Lower End-diastolic Velocities Research Articles

Ultrasonographic Predictors for Post-operative Ischemic Events After Indirect Revascularization Surgeries in Patients with Moyamoya Disease

ObjectiveRecurrent stroke after revascularization surgeries predicts poor outcome in patients with moyamoya disease (MMD). Early identification of patients with stroke risk paves the way for rescue intervention. This study aimed to investigate the role of ultrasound in identifying patients at risk of post-operative ischemic events (PIEs). MethodsThis prospective study enrolled patients with symptomatic MMD who underwent indirect revascularization surgeries. Ultrasound examinations were performed preoperatively and at 3 mo post-operatively to evaluate the hemodynamic changes in extracranial and intracranial arteries on the operated side. PIE was defined as ischemic stroke or transient ischemic attack in the operated hemisphere within 1 y. The areas under receiver operating characteristic curves were compared between models for prediction of PIE. ResultsA total of 56 operated hemispheres from 36 patients (mean age, 23.0 ± 18.5 y) were enrolled in this study, and 27% developed PIE. In multivariate logistic regression models, PIE was associated with lower end-diastolic velocity and flow volume (FV) of the ipsilateral external carotid artery (ECA), and lower FV of ipsilateral superficial temporal artery and occipital artery at 3 mo post-operatively (all p < 0.05). Moreover, the post-operative FV of the ipsilateral ECA was the only one factor that significantly increased the areas under receiver operating characteristic curves from 0.727 to 0.932 when adding to a clinical–angiographic model for prediction of PIE (p = 0.017). This parameter was significantly lower in hemispheres with PIE, both in adult and pediatric patients. ConclusionAfter indirect revascularization, surgeries in patients with symptomatic MMD, FV of ipsilateral ECA at 3 mo helps clinicians to identify patients at risk of PIE.

Correlation between Carotid Blood Flow Velocity and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients with Recent Small Subcortical Infarcts.

The common and internal carotid arteries are the upstream vessels of the small cerebral vessels. The relationship between hemodynamic changes in the significant cervical vessels and cerebral small vessel disease (CSVD) remains uncertain. This research sought to analyze the correlation between carotid blood flow velocity and the total magnetic resonance imaging (MRI) burden of CSVD in patients with recent small subcortical infarcts (RSSIs). Data were gathered from individuals diagnosed with RSSIs admitted to Changzhou Second People's Hospital between January 2022 and June 2023. Brain MRI was performed on every patient to determine the overall MRI burden of CSVD, along with carotid duplex ultrasound to evaluate carotid blood flow velocity and pulsatility index (PI) of the common carotid (CCA) and internal carotid (ICA) arteries. The association between carotid blood flow velocity and the total MRI load of CSVD was examined using univariate and multivariate analyses. For our investigation, 272 individuals with RSSIs were screened. 82 individuals had a moderate to severe load of CSVD, while 190 participants showed a mild burden. Patients with moderate to severe burden of CSVD had lower end-diastolic velocity (EDV) and higher PI in CCA and ICA than those with mild load (P < 0.001). After adjusting for variables like age, hypertension, systolic blood pressure, and blood homocysteine levels, multivariate logistic regression analysis showed that EDV in CCA (OR, 0.894; P = 0.011), PI in CCA (OR, 5.869; P = 0.017), EDV in ICA (OR, 0.909; P = 0.008), and PI in ICA (OR, 5.324; P = 0.041) were independently related to moderate to severe CSVD burden. Spearman correlation analysis showed that EDV in CCA and ICA was negatively related to the total MRI load of CSVD in patients with RSSIs (P < 0.001). PI in CCA and ICA was positively associated with the whole MRI load of CSVD (P < 0.001). Low carotid blood flow velocity and high carotid pulsatility index are independently associated with moderate to severe burden of CSVD.

Orbital blood vessels changes on color duplex imaging in diabetics with and without diabetic retinopathy

