Perfusion In Women Research Articles

Abstract 4141485: Liver Steatosis in Women with Coronary Microvascular Dysfunction

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been previously associated with coronary microvascular dysfunction (CMD) and is closely related to metabolic syndrome among men and women. Data regarding the association of quantitative liver steatosis and CMD in women with ischemia and no obstructive coronary arteries (INOCA) are scarce. Aim: To evaluate the association of liver steatosis with myocardial perfusion in women with CMD and reference controls. Methods: Women with CMD and no obstructive coronary arteries (n=55) from 2 prospective cohort studies (R01HL146158, R01HL153500) and asymptomatic age- and sex-matched reference controls (n=10) underwent stress and rest cardiac magnetic resonance imaging (MRI), with a validated MRI quantification of liver fat by proton density fat fraction (PDFF), at a single center. CMD was confirmed by coronary function testing or prior diagnostic stress tests. Parameters of liver fat and LV structure, function and myocardial perfusion reserve index (MPRI, a measure of CMD) were compared between cases and controls. A threshold of PDFF ≥5.2% was used to define significant liver steatosis. Results: Other than higher prevalence of hypertension in the CMD group, age and cardiometabolic history were not significantly different between the groups, as were the PDFF and prevalence of liver steatosis (Table). PDFF directly correlated with body mass index (r=0.41, p<0.01). There was no correlation between PDFF and MPRI (Figure). Conclusions: In this pilot study, our results suggest similar prevalence of liver steatosis between women with CMD and reference controls. Interestingly, MPRI did not correlate with PDFF, suggesting that mechanisms other than metabolic health may play a significant role in the pathophysiology of CMD among women with INOCA.

Is Kinesio taping acutely effective for peripheral tissue perfusion in women with mild to moderate chronic venous insufficiency? A randomized controlled trial

Objective To evaluate the acute effect of Kinesio Taping® (KT) on peripheral tissue perfusion in women with chronic venous insufficiency (CVI). Methods: This randomized, double-blind controlled trial included 59 women with mild to moderate CVI. They were randomized to a control group (n = 23; 54.08 ± 9.04 years) and KT group (n = 36; 55.87 ± 9.97 years). Near-infrared spectroscopy was positioned in the medial gastrocnemius muscle for assessment of resting tissue perfusion 48 h after the first day of evaluation and after placement of the Kinesio Taping® tape. The evaluation also consisted of performing movements of the plethysmography examination. To verify the comparisons of pre- and post-Kinesio Taping® data, the variation delta was used for analysis. Mann–Whitney U test was performed an an alpha of 5% was considered statistically significant. Results: There wasn't a significant difference between groups regarding the peripheral tissue perfusion evaluation variables Peripheral Oxygen Saturation Difference – DELTA_SPO2: (KT Group 3.21 (0.84–3.62); Control 2.21 (1.59–4.83), p = 0.219) and Difference in deoxygenate hemoglobin values – DELTA_HHB (units) KT Group -0.62 (-2.14–0.67); Control Group -0.07 (-2.15–2.62) p = 0.238). Despite the lack of statistical significance, the KT group had a 785.7% greater drop in HHB values than the control group. Conclusions: Acute use of Kinesio Taping® in women with CVI did not significantly alter tissue perfusion of calf muscles. However, it was possible to observe percentage differences in venous retention to be considered from a clinical point of view

The Performance of the Uterine Artery Resistance Index following Stimulation of the Cervix in the Diagnosis of Endometriosis: A Prospective Study

