Peak Blood Flow Velocity Research Articles

The Value of Echocardiography Combined with NT-pro BNP Level in Assessment and Prognosis of Diastolic Heart Failure.

Background To investigate the significance of echocardiography combined with N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels in the evaluation and prognosis of diastolic heart failure (DHF). Methods Clinical data were collected from 168 patients with DHF. Serum levels of NT-pro BNP were first measured by ELISA. Meanwhile, the echocardiography was used to examine left ventricular end-diastolic diameter (LVEDD), left ventricular diameter (LVD), and other parameters. Multivariate logistic regression analysis was performed for variables in heart failure assessment grade or poor prognosis. Finally, the predictive ability for New York Heart Association (NYHA) class as well as prognosis was assessed by ROC curves. Results NT-pro BNP was the overexpression in the serum of patients with DHF. And the degree of elevation was related to NYHA class, while NT-pro BNP levels were significantly higher in the P-MACE group than in the N-MACE group. According to the multivariate logistic regression analysis, the ratio of peak velocity of left atrial early diastolic blood flow to early diastolic peak velocity of mitral annulus (E/Ea) and serum NT-pro BNP level was risk factors for NYHA class and prognosis. However, LVEF, LVEDD, and flow propagation velocity (Vp) can be a benefit condition. In addition, ROC curve showed that echocardiography combined with NT-pro BNP content had higher accuracy in NYHA class and prognostic assessment of DHF than applied separately. Conclusions The diagnosis of echocardiography combined with NT-pro BNP levels has the potential to distinguish the NYHA class in heart function of patients with DHF and determine the prognosis of patients.

Doppler Blood Flow Characteristics and Hemodynamic Features in Posterior Circulation in Normal

The aim of this study was to determine reference doppler values of blood flow and to investigate features of normal hemodynamics in main arteries of posterior circulation using color-coded duplex sonography (DS). The study involved 65 apparently healthy male volunteers aged 21 to 57 years (36 ± 12 years). A decrease in peak blood flow velocities during the transition from V1-segment of vertebral artery (VA) to V2 and an increase at intracranial level from proximal to distal part (from V4-segments of VA to distal part of basilar artery (BA)) were recorded. There was a tendency towards higher blood flow values in left VA and in posterior cerebral artery (PCA) in comparison with right ones. The features of hemodynamics, most likely, were due to the structural features of posterior circulation arteries—frequent asymmetry of VA in diameters, different branching of BA, as well as differences in peripheral resistance level associated with both the activity and metabolism of blood-supplied structures and the tone of resistive vascular network (less pronounced in the supratentorial structures).

Characteristics of deep vein thrombosis in the critically ill COVID-19 patient - an observational cohort study with Doppler ultrasound measurements.

COVID-19 is associated with an increased prevalence of deep venous thrombosis (DVT), mainly in the lower limbs. However, the characteristics and rheological conditions, which contribute to facilitating DVT occurrence have been poorly investigated. We aimed to report DVT characteristics, vein diameters and peak blood flow velocities (PBFV) in the common femoral veins (CFVs) of critically ill COVID-19 patients. We conducted a prospective single-center cohort study in March-October 2020 including all consecutive mechanically ventilated COVID-19 adults. Doppler ultrasound of the lower limbs was performed systematically during the first week of hospitalization. In DVT-free patients, a second Doppler ultrasound was performed seven days later. Data are expressed as medians (interquartile ranges) or percentages. Comparisons were performed using Mann-Whiney and Wilcoxon signed-rank tests or Fischer's exact tests, as appropriate. Fifty-five patients [age, 63 years (56-74); female/male ratio, 0.62; body-mass index, 29 kg/m2 (26-33); hypertension, 47%; diabetes, 38%; ischemic heart disease, 11%] were included. DVT was diagnosed in 19 patients (35%) including in 5 femoral (9%), 2 popliteal (4%) and 12 below-the-knee sites (22%). CFV diameter was increased to 12.0 mm (11.0-15.0) (normal range, 9.1-12) and PBFV reduced to 11.9 cm/s (8.8-15.8) (normal range, 21.3-49.2) [right-side values]. In four patients who had ultrasound before intubation, CFV diameter increased from 12.5 mm (11.8-13.3) before to 14 mm (13.6-15.3) after intubation (p = 0.008). DVT in the CFV occurred in 9% of the critically ill COVID-19 patients with an overall 35%-DVT prevalence. Venous return difficulty evidenced by larger than normal CFV diameters and lower than normal PBFVs may have facilitated proximal DVT occurrence.