To compare changes in ophthalmic artery (OA) and its branches in diabetics with and without diabetic retinopathy (DR) using color duplex imaging (CDI), and to correlate these changes with the disease variables. 60 eyes of 60 diabetic patients were enrolled, divided into 3 groups: without DR (Group A), with Non-Proliferative DR (Group B) and with Proliferative DR (PDR) (Group C). Laboratory testing including HbA1c was done. Patients underwent CDI, by which OA, Central Retinal Artery (CRA) and Ciliary Arteries were identified; for each of them we measured Peak systolic velocity (PSV), End Diastolic velocity (EDV) and Resistivity Index (RI). Results were compared to clinical, laboratory and fundus examination. OA EDV was significantly lower and OA RI was found to be significantly higher in Group C (p = 0.027 and 0.025 respectively). CRA PSV and EDV were significantly lower in Group C (p = 0.017 and 0.001 respectively). PCA RI was significantly higher in Group C (p = 0.008). HbA1c was negatively correlated with CRA PSV (p = 0.041), also it was negatively correlated with CRA EDV (p = 0.0001), as well as with PCA EDV (p = 0.002). There was direct significant correlation between HbA1c and PCA RI (p = 0.012). Duration since diagnosis was negatively correlated with CRA EDV (p = 0.004). Multivariate linear regression showed that DR is an independent predictor for low OA EDV, high OA RI, low CRA EDV and high PCA RI. DR is an independent risk factor for orbital and ocular vessels flow alteration, thus can be used as a prognostic tool in diabetic patients. CDI can be reliably used in diabetics to predict early changes or progression of DR.

Investigating the risk factors of penile arterial insufficiency and veno-occlusive dysfunction in patients with erectile dysfunction.

To investigate the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED). Patients who attended our urology clinic complaining of ED for more than 6 months were prospectively enrolled in this study over 1-year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie's disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile and glycated haemoglobin (HA1c). A penile duplex ultrasound study (PDU) was done for all patients after intracavernosal injection (ICI) with alprostadil. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured after 15 min. Statistical analysis was done using SPSS. A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r= -0.361, P= 0.000) and higher EDV (r= 0.174, P= 0.001), and both correlations were highly statistically significant. Diabetics had lower PSV (r= -0.318, P= 0.000) and higher EDV (r= 0.139, P= 0.008), which were also highly statistically significant. Smokers had lower PSV (r= -0.140, P= 0.008) and higher EDV (r= 0.178, P= 0.001), which were highly statistically significant. Men with larger penises measured skin to tip had lower EDV (r= -0.119, P= 0.024), which was less significant. Interestingly, there was neither a significant correlation between BMI and PSV (0.16, P= 0.745) nor a significant correlation between testosterone and PSV (0.029, P= 0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Ageing, tobacco consumption, DM and hypertension seem to have a negative impact on penile haemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile haemodynamics in patients with increased BMI, low testosterone or PD or according to the size of the penis.

(124) Investigating the Risk Factors of Penile Arterial Insufficiency and Veno-occlusive Dysfunction In Patients with Erectile Dysfunction

Abstract Introduction It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency (PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries. Objective We investigated the risk factors for PAI which is a known cause of erectile dysfunction (ED Methods Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS. Results A total of 440 patients were enrolled in this analysis. The mean age was 48 (23-81), and the mean BMI was 30 (18-51). Older patients had lower PSV (r=-0.361, P=0.000) and higher EDV (r=0.174, P=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, P=0.000) and higher EDV (r=0.139, P=0.008) which were also highly statistically significant. Hypertensive patients had lower PSV (r=-0.296, P=0.000) which was highly statistically significant. Smokers had lower PSV (r=-0.140, P=0.008) and higher EDV (r=0.178, P=0.001) which were highly statistically significant. Men with larger penises measured skin to tip, had lower EDV (r=-0.119, P=0.024) which was less significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD. Conclusions Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction. Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function. Disclosure No

