Pulsatility Index Research Articles

The Pulmonary Artery Pulsatility Index Provides No Additional Prognostic Information in Pediatric Pulmonary Arterial Hypertension.

The pulmonary artery pulsatility index (PAPi, calculated as (SPAP - DPAP)/mRAP) has been suggested as a measure of right ventricular-vascular coupling (RVVC) and as a prognostic parameter in cardiovascular conditions, particularly right ventricular failure. This retrospective study investigated the relationship between the PAPi and its components with disease severity parameters, the RVVC, and clinical outcomes in children with pulmonary arterial hypertension (PAH). We analyzed data from 111 children from the Dutch National Registry with PAH. The PAPi (median 6.0 [3.9-8.3]) was calculated from heart catheterization data and the RVVC was determined as the TAPSE/sPAP ratio via echocardiography (0.25 ± 0.12 mm/mmHg). Disease severity was characterized by clinical, hemodynamic, and laboratory data. Cox proportional hazard modeling assessed the PAPi's predictive value for transplant-free survival. There was no correlation between the RVVC and PAPi (R = -0.208, p = 0.111, n = 60). The PAPi correlated negatively with uric acid (R = -0.387, p < 0.001) but not with other disease severity parameters. Mean right atrial pressure correlated with multiple disease severity indicators. Transplant-free survival rates at 1, 3, and 5 years were 87%, 79%, and 73%, respectively. Neither the PAPi nor its components correlated with transplant-free survival. In conclusion, the PAPi does not correlate with the RVVC and this study could not demonstrate any prognostic value of the PAPi regarding disease severity or outcomes in children with PAH, challenging its utility in this population.

First-trimester uterine artery Doppler and PAPP-A levels as predictors of pre-eclampsia in a South Asian population; Mardan city, Pakistan

One of the most common causes of maternity and neonatal fatalities and mortality is Pre-eclampsia (PE) which is responsible for 14% of global maternal deaths. The condition is primarily attributed to impaired trophoblastic invasion, which increases uterine artery pulsatility index (PI). A predictive analysis was done at Swat Medical College and Women's Hospital in Mardan, Pakistan from June 2022 to June 2023, including 218 pregnant women aged 11-13+6 weeks. Females with multifetal pregnancies, congenital fetal anomalies, and pre-existing medical conditions were excluded from this research. Uterine artery the Doppler and the PAPP-A testing were done to screen the conditions. Of 624 screened women, 218 were included in the final analysis using SPSS. The study population's mean age was 28 years, with 59% primiparous and 41% multiparous women. The incidence of PE was 35.5%, and gestational hypertension was 22.5%. Women developing hypertensive disorders had significantly higher mean uterine artery PI (2.11) compared to normotensive women (1.21, p=0.01), and significantly lower mean PAPP-A MoM levels (0.78 vs. 1.42, p&lt;0.001). Coupled aberrant uterine blood vessels PI and PAPP-A predicted PE with high significance (p&lt;0.001). Uterine artery in the first trimester Doppler and PAPP-A levels are effective in predicting pre-eclampsia in a South Asian population. Implementing these screenings could enhance early detection and management of PE, potentially reducing associated morbidity and mortality.

Is Averaging of Three Waveforms Sufficient to Generate a Truly Representative Value for Pulsed-Wave Doppler Measures of Impedance?

We aimed to evaluate the physiological variation in common pulsed-wave Doppler (PWD) indices of impedance to determine the number of waveforms to be averaged to minimise variability to 5%. A single-centre, prospective, cross-sectional cohort study of uncomplicated singleton pregnancies at 20-37 week's gestation. From each patient 100 PWD waveforms were acquired including the umbilical artery (UA), middle cerebral artery (MCA) and uterine arteries (UtAs), with 30 waveforms acquired from the ductus venosus. Each waveform was individually measured using the machine's in-built software in automated mode. The variability was assessed using coefficient of variation. The number of waveforms to be averaged was calculated using the moving average and standard error of mean. From a cohort of 200 pregnancies, a total of 189 were analysed. The pulsatility index (PI) demonstrated greater variability compared with the resistance index (RI) in all vessels studied. A minimum of 14 UA and MCA, and 13 UtA PWD waveforms were required to reduce PI variability to 5%, while only 2 RI waveforms were required for UA, 1 for MCA and 8 for UtAs. The variability shown across all PWD indices and between vessels means that PWD indices results should be interpreted cautiously and averaged over multiple waveforms. Consideration should be given to adoption of RI, as it showed greater stability than PI for maternal-fetal Doppler.