Application value of bedside ultrasound for assessing volume responsiveness in patients with septic shock

Background/Aim. Septic shock is a serious complication that can occur as consequence of infection. As the effective circulating blood volume is of vital importance in these cases, it is very important to keep track of this parameter constantly. The aim of this study was to explore the application value of bedside ultrasound for assessing volume responsiveness in patients with septic shock. Methods. A total of 102 patients with septic shock were selected. The volume load (VL) test was performed, and based on the results of the test, the patients were divided into the response group that had an increase in stroke volume (?SV ) ? 15% and non-response group (?SV < 15%). Hemodynamic parameters were compared before and after the test. The correlation between ?SV and each hemodynamic index was explored by Pearson?s analysis. The receiver operating characteristic (ROC) curve was plotted. Results. There were 54 patients in response group and 48 patients in non-response group. Before VL test, retro-hepatic inferior vena cava (IVC) distensibility index (?IVC1), respiratory variation in IVC index (?IVC2), respiratory variation in aortic blood flow peak velocity index (?VpeakAO), respiratory variation in brachial artery blood flow peak velocity index (?VpeakBA) and respiratory variation in common femoral artery blood flow peak velocity index (?VpeakCFA) were all higher in response group than those in non-response group (p < 0.05), while heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) were similar (p > 0.05). After VL test, response group had significantly decreased HR, ?IVC1, ?IVC2, ?VpeakAO, ?VpeakBA and ?VpeakCFA, and increased MAP and CVP (p < 0.05), while non-response group had significantly decreased CVP (p < 0.05) and no significant changes in other indices. ?IVC1, ?IVC2, ?VpeakAO, ?VpeakBA and ?VpeakCFA significantly correlated with ?SV ( r= 0.589, r = 0.647, r = 0.697, r = 0.621, r = 0.766, p < 0.05), but there was no correlation between CVP and ?SV (r = -0.345, p > 0.05). The areas under the curves of ?IVC1, ?IVC2, ?VpeakAO, ?VpeakBA and ?VpeakCFA for predicting volume responsiveness were 0.839, 0.858, 0.878, 0.916 and 0.921, respectively, which were significantly larger than that of CVP (0.691), indicating higher sensitivity and specificity. Conclusion. Bedside ultrasound monitoring of ?IVC, ?VpeakAO, ?VpeakBA and ?VpeakCFA can better assess the volume responsiveness in patients with septic shock.

N-Acetylcysteine Inhibits Aortic Stenosis Progression in a Murine Model by Blocking Shear-Induced Activation of Platelet Latent Transforming Growth Factor Beta 1.

Objective: Aortic stenosis (AS) is characterized by narrowing of the aortic valve opening, resulting in peak blood flow velocity that induces high wall shear stress (WSS) across the valve. Severe AS leads to heart failure and death. There is no treatment available for AS other than valve replacement. Platelet-derived transforming growth factor beta 1 (TGF-β1) partially contributes to AS progression in mice, and WSS is a potent activator of latent TGF-β1. N-acetylcysteine (NAC) inhibits WSS-induced TGF-β1 activation in vitro. We hypothesize that NAC will inhibit AS progression by inhibiting WSS-induced TGF-β1 activation. Approach: We treated a cohort of Ldlr(-/-)Apob(100/100) low density lipoprotein receptor (LDLR) mice fed a high-fat diet with NAC (2% in drinking water) at different stages of disease progression and measured its effect on AS progression and TGF-β1 activation. Results: Short-term NAC treatment inhibited AS progression in mice with moderate and severe AS relative to controls, but not in LDLR mice lacking platelet-derived TGF-β1 (TGF-β1platlet-KO-LDLR). NAC treatment reduced TGF-β signaling, p-Smad2 and collagen levels, and mesenchymal transition from isolectin B4 and CD45-positive cells in LDLR mice. Mechanistically, NAC treatment resulted in plasma NAC concentrations ranging from 75.5 to 449.2 ng/mL, which were sufficient to block free thiol labeling of plasma proteins and reduce active TGF-β1 levels without substantially affecting reactive oxygen species-modified products in valvular cells. Conclusions: Short-term treatment with NAC inhibits AS progression by inhibiting WSS-induced TGF-β1 activation in the LDLR mouse model of AS, motivating a clinical trial of NAC and/or other thiol-reactive agent(s) as a potential therapy for AS.

Dynamic variables predict fluid responsiveness in pre-school and school children undergoing neurosurgery: a prospective observational study.