MP45-02 INVESTIGATING THE RISK FACTORS OF PENILE ARTERIAL INSUFFICIENCY AND VENO-OCCLUSIVE DYSFUNCTION IN PATIENTS WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP45-02 INVESTIGATING THE RISK FACTORS OF PENILE ARTERIAL INSUFFICIENCY AND VENO-OCCLUSIVE DYSFUNCTION IN PATIENTS WITH ERECTILE DYSFUNCTION Mohamad Habous, Ahmed Khattak, Mohammed Nassar, Saleh Binsaleh, and Gordon Muir Mohamad HabousMohamad Habous More articles by this author , Ahmed KhattakAhmed Khattak More articles by this author , Mohammed NassarMohammed Nassar More articles by this author , Saleh BinsalehSaleh Binsaleh More articles by this author , and Gordon MuirGordon Muir More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It was reported that a more generalized peripheral atherosclerotic process is associated with a severer penile arterial insufficiency(PAI), and this in turn was correlated well with decreased blood supply in more important arteries like the coronary and carotid arteries.Aim We investigated the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED). METHODS: Patients who attended our urology clinic complaining of ED for more than 6 months, were prospectively enrolled in this study in one year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie’s disease (PD)and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile, and glycated haemoglobin (HbA1c). Penile duplex ultrasound study (PDU) was done for all patients after intra-cavernosal injection (ICI) with Alprostadil. peak systolic velocity (PSV)and end diastolic velocity (EDV) were measured after 15 minutes. Statistical analysis was done using SPSS. RESULTS: A total of 440 patients were enrolled in this analysis. The mean age was 48(23-81), and the mean BMI was 30(18-51). Older patients had lower PSV (r=-0.361, p=0.000) and higher EDV (r=0.174, p=0.001) and both correlations were highly statistically significant. Diabetics had lower PSV (r=-0.318, p=0.000) and higher EDV (r=0.139, p=0.008) which were also highly statistically significant. Smokers had lower PSV (r=-0.140, p=0.008) and higher EDV (r=0.178, p=0.001) which were highly statistically significant. Men with longer penises measured skin to tip, had lower EDV (r=-0.119, p=0.024) which was also significant. Interestingly there was neither significant correlation between BMI and PSV (0.16, p=0.745) nor significant correlation between testosterone and PSV (0.029, p=0.552). Also, there was no correlation between PSV and either dyslipidaemia or Peyronie’s disease. CONCLUSIONS: Our study highlights key risk factors - Increased age, tobacco consumption, DM and hypertension - are factors that have a statistically significant negative impact on penile haemodynamics. Of these, tobacco consumption, good diabetic control and hypertension are potentially modifiable and should form part of any treatment plan for erectile dysfunction.Other risk factors – increased BMI, low testosterone, PD and penile size – had no statistically significant impact on penile hemodynamics. This allows for targeted advice that can be given to patients who present with this very common problem. Ultimately, good vascular health goes hand in hand with good erectile function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e621 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamad Habous More articles by this author Ahmed Khattak More articles by this author Mohammed Nassar More articles by this author Saleh Binsaleh More articles by this author Gordon Muir More articles by this author Expand All Advertisement PDF downloadLoading ...

MP79-11 A SHAM-CONTROLLED RANDOMIZED TRIAL OF LOW INTENSITY SHOCKWAVE THERAPY FOR ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP79-11 A SHAM-CONTROLLED RANDOMIZED TRIAL OF LOW INTENSITY SHOCKWAVE THERAPY FOR ERECTILE DYSFUNCTION Irwin Goldstein, Sue W. Goldstein, and Noel N. Kim Irwin GoldsteinIrwin Goldstein More articles by this author , Sue W. GoldsteinSue W. Goldstein More articles by this author , and Noel N. KimNoel N. Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We performed a sham-controlled, randomized prospective trial in men with ED using an electrohydraulic shockwave device FDA cleared for connective tissue activation and improved blood flow. METHODS: This single-blind study was performed in men with ED naïve to acoustic wave and shockwave therapy. Patients were randomized to treatment and assigned to active low intensity shockwave therapy (LiSWT) (4 Hz, 0.12 mJ/mm2) or sham treatment, 2:1. Arm 1 consisted of 3 treatments of 5000 shocks every 3 weeks. Arm 2 consisted of 5000, 3000, and 3000 shocks during weeks 1, 2, and 3, respectively, followed by an identical cycle of treatment 3 weeks later. Doppler ultrasound and grayscale imaging with a 15.4 MHz probe were performed under pharmacologic erection at weeks 20 and 32. Subjects completing sham treatment were unblinded and crossed over to the opposite arm for active treatment. Post-treatment end diastolic velocity (EDV) and peak systolic velocity (PSV) were measured, and visual grading scores were used to assess extent of hypoechoic regions in the corpora cavernosa. Data were analyzed by 2-way repeated measures ANOVA with Geisser-Greenhouse correction. Pairwise comparisons were performed to baseline used Dunnett’s multiple comparison test. Missing data were imputed by “last observation carried forward”. RESULTS: Although powered for 60, recruitment was limited due to COVID and 36 subjects (22 active, 14 sham) were randomized. Sham treatments showed no significant changes in outcome measures. The number of subjects with improved visual grading scores in the proximal region was consistently higher in active LiSWT vs sham (Arm 1=88.9% vs. 11.1%; Arm 2=40.0% vs. 20.0%, respectively) with statistical significance in Arm 1 at weeks 20 (p=0.005) and 32 (p=0.001). Sham subjects rolled over to active LiSWT also had improved grayscale ratings (Arm 1=33.3% vs. 11.1%; Arm 2=40.0% vs. 20.0%). After LiSWT, greater numbers of patients had higher PSV, lower EDV, or no worsening of blood flow parameters relative to baseline. Decrease in EDV was statistically significant in active treatment Arm 2 at Week 32 (p=0.003). Mean IIEF-EF scores were nominally higher in subjects in active treatment who had improved visual grading scores vs those with no improvement. Adverse events were transient. CONCLUSIONS: Flaccid penile LiSWT appears to be safe and efficacious for treating ED based on statistically significant changes from baseline between sham and active treatments in primary outcome measures. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1145 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Irwin Goldstein More articles by this author Sue W. Goldstein More articles by this author Noel N. Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Analysis of the Optic Nerve Head Microcirculation Using Optical Coherence Tomography Angiography and the Upstream Macrocirculation Using Color Doppler Imaging in Low-Tension and High-Tension Glaucoma Patients