Background: We speculated that stimulating the uterine cervix of patients may increase blood flow resistance of the uterine artery more significantly in women with endometriosis than those without. Accordingly, the resistance index (RI) of the uterine artery following stimulation of the cervix may offer a novel and promising non-invasive method for diagnosing endometriosis. In this prospective study, the aim was to determine the performance of the uterine artery resistance index (RI) following stimulation of the cervix in the diagnosis of endometriosis. Methods: This prospective cohort study included 270 patients with non-uterine diseases who were scheduled for laparoscopic surgery. Each patient underwent Doppler sonography for peak systolic velocity (PSV), end diastolic velocity (EDV), and RI before and after stimulation of the cervix, in addition to conventional ultrasound examination one day prior to laparoscopic surgery. The cervix was stimulated using a double convex array electronic vaginal probe for real-time tissue elastography. Results: Laparoscopic surgical evaluation revealed endometriosis in 91 (33.7%) patients. Following stimulation of the cervix, the RI of the uterine artery was significantly increased in the endometriosis group (p = 0.00), but no significant increase in the RI was observed in the control group (p = 0.45). The sensitivity and specificity of the post-stimulation RI for diagnosing endometriosis (using a cut off of 0.83) were 85.71% (95% confidence interval (CI): 76.45–91.88) and 88.83% (95% CI: 83.05–92.87), respectively. For peritoneal endometriosis (PEM), sensitivity and specificity were 86.96% (95% CI: 65.33–96.57) and 88.83% (95% CI: 83.05–92.87), respectively. The sensitivity and specificity of transvaginal ultrasonography (TVU) for diagnosing endometriosis were 63.74% (95% CI: 52.93–73.37) and 94.41% (95% CI: 89.68–97.14), respectively. The positive rate for TVU in diagnosing all endometrioses was 63.7%, and this was lower than that for the post-stimulation RI (84.6%, p = 0.001). Conclusions: Stimulation of the cervix leads to a significant decrease in uterine blood perfusion in women with endometriosis. TVU is a sensitive and specific method for the diagnosis of endometrioma, while the RI is a more sensitive parameter for diagnosing PEM than TVU. For the diagnosis of endometriosis, especially for PEM, the post-stimulation RI may prove to be a promising non-invasive diagnostic technique.

Aortic Stiffness is Negatively Associated with Microvascular Glycocalyx Thickness and Microvascular Perfusion among Older Adults: Role of Carotid Pressure Pulsatility

IntroductionThe glycocalyx layer is essential to the maintenance of a healthy microvascular endothelium and diminishes with advancing age. Similarly, the aorta stiffens with aging and increases the risk of cardiovascular disease and target organ damage, possibly through pressure pulsatility‐associated microvascular damage. However, whether aortic stiffness and/or pressure pulsatility are associated with microvascular endothelial glycocalyx structure/function among older adults is unknown. Therefore, the objective of this analysis was to investigate the potential relation between aortic stiffness and pressure pulsatility with glycocalyx thickness and microvascular perfusion in older adults. We hypothesized that increased aortic stiffness and pressure pulsatility would be associated with less glycocalyx thickness and microvascular perfusion in older adults.MethodsSublingual microvessels were assessed using intravital microscopy in older adults (n=24; age 61 ± 6y, 46% women). Perfused boundary region (PBR) and red blood cell (RBC) filling %, indirect indices of glycocalyx thickness (larger PBR=smaller thickness) and microvascular perfusion respectively, were determined in vessels between 5‐25 µm RBC column width. Aortic stiffness was quantified by carotid‐femoral pulse wave velocity (cfPWV) and carotid pressure pulsatility as carotid pulse pressure (PP)/mean arterial pressure (MAP).ResultsAdjusting for age, sex and MAP, cfPWV was associated with larger PBR 5‐25 (β: 0.08; p=0.001) and lower RBC filling % (β: ‐0.02, p=0.002). Higher carotid pressure pulsatility was associated with lower RBC filling % (β: ‐0.12; p=0.03), but this relation was attenuated after adjusting for sex (p=0.11). Upon stratification by sex, higher carotid pressure pulsatility was associated with larger PBR 5‐25 (r=0.66, P=0.03) and lower RBC filling % (r=‐0.73, P=0.01) in women, but not men (P=0.94 and P=0.77 respectively).ConclusionHigher aortic stiffness was negatively associated with microvascular glycocalyx thickness and microvascular perfusion among older adults. Additionally, carotid pressure pulsatility was negatively associated with glycocalyx thickness and microvascular perfusion in women only. The mechanisms that contribute to sex differences in the relation between pressure pulsatility and glycocalyx structure/function in older adults require further study.