BackgroundThe evidence that plethysmographic variability index (PVI), pulse pressure variation (PPV), FloTrac/Vigileo-derived stroke volume variation (SVV), and Eadyn (dynamic arterial elastance) predict fluid responsiveness in children is limited by conflicting results. We aim to evaluate their accuracy and reliability to predict fluid responsiveness after induction in children aged 4–9 years undergoing major neurosurgery.MethodsChildren aged 4–9 years undergoing intracranial epileptic foci excision were enrolled. After the induction of anesthesia, fluid loading with 10 mL/kg of Ringer’s solution over 10 min was administered before surgical incision. PVI, PPV, SVV, and Eadyn were measured before and within 5 min after fluid loading. Respiratory variation in aortic blood flow peak velocity (∆Vpeak) >15% at baseline, measured using transthoracic echocardiography, identified fluid “responders”. The abilities of dynamic variables to predict an increase in mean arterial pressure (MAP) of >10% following fluid loading were also assessed.ResultsFourteen (31.8%) of forty-four patients were responders defined by a baseline ∆Vpeak >15%. Before fluid loading, only the PVI value was significantly different between R and NR (P=0.017). Baseline PVI showed fair diagnostic accuracy for fluid responsiveness, with an area under the curve (AUROC) of 0.735 and the cutoff value of 13%. The R group showed a significantly greater absolute change in PPV and SVV after fluid loading from baseline compared with the NR group (P=0.021 and 0.040, respectively). The absolute change in the PPV and SVV values from baseline was greater in R than those in NR (P=0.021 and 0.040, respectively). Twenty (45.5%) showed a MAP increase of >10% following fluid loading and were defined as responders. Baseline ∆Vpeak and SVV showed fair predictive values for a MAP increase of >10% (AUROC =0.758 and 0.715, respectively).ConclusionsPVI at baseline showed fair reliability to predict fluid responsiveness after anesthesia induction in mechanically ventilated children aged 4–9 years undergoing neurosurgery. Baseline ∆Vpeak and SVV were fairly predictive for an increase in MAP following fluid loading.

Characteristics of the athlete's heart in aged hypertensive and normotensive subjects.

Both hypertension and age-related impairment of the cardiac condition are known to be improved by regular physical training. As relatively few studies have been reported about the older, hypertensive patients, the aim of this study was to establish cardiac benefits of active lifestyle in these subjects. Two-dimensionally guided M-mode, Doppler- and tissue Doppler echocardiography was performed in 199 normo- and hypertensive, active and sedentary older (age >60 years) men (N.=111) and women (N.=88). Results were compared either by ANOVA, or by Kruskall-Wallis test. The Left Ventricular Muscle Index (LVMI), which is higher in young active than in sedentary persons, proved to be smaller in the active than sedentary older subjects: men normotensives: actives 83 vs. sedentary ones 98, hypertensives: actives 88 vs. sedentary ones 107, women normotensives: actives 77 vs. sedentary ones 89 g/m3. Diastolic function was better in the active groups demonstrated both by the ratio of the early to atrial peak blood flow velocities (men: normotensives: actives 1.03 vs. sedentary ones 0.76, women normotensives: actives 1.21 vs. sedentary ones 0.9, hypertensives: actives 1.04 vs. sedentary ones 0.88). The tissue Doppler results were also better in the active groups; the difference between the active and sedentary groups was more marked in the normotensive male groups than in the hypertensive ones. Active lifestyle prevents age-related pathological LV hypertrophy, and attenuates the LV diastolic dysfunction.

Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report.

IntroductionAbdominal pain and flank pain cause a significant proportion of emergency department (ED) visits. The diagnosis often remains unclear and is frequently associated with repeat visits to the ED for the same complaint. A rare cause of left upper abdominal and flank pain is compression of the left renal vein between the aorta and the superior mesenteric artery known as nutcracker syndrome. Diagnostic findings on ultrasound include increased left renal vein diameter proximal and peak blood flow velocity increase distal to the superior mesenteric artery. We describe such a patient presenting to an ED repeatedly with severe pain mimicking renal colic before the final diagnosis and intervention occurred.Case ReportA 16-year-old female, long-distance runner presented four times complaining of intractable left upper quadrant abdominal pain radiating to the left flank after exercise. On each visit urinalysis revealed proteinuria and hematuria, and on two visits abdominal computed tomography revealed no kidney stone or dilatation of the collecting system. Ultimately, she was referred to vascular surgery where Doppler ultrasonography was used to diagnose left renal vein compression. Transposition of the left renal vein improved Doppler diameter and flow measurements and eliminated symptoms.ConclusionEmergency physicians must maintain a large list of possible diagnoses during the evaluation of abdominal and flank pain with a repetitive and uncertain etiology. Nutcracker syndrome may mimic other causes of abdominal and flank pain such as renal colic and requires appropriate referral.