Introduction: The aim of the study was to analyze the optic nerve head (ONH) microcirculation using optical coherence tomography angiography (OCT-A) and the upstream macrocirculation using color Doppler imaging (CDI) in low-tension and high-tension glaucoma (LTG and HTG, respectively). Methods: This cross-sectional study included 67 eyes of 67 HTG patients, 55 eyes of 55 LTG patients, and 42 eyes of 42 healthy controls. We recorded the complete ophthalmological examination, visual fields, retinal nerve fiber layer (RNFL) thickness, ONH vessel density (VD) measured using OCT-A, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) measured using CDI. SPSS software was used for data analysis. Data are presented as mean ± standard deviation or median (interquartile range) and compared using t test or Mann-Whitney U test, as appropriate. Pearson χ2 test or Fisher’s exact test was used for comparisons, as appropriate. Pearson correlation analysis was used to evaluate the correlations between variables. p < 0.05 was considered statistically significant. Results: The ONH VD and RNFL thickness were considerably lower in glaucomatous eyes than in healthy eyes (both p < 0.001). Compared with the HTG group, the LTG group had lower VD in the peripapillary region (p = 0.027). Compared with the healthy group, the HTG group had lower PSV (p = 0.029 and = 0.023, respectively), lower EDV (p = 0.023 and <0.001, respectively), and higher RI (p = 0.019 and = 0.006, respectively) of the internal carotid artery (ICA) and central retinal artery (CRA). The LTG group had lower PSV (p = 0.015 and <0.001, respectively) and EDV (p = 0.047 and = 0.001, respectively) of the ophthalmic artery (OA) and CRA. The LTG group had lower PSV of CRA than the HTG group (p = 0.034). In glaucomatous eyes, peripapillary VD had a significant association with the mean defect (p < 0.001) and RNFL thickness (p < 0.001), but not with the other CDI indices (all p > 0.05). Conclusion: The ONH microcirculation and upstream macrocirculation of the large arteries exhibited differences in the blood flow characteristics between the LTG and HTG groups. These differences may improve our understanding of glaucoma. There was no correlation between the characteristics of the ONH microcirculation and the upstream macrocirculation of large vessels in the LTG and HTG groups.

End-diastolic velocity mediates the relationship between renal resistive index and the risk of death.

Renal resistive index predicts the risk of death in many populations but the mechanism linking renal resistive index and death remains elusive. Renal resistive index is derived from end-diastolic velocity (EDV) and peak systolic velocity (PSV). However, the predictive value of EDV or PSV considered alone is unknown. We conducted a retrospective analysis of 2362 consecutive patients who received a kidney transplant from 1985 to 2017. EDV and PSV were measured at 3 months after transplantation, renal resistive index was calculated, and the risk of death was assessed [median follow-up: 6.25 years (0.25-29.15); total observation period: 13 201 patient-years]. Doppler indices were available in 1721 of 2362 (78.9%) patients (exclusions: 113 who died or returned to dialysis before, 427 with no Doppler studies, 27 with renal artery stenosis, 74 missing values). Among them, 279 (16.4%) had diabetes before transplantation. Mean age was 51.5 ± 14.7, 1097 (63.7%) were male. During follow-up, 217 of 1721 (12.6%) patients died. Renal resistive index and EDV shared many determinants (notably systolic, diastolic and pulse pressure, recipient age and diabetes) unlike renal resistive index and PSV. EDV used as a binary [lowest tertile vs. higher values: (hazard ratio: 2.57 (1.96-3.36), P < 0.001)] and as a continuous (the lower EDV, the greater the risk of death) variable was significantly associated with the risk of death. This finding was confirmed in multivariable analyses. Prediction of similar magnitude was found for renal resistive index. No association was found between PSV used as a binary or a continuous variable and the risk of death. Low EDV explains high renal resistive index, and the mechanism-linking renal resistive index to the risk of death is through low EDV.