Clitoral blood flow using color Doppler ultrasonography in women with and without provoked vestibulodynia.

To compare blood flow of the dorsal clitoral artery in women diagnosed with provoked vestibulodynia (PVD) and in healthy controls using color Doppler ultrasonography. We hypothesized that women with PVD would have a restricted blood flow compared to controls. This cross-sectional study evaluated the function of the dorsal clitoral artery through the spectral wave analysis of color Doppler ultrasonography (US) in 20 women diagnosed with PVD according to Friedrich's criteria and 21 healthy controls. Participants were evaluated during their follicular phase and were asked to abstain from sexual activities 24 ho prior the examination. Assessment was performed by an assessor blinded to participant diagnosis, in the morning after a 10-min rest period in a supine lying position in a room with temperature set at 22 °C. Measurements of the peak systolic velocity (PSV), time-averaged maximum velocity (TAMX), end-diastolic velocity (EDV), pulsatility (PI) and resistance index (RI) were performed at rest considering the mean value of three consecutive waveforms. Women with PVD and healthy controls did not present any statistically different baseline characteristics. Participants with PVD presented higher values of Doppler-US PSV, TAMX, EDV and RI compared to controls (p ≤ 0.05), which are suggestive of a decrease in blood flow. However, non-significant difference was found regarding PI values between the two groups (p > 0.05). Our findings revealed decreased peripheral tissue perfusion in women with PVD compared to healthy controls using color Doppler US, based on the alteration of four of the five assessed data of US parameters.

Investigation of uterine vessel perfusion of the failure uterus scar after cesarean section

In modern conditions, due to the increased frequency of cesarean section, which is not only a method of surgical delivery of pregnant women, but also surgery, there are problems in the reproductive health of operated women.Given the solution of many aspects of re-cesarean section, the issues of determining the diagnostic criteria for failure of uterus scar, their diagnostic value and use in practical medicine remain debatable.The objective: the investigate the features of uterine perfusion in pregnant women after a previous cesarean section and develop criteria for predicting the failure of the uterus scar.Materials and methods. A comprehensive two-stage (before and during pregnancy) examination of 180 women with a uterus scar after a previous cesarean section for the period from 2014–2019. Women were divided into groups and subgroups depending on the time of pregnancy.Results. Based on the conducted clinical and anamnestic data and the results of ultrasound examinations of the operated uterus, we detected changes in the blood flow of the uterine arteries and developed an arterial perfusion index in pregnant women. Using the proposed index, the features of arterial perfusion in women of childbearing age, depending on the time of pregnancy and the failure of the uterus scar after a previous cesarean section. This allowed us to determine the limit values of this indicator for each group of women, in which the value of this indicator differed significantly from healthy women. The proposed limit levels of uterine perfusion allow to diagnose uterine perfusion disorders during pregnancy at different times.Conclusion. Determining the arterial perfusion index in pregnant women expands the diagnostic capabilities of physician in determining the condition of the postoperative uterus scar after a previous cesarean section and is an additional preventive measure to determine its failure. The output of the values of this indicator beyond the predicted threshold values will require additional diagnostic actions on the part of the physicians to find additional combined pathology that may affect uterine blood perfusion.

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction.

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction.

Evaluation of computed tomography myocardial perfusion in women with angina and no obstructive coronary artery disease.

Women with angina and no obstructive coronary artery disease (CAD) have worse cardiovascular prognosis than asymptomatic women. Limitation in myocardial perfusion caused by coronary microvascular dysfunction (CMD) is one of the proposed mechanisms contributing to the adverse prognosis. The aim of this study was to assess myocardial perfusion in symptomatic women with no obstructive CAD suspected for CMD compared with asymptomatic sex-matched controls using static CT perfusion (CTP). We performed a semi-quantitative assessment of the left ventricular myocardial perfusion and myocardial perfusion reserve (MPR), using static CTP with adenosine provocation, in 105 female patients with angina and no obstructive CAD (< 50% stenosis) and 33 sex-matched controls without a history of angina or ischemic heart disease. Patients were on average 4years older (p = 0.04) and had a higher burden of cardiovascular risk factors. While global perfusion during rest was comparable between the groups (age-adjusted p = 0.12), global perfusion during hyperemia was significantly reduced in patients compared with controls (163 ± 23 HU vs. 171 ± 25 HU; age-adjusted p = 0.023). The ability to increase myocardial perfusion during adenosine-induced vasodilation was significantly diminished in patients (MPR 148% vs. 158%; age-adjusted p < 0.001). This remained unchanged after adjustment for cardiovascular risk factors (p = 0.008). Women with angina and no obstructive CAD have reduced hyperemic myocardial perfusion and MPR compared with sex-matched controls. Impaired myocardial perfusion may be related to the presence of CMD in some of these women.