Serum macrophage stimulating protein α-chain and uterine artery Doppler ultrasound in the first trimester for the prediction of preeclampsia

To assess how effective macrophage stimulating protein α-chain (MSP-α) combined with uterine artery Doppler is in predicting preeclampsia in singleton pregnancies during 11–13+6 weeks of gestation. This prospective observational study included singleton pregnant women who attended antenatal care at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University between December 2021 and April 2023, during 11–13+6 weeks of gestation. Serum MSP-α levels were collected and uterine artery Doppler ultrasound was performed. Pregnancy outcomes were recorded, and the predictive values of these tests were determined to predict preeclampsia. A total of 365 patients, with 21 cases of preeclampsia (5.8%), were analyzed. Serum MSP-α levels were higher in pregnant women who developed preeclampsia than those who did not (899.7 ± 550.1 ng/ml vs 642.5 ± 466.1 ng/ml, p = 0.016). The mean pulsatility index of the uterine artery and the presence of diastolic notching were not significantly different between the groups. As a cut-off value for predicting preeclampsia, using serum MSP-α levels higher than 1.0 multiple of median for gestational age, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.4%, 50.3%, 8.1%, and 96.7%, respectively. Additionally, when abnormal serum MSP-α levels were combined with a uterine artery Doppler pulsatility index above the 95th percentile and bilateral notching as predictive values for preeclampsia, the sensitivity was 85.7%, specificity was 18.3%, PPV was 6.0%, and NPV was 95.5%. Serum MSP-α alone at 11–13+6 weeks of gestation was effective in predicting preeclampsia. However, the use of serum MSP-α in combination with uterine artery Doppler increased sensitivity but reduced specificity for the prediction of preeclampsia.

Using Doppler ultrasound to assess fetal cardiac function and pregnancy outcomes in obstetric antiphospholipid syndrome pregnancies: a case-control study.

This study aimed to evaluate fetal left ventricular function (LVF) in pregnant women with obstetric antiphospholipid syndrome (OAPS) by Doppler ultrasound and developed a clinical nomogram to predict adverse perinatal outcomes. In this prospective observational study, 105 pregnant women were enrolled and divided into the OAPS cohort (n = 60) and the control cohort (n = 45). Fetal cardiac function parameters were collected and compared between two cohorts. Univariate and multivariate analysis was conducted to select the risk factors associated with adverse perinatal outcomes, and a clinical nomogram was developed based on these selected risk factors. The predictive performance of corresponding indicators for adverse perinatal outcomes was evaluated using receiver operating characteristic (ROC) curve analysis. The OAPS cohort revealed an increase in the isovolumic relaxation time (IVRT) and myocardial performance index (MPI), a decrease in the ejection time (ET), middle cerebral artery pulsatility index (MCA-PI) and cerebroplacental ratio (CPR) compared to the control cohort. Through univariate and multivariate analysis, gravidity, CPR, and MPI were the risk factors associated with adverse perinatal outcomes. A model predicting adverse perinatal outcomes in OAPS pregnant women was constructed based on these three factors and visualized as a nomogram. The nomogram could accurately predict adverse perinatal outcomes with an area under the curve of 0.923 (95% CI: 0.858-0.982). This performance was better than evaluating individual factors such as MPI (0.825, 95% CI: 0.739-0.911) and CPR (0.816, 95% CI: 0.705-0.927) for efficacy. MPI can be used to assess fetal LVF and predict adverse perinatal outcomes. We developed a nomogram to predict adverse perinatal outcomes in OAPS women. This imaging-based evidence can provide timely clinical intervention, enabling personalized clinical decision-making.

Haemodynamic effects of intra-aortic balloon pumps stratified by baseline pulmonary artery pulsatility index.