Quantification of peak blood flow velocity at the cardiac valve and great thoracic vessels by four-dimensional flow and two-dimensional phase-contrast MRI compared with echocardiography: a systematic review and meta-analysis

To objectively examine the agreement and correlation between four-dimensional (4D) flow magnetic resonance imaging (MRI) and traditional two-dimensional (2D) phase-contrast (PC) MRI with the reference standard of Doppler echocardiography for measuring peak blood velocity at the cardiac valve and great arteries, and to assess if 4D flow MRI offers an advantage over the traditional 2D method. The literature was searched systematically for studies that evaluate the degree of correlation and agreement between 4D flow MRI or 2D PC MRI and Doppler retrieved from PubMed, EMBASE, and the Cochrane Library. A meta-analysis was conducted to determine the peak velocity pooled bias with 95% limits of agreement (LoA) and correlation coefficient (r) for 4D flow MRI and 2D PC MRI compared with Doppler. Ten studies that compared 4D flow MRI with Doppler and 12 studies that compared 2D PC MRI with Doppler were included. 4D flow MRI showed an underestimation with bias and 95% LoA of -0.09 (-0.41, 0.24) m/s (p=0.079) while 2D PC MRI showed a poorer agreement with a bias and 95% LoA of -0.25 (-0.53, 0.03), p=0.596. 4D flow MRI and 2D PC MRI showed a strong correlation with R=0.80 (95% CI 0.75, 0.84; p<0.001) and R=0.83 (95% CI 0.79, 0.87; p<0.001), respectively. In this meta-analysis, 4D flow MRI provides improved assessment of peak velocity when compared with traditional 2D PC MRI. 4D flow MRI can be considered an important complement or substitute to Doppler echocardiography for peak velocity assessment.

Sports compression garments improve resting markers of venous return and muscle blood flow in male basketball players

BackgroundThe benefits associated with sports compression garments are thought to be closely related to enhanced blood flow. However, findings are equivocal, possibly due to heterogeneity in the techniques used for measuring blood flow, the garment types used, and the pressures applied. This study combined Doppler ultrasound and near-infrared spectroscopy technologies to provide the first comprehensive assessment of the effects of 3 sports compression garment types on markers of venous return and muscle blood flow at rest. MethodsResting lower-limb blood flow measures (markers of venous return, muscle blood flow, and muscle oxygenation) of 22 elite, junior, male basketball players (age = 17.2 ± 0.9 years, mean ± SD) were assessed in 4 separate conditions: no compression (CON), compression tights (TIGHTS), compression shorts (SHORTS), and compression socks (SOCKS). Markers of venous return (cross-sectional area, time-averaged mean and peak blood flow velocity, and venous blood flow) were measured via Doppler ultrasound at the popliteal and common femoral veins. Muscle blood flow and muscle oxygenation were measured in the gastrocnemius medialis and vastus lateralis using near-infrared spectroscopy. ResultsPopliteal markers of venous return were higher in TIGHTS compared to CON (p < 0.01) and SHORTS (p < 0.01), with SOCKS values higher compared with CON (p < 0.05). Common femoral vein markers of venous return were higher for all conditions compared to CON (p < 0.05), with TIGHTS values also higher compared to SOCKS (p < 0.05). Gastrocnemius medialis blood flow was higher for TIGHTS compared to CON (p = 0.000), SOCKS (p = 0.012), and SHORTS (p = 0.000), with SOCKS higher compared to SHORTS (p = 0.046). Vastus lateralis blood flow was higher for TIGHTS compared to CON (p = 0.028) and SOCKS (p = 0.019), with SHORTS also higher compared to CON (p = 0.012) and SOCKS (p = 0.005). Gastrocnemius medialis oxygenation was higher for TIGHTS compared to CON (p = 0.003), SOCKS (p = 0.033), and SHORTS (p = 0.003), with SOCKS higher compared to CON (p = 0.044) and SHORTS (p = 0.032). Vastus lateralis oxygenation was higher for TIGHTS compared to CON (p = 0.020) and SOCKS (p = 0.006). ConclusionMarkers of venous return, muscle blood flow, and muscle oxygenation are increased with sports compression garments. TIGHTS are most effective, potentially because of the larger body area compressed.

1203-P: High-Dose Erythropoietin and Cardiac Function in Mice

Erythropoietin (EPO) is the cytokine required for erythropoiesis. EPO stimulated increase in hematocrit elevates blood viscosity that may cause hemodynamic risks in the cardiovascular system, promote ischemic heart disease, and stroke. Herein, we studied the physiological effect of high dose exogenous EPO (i.p. 3000 U/kg, 3 times/week for three weeks) with high fat diet (HFD) on cardiac function using echocardiographic measurements in young wild-type (WT) male and female mice and older obese WT male mice with fat mass &amp;gt;45%. In young male mice, but not in female and older obese male mice, EPO treatment with HFD decreased body weight and fat mass accumulation compared with saline, although all groups showed similar EPO stimulated increases in hematocrit. EPO reduced ejection fraction and fractional shortening of left ventricle (LV) in both young male and female mice. This is consistent with the previous report that mice with chronic overexpression of human EPO have decreased fractional shortening of LV. In contrast, older obese male mice have reduced basal ejection fraction and fractional shortening that remain unchanged with EPO treatment indicating that the changes in basal ejection fraction and fractional shortening with EPO treatment in younger mice were not due to EPO stimulated increase in red cell mass. EPO decreased peak velocity of blood flow in the pulmonary artery in all groups indicative of increased hematocrit promoting higher blood viscosity. In addition, EPO increased LV posterior wall thickness in diastole in older male obese mice. This is consonant with observations that high hematocrit is related to concentric left ventricular hypertrophy in human. These data suggest that high dose EPO treatment may be associated with possible cardiac dysfunction with decreased ejection fraction and fractional shortening of LV, and alteration of left ventricular geometry. Disclosure J. Lee: None. C. T. Noguchi: None.