Effect of Mental Stress on Myocardial Perfusion in Women

Effect of Mental Stress on Myocardial Perfusion in Women

Intraoperative Assessment of Ureteral Perfusion in Women With Endometriosis

Intraoperative Assessment of Ureteral Perfusion in Women With Endometriosis

The measurement of endometrial volume and sub-endometrial vascularity to replace the traditional endometrial thickness as predictors of in-vitro fertilization success

To assess the value of endometrial thickness, volume, and sub-endometrial perfusion in women undergoing IVF. In 82 women candidate for ICSI, endometrial thickness and sub-endometrial perfusion were measured with a trans-vaginal 2 D ultrasound and 3 D power Doppler respectively on day of hCG trigger and Embryo transfer (ET). The primary outcome was the clinical pregnancy rate. Endometrial volume showing a statistically significant difference between pregnant and nonpregnant women (4.11 ± 1.19 vs. 3.4 ± 1.1 p = .019) on day of triggering and at ET (4.02 ± 1.15 vs. 3.45 ± 0.90, p = .022). VFI was significantly higher in pregnant group at both days of triggering and ET (0.54 ± 0.48 vs. 0.33 ± 0.31 and 0.47 ± 0.22 vs. 0.34 ± 0.2, p = .02). At cutoff values of 3.265 and 2.95 cm3 (70 & 80% sensitivity, specificity 64.5 & 51.6%, a positive predictive value 38.9 & 34.8%, and negative predictive value 87.0 & 88.9%) to predict pregnancy on the day of hCG trigger & ET respectively. Cutoff value for Endometrial VFI on the day of ET was 0.674 (sensitivity of 70%, specificity of 80.6%, PPV 53.8%, and NPV 89.3%). Higher endometrial volume and VFI were associated with pregnancy.

Does low-dose aspirin improve pregnancy rate in women undergoing frozen-thawed embryo transfer cycle? A pilot double-blind, randomized placebo-controlled trial.

To evaluate the effect of adjuvant low-dose aspirin therapy on clinical pregnancy rate and uterine perfusion in women undergoing frozen-thawed embryo transfer (FET) cycles. This study was performed as a pilot randomized, double-blind placebo-controlled trial, from May 2012 to February 2015. Overall, 60 available eligible women who were candidates for FET were randomly assigned to two groups receiving either 100 mg oral aspirin (n =30) or placebo (n =30). The primary outcome measure was clinical pregnancy rate. Secondary outcome measures were pulsatility index (PI), resistance index (RI), implantation rate, live birth rate and miscarriage rate. There was no significant difference in endometrial thickness, PI and RI. However, the study group had higher rates of clinical pregnancy, implantation, live birth (P = 0.042, P = 0.031 and P = 0.007, respectively) and lower rate of miscarriage (P = 0.020) as compared to the control group. Twin birth rate was comparable between the two groups. Our pilot study demonstrated that administration of low-dose aspirin in FET cycles results in better pregnancy, implantation and live birth rates without changing the uterine hemodynamics or endometrial thickness. However, further randomized clinical studies in larger populations are needed to confirm these findings.