Intra-aortic balloon pump (IABP) devices are commonly used in patients with heart failure related cardiogenic shock (HF-CS), including those with out-of-proportion right ventricular (RV) dysfunction. Pulmonary artery pulsatility index (PAPi) is a haemodynamic surrogate for RV performance. We aimed to assess short-term haemodynamic changes in patients with HF-CS following IABP support stratified by baseline PAPi. This is a single-centre study of 67 consecutive patients with HF-CS who underwent IABP placement between 2020 and 2022. The primary aim was haemodynamic changes of specific variables on pulmonary artery catheter monitoring over 72h following IABP placement. Secondary aims were clinically significant changes in diuretic regimens, changes in inotropes or vasopressors at 72h following IABP, along with clinical outcomes. Prior to IABP placement, 57% of the total cohort (median age 59years [48, 69], 31% female) had Society of Cardiovascular Angiography and Interventions Stage C HF-CS. Thirty-eight (56%) patients had a PAPi <2.0. Following 72h of IABP support, the PAPi <2.0 group had an observed significant decrease in central venous pressure (CVP; 20 to 12mmHg, P<0.001) and mean pulmonary artery pressure (mPAP; 37.5 to 28.5mmHg, P=0.001), and an increase in PAPi (1 to 1.6, P=0.001). No significant change in cardiac index (CI; 2 to 2.1L/min/m2, P=0.31) was observed. The PAPi ≥2.0 group (N=29) had no observed significant change in CVP (10 to 8mmHg, P=0.47), or PAPi (2.6 to 2.8, P=0.92), but there was a significant improvement in CI (1.9 to 2.5L/min/m2, P=0.004) along with reduction in mPA (37 to 29mmHg, P=0.03). The PAPi <2.0 group had a significant increase in diuretic requirement (52.6% vs. 20.7%, P=0.01) and numerically greater addition of inotropes/vasopressors (47.3% vs. 34.4%, P=0.07) compared with the PAPi ≥2.0 group at 72h following IABP placement. Significantly more patients in the PAPi ≥2.0 group underwent left ventricular assist device (55.2% vs. 26.3%, P=0.02), with no overall significant differences observed in escalation to veno-arterial extracorporeal membrane oxygenation, 30-day mortality, renal replacement therapy post-IABP, or rates of heart transplantation. IABP devices in those with HF-CS and low or abnormal PAPi may provide modest short-term haemodynamic benefits without significant improvement in CI, along with greater need for adjustment in medical therapeutics to achieve haemodynamic optimization.

Maternal vascular indices at 36 weeks' gestation in pregnancy with small or growth-restricted fetus.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by delivery of a small-for-gestational-age (SGA) or growth-restricted (FGR) neonate. This was a prospective observational study of women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics, medical history, vascular indices and hemodynamic parameters, which were obtained using a non-invasive operator-independent device and included pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. Women with hypertensive disorders of pregnancy were excluded. SGA was diagnosed if birth weight was < 10th percentile. FGR was diagnosed if, in addition to birth weight < 10th percentile, at the 35-37-week scan, uterine artery or umbilical artery pulsatility index (PI) was > 95th percentile or fetal middle cerebral artery PI was < 5th percentile. Among the 6413 women included in the study, there were 605 (9.4%) cases of SGA, 133 (2.1%) cases of FGR and 5675 (88.5%) cases that were unaffected by SGA or FGR. Women with SGA or FGR, compared to unaffected pregnancies, had increased peripheral vascular resistance and reduced cardiac output. Central systolic and diastolic blood pressure were increased in the FGR group compared with the unaffected group. Aortic stiffness, as assessed by pulse-wave velocity, and augmentation index did not differ between affected and unaffected pregnancies. In the FGR group, compared with the SGA group, central systolic and diastolic blood pressure were higher, whereas heart rate was lower. SGA and FGR pregnancies exhibit deranged maternal hemodynamic responses compared with unaffected pregnancies. Pregnancies with FGR have higher central blood pressure compared to those with SGA, but it remains unclear whether these differences are driven by the size of the fetus or pathological fetal growth. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

A comparison of the effects of nifedipine and indomethacin used in preterm labor tocolytic treatment on feto-maternal Doppler ultrasonography flow.