Cerebral Hemodynamic Evaluation of Main Cerebral Vessels in Epileptic Patients Based on Transcranial Doppler.

Objective: To study whether there is a difference in peak and mean blood flow velocity between the left and right major cerebral vessels in patients with epilepsy.Methods: Sixteen patients with epilepsy underwent FDG18-PET-CT (PET) scan and electroencephalogram (EEG) examinations. Transcranial Doppler (TCD) was used to detect the peak flow velocity (PFV), mean flow velocity (MFV), and other hemodynamic indicators of bilateral anterior, middle, and posterior cerebral arteries in each patient. According to different patterns of the PET or interictal EEG, the differences in PFV, and MFV of corresponding vessels on both sides under different patterns were compared.Results: According to the PET of the low-metabolism region corresponding to the supplying artery, the PFV and MFV of the supplying artery in the low-metabolism region were lower than the value of the corresponding contralateral vessel. The PFV and MFV on the low metabolic side of PET were lower than that of the corresponding vessels on the opposite side. The PFV and MFV on the discharge side of interictal EEG were also lower than the PFV and MFV of the corresponding vessels on the opposite side. The MFV of posterior cerebral artery on the low metabolic side of PET or the interictal discharge side was significantly different from that of the contralateral vessels (P < 0.05). However, the other aforementioned differences in PFV and MFV did not achieve statistical significance.Conclusion: In epileptic patients, the PFV and MFV of main cerebral vessels on the PET hypometabolized side or the interictal discharge side was lower than that of corresponding vessels on the contralateral side. To some extent, the difference in the MFV of PCA between the bilateral sides can facilitate the lateral diagnosis of the epileptogenic zone.

Changes in left ventricular and atrial mechanics and function after dialysis in patients with end-stage renal disease.

Hemodialysis (HD) can influence end-stage renal disease (ESRD) patients' circulatory system. The present study aimed to evaluate the effect of volume depletion on left ventricular (LV) and left atrial (LA) function and determine the volume-independent parameters before and after HD in patients with ESRD. Between January 2018 and January 2019, we recruited long-term HD patients (n=40, 51.0±16.4 years), excluding those with structural cardiac disease. Echocardiographic parameters, including LV and LA volumes, flow Doppler, pulsed tissue Doppler, and speckle tracking echocardiography (STE) before and after HD (within 24 h), were examined, and the values were compared. Following HD, alteration in LV end-systolic volume was not detected, whereas LV end-diastolic volume (90.18±23.91 vs. 84.21±23.54 mL, P=0.036) and LV ejection fraction (LVEF; 64.63%±6.56% vs. 62.84%±6.56%, P=0.049) decreased. Peak early diastolic trans-mitral flow velocity (E-wave; 82.22±20.13 vs. 72.43±18.32 cm/s, P<0.001), peak early diastolic tissue Doppler velocity (e'; 6.45±1.88 vs. 5.77±1.63 cm/s, P<0.001) at the septal side of the mitral annulus, the ratio of early to late Doppler velocities of diastolic mitral inflow (0.90±0.27 vs. 0.79±0.23, P<0.001), and the average E/e' ratio (12.54±4.08 vs. 11.28±4.52, P=0.049) decreased significantly. No significant difference was found in peak blood flow velocity at the mitral valve during late diastole and e' at the lateral side of the mitral annulus after HD. LA volume index (35.55±12.61 vs. 30.22±9.80 mL/m2, P<0.001), tricuspid regurgitation velocity (260.11±36.54 vs. 242.37±32.22 cm/s, P=0.002), and pulmonary artery systolic pressure (33.63±11.29 vs. 29.94±7.80 mmHg, P=0.006) significantly decreased. LV global longitudinal systolic strain (GLS) of 4-chamber view (-24.37%±3.02% vs. -23.38%±3.33%, P=0.019), rather than global circumferential systolic strain, exhibited significant change after HD. Significant changes were also found in LV longitudinal early diastolic strain rate (LSRe; 1.17±0.25 vs. 1.05±0.24 s-1, P<0.001) and early diastolic global radial velocity (Ve; 2.62±0.59 vs. 2.25±0.67 cm/s, P=0.011) after HD, but not in other strain rates and global radial velocity measurements. LA maximal volume (35.55±12.61 vs. 30.22±9.80 mL/m2, P<0.001), LA total emptying fraction (54.19%±10.39% vs. 49.63%±11.05%, P=0.009), and LA passive emptying fraction (32.23%±12.86% vs. 26.81%±9.28%, P=0.004) decreased significantly after HD, while LA minimal volume, the volume at the onset of atrial systole, and LA active emptying fraction after HD were not significantly different. Most indices of systolic (LVEF and GLS of 4-chamber view) and early diastolic function (E-wave, e', LSRe, global radial Ve, and LA passive emptying fraction) were preload dependent. Late diastolic indices, including LV late diastolic global longitudinal strain rate, late diastolic global radial velocity, and LA active emptying fraction, did not change with volume depletion.