Retrobulbar blood flow velocity in systemic lupus erythematosus assessed by color Doppler imaging.

To analyze the blood flow in retrobulbar vessels in systemic lupus erythematosus (SLE) by color Doppler imaging (CDI) and to investigate the associations between immunological markers, retinal abnormalities, disease activity, and vascular parameters. We examined 30 patients with SLE who were aged 32.1 ± 11.6years with a disease duration of 68.0 ± 55.6months and 30 participants in a control group. The peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) of the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary arteries (PCAs) were determined. Physical and ophthalmic examinations with assessments of immunological markers were performed. All parameters were compared between SLE patients and normal controls while the correlations among parameters were analyzed. In the SLE group, CDI confirmed blood flow abnormalities in the CRA and PCAs, with significantly lower blood flow velocities and increased RI and PI (p < 0.05). There was a significantly negative correlation between disease duration and EDV in the CRA, PCA, and OA (p = 0.0423, 0.0453, 0.0448). There was also a significant relationship between the SLE Disease Activity Index and the PI of the OA (p = 0.0367). The patients who had received biological agents (Rituximab) had lower EDV in the CRA and PCA (p = 0.0026, 0.028). SLE patients with kidney or CNS involvement had a significant increase in the PI in the OA (p = 0.0287). The PSV and EDV in the CRA were significantly related to creatinine (p = 0.0007 and 0.0418). We also noted a significant decreased EDV in the CRA and an increased RI in the OA among participants positive for anti-dsDNA antibodies (p = 0.0331 and 0.0228). Retrobulbar circulatory disturbances were detected in SLE patients by CDI. These findings seem likely to affect smaller vessels like the CRA and PCA. However, the presence of measurable changes in the OA is generally indicative of a coexistent nephropathy or central nervous system (CNS) vasculitis. Creatinine, the disease activity index, being positive for anti-dsDNA, and receiving biological agents were associated with measurable changes on the retrobulbar blood flow.

Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis.

Giant cell arteritis (GCA) is a primary autoimmune vasculitis that specifically affects medium-sized extracranial arteries, like superficial temporal arteries (TAs). The most important data to be considered for the ultrasound (US) diagnosis of temporal arteritis are stenosis, acute occlusions and “dark halo” sign, which represent the edema of the vascular wall. The vessel wall thickening of large vessels in GCA can be recognized by the US, which has high sensitivity and is facile to use. Ocular complications of GCA are common and consist especially of anterior arterial ischemic optic neuropathies or central retinal artery occlusion with sudden, painless, and sharp loss of vision in the affected eye. Color Doppler imaging of the orbital vessels (showing low-end diastolic velocities and a high resistance index) is essential to quickly differentiate the mechanism of ocular involvement (arteritic versus non-arteritic), since the characteristics of TAs on US do not correspond with ocular involvement on GCA. GCA should be cured immediately with systemic corticosteroids to avoid further visual loss of the eyes.

A sex specific approach of ophthalmic and middle cerebral arteries Doppler in smokers

Vascular dysfunctions can progress and lead to stroke and cardiovascular disease, especially in smokers. The presence of particular vascular changes according to sex has been described and they can be identified by the Doppler method. This study evaluated Doppler velocimetry parameters of the Ophthalmic Artery (OA) and the Middle Cerebral Artery (MCA) according to sex in smokers regarding a non-smoker group. This cross-sectional observational study included 178 subjects: 93 women and 85 men. Doppler parameters were assessed in OA and MCA. Student’s t-test was used, with p < 0.05. There were no significant differences in OA and MCA Doppler velocimetry data between male non-smokers and smokers. However, female smokers presented several differences compared with non-smokers: lower pulsatility index (PI) and higher peak ratio in OA, and higher PI and resistance index and lower end diastolic velocity in MCA. There were different brain vascular waveforms in the group of female smokers compared with non-smokers. Cigarette smoking also led to opposite arterial patterns in OA and MCA in the female group, with signs of falling impedance in OA and increased impedance in MCA. An individualized approach regarding arterial changes according to sex is desirable.

Association of carotid ultrasonography with perioperative stroke after thoracic aortic aneurysm treatment: a retrospective study.