To compare the effects of nifedipine and indomethacin, used for tocolytic purposes in the treatment of preterm labor (PTL), on fetal-maternal Doppler blood flows and perinatal outcomes. Eighty pregnant women between weeks 24 and 32 of gestation who used nifedipine (n = 40) and indomethacin (n = 40) as tocolytic treatments due to PTL were prospectively and consecutively included in the study. Sociodemographic, obstetric, and laboratory and Doppler flow parameters were compared between the groups. Statistically significant differences were observed between the groups in terms of gestational age at delivery and birth weight, Doppler flows (umbilical artery (UA) Pulsatility Index (PI), and UA Resistance Index (RI)) at 12, 24, and 48 h, middle cerebral artery RI at 12 h, and ductus venosus (DV) PI and DV-RI at 12, 24, and 48 h (p < 0.05). The findings of this study showed that nifedipine and indomethacin used in the treatment of PTL had significant effects on UA-PI and UA-RI Doppler flows at 12, 24, and 24 h, MCA-RI Doppler flows at 12 h, and DV-PI and DV-RI Doppler flows at 12, 24, and 48 h. Further studies involving larger numbers of participants are now needed to support these results.

Prioritisation of early pregnancy risk factors for stillbirth: An international multistakeholder modified e-Delphi consensus study

ObjectiveTo identify and prioritise early pregnancy risk factors for stillbirth to inform prognostic factor and model research. Study designWe used a modified e-Delphi method and consultation meeting to achieve consensus. Risk factors for early, late and stillbirth at any gestation identified from an umbrella review of risk factors for stillbirth were entered into a two-stage online Delphi survey with an international group of stakeholders made up of healthcare professionals and researchers.The RAND/ University of California at Los Angeles appropriateness method was used to evaluate consensus. Responders voted on a scale of 1–9 for each risk factor in terms of importance for early, late, and stillbirth at any gestation. Consensus for inclusion was reached if the median score was in the top tertile and at least two thirds of panellists had scored the risk factor within the top tertile. ResultsTwenty-six risk factors were identified from an umbrella review and presented to stakeholders in round 1 of our e-Delphi survey. Round 1 was completed by 68 stakeholders, 79% (54/68) of whom went on to complete the second round. Seventeen risk factors were discussed at the consensus meeting. From the twenty-six risk factors identified, fifteen of these were prioritised for stillbirth at any gestation, eleven for early stillbirth, and sixteen for late stillbirth, across three domains of maternal characteristics, ultrasound markers and biochemical markers. The prioritised maternal characteristics common to early, late, and stillbirth at any gestation were: maternal age, smoking, drug misuse, history of heritable thrombophilia, hypertension, renal disease, diabetes, previous stillbirth and multiple pregnancy. Maternal BMI, access to healthcare, and socioeconomic status were prioritised for late stillbirth and stillbirth at any gestation. Previous pre-eclampsia and previous small for gestational age baby were prioritised for late stillbirth. Of the ultrasound markers, uterine artery Doppler pulsatility index and congenital fetal anomaly were prioritised for all. One biochemical marker, placental growth factor, was prioritised for stillbirth at any gestation. ConclusionsOur prioritised risk factors for stillbirth can inform formal factor-outcome evaluation of early pregnancy risk factors to influence public health strategies on prevention of such risk factors to prevent stillbirth.

Efficacy of butylphthalide in the treatment of patients with stroke attributed to intracranial arterial stenosis.

To explore the clinical efficacy of butylphthalide in treating patients with stroke attributed to intracranial artery stenosis (ICAS). In this retrospective study, records of 163 patients with stroke attributed to ICAS admitted to Jiaxing Second Hospital from January 2021 to January 2023 were retrospectively analyzed. Patients were divided into two groups based on the treatment received: control group (patients received routine treatment, n=55) and observation group (patients treated with butylphthalide on a routine basis, n=58). Changes in levels of cerebrovascular reactivity (CVR), breath-holding index (BHI), pulsatility index (PI), and middle cerebral artery mean flow velocity (Vm) between the two groups before and after treatment were compared. In addition, cognitive function, neurological function, and living ability were compared between the two groups before and after treatment, as well as the overall clinical efficacy of the treatment. The baseline data was comparable between the two groups (P>0.05). After the treatment, CVR, BHI, and Vm indicators in the observation group were significantly higher than those in the control group, while the levels of PI indexes were significantly lower than those in the control group (P<0.05). Montreal Cognitive Assessment (MoCA) and Barthel scale scores of the observation group were significantly higher compared to the control group, while the scores of National Institutes of Health Stroke Scale (NIHSS) were significantly lower (P<0.05). Butylphthalide in addition to routine treatment can effectively improve cerebrovascular reserve function, promote neurological and cognitive dysfunction recovery, and enhance daily living ability of patients with stroke caused by ICAS.