ГЕМОДИНАМИЧЕСКИЕ НАРУШЕНИЯ ПРИ ВАРИКОЗНОЙ БОЛЕЗНИ

Aim. Duplex ultrasound scanning (DUS) is a routine diagnostic procedure in patients with varicose vein disease. DUS mostly evaluates the qualitative (anatomical) parameters of the disease. Still, it is difficult to assess the microcirculatory parameters in trophic disorders based only on the anatomy, therefore assessment of quantitative blood flow parameters is needed. Our aim was to determine the potentials of conventional DUS in assessment of the hemodynamic disorders in patients with varicose disease. Materials and Methods. The study included 583 patients with varicose disease, 348 of which had trophic alterations. The patients were divided into 4 groups according to the CEAP clinical classes. Standard Valsalva and Siegel tests were performed during DUS. The following parameters were assessed in the superficial and deep veins: diameter of veins, antegrade blood flow velocity, retrograde blood flow velocity, reflux time; in the perforator veins (PV) – diameter, maximum velocity and average velocity of reflux. Peripheral resistance index (RI) in the arteries accompanying the PV was also analyzed. Results. A statistically significant difference in the diameter of the GSV was obtained between classes C2 and C3, C3 and C4, but not between class C5, 6 and class C4. Similar findings were observed in the assessment of diameter of the PVs and the velocity of retrograde blood flow through them. A gradual increase in these parameters could be seen with the progression of the disease, but a statistically significant difference was obtained only between classes C2 and C3 for the diameter of the PV and the peak velocity of retrograde blood flow. As for the average blood flow velocity, a statistically significant difference was obtained between classes C2 and C3, C3 and C4. Arteries in the perforator bundles demonstrated low RI which may be attributed to the presence of an arteriolo-venular bypass. Statistically significant differences were obtained for CEAP classes C2 and C3. Conclusions. Ultrasound duplex scanning of the study with use of Superb Micro-Vascular Imaging mode is an effective method in assessing the quantitative and microcirculatory parameters of hemodynamic disorders in patients with varicose vein disease of the lower extremities. Trophic ulcers in varicose vein disease are not an obligatory component of the disease, but only its complication.

Adoption of Color Doppler Ultrasound in the Measurement of Fetal Hypoxia in Late Pregnancy

Objective: In order to improve the detection rate of fetal hypoxia in the third trimester and reduce the probability of adverse pregnancy outcome, color doppler ultrasound (CDU), and contractions were used to assess the severity of fetal hypoxia. Methods: The 61 pregnant women diagnosed with intrauterine hypoxia in South District of The Affiliated Hospital of Chengde Medical College from October 2017 to September 2019 were classified as the sick group. Meanwhile, the 61 normal pregnant women were selected as the control group. CDU was used to detect the relevant indexes of umbilical artery (UA) and middle cerebral artery (MCA) in the two groups, including pulse index (PI), resistance index (RI), systolic peak blood flow velocity (S) and diastolic peak blood flow velocity (D). The Apgar scale was used to score neonatal status. According to the score results, newborns were divided into Apgar ≤ 7 group and Apgar &gt; 7 group. The indexes of UA and MCA were compared between the two groups. The amniotic fluid status of pregnant women was assessed using the contractile stimulation test (CST). The rate of amniotic fluid pollution in pregnant women and the incidence of neonatal asphyxia were calculated. Pregnant women were grouped according to the CST score. The correlation between CST score and amniotic fluid pollution and neonatal asphyxia in pregnant women was analyzed. Results: First, the index of fetal UA was obviously higher than that of the control group, while the index of MCA was obviously lower than that of the control group (P &lt; 0.05). Second, the indexes of fetal UA in Apgar ≤ 7 group were obviously higher than those in Apgar &gt; 7 group, while those in MCA were obviously lower than those in Apgar &gt; 7 group (P &lt; 0.05). Third, the incidence of amniotic fluid pollution and neonatal asphyxia in low and middle groups of pregnant women was obviously higher than that in high groups (P &lt; 0.01). Conclusion: This indicates that the CDU technology combined with uterine contraction stimulation experiment can assess the degree of intrauterine hypoxia in the late stage of pregnancy, which provides a feasible scheme for clinical detection of intrauterine hypoxia.