Reliability of vulvar blood perfusion in women with provoked vestibulodynia using laser Doppler perfusion imaging and laser speckle imaging

BackgroundMicrovascular assessment has become increasingly used in gynecology to better understand the pathophysiology of various vulvar conditions and to study sexual function. Alteration in blood perfusion of the vulvar area has been observed using laser technologies in women with provoked vestibulodynia (PVD), the leading cause of vulvar pain. However, no studies have thus far investigated the reliability of and agreement between lasers for evaluating vulvar blood perfusion. ObjectivesThe main objective was to investigate the between-session reliability of the laser Doppler perfusion imaging (LDPI) and laser speckle contrast imaging (LSCI) for assessing blood perfusion of the vulvar vestibule in women with PVD. Secondary aims were to evaluate the association and agreement between the two laser technologies. MethodsTwenty-six women with PVD participated in the study. Blood perfusion of the vulvar vestibule was assessed with LDPI and LSCI during two sessions 2 to 4 weeks apart. Blood perfusion was analyzed in five specific areas of the vulvar vestibule: 1) 3 o'clock site, 2) 6 o'clock site, 3) 9 o'clock site, 4) central area (delimited by areas 1, 2 and 3), and 5) posterior fourchette. The reliability of the measurements of the two instruments was calculated with intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs) and coefficients of variation (CVs). Paired t-tests were also computed to compare the CVs of each laser technology. The association and agreement between LDPI and LSCI measurements were evaluated by Pearson's correlation coefficients and Bland-Altman plots, respectively. ResultsExcellent reliability was found for LDPI (ICCs = 0.78–0.80, p < 0.001, SEMs = 16.1–47.9) and LSCI measurements (ICCs = 0.75–0.81, p ≤ 0.001, SEMs = 17.0–52.2) for all vulvar vestibule areas. However, CVs were significantly higher using LDPI (CVs = 15.1–19.8) when compared to LSCI (CVs = 7.0–11.6) for all areas (p ≤ 0.031), except for area 4 (p = 0.079). Significant correlations were found between LDPI and LSCI for all areas (r = 0.58–0.89, p ≤ 0.003). Bland-Altman plots revealed a systematic difference between LDPI and LSCI measurements. ConclusionFindings show that both LDPI and LSCI measurements are reliable for assessing blood perfusion of the vulvar vestibule in women with PVD. The LSCI appears to be a more reliable measurement as it presents less variation than LDPI. Finally, although LDPI and LSCI measurements are related, the systematic difference observed between them makes it impossible to compare absolute units.

Clinical use of endovenous indocyanine green during rectosigmoid segmental resection for endometriosis

To describe a new use of endovenous indocyanine green (ICG) to allow real-time visualization of bowel perfusion in women with recto-sigmoid endometriosis who may be candidates for segmental resection. Step-by-step explanation of this method using descriptive text and educational video. Tertiary level referral academic center. A nulliparous 36-year-old woman affected by a large rectal endometriotic nodule was referred for severe dysmenorrhea, dyspareunia, hematochezia, and dyschezia, despite progestinic therapy. An intravenous injection of 1.5 mL solution containing 3.75 mg dose of ICG for intraoperative fluorescence imaging. Evaluation of blood perfusion of bowel and rectal endometriosis nodule. Evaluation of neoanastomosis vascularization after bowel resection. The procedure of endometriosis removal was performed using the daVinciXi surgical platform (Intuitive Surgical, Sunnyvale, CA). After ovarian endometriosis removal and adhesiolysis, we identified the endometriosis nodule on the anterior surface of the rectum. Pararectal, rectovaginal, and retrorectal spaces were dissected with a nerve-sparing technique. Indocyanine green was administered through a peripheral line. A near-infrared camera head enabled vision of the colorant after latency of a few seconds. We observed the ischemic area around the rectal nodule and perfusion areas upstream and downstream from the lesion. We selected the transecting line for rectal resection, taking account of this objective evaluation, beyond the limits of macroscopic disease. After direct mechanical anastomosis, we checked the rectal vascularization with ICG. To the best of our knowledge, this is the first reported use of endovenous ICG during a bowel resection for deep endometriosis. Endovenous ICG is proposed during surgery for rectosigmoid endometriosis to assess the perfusion of the bowel and select the transecting line. With ICG fluorescence imaging, we can objectively evaluate whether blood supply to the anastomosis is adequate. Endovenous ICG for objective vascular assessment is simple and rapid to use, and no complications related to ICG use were recorded.