Impact of Sonographer Experience, Insonation Angle, and Bladder Filling on Uterine Artery Doppler Measurements in the First Trimester of Pregnancy.

To investigate the influence of different measurement conditions and ultrasound training level on uterine artery pulsatility index (UtA-PI) measurements as required for combined first trimester preeclampsia (PE) screening. This was a prospective study of consecutive patients with singleton pregnancies presenting for an ultrasound examination between 11 and 14 weeks' gestation. UtA-PI measurements were conducted by residents in training and repeated by experienced sonographers thereafter. UtA-PI measurements were conducted under different examination conditions. First, the trainee sonographers performed transabdominal sagittal and transverse UtA-PI measurements without bladder filling. These measurements were then repeated by the expert sonographers. Additionally, the expert sonographers also performed transvaginal UtA-PI measurements and transabdominal measurements with bladder filling. Statistical analysis was conducted with the statistical software R and included descriptive statistics as well as 2-sided paired t tests. A total of 100 women were included in the study. Mean age was 31.7 ± 4.92 years and mean gestational week was 12.5 ± 0.53 weeks. A total of 56% were nulliparous and 44% were parous. UtA-PI was significantly lower if performed by a sonographer in training versus an experienced sonographer (P = .031). No significant difference was observed in comparing transverse and sagittal techniques (P = .241). There was also no significant difference in transabominal versus transvaginal measurements (P = .806) and with an empty versus full bladder (P = .444). Experience of sonographer has a significant impact on UtA-PI. Supervised onsite training is necessary to improve reliability and consistency of UtA-PI measurements and make PE screening reliable for implementation in a universal screening setting.

Assessing Cerebral Microvascular Volumetric Pulsatility with High-Resolution 4D CBV MRI at 7T.

Arterial pulsation is crucial for promoting fluid circulation and for influencing neuronal activity. Previous studies assessed the pulsatility index based on blood flow velocity pulsatility in relatively large cerebral arteries of human. Here, we introduce a novel method to quantify the volumetric pulsatility of cerebral microvasculature across cortical layers and in white matter (WM), using high-resolution 4D vascular space occupancy (VASO) MRI with simultaneous recording of pulse signals at 7T. Microvascular volumetric pulsatility index (mvPI) and cerebral blood volume (CBV) changes across cardiac cycles are assessed through retrospective sorting of VASO signals into cardiac phases and estimating mean CBV in resting state (CBV0) by arterial spin labeling (ASL) MRI at 7T. Using data from 11 young (28.4±5.8 years) and 7 older (61.3±6.2 years) healthy participants, we investigated the aging effect on mvPI and compared microvascular pulsatility with large arterial pulsatility assessed by 4D-flow MRI. We observed the highest mvPI in the cerebrospinal fluid (CSF) on the cortical surface (0.19±0.06), which decreased towards the cortical layers as well as in larger arteries. In the deep WM, a significantly increased mvPI (p = 0.029) was observed in the older participants compared to younger ones. Additionally, mvPI in deep WM is significantly associated with the velocity pulsatility index (vePI) of large arteries (r = 0.5997, p = 0.0181). We further performed test-retest scans, non-parametric reliability test and simulations to demonstrate the reproducibility and accuracy of our method. To the best of our knowledge, our method offers the first in vivo measurement of microvascular volumetric pulsatility in human brain which has implications for cerebral microvascular health and its relationship research with glymphatic system, aging and neurodegenerative diseases.

Abstract 65: Postpartum Alterations of Middle Cerebral Artery Reactivity and Hemodynamics in a Transgenic Rat Model of Preeclampsia