Haemodynamic collapse immediately after transcatheter aortic valve implantation due to dynamic intraventricular gradient: a case report and review of the literature.

BackgroundDynamic intraventricular obstruction after transcatheter aortic valve implantation (TAVI) has been previously reported. There is a risk of haemodynamic collapse in the case of left ventricular outflow tract (LVOT) obstruction due to systolic anterior motion (SAM) of the mitral valve.Case summaryAn 83-year-old woman with aortic stenosis (AS) was referred to our hospital for TAVI. Transthoracic echocardiography revealed a severely calcified aortic valve with a peak velocity of 6.3 m/s across the valve. Acceleration of blood flow (peak velocity 2.6 m/s) at the LVOT due to a septal bulge was also seen. Transfemoral TAVI was performed, and a 29 mm Evolut PRO was implanted under general anaesthesia. After the implantation, a complete atrioventricular block with junctional rhythm developed, and refractory hypotension occurred immediately. Transoesophageal echocardiography revealed LVOT obstruction due to SAM of the mitral valve associated with severe mitral regurgitation (MR), which was not observed preoperatively. Fluid infusion and catecholamine administration were not effective. However, after performing temporary pacing from the right ventricular (RV) apex, the LVOT obstruction and severe MR improved. Her haemodynamics stabilized, and we could complete the procedure. A dual-chamber permanent pacemaker with beta-blocker administration as a longer-term treatment further improved the LVOT obstruction. The patient was finally discharged to a rehabilitation hospital.DiscussionAlertness and recognition of potential LVOT obstruction after TAVI are important. Pacing from the RV apex, as well as dual-chamber pacing, comprise a less invasive and feasible therapeutic option in such cases.

Effect of Bundle Care on Deep Venous Thrombosis in Patients Received Renal Biopsy

Objective: To explore the effect of bundle care on the incidence of venous thromboembolism (VTE) in patients who received renal biopsy, and provide reference for clinical care. Methods: 300 patients with nephrotic syndrome who received renal biopsy in our hospital from February 2018 to August 2020 were selected and randomly divided into the observation group and the control group, with 150 patients in each group. In the control group, patients were given routine care: informing the precautions before and after operation, observing the changes of vital signs and bleeding after operation, etc. In the observation group, patients were given bundle care intervention, including preoperative, intraoperative and postoperative routine care, ankle pump exercise, Intermittent Pneumatic Compression (IPC) treatment and psychological care. The incidence of lower-limb venous thrombosis was compared between the two groups. Results: The incidence of deep venous thrombosis in the observation group was lower than that in the control group (P < 0.05), 1 case (0.6%) in the observation group and 8 cases (5.3%) in the control group; the peak velocity and mean velocity of lower-limb venous blood flow in the observation group were higher than those in the control group; the average length of stay in the observation group was less than that in the control group, and the satisfaction degree in the observation group was higher than that in the control group. The differences were statistically significant (P < 0.05). Conclusion: For patients who received renal biopsy, bundle care can help improve the peak velocity and mean velocity of venous blood flow, reduce the incidence of VTE, the average length of stay, and social costs, relieve their pain, and improve satisfaction degree of care; moreover, it plays an important role in reducing the incidence of deep venous thrombosis.

Effect of moxibustion on cardiac remodeling and myocardial function in rats with exercise-induced fatigue

Objective: To explore the effect of moxibustion at Shenque(CV8) on myocardial structure and function in rats with exercise-induced fatigue. Methods: A 12-week treadmill training program was used to establish a rat model of exercise-induced fatigue. Fifty-six male SD rats removed six rats that did not reach the molding condition, Remaining rats were randomly divided into the following five groups: a normal group (n=10) that did not under go the exercise routine and were not treated, a control group (n=10) that did not under go the exercise routine, but received a mild dose of moxibustion at “Shenque” (CV 8) for 15 min, an untreated group (n=10) that received no treatment after exercise, a CV 8 group (n=10) that received a mild dose of moxibustion at “Shenque” (CV 8) for 15 min after exercise, a non-acupoint(tail) group(n=10) that received a mild dose of moxibustion at “non-acupoint” for 15 min after exercise. At one hour after the end of the 12-week training program, the left ventricular diastolic volume (LVDV), left ventricular systolic volume (LVSV), peak early diastolic mitral blood flow velocity (E), and peak late diastolic mitral blood flow velocity (A) were measured,and the E/A ratio were calculated. The serum myoglobin (Mb), creatine kinase-muscle/brain (CK-MB), and cardiac troponin-I (cTnI) levels were detected using an automatic biochemical analyzer. Results: When the values obtained before and after treatment were compared within the same groups, the LVDV, LVSV, E, and A were increased (P

Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness.

