial NIHSS score and neutrophil-to-lymphocyte ratio were significantly associated with END in patients with anterior circulation SSIs. On the contrary, higher pulsatility index values and the presence of parent artery disease were independent predictors for END in patients with SSIs in the posterior circulation. Initial NIHSS score, pulsatility index, parent artery disease, and neutrophil-to-lymphocyte ratio are associated with END in patients with SSIs. The frequency and predictors for END differ depending on the location of the SSI.

Doppler sonography of cerebral blood flow for early prognostication after out-of-hospital cardiac arrest: DOTAC study

AimTo assess the neurological prognosis of comatose survivors of cardiac arrest by early transcranial Doppler sonography (TCD). MethodsThis was a prospective study performed between May 2016 and October 2017 in a medical intensive care unit (ICU) and a cardiac ICU of a university teaching hospital.All patients older than 18 years who were successfully resuscitated from an out-of-hospital cardiac arrest (OHCA) with persistent coma after the return of spontaneous circulation (ROSC) were eligible. We excluded patients for whom OHCA was associated with traumatic brain injury, no possibility of TCD measurements, or who were dead before establishing the neurological prognosis.We measured the pulsatility index (PI) and diastolic flow velocity (DFV) of the right and left middle cerebral arteries within 12 h after ICU admission. The lowest DFV and highest PI values were used for the statistical analysis. The neurological outcome at hospital discharge was evaluated by the cerebral performance category. ResultsForty-two patients were included in the final analysis: 15 had good and 27 poor neurological outcomes. The PI was higher in the poor outcome (1.49 vs. 1.12, p = 0.01) than good outcome group and the DFV was lower in the poor outcome group (17.3 cm s−1vs. 26.0 cm s−1; p = 0.01). ConclusionData provided by early TCD after ROSC are associated with neurological outcome. The use of TCD could help guide interventions to improve cerebral perfusion after ROSC in patients resuscitated from OHCA.

PS-02-001 Cardiometabolic risk and female sexuality: Focus on clitoral vascular resistance

... The relationship between sexual and cardiovascular health in women is not well defined. Clitoral colour Doppler ultrasound (CDU) with assessment of pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. The aim of the present study was to investigate the associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters and self-perception of body image. Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. Patients underwent a physical, laboratory and clitoral CDU examination, and completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). Clitoral PI was positively correlated with body mass index (BMI) (r=0.441, p<0.0001), waist circumference (r=0.474, p<0.0001), glycaemia (r=0.300, p=0.029), insulin (r=0.628, p=0.002), HOMA index (r=0.605, p=0.005), triglycerides (r=0.340, p=0.011), total cholesterol (r=0.346, p=0.010) and LDL cholesterol (r=0.334, p=0.016). All the relationships, with the exception of glycaemia, retained statistical significance after adjusting for age, smoking habit and years of menopause (p<0.0001 for BMI, waist circumference and triglycerides; p<0.05 for all the other associations). At ANCOVA, after adjusting for confounders, women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (F=17.79, p=0.001; F=7.37, p=0.019, for obesity and MetS, respectively). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β=0.434; p=0.007). Clitoral PI was negatively associated with FSFI arousal (β=-0.321, p=0.014) and satisfaction scores (β=-0.289, p=0.026) and positively associated with somatized anxiety symptoms (MHQ-S), even after adjusting for age, smoking habit, years of menopause and current use of psychiatric medication (β=0.354, p=0.011). A positive association was also observed between PI and BUT Positive symptom distress index (PSDI) (β=0.322, p=0.039) and BUT-B dislike of womb, genitals and breast (β=0.538, p<0.0001; β=0.642, p<0.0001; β=0.549, p<0.0001, respectively). After introducing waist circumference as a further covariate, the associations between clitoral PI and BUT-PSDI, dislike of womb, genitals and breast retained statistical significance (p=0.038 for PSDI and p<0.0001 for the dislike of womb, genital and breast, respectively).