The effects of cardiac rehabilitation on overall physical capacity and myocardial perfusion in women with microvascular angina.

Cardiac syndrome X (CSX) is linked with changes in microcirculation, without significant changes in main coronary vessels. According to European Society of Cardiology 2013 stable coronary artery disease (CAD) criteria, CSX was replaced by microvascular angina (MA). The main feature of MA should be regional myocardial ischaemia; however, there are several works on this subject which failed to demonstrate the presence of perfusion defects. To determine the effect of non-pharmacological procedures (cardiac rehabilitation) in patients diagnosed with MA on changes in left ventricular perfusion as assessed by myocardial single photon emission computed tomography, along with potential related improvements in exercise capacity. Toward this goal we screened for the presence of CAD in a group of 528 women, of whom 55 were not only diagnosed with MA but also agreed to participate in our study, which involved myocardial perfusion imaging (MPI) studies, during which exercise tests and cardiac rehabilitation were performed. Comparison of results obtained at the beginning of the study with data obtained after completion of a three month period of cardiac rehabilitation showed improvements in both exercise test parameters (length of test, metabolic equivalents, blood pressure control during extortion) and MPI parameters for the left ventricle (both at rest and stress, global and regional). Cardiac rehabilitation is a very useful tool of choice in the treatment of patients with MA.

Angiogenic factors and uterine Doppler velocimetry in early‐ and late‐onset preeclampsia

To assess correlations between maternal serum levels of pro- and anti-angiogenic factors with uterine perfusion in women with early- compared with late-onset preeclampsia, and in healthy pregnant women. Case-control study. Antenatal care clinic located within a hospital (São Bernardo do Campo, Brazil). We enrolled 54 preeclamptic and 54 healthy control women who were coming for routine ultrasound at 28-36 weeks' gestation. All participants had uterine artery and umbilical Doppler studies and a blood sample to assess maternal serum levels of soluble fms-like tyrosine kinase-1, soluble endoglin, adiponectin and plasminogen activator inhibitor-1. All angiogenic factors were measured using enzyme-linked immunosorbent assay. Levels of pro- and anti-angiogenic factors in maternal serum, and uterine artery Doppler findings. Concentrations of soluble fms-like tyrosine kinase-1 and soluble endoglin were significantly higher in preeclamptic than control women (p < 0.0001 and p < 0.0001, respectively), especially in those with early-onset (<34 weeks) preeclampsia. These two anti-angiogenic mediators were significantly correlated with increased uterine artery Doppler in the preeclamptic women. Plasminogen activator inhibitor-1 levels were significantly higher in preeclampsia (p = 0.03) but unrelated to uterine artery resistance. Adiponectin levels were similar in cases and controls, independent of body mass index and unrelated to uterine artery resistance. Preeclamptic patients have increased soluble fms-like tyrosine kinase-1 and soluble endoglin serum levels and this increase is directly correlated with uterine artery resistance, especially in those with early-onset preeclampsia.

Microcirculation in women with severe pre‐eclampsia and HELLP syndrome: a case–control study

To compare microcirculatory perfusion in women with severe pre-eclampsia against that in healthy pregnant women, and secondly in women with severe pre-eclampsia with or without HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets). Case-control study. University Hospital Rotterdam, the Netherlands. Twenty-three women with severe pre-eclampsia and 23 healthy pregnant controls, matched for maternal and gestational age. Out of the 23 women with severe pre-eclampsia, ten presented with HELLP syndrome. Microcirculation was analysed sublingually by a non-invasive sidestream dark-field imaging device (SDF). Perfused vessel density (PVD), microcirculatory flow index (MFI), and heterogeneity index (HI) were calculated for both small vessels (∅ < 20 μm; capillaries) and non-small vessels (∅ > 20 μm; venules and arterioles). There were no significant differences between women with severe pre-eclampsia and healthy controls. Women with pre-eclampsia and HELLP syndrome showed a reduced PVD (P = 0.045), MFI (P = 0.008), and increased HI (P = 0.002) for small vessels, as compared with women with pre-eclampsia but without HELLP syndrome. Sidestream dark-field is a novel, promising technique in obstetrics that permits the non-invasive evaluation of microcirculation. We did not observe major differences in sublingual microcirculatory perfusion between women with severe pre-eclampsia and healthy pregnant controls. In women with severe pre-eclampsia, the presence of HELLP syndrome is characterised by impaired capillary perfusion.