The purpose of this study was to verify whether carotid ultrasonography (CUS) findings could be associated with the occurrence of perioperative stroke after thoracic aortic aneurysm (TAA) treatment. Patients with TAAs who were treated by either total arch replacement or thoracic endovascular aortic repair (TEVAR) were retrospectively enrolled. Left subclavian artery (LSA) embolization and bypass surgery of the left common carotid artery (CCA) to the LSA before TEVAR were additionally performed for some patients. CUS was performed before TAA treatment to evaluate carotid atherosclerosis and flow velocities of bilateral cervical arteries. After dividing patients into those with and without perioperative stroke, their background, atherosclerotic risk factors, history of stroke, TAA location and size, treatment procedures, and CUS parameters were compared between the two groups. Of the 60 patients (18 women, 42 men; mean age 73.5 ± 10.2years) with TAA, four (7.5%) developed perioperative stroke. There were no significant differences in the patients' characteristics and their TAAs between those with and without perioperative stroke. For the CUS parameters, end-diastolic velocity (EDV) of bilateral CCAs was significantly decreased in perioperative stroke patients (with vs without stroke; right: 9.2 ± 1.8 vs. 14.5 ± 4.6cm/s, P = 0.025, left: 9.1 ± 0.3 vs. 15.0 ± 4.5cm/s, P = 0.012), whereas the resistance index (RI) of bilateral CCAs was significantly elevated (right: 0.76 vs. 0.87, P = 0.008, left: 0.76 vs. 0.87, P < 0.001). Lower EDV and higher RI of bilateral CCAs were significantly associated with perioperative stroke after TAA treatment. Thus, CUS findings may help predict the occurrence of perioperative stroke.

Associations of Blood Pressure and Carotid Flow Velocity with Brain Volume and Cerebral Small Vessel Disease in a Community-Based Population.

Cerebral small vessel disease (CSVD) is a common finding on brain magnetic resonance imaging (MRI). We previously demonstrated that high blood pressure (BP) and low carotid flow velocity were associated with cerebrovascular disease. However, their associations with brain volume and CSVD remain to be determined. A total of 721 adults (≥ 50years) from the community-based I-Lan Longitudinal Aging Study were included. Flow velocities at the common (CCA) and internal carotid artery (ICA), including peak systolic velocity (PSV) and end-diastolic velocity (EDV), were measured with Doppler ultrasound. We further detected the presence of CSVD including lacune, microbleed, and white matter hyperintensity (WMH) on brain MRI, which were used to construct a combined CSVD score. General linear regression and logistic regression analysis were exploited to evaluate the association between carotid flow velocity, BP, brain volume, and CSVD. The mean of white matter, gray matter, and WMH volume were 422.2cm3, 546.9cm3, and 2.61cm3, respectively. The proportion of lacune and microbleed were 11.1% and 14.2%, respectively. The CSVD score were negatively associated with gray (r = - 0.121, p < .01) and white matter volume (r = 0.058, p = 0.12), but positively associated with systolic BP (beta = 1.02, p = 0.0017). EDV at common carotid artery associated positively with white matter volume (beta = 1.013, p = 0.0064) and negatively predicted the presence CSVD (odds ratio [OR] = 0.93, p = 0.0023). In the ordinal logistic regression analysis adjusting for age, sex, total intracranial volume education, low-density lipoprotein cholesterol, and fasting glucose, compared with hypertensive subjects with low EDV, normotensive subjects with low, middle, and high EDV had an odds ratio of 0.656 (0.327-1.318), 0.429 (0.261-0.705), and 0.272 (0.147-0.502) for CSVD score, respectively. High SBP and low carotid flow velocities were independently associated with brain volume and CSVD. These associations may be involved in the pathophysiology of cognitive function decline.

Ovarian and uterine arteries blood flow waveform response in the first two cycles following superstimulation in cows

To investigate the ovarian and uterine blood flow responses, hemodynamic, circulating ovarian hormones and nitric oxide (NO) after end of treatment by Folltropin. Holstein Friesian (12) cows previously synchronized with CIDR underwent Doppler ultrasound after administrating of FSH daily for 4days in eight injections started on day 10 of the second ovulation (day -5). Oestradiol (E2), progesterone (P4) and nitric oxide (NOMs) were measured. During the follicular phase, follicle area and antrum area of the second cycle reached maximum value on the day of ovulation compared with that in the first cycle, while during the luteal phase, both showed a pattern of increase and decrease. The luteal area and total coloured area increased till day 10 in the first and second cycle. The first cycle ipsilateral ovarian artery (Ov.A) had higher pulsatility (PI) (p=.001), resistance (RI) (p=.001), peak velocity (PSV) (p=.009) and lower end-diastolic velocity (EDV) (p=.003) compared with the second cycle. The increased ipsilateral Ov.A PSV (p=.009) was accompanied by lower EDV. The first cycle ipsilateral middle uterine artery (MUA) had higher PI (p=.001) and RI (p=.001), with lower PSV (p=.001) and EDV (p=.001). It was concluded that blood flow of ovarian and middle uterine arteries changed after the end of superstimulation as the increased ipsilateral Ov. A and MUA PSVs accompanied by lower EDV and both Doppler indices that reflect the amount of ovarian and uterine blood flow waveform.