Two-dimensional sonographic and Doppler changes in the uteri of bitches according to breed, estrus cycle phase, parity, and fertility

This study aimed to evaluate the two-dimensional and Doppler ultrasonographic features of bitches' uteri according to breed, cycle phase, parity and fertility during the follicular and early diestrus phases. Thirty-nine pubertal bitches were divided into groups according to breed, parity, and fertility. Sonographic assessments started from the first day of vaginal bleeding and were performed weekly for a month. The diameter of the uterine body was measured longitudinally and the uterine characteristics observed sonographically were evaluated. The resistivity index (RI) and pulsatility index (PI) of the uterine artery were calculated and the spectral morphology analyzed subjectively. The uterine diameter increased from proestrus to the diestrus regardless of the breed or parity. Multiparous bitches of both breeds had higher uterine diameters than nulliparous bitches, except Fila Brasileiro bitches in estrus. In diestrus and proestrus, the uterine diameters were significantly the largest for multiparous bitches, followed by the primiparous bitches and smallest for nulliparous bitches. The uterine diameter was larger in Fila Brasileiro females than in French Bulldogs during estrus and diestrus. The RI did not differ during the different phases of the cycle for the same breed. However, the RI was higher in nulliparous and primiparous Fila Brasileiro females compared to French Bulldog females. Within Fila Brasileiro, multiparous bitches showed lower RI than nulliparous and primiparous bitches. Higher PI values were found during proestrus. All multiparous French Bulldog bitches had greater PI than nulliparous bitches, while multiparous Fila bitches had lower PI. Nulliparous and primiparous Fila bitches had larger PI larger than bitches with the same reproductive status of the breed French Bulldog. Infertile bitches had higher RI and PI than bitches considered fertile during the initial estrus and diestrus. Triphasic and types A, C, and D spectral morphologies were found in females who did not gestate; while pregnant females showed spectral morphologies of type B, C and D. Hence, it was concluded that the breed, the phase of estrus cycle and pregnancy history should be considered when studies the uterine artery flow during estrus and early diestrus using investigations such as Doppler assessment, which can be an important tool in diagnosing fertility in dogs.

The correlation between cerebral arterial pulsatility and cognitive dysfunction in Alzheimer's disease patients

BackgroundPotential role of vascular dysfunction has been suggested in the pathogenesis of Alzheimer's disease (AD). Previous cross-sectional studies have demonstrated relations between abnormal transcranial Doppler (TCD) parameters and cognitive impairment. We aimed to investigate the associations between longitudinal changes of TCD parameters and cognitive decline in patients with AD. MethodsWe have enrolled patients with mild to moderate AD who aged 60 to 79years. Mean flow velocity and pulsatility index (PI) of anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries were evaluated. Cognitive functions were assessed using mini-mental state examination (MMSE), clinical dementia rating sum of boxes (SOB), and Alzheimer's Disease Assessment Scale (ADAS-cog), which was further categorized as praxis, language, and memory subscores. TCD and cognitive assessments were followed up 1year later, and the longitudinal changes (Δ) between the baseline and follow-up measurements were evaluated. ResultsA total of 51 patients completed the follow-up evaluations (baseline age 71.5years, MMSE 21.2). In the baseline evaluations, high PI values of ACA and MCA were associated with poor MMSE score, ADAS-cog total, memory, and praxis subscores. After 1year, the increases of ACA and MCA PI were correlated with the aggravation of ADAS language subscore, and ΔACA PI was also correlated with ΔSOB. The decrease in mean flow velocity of ACA was associated with aggravation of ADAS-cog praxis score. ConclusionsThere was significant correlation between longitudinal changes of TCD parameters and cognitive dysfunction in patients with mild to moderate AD. Serial assessment of TCD may provide useful information regarding to the disease progression.

Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance

IntroductionThe relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. AimTo investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. MethodsSeventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. Main Outcome MeasuresPatients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). ResultsClitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = −0.321, P = .014) and satisfaction (β = −0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast). ConclusionClitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

Intraoperative bypass graft flow in intra-aortic balloon pump–supported patients: Differences in arterial and venous sequential conduits

The intra-aortic balloon pump is used worldwide as an anti-ischemic strategy. However, little is known about the modifications of the graft flowmetry during use of intra-aortic balloon pump. An observational study aimed at analyzing transit-time flow measurements during 1:1 intra-aortic balloon pump use and during its cessation in 138 consecutive patients using intra-aortic balloon pump before coronary artery bypass grafting (n = 442 graft segments) was reported. In normally functioning grafts, the mean diastolic and mean blood flow improved significantly during 1:1 intra-aortic balloon pump use compared with during intra-aortic balloon pump cessation (P < .001), although mean and diastolic arterial pressures were significantly lower (P = .001). Arterial and sequential saphenous vein grafts showed greater improvements in mean diastolic and mean flow compared with single venous grafts. Surplus graft flow (defined as mean flow during 1:1 intra-aortic balloon pump use/mean flow with intra-aortic balloon pump off) was recorded (surplus graft flow > 1) during 1:1 intra-aortic balloon pump use in all normally functioning grafts, with higher values in single arterial or sequential saphenous vein grafts versus single venous grafts (both P < .001). In the 9 cases of graft failure, the mean diastolic, mean systolic, and mean flow were significantly lower and the pulsatility index greater, compared with normally functioning grafts (all P <or= .001). Blood flow did not change appreciably during 1:1 intra-aortic balloon pump use in failed bypass grafts; thus the surplus graft flow approached 1. In this analysis, use of intra-aortic balloon pump was associated with improved diastolic and mean blood flow in bypass grafts. Arterial and sequential grafts were associated with greater improvements in blood flow and surplus graft flow. Graft failure was associated with poor transit-time flow results, high pulsatility index values, and absent surplus graft flow.