Evidence suggests that cerebrovascular disease is a leading cause of morbidity and mortality in women with preeclampsia (PE), however the mechanisms are unknown. In a transgenic rat displaying PE-like syndrome (TGA-PE: female transgenic for angiotensinogen mated to male transgenic for renin), we have shown postpartum alterations in cerebrovascular hemodynamics suggesting dysfunctional autoregulation. We hypothesize that impaired middle cerebral artery (MCA) reactivity contributes to the cerebrovascular dysfunction in this model. High frequency ultrasound was used to determine the pulsatility index (PI) of left MCA (LMCA). Vascular responses were studied in isolated segments of LMCA from SD (n= 12) and TGA-PE (n=8) two months post-delivery. Arteries were mounted on a Multi-Wire Myograph for determination of isometric force (USA-DMT). The contractile responses to K + 75 mM and endothelin-1 (ET-1, 10 -11 -10 -7 M) were measured in basal tone. Vasodilatory responses to acetylcholine (ACh, 10 -11 -10 -4 M) were determined in arteries pre-constricted with the thromboxane agonist U46619 (10 -7 M); the maximal response ( R MAX ) and sensitivity (pD 2 =-Log[EC 50 ]) were analyzed. Our data show that systolic blood pressures were elevated in TGA-PE versus SD at 2 months post-delivery (144.9±2.7 vs. 118.4±2.5, p&lt;0.05; n=10-19). However, the PI was lower in TGA-PE vs. SD (0.96±0.05 vs. 1.31±0.06; p&lt;0.05, n=8-13). No differences in basal tone of MCA segments were observed, whereas TGA-PE arteries displayed a lower optimal diameter (175±4 μm vs. 217±4 μm; p&lt;0.05) and a lower response to K + (0.85±0.11 vs. 1.29±0.1 mN/mm; p&lt;0.05) compared to SD. Vasodilatation to acetylcholine was similar (ACh MAX : 79±8 vs. 70±9%) with a lower sensitivity (pD 2 : 5.2±0.1 vs. 6.7±0.4; p&lt;0.05) in TGA-PE. The contractile response to ET-1 was increased in TGA-PE arteries (ET-1 MAX : 159±7 vs. 129±6 % K MAX ; p&lt;0.05) with no differences in sensitivity (pD 2 : 8.8±0.1 vs. 8.9±0.1). Our data demonstrate structural and functional differences in MCA from TGA-PE vs. SD at 2 months postpartum. In addition to a smaller functional diameter, a lower non-receptor dependent contraction may explain the lower resistance of MCA observed in the preeclamptic model. We conclude that attenuated vasodilatory and increased contractile responses of MCA could promote cerebrovascular dysfunction in this model, and that these adaptations may contribute to cerebrovascular pathology in postpartum preeclamptic state. Supported by NIH 1R01HL155420

Competitive flow of bilateral internal thoracic artery Y-graft: Insights from hemodynamics and transit time flow measurement parameters

Recent studies have demonstrated the superior efficacy of bilateral internal thoracic artery (BITA) grafts compared to other graft methods in treating coronary artery disease. Competitive flow (CF) is a primary factor contributing to graft failure in the long term. For the first time, the CF of the BITA-Y graft has undergone rigorous numerical analysis. Through the application of transit time flow measurement (TTFM) and hemodynamic parameters, this study provides a new perspective on graft performance. Simulation results indicate that average flow, TTFM, and hemodynamic parameters fall within the critical range for stenosis severities below 90%. Specifically, at 80% stenosis, the mean graft flow (MGF) and pulsatility index (PI) of the left internal thoracic artery (LITA) were 0.071 cc/s and 27, respectively, while those of the right internal thoracic artery (RITA) were 0.211 cc/s and 11. With increasing stenosis severity, TTFM parameters remained within the clinical permissible limit (MGF &amp;gt; 0.34 cc/s and PI &amp;lt; 5). At 95% stenosis severity, the MGF and PI for LITA were 0.526 cc/s and 1.2, respectively, while those for RITA were 0.790 cc/s and 0.9. The results indicate the presence of competitive flow within the BITA-Y graft for stenosis severities below 90% area reduction, suggesting a potential risk of graft failure in the long term. Additionally, the results indicated that when there are significant differences in stenosis severity between the two native arteries, the BITA-Y graft is not optimal due to CF, characterized by low MGF and high reverse flow.

Cook’s balloon versus dinoprostone for Labour induction of term pregnancies with fetal GROWth restriction: study protocol for a randomised controlled trial in tertiary maternity hospitals in Spain (COLIGROW study)

IntroductionFetal growth restriction (FGR) affects about 3%–5% of term pregnancies. If prenatally detected and anterograde umbilical artery flow is preserved (stage I), it is recommended to deliver at term (≥...

Prognostic Significance of Hemodynamics in Patients With Transposition of the Great Arteries and Systemic Right Ventricle.