A Comparison of Doppler Flow Parameters in the Ophthalmic Artery and Central Retinal Artery in Patients With Graves' Disease and Toxic Nodular Goiter.

Purpose: Despite unquestionable clinical usefulness of Clinical Activity Score, the evaluating system needs frequent supplementation. One of such diagnostic tools is Doppler imaging that is used for the analysis of flow in the retrobulbar vessels. The improvement of the reliability and sensibility of measurements could make Doppler imaging an everyday clinical tool and improve the efficacy of treatment in patients with active thyroid-associated orbitopathy. However, the systemic influence of hyperthyroidism on the orbital vessels can falsify the assessment of local inflammation severity.Methods: To eliminate the influence of systemic hyperthyroidism on orbital vessels, we compared peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) in the central retinal artery (CRA), and ophthalmic artery (OA) in patients with hyperthyroidism in the course of Graves' disease without any detectable orbital changes, (CAS = 0) and toxic nodular goiter.Results: There were no statistically significant differences between the patients with Graves' disease and toxic nodular goiter in terms of the examined parameters in either of the arteries. However, higher PSV and RI and lower EDV in the CRA as well as higher PSV and EDV and unchanged RI in the OA were found in the patients with Graves' diseases and toxic nodular goiter.Conclusion: Hyperthyroidism and hyperthyroidism-induced hyperkinetic flow have a systemic influence on the orbital vessels, irrespective of the cause of hyperthyreosis. Thus, it is necessary to compare the flow parameters in retrobulbar vessels in Graves' patients with the toxic nodular goiter patients to eliminate the systemic influence of hyperthyroidism on the orbital vessels.

Abstract WMP67: Arterial Velocity on Carotid Ultrasonography Can Predict the Stenosis Progression in Patients With Vertebro-basillar Dissection

Purpose: Morphological changes of affected arteries in intracranial artery dissection often occur in the acute phase. The usefulness of carotid ultrasonography (CU) to evaluate the changes is not well investigated. The purpose of this study was to assess the value of CU indexes to detect artery stenosis progression on magnetic resonance angiography (MRA). Methods: This is a retrospective, single-center, observational study. We enrolled patients with intracranial vertebro-basilar artery dissection diagnosed based on criteria by the expert group (Debette S, et al: Lancet Neurol 2015) who were admitted within 30 days after onset from 2011 January to 2017 June. Carotid ultrasonography was performed on admission (median 0 days after onset) and follow-up (median, 40 days after onset; interquartile range, 11-106) to examined the flow velocity of both vertebral arteries. MRA was done on admission and follow-up just before or after the follow-up CU. Two stroke neurologists who were blinded to patients’ information assessed the change of vessel forms on MRA; stenosis progression was defined as an follow-up arterial diameter of &lt;50% as compared to that at baseline on MRA. Patients were divided into two groups: those with stenosis progression (P group ) and the others (non-P group). Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV) and pulsatility index (PI) were measured by CU and each baseline to follow-up ratio (follow-up/baseline) was compared between the two groups. Result: Of 26 patients (11 women, 53±8 years old) who were enrolled, 10 (28%) showed stenosis progression (P group). The P group had lower EDV ratio (0.34±0.63 vs 1.05±0.39, P&lt;0.01) and higher PI ratio (1.95±0.76 vs 0.85±0.30, P&lt;0.01) than the non-P group. Using Receiver Operating Characteristic (ROC) curve analysis, the area under the curve (AUC) of EDV ratio to predict stenosis progression was 0.87 (P&lt;0.01) with the cut-off value of 0.54, sensitivity of 87.5% and specificity of 93.3% and that of PI ratio was 0.93 (P&lt;0.01) with 1.17, 88.9% and 82.3%, respectively. Conclusion: Carotid ultrasonography is useful to predict the chrocnic stenosis progression of vertebra-basilar artery dissection.