To assess whether respiratory variation in aortic blood flow peak velocity can predict preload responsiveness in mechanically ventilated and hemodynamically unstable neonates. Prospective observational diagnostic accuracy study. Third-level neonatal ICU. Hemodynamically unstable neonates under mechanical ventilation. Fluid challenge with 10 mL/kg of normal saline over 20 minutes. Respiratory variation in aortic blood flow peak velocity and superior vena cava flow were measured at baseline (T0), immediately upon completion of the fluid infusion (T1), and at 1 hour after fluid administration (T2). Our main outcome was preload responsiveness which was defined as an increase in superior vena cava flow of at least 10% from T0 to T1. Forty-six infants with a median (interquartile range) gestational age of 30.5 weeks (28-36 wk) were included. Twenty-nine infants (63%) were fluid responders, and 17 (37%) were nonresponders Fluid responders had a higher baseline (T0) respiratory variation in aortic blood flow peak velocity than nonresponders (9% [8.2-10.8] vs 5.5% [3.7-6.6]; p < 0.001). Baseline respiratory variation in aortic blood flow peak velocity was correlated with the increase in superior vena cava flow from T0 to T1 (rho = 0.841; p < 0.001). The area under the receiver operating characteristic curve of respiratory variation in aortic blood flow peak velocity to predict preload responsiveness was 0.912 (95% CI, 0.82-1). A respiratory variation in aortic blood flow peak velocity cut-off point of 7.8% provided a 90% sensitivity (95% CI, 71-97), 88% specificity (95% CI, 62-98), 7.6 positive likelihood ratio (95% CI, 2-28), and 0.11 negative likelihood ratio (95% CI, 0.03-0.34) to predict preload responsiveness. Respiratory variation in aortic blood flow velocity may be useful to predict the immediate response to a fluid challenge in hemodynamically unstable neonates under mechanical ventilation. If our results are confirmed, this measurement could be used to guide safe and individualized fluid resuscitation in critically ill neonates.

A pro-thrombotic left atrial haemodynamic profile is present in older individuals with cardiovascular risk factors even without atrial fibrillation

Abstract Background Atrial fibrillation (AF), by inducing left atrial (LA) stasis and thrombus formation, is a major cause of ischaemic embolic stroke. However, up to 25% of embolic strokes occur in the absence of AF or any other identifiable mechanism. We hypothesised that exposure to risk factors leads to a prothrombotic LA haemodynamic profile, with a consequent risk of thrombus formation and embolic stroke even in sinus rhythm (SR). Purpose To quantify the relative effects of AF and risk factors on LA function and haemodynamics in three groups: (1) patients with persistent AF before and after cardioversion, (2) patients in SR with no history of AF who were matched to AF patients for stroke risk, and (3) healthy controls. Methods Ninety-five participants were recruited: 37 AF patients scheduled for cardioversion [median CHA2DS2-VASc = 2 (1.5–3.5); median age 69 years], 35 matched non-AF patients [median CHA2DS2-VASc 3 (2.0–4.0); median age 69 years], and 23 healthy subjects [median CHA2DS2-VASc 0 (0–0); median age 33 years]. Advanced cardiovascular MRI was used to assess LA function and 4D flow. Results Patients with persistent AF displayed significantly lower LA emptying fraction (LAEF), reservoir strain, and peak blood flow velocities compared to both control groups in SR, as well as profound alterations in atrial blood flow patterns and vortex volume ratio (all p&amp;lt;0.001 vs both control groups). In the 65% of patients who were in SR at ≥4 weeks post cardioversion, all LA parameters were significantly improved (all paired p&amp;lt;0.001 vs baseline scan in AF; red vs blue in Figure 1), but LA haemodynamics were now no longer different from those in matched non-AF patients (all p=ns; blue vs green in Figure 1 C-D). However, both AF patients cardioverted to SR and matched non-AF patients had significantly impaired LA function (LA EF and LA reservoir strain) and LA haemodynamics (lower peak velocity and higher vortex volume ratio), compared to heathy controls (all p&amp;lt;0.01; blue/green vs grey in Figure 1). Conclusions We found evidence of a gradient of LA haemodynamic dysfunction, where the most marked phenotype was seen in patients scanned in AF, but with significant abnormalities remaining after restoration of SR in AF patients, and intriguingly, also present to a similar degree in matched non-AF patients. Advanced atrial imaging offers the potential to select patients with an adverse pathophysiological substrate directly predisposing to LA thrombus formation for future clinical trials of anticoagulation in SR. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIHR Oxford Biomedical Research Centre