Patients with transposition of the great arteries (TGA) and systemic right ventricle often confront significant adverse cardiac events. The prognostic significance of invasive hemodynamic parameters in this context remains uncertain. Our hypothesis is that the aortic pulsatility index and hemodynamic profiling utilizing invasive measures provide prognostic insights for patients with TGA and a systemic right ventricle. This retrospective multicenter cohort study encompasses adults with TGA and a systemic right ventricle who underwent cardiac catheterization. Data collection, spanning from 1994 to 2020, encompasses clinical and hemodynamic parameters, including measured and calculated values such as pulmonary capillary wedge pressure, aortic pulsatility index, and cardiac index. Pulmonary capillary wedge pressure and cardiac index values were used to establish 4 distinct hemodynamic profiles. A pulmonary capillary wedge pressure of ≥15 mm Hg indicated congestion, termed wet, while a cardiac index <2.2 L/min per m2 signified inadequate perfusion, labeled cold. The primary outcome comprised a composite of all-cause death, heart transplantation, or the requirement for mechanical circulatory support. Of 1721 patients with TGA, 242 individuals with available invasive hemodynamic data were included. The median follow-up duration after cardiac catheterization was 11.4 (interquartile range, 7.5-15.9) years, with a mean age of 38.5±10.8 years at the time of cardiac catheterization. Among hemodynamic parameters, an aortic pulsatility index <1.5 emerged as a robust predictor of the primary outcome, with adjusted hazard ratios of 5.90 (95% CI, 3.01-11.62; P<0.001). Among the identified 4 hemodynamic profiles, the cold/wet profile was associated with the highest risk for the primary outcome, with an adjusted hazard ratio of 3.83 (95% CI, 1.63-9.02; P<0.001). A low aortic pulsatility index (<1.5) and the cold/wet hemodynamic profile are linked with an elevated risk of adverse long-term cardiac outcomes in patients with TGA and systemic right ventricle.

The Association between the Severity of Distal Sensorimotor Polyneuropathy and Increased Carotid Atherosclerosis in Individuals with Type 2 Diabetes.

Diabetes contributes to a spectrum of complications encompassing microvascular and macrovascular disorders. This study aimed to explore the correlation between distal sensorimotor polyneuropathy (DSPN) severity and heightened carotid atherosclerosis among individuals with type 2 diabetes mellitus (T2DM). Method: Participants underwent comprehensive assessments including nerve conduction studies (NCS), Toronto Clinical Neuropathy Score (TCNS) evaluations, assessment of cardiometabolic risk factors, and carotid sonography studies covering dynamic and morphological parameters. The resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) in both the common carotid artery (CCA) and internal carotid artery (ICA), carotid intima-media thickness (IMT), and carotid plaque score (CPS) were also measured. Peripheral nerve function severity was assessed using composite amplitude scores (CAS) derived from NCS. Individuals with DSPN exhibited lower EDV in the CCA and ICA (p < 0.0001 and p = 0.002), higher PI and RI in both CCA and ICA (all p < 0.0001), and higher CPS (p = 0.002). They also demonstrated a higher prevalence of retinopathy as an underlying condition, higher index HbA1c, and reduced estimated glomerular filtration rate (eGFR) (all p < 0.0001). Multiple linear regression analysis revealed significant associations where eGFR, ICA-PI, index HbA1c, waist circumference, and age were correlated with CAS. Meanwhile, diabetes duration, waist circumference, age, and index HbA1c showed significant associations with TCNS. Our study suggests that individuals with T2DM who exhibit more severe carotid atherosclerosis may not only be at increased risk of developing DSPN but also may experience greater severity of DSPN. PI in both the CCA and ICA, along with the CPS, serve as surrogate biomarkers for DSPN severity.

Intra-ovarian Doppler artery indices values in cases with polycystic ovarian syndrome: a case control study

Background and objective: polycystic ovarian syndrome (PCOS) is the most common female endocrine disorder during their reproductive age which results in hyperandrogenism and anovulation or oligo-ovulation. Significant changes occur in ovarian vascularization at the level of the intra ovarian arteries in PCOS patients. The objective is to assess Doppler hemodynamic changes in ovarian stromal arteries in follicular phase of the cycle in both ovaries in women with PCOS compared to normal ovulatory fertile women (control) using transvaginal Color Doppler technique, by calculating intra ovarian Doppler artery indices values: Resistive index (RI) and pulsatility index (PI) of both ovaries. Methods: Two hundred women were included in the study. One hundred patients were diagnosed as PCOS (cases) according to Rotterdam’s criteria and another one hundred were normal fertile women (controls). Transvaginal color Doppler technique is used in examining the recruited cases and controls, Doppler indices values of intraovarian stromal arteries were measured. Results: in the current study, the RI and PI of the ovarian stromal artery were lower in women with PCOS (cases) compared to controls. These hemodynamic changes are a predictor for the diagnosis of PCOS. Conclusion: Doppler ultrasonography was a successful tool in assessing the hemodynamic changes in PCOS women.