Transcranial doppler study of cerebral arteriovenous malformations after gamma knife radiosurgery

The aim of this study was to evaluate the clinical value of the Transcranial Doppler (TCD) in follow-up examinations after gamma knife radiosurgery (GKS) for arteriovenous malformations (AVM). We performed TCD after GKS in 18 patients who had cerebral AVMs to evaluate the hemodynamic effects of the procedure. Ten patients underwent TCD within 12 months after GKS, and eight between 12 and 24 months. The mean blood velocity (Vm) and pulsatility index (PI) were primarily analyzed in the feeding arteries (FAs) and non-FAs. Fifteen healthy volunteers served as control patients. The Vm values in the FAs after GKS ranged from 31 cm/s to 90 cm/s, with PI values ranging from 0.48 to 1.03. The Vm values in the comparable normal arteries ranged from 28 cm/s to 87 cm/s, and the PI values in these arteries ranged from 0.62 to 1.02. The Vm and PI values in every FA in all patients were normal compared to the values in the non-FAs (p=0.67 and 0.38, respectively). Our results suggest that AVM vessels with high Vm and low PI values return to normal as the nidus of the AVM is obliterated after GKS. Although there was a trend toward a reduction of the Vm values after obliteration, this trend was not significant, except when the < 12 month subgroup was compared to the 12-24 month subgroup. In our limited study, TDC proved to be a reliable, safe and non-invasive method to monitor the outcome of GKS for cerebral AVMs.

Midluteal phase Doppler assessment of uterine artery blood flow in nonpregnant women having a history of recurrent spontaneous abortions: correlation to different etiologies

To compare the impedance to uterine artery blood flow, during the midluteal phase, in women with recurrent spontaneous abortion (RSA) as compared to normal fertile controls. A prospective study involving women with a history of RSA and fertile controls. University of Rome "Tor Vergata." Two hundred thirty women with RSA and 50 fertile controls referred for routine examination. Transvaginal Doppler examination of uterine arteries during the midluteal phase of untreated cycles. The mean pulsatility index (PI) of uterine arteries. Uterine arteries PI values in RSA patients (2.42 +/- 0.79) were significantly higher with respect to those found in the control group (2.08 +/- 0.47). When patients were grouped according to the different RSA causes, the highest PI values were found among patients with uterine abnormalities (2.82 +/- 1.0), antiphospholipid antibodies syndrome (2.70 +/- 1.1), and unexplained RSA (2.60 +/- 0.7). These values were significantly higher with respect to that found in the control group. No differences were observed in PI values between fertile patients and those with RSA due to thyroid abnormalities (2.10 +/- 0.55), inherited thrombophilia (2.03 +/- 0.45), autoimmune pathology (2.34 +/- 1.18), and genetic anomalies (2.47 +/- 0.54). Similar results were observed when patients were grouped according to primary and secondary RSA. Increased resistance to uterine blood flow may be an important contributing factor to some causes of RSA and may represent an independent indication of the risk of pregnancy loss.

Posters

The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning.To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image.Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited.Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT).Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = −0.321, P = .014) and satisfaction (β = −0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast).Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

The effect of exogenous estradiol benzoate and altrenogest on uterine and ovarian blood flow during the estrous cycle in mares