Renal artery injury caused by Kawasaki disease

To investigate renal artery injury caused by Kawasaki disease (KD). Forty-three children with KD were enrolled in the study. According to the blood pressure in the acute stage, these children were classified into normal blood pressure subgroup and increased blood pressure subgroup. Eighteen children with fever caused by acute upper respiratory tract infection were enrolled as the control group. The diameter of the origin of the main renal artery, hemodynamic parameters of the main renal artery and the renal interlobar artery, rennin activity, and levels of angiotensin II and aldosterone were compared between groups. During the acute stage of KD, both subgroups had a significantly smaller diameter of the origin of the main renal artery, a significantly higher resistance index (RI) of the main renal artery, and a significantly lower end-diastolic velocity (EDV) than the control group (P<0.05).The increased blood pressure subgroup had a significantly lower EDV of the interlobar artery than the normal blood pressure subgroup, a significantly higher RI than the normal blood pressure subgroup and the control group, as well as a significantly higher rennin activity and significantly higher levels of angiotensin II and aldosterone than the normal blood pressure subgroup (P<0.05). A significantly increased EDV and a significantly reduced RI of the renal interlobar artery were observed in the increased blood pressure subgroup in the subacute stage compared with the acute stage (P<0.05). KD may cause renal artery injury and early hemodynamic changes, resulting in a transient increase in blood pressure in some patients.

Characterization of early changes in fetoplacental hemodynamics in a diet-induced rabbit model of IUGR.

Intrauterine growth restriction (IUGR) is associated with adverse perinatal outcomes and late-onset diseases in offspring. Eating disorders, voluntary caloric restriction and maternal undernutrition can all induce IUGR but a relevant model is required to measure all its possible consequences. In this work, pregnant rabbits were used as an IUGR model. Control females (n=4) received ad libitum diet throughout pregnancy, whereas underfed females (n=5) were restricted to 50% of their daily requirements. Offspring size was measured by ultrasonography and in vivo at birth. Hemodynamic features of the umbilical cords and middle cerebral arteries (systolic peak velocity, end diastolic velocity, pulsatility index and resistance index) were characterized by Doppler ultrasonography. At day 21, maternal underfeeding resulted in a significant reduction of fetal size (occipito-nasal length). At birth, the size of kits from the underfed group was significantly lower (lower crown-rump length, biparietal and transversal thoracic diameters) and a reduced weight with respect to the control group. Feed restriction altered blood flow perfusion compared with does fed ad libitum (significant higher systolic peak, time-averaged mean velocities and lower end diastolic velocity). Fetuses affected by IUGR presented with compensative brain-sparing effects when compared with the control group. In conclusion, the present study supports using rabbits and the underfeeding approach as a valuable model for IUGR studies. These results may help to characterize IUGR alterations due to nutrient restriction of mothers in future research.

Is a Low End-Diastolic Velocity Parameter Enough to Exclude an 80–99% Internal Carotid Artery Stenosis?

Introduction —High resistive internal carotid artery (ICA) waveforms (high peak systolic velocity &gt;250 cm/sec with low end-diastolic velocity (EDV) &lt;125 cm/sec, having an external carotid artery waveform appearance) are uncommon and present a diagnostic challenge for intervention. Most ICA stenotic classifications rely on a greater EDV to delineate a critical stenosis of 80–99%. Methods —Review of a multiple-laboratory, single-center, Intersocietal Accreditation Commission-accredited, noninvasive vascular laboratory database for ICA carotid examinations performed from January 1, 2008 to November 1, 2012, with a positive stenotic range &gt;60%. Medical records, archived ultrasound images, and correlative imaging studies were reviewed. Results —A total of 843 carotid duplex studies (1,686 arteries) positive for &gt;60% stenoses of at least one side were reviewed. There were 102 duplex studies with high resistive ICA waveforms that were identified. Of these, 35 duplex studies had 40 correlative results, and 67 duplex studies did not have any correlative results. Of the 35 correlated duplex studies, median age was 78 years (range, 53–86 years). Gender distribution was 57% male. The median age of the male subjects was 77 years with a range of 63–82 years and the median age of female subjects was 73 years old with a range of 53–86 years. Seven of the 35 patients presented with symptoms of visual disturbance, transient ischemic attack, or syncope (21% symptomatic). Side distribution was 12 males and 8 females had right-side involvement, and 7 males and 7 females had left-side involvement. There was one female patient who had bilateral involvement. This provides us with 36 duplex ultrasound studies to correlate. Mean PSV was 369 cm/sec (range, 187–492 cm/sec). Mean EDV was 89 cm/sec (range 18–130 cm/sec). Average ICA/common carotid artery ratio was 6.2 (range, 3.2–12.5). Correlative computed tomography angiography was available for 12 of the studies, angiography for 10 of the studies, and surgical findings for 18 of the 35 studies. Conclusion —Assessing all Doppler parameter used to categorize an ICA stenotic range may be beneficial in determining the need for patient intervention. Sonographer impression of audible clues and cardiac history is helpful to the interpreting physician reviewing 2D images and waveforms.