Dynamic assessment of left ventricular coupling and myocardial reserve in patients with cardiogenic shock.

Pulmonary artery catheter haemodynamics are associated with improved survival in cardiogenic shock (CS). We investigated the utility of aortic pulsatility index (API) and cardiac power output (CPO) as surrogates for left ventricular (LV) coupling and myocardial reserve, respectively, in patients with CS undergoing dynamic assessment after a milrinone bolus. Patients with SCAI Stage C CS underwent a milrinone drug study (50 mcg/kg bolus infused over 10 min) to assess inotropic response. Haemodynamic measurements were obtained at baseline and following the bolus. Aortic pulsatility index and CPO were used to risk-stratify patients with the incidence of LV assist device (LVAD), orthotopic heart transplantation (OHT), or death at 1 year as the primary composite endpoint. Two hundred and twenty-four patients in SCAI Stage C CS underwent haemodynamics prior to milrinone bolus, and 117 patients had low baseline API < 1.45. Of the 117 patients, 88 had a final API < 2.2 after milrinone load, consistent with LV decoupling, in which 73% met the composite endpoint. The remaining 29 patients had a final API ≥ 2.2 consistent with LV recoupling, and only 55% met the composite endpoint (P = 0.046). Of the 117 patients, 40 patients had low myocardial reserve (final CPO < 0.77 W), in which 78% met the composite endpoint. Of the 77 patients who demonstrated myocardial reserve (final CPO ≥ 0.77 W), only 64% met the composite endpoint (P = 0.039). The use of API and CPO in a dynamic assessment after provocative testing led to improved risk stratification in patients with SCAI Stage C CS for clinical outcomes including LVAD, OHT, or death at 1 year.

Evaluation of Ophthalmic Artery Doppler Parameters in Preeclamptic and Normotensive Pregnant Women.

Preeclampsia, whose pathophysiology is still not fully elucidated today, is a pregnancy-specific disease that affects most organ systems in pregnant women, including the central nervous system. In this context, we aimed to investigate the effects of preeclampsia on blood flow in the ophthalmic artery of the eye, which is considered a part of the central nervous system. This prospective, non-interventional cohort study was conducted between February 2022 and June 2022 at Umraniye Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey. Forty-six normotensive healthy pregnant women constituted the control group and 46 preeclamptic pregnant women constituted the preeclampsia group. Prenatal follow-up and delivery of the participants were carried out in our clinic. First, an obstetric ultrasound was performed on all participants with the same ultrasound device and the same clinician. Then, Doppler measurements of the ophthalmic artery of both eyes were made by the same clinician using the linear probe of the same ultrasound. Both groups were compared in terms of the first peak of systolic velocity (PSV), second PSV, pulsatility index (PI), PSV ratio, end-diastolic velocity (EDV), resistance index (RI), and systolic/diastolic ratio (S/D) measurements of the ophthalmic artery. RESULTS : The first PSV, second PSV, PSV ratio, and EDV were significantly higher in the preeclampsia group than in the control group (p=0.001, p<0.001, p=0.019, p<0.001, respectively). According to the receiver operating characteristic analysis, the second PSV with a cut-off value of 43.75 cm/s was the most powerful ophthalmic artery Doppler parameter in detecting preeclampsia with 63% sensitivity and 63% specificity. No significant difference was found between the early and late onset or mild and severe preeclampsia groups in terms of ophthalmic artery Doppler parameters. Although the number of participants was too small to draw a definitive conclusion, the second PSV seems to be the most powerful parameter for the detection of preeclampsia. Studies with larger series are needed to determine the usability of ophthalmic artery Doppler parameters in the routine clinical diagnosis of preeclampsia and follow-up of the disease.