In recent years, a positive relationship between genital perfusion and fertility has been established; in species other than horses, uterine and ovarian perfusion was improved by exogenous estrogen but impaired by exogenous progestin. The goal of the present study was to investigate the effect of exogenous estrogen and progestin on uterine and ovarian blood flow in cycling mares. Five Trotter mares were examined daily during three estrous cycles. Mares were given no treatment, altrenogest (0.044 mg/kg BW) orally from Day 0 (ovulation) to Day 14 and estradiol benzoate (5 mg i.m.) on Days 0, 5, and 10, in three cycles, respectively. There was no difference ( P>0.05) in the length of untreated versus estrogen-treated cycles (22.8±1.3 days and 23.2±1.5 days, respectively), but cycle length was increased ( P<0.05) in progestin-treated cycles (26.0±1.2 days). To facilitate comparisons among cycles with different lengths, data from Days 0 to 15 (diestrus) and from Days −6 to −1 (estrus) were analyzed. Transrectal Doppler sonography was used to evaluate blood flow in both uterine arteries and in the ovarian artery ipsilateral to the preovulatory follicle during estrus and ipsilateral to the corpus luteum during diestrus. Blood flow was assessed semiquantitatively using the pulsatility index (PI); high PI values indicated high resistance and a low perfusion and vice versa. An immediate effect of treatments occurred only after the administration of estradiol benzoate on Day 0; uterine PI values decreased ( P<0.05) between Days 0 and 1 and estrogen-treated mares but increased ( P<0.05) at the corresponding time in untreated cycles. Mean PI values for the uterine and ovarian arteries during both diestrus and estrus were higher ( P<0.05) in estrogen-treated versus untreated mares. Furthermore, mean uterine PI values during diestrus and estrus were higher ( P<0.05) in altrenogest-treated versus untreated mares. Neither estrogen nor altrenogest treatments had a significant immediate effect on ovarian PI values. Compared to untreated cycles, mean ovarian PI values were elevated ( P<0.05) only in the estrus following altrenogest administration. In conclusion, exogenous estrogen and progestin both decreased genital perfusion in cycling mares.

Uterine and ovarian blood flow during the estrous cycle in mares

Uterine and ovarian blood flow was investigated in four mares during two consecutive estrous cycles using transrectal color Doppler sonography. The uterine and ovarian arteries of both sides were scanned to obtain waves of blood flow velocity. The pulsatility index (PI) reflected blood flow. There were significant time trends in PI values of all uterine and ovarian blood vessels during the estrous cycle ( P<0.05). PI values did not differ between the uterine arteries ipsi- and contralateral to the corpus luteum or the ovulatory follicle. PI values of the uterine arteries showed a wave shaped profile throughout the estrous cycle. The highest PI values occurred on Days 0 and 1 (Day 0=ovulation) and around Day 11, and the lowest PI values were measured around Days 5 and −2 of the estrous cycle. During diestrus (Days 0–15) PI values of the ovarian artery ipsilateral to the corpus luteum were significantly lower than PI values of the contralateral ovarian artery ( P<0.0001). No differences ( P>0.05) in resistance to ovarian blood flow occurred between sides during estrus (Days −6 to −1). In this cycle stage PI values decreased in both ovarian vessels ( P<0.05). During diestrus, high PI values of the ovarian artery ipsilateral to the corpus luteum were measured between Days 0 and 2, followed by a decline until Day 6 ( P<0.05). From this time on, the resistance to blood flow increased continuously until Day 15 ( P<0.05). The cyclic blood flow pattern in the contralateral ovarian artery was similar to that in the uterine arteries ( r=0.68; P<0.0001). No correlations occurred between the diameter of the corpus luteum and the PI values of the ipsilateral ovarian artery ( P>0.05) during diestrus. During estrus, there was a negative relationship between growth of the diameter of the ovulatory follicle and changes in PI values of the dominant ovarian artery ( r=−0.41; P<0.05). PI values of the uterine arteries and of the ovarian artery ipsilateral to the ovulatory follicle were negatively related to estrogen (E) levels in plasma during estrus (uterine arteries: r=−0.21; P<0.05; dominant ovarian artery: r=−0.35; P<0.05). In diestrus, PI values of the dominant ovarian artery were negatively related to plasma progesterone levels ( r=−0.38; P<0.0001), but not the PI values of the uterine arteries ( P>0.05). The findings of this study show that there are characteristic changes in blood supply of the uterus and the ovaries throughout the equine estrous cycle. There are negative correlations between resistance to blood flow in the uterine and ovarian arteries and the plasma estrogen levels during estrus. In diestrus, there is a negative relationship between the resistance to ovarian blood flow and the progesterone levels.

Investigation of intraplacental villous arteries by doppler flow imaging in growth-restricted fetuses

Objective: The purposes of our study were to assess the ability of color and power Doppler sonography to depict the blood flow in the intraplacental villous arteries and to evaluate whether the blood flow of intraplacental villous arteries in a normal pregnancy is different from that in a pregnancy that is associated with intrauterine growth restriction. Study Design: Eighty-five women with uncomplicated pregnancy and 16 women with intrauterine growth-restricted fetuses between 27 and 38 weeks of gestation were examined by color and power Doppler imaging. The blood flow of intraplacental villous arteries was analyzed comparatively. The pulsatility index and peak systolic velocity were measured. Results: A unit of 1 intraplacental villous artery-1 and its branches were seen as 1 cotyledon by color and power Doppler imaging. The cotyledon was easily identified and counted. Each cotyledon contained only 1 intraplacental villous artery-1. This method can visualize the intraplacental villous artery-1 to intraplacental villous artery-4 in normal pregnancies. The terminal villous arteries beyond intraplacental villous artery-4 were not imaged. The number of detectable intraplacental villous artery-1 in 1 placenta in intrauterine growth restriction was significantly lower than that in normal pregnancy. The number of detectable branches in intrauterine growth restriction was also significantly lower than in normal pregnancy. No intraplacental villous artery-4 blood flow was found in women with intrauterine growth restriction. In examined arteries, pulsatility index decreased and peak systolic velocity increased significantly with advancing gestational age (P <.02). At any given gestational age, pulsatility index and peak systolic velocity in the peripheral arteries were significantly lower than those in the upstream arteries in normal pregnancy (P <.001). The pulsatility index value of each intraplacental villous artery was also lower than that of the umbilical artery in the women with intrauterine growth restriction (P <.05). There were no differences in pulsatility index in each artery between the groups, although there were a few high pulsatility index values in intrauterine growth restriction. Conclusion: Color Doppler and power flow sonography are valuable tools for the detection of the blood flow of intraplacental villous arteries. The decrease in the number of detectable intraplacental villous artery-1 and branches was associated with intrauterine growth retardation. (Am J Obstet Gynecol 2002;186:297-302.)

WS17: Newcomers WS17‐01Hormone replacement therapy reduces impedance to flow in different vascular beds

An HRT‐associated reduction of the pulsatility index (PI) has been reported in the literature, although cross‐sectional studies have shown conflicting data. In a prospective, controlled study we randomized 30 healthy postmenopausal women (mean age 52 ± 3 years) into two groups. Women in the HRT group (N = 15) received 1 mg micronized 17β‐estradiol daily (E2) sequentially combined with 5 or 10 mg dydrogesterone for 14 days of each 28‐day cycle during 12 months, and, thereafter, 2 mg E2 combined with 10 mg dydrogesterone for a period of 3 months. The control group (N = 15) received no treatment. Color Doppler ultrasound was used to measure the impedance to flow (pulsatility index [PI]) within the uterine, central retinal and ophthalmic arteries in the E2‐phase at baseline and after 3, 12 and 15 months. Compared to controls, 12 months of HRT was associated with a significant decrease in the mean PI of the uterine artery of −39% (HRT −25%, controls +14%) and in that of the central retinal artery of −29% (HRT −9%, controls +20%). After 3 months this effect was already evident. During HRT, the reductions in mean PI of the uterine and central retinal arteries vs. baseline were larger (both P = 0.002) in the women with high pretreatment PI values when compared to those with low pretreatment values. The baseline PI of the uterine artery correlated positively with age and with duration of amenorrhoea (r = 0.42, P = 0.01 and r = 0.48, P = 0.008, respectively). Our 12‐month study expanded on earlier reports of a reduced PI of the uterine artery. We used a combined regimen containing a low‐dose of oestrogens. These results are important because the recent trend is to recommend combined HRT that contain lower dosages of oestrogens than before. Furthermore, a 29% reduction of the PI of the central retinal artery was observed, which suggests that HRT has a positive influence on the impedance of the cerebral circulation. From the point of view of atherothrombotic risk these observations are beneficial and possibly helpful in understanding the decreased risk of cardiovascular disease, and of the impairment of cognitive functions associated with oestrogens in epidemiological data.

The effect of maternal exercise on uterine artery velocimetry waveforms

Summary One hundred and two subjects in the second half of pregnancy were subject to an acute exercise test lasting 5 minutes on an upright bicycle ergometer. The pulsatility index (using Doppler ultrasound) of the right uterine artery was analysed before exercise and at 2, 4, 6, 8, 10, 12, 16, 20, 24 and 30 minutes after exercise. The mean exercise intensity achieved was 67.2% of sub-maximal exercise (range 51-90%). At 2 minutes post-exercise, the mean uterine artery pulsatility index was increased from the baseline value, reaching a maximum of 0.64 at 8 minutes (baseline 0.583). After 8 minutes there was a gradual decrease in the pulsatility index, and at 24 and 30 minutes the values were significantly lower (P < 0.001 and P < 0.001 respectively). Smokers had significantly higher pulsatility index values than non-smokers (P < 0.004). Primigravidae also had lower resistance indices compared with multigravidae (P < 0.001). We conclude that exercise in the second half of pregnancy appears to cause a transient increase in the maternal uterine artery pulsatility index. We also believe that at this level of exercise intensity there was no evidence of harmful effects on maternal uterine blood flow.

Maternal anxiety in late pregnancy and fetal hemodynamics

The aim of this study was to investigate if fetal circulation is affected by maternal anxiety, 37 nulliparous women were studied prospectively in the third trimester of pregnancy, with self-rate tests of anxiety (STAI). Doppler ultrasound examination of the umbilical artery and fetal middle cerebral artery was performed at 37–40 gestational weeks. The pulsatility index (PI) was calculated and corrected for heart rate. The women were divided into groups of increasing levels of anxiety. The fetuses of women with high trait anxiety scores had significantly higher PI values in the umbilical artery ( p = 0.0056), significantly lower PI values in the fetal middle cerebral artery ( p = 0.0029) and significantly lower cerebro-umbilical PI ratios ( p = 0.0002), suggesting a change in blood distribution in favor of brain circulation in the fetuses. Maternal weight, weight-increase, height, age, marital status, smoking habits, drinking habits and socioeconomic factors known to affect fetal well-being did not interfere with these findings. No significant differences in birth-weight, length and head circumference were found between infants born to mothers with higher trait anxiety levels compared to mothers with lower trait anxiety levels. Our results suggest that maternal stress, in terms of trait anxiety, influences fetal cerebral circulation.

The association between hormone levels and vascular resistance in uterine and ovarian arteries in spontaneous menstrual cycles--a Doppler ultrasound study.

Ninety-four infertility patients were studied by Doppler ultrasound during spontaneous ovulatory menstrual cycles. The pulsatility index (PI) in uterine and ovarian arteries was measured in the follicular and midluteal phase of the cycle. Associations between high PI values and hormones (estradiol, progesterone, prolactin, testosterone, follicle stimulating hormone) measured during the investigated cycle and age were evaluated. A high PI in uterine arteries in the follicular phase was associated with low estradiol (E2) and progesterone (P) levels in the studied cycle. In the luteal phase PI values of uterine arteries have no obvious association with E and P levels, and other vasoactive compounds influence the perfusion of uterus during this period. The other hormones analysed and age did not correlate with vascular resistance in spontaneous ovulatory cycles.

Fetal and neonatal cerebral circulation: a pulsed Doppler study.

We studied the relation between the fetal cerebral circulation and changes in the cerebral circulation directly after birth. With a combined real time ultrasound/pulsed Doppler technique flow velocity waveforms from the fetal umbilical- and carotid-circulation were monitored. Pulsatility Index (PI) was computed and the ratio between Umbilical PI and Carotid PI was calculated. Flow velocity waveforms of the cerebral circulation before birth were related to anterior cerebral artery flow velocity waveforms recorded immediately after birth. The study shows that changes in flow velocity waveforms associated with the intra uterine brain-sparing effect are related to poor obstetrical outcome. Furthermore is shown that the brain-sparing effect in the fetal period is associated with higher PI values in the cerebrovascular circulation in the neonatal period. It is suggested that changes in these PI values, representing changes in cerebrovascular resistance, might be indicative of cerebral ischemia in the neonate.

Uteroplacental Doppler velocimetry during Braxton Hicks' contractions.

Pulsed-wave Doppler ultrasound was used to evaluate the influence of Braxton Hicks' contractions on flow velocity waveforms in the uterine arteries. Flow velocity waveforms were obtained from a standardized site, at the crossing of the uterine artery with the external iliac artery near the uterine wall. Doppler signals were recorded in 16 healthy near-term nulliparous pregnant women. During Braxton Hicks' contractions, a considerable increase in pulsatility index (PI) was found in the uterine arteries increasing from 0.71 +/- 0.21 (mean +/- SD) to 1.14 +/- 0.67 (p < 0.005). Maternal heart rate decreased slightly but significantly during contractions. Despite the high PI values that were found during Braxton Hicks' contractions, a diastolic notch in the flow velocity waveform was never noticed. The findings indicate that during Braxton Hicks' contractions, resistance to blood flow in the uteroplacental circulation is considerably increased.