Hepatic portal vein flow and three dimensional indices of hepatic perfusion in pre-eclampsia compared with normal pregnancy

It has been suggested that the origins of pre-eclampsia arise from the maternal venous system dysfunction. This study aimed to test this hypothesis by assessing hepatic perfusion in pre-eclampsia using three-dimensional (3D) ultrasound. The hepatic portal vein flow in 12 women with normal pregnancy and 11 women with pre-eclampsia was measured using standard Doppler ultrasound. The 3D indices of hepatic perfusion: flow index (FI), vascular index (VI) and vascularisation flow index (VFI), which are believed to reflect vascularity and flow intensity were also measured. Because of small numbers, a non-parametric test was used to test differences between groups. Hepatic portal vein flow was no different between women with normal pregnancy compared with women with pre-eclampsia (228.1 (215.5–270.6) vs 283.0 (145.9–344.6); p = 0.90). The 3D indices of hepatic perfusion were as follows (FI: 36.3(30.7–42.5) vs 39.7 (27.7–44.2), p = 1.00; VI: 11.7 (3.6–21.2) vs 3.0 (0.5–7.6), p = 0.04; VFI: 4.7 (1.2–8.3) vs 1.2 (0.1–3.2), p = 0.06, respectively). This study was not able to support or refute the suggestion that the genesis of pre-eclampsia arises from the maternal venous circulation. There may be biological differences in the 3D indices of hepatic perfusion in women with pre-eclampsia compared with normal pregnant women.

Cardiac risk factors and myocardial perfusion reserve in women with microvascular coronary dysfunction.

Women with myocardial ischemia without obstructive coronary artery disease (CAD) often have microvascular coronary dysfunction (MCD). Traditional cardiac risk factors (RFs) contribute modestly to MCD detected by invasive coronary reactivity testing (CRT). Cardiac magnetic resonance imaging (CMRI) is an emerging noninvasive technique used to evaluate MCD. We evaluated RFs related to CMRI myocardial perfusion in women with MCD. 53 women with CRT confirmed MCD underwent adenosine stress and rest CMRI (1.5 Tesla). The myocardial perfusion reserve index (MPRI) was calculated (Pie Medical) with lower MPRI meaning less perfusion reserve. Relationships between RFs and MPRI were examined. The mean age was 54±10 years with a mean body mass index (BMI) of 26.2±4.2. The mean MPRI was 1.63±0.39. Hypertension, dyslipidemia, elevated BMI, and post-menopausal status were inversely related to MPRI, while ever smoking, age, family history of CAD, history of irregular menses, and history of menopausal hormone therapy (MHT) or oral contraceptive (OC) use were not. Dyslipidemia and BMI remained significant independent predictors of MPRI. Regression modeling demonstrated that the RFs of dyslipidemia, obesity, hypertension, family history of CAD, and history of irregular menses explained 27% of the observed MCD variance. In conclusion, impaired MPRI measured by CMRI is related to dyslipidemia and elevated BMI in women with MCD. These results suggest traditional RFs contribute modestly to MCD; a larger cohort of women with MCD should be examined to confirm and extend these observations. The impact of traditional CAD RF modification strategies, including optimal medical therapy, should be explored as MCD treatment targets.

Effects of Cabergoline administration on uterine perfusion in women with polycystic ovary syndrome

The aim of this study was to determine the effects of Cabergoline administration on uterine blood flow in women suffering from polycystic ovary syndrome (PCOS). This study is a randomized, controlled, triple-blind trial which is tested on 40 women who were randomly divided into two groups of 20 people and using arandomized blockdesign during which the subjects were assessed and included. They were suffering from polycystic ovarian syndrome. Inclusion criteria were classically defined PCOS criteria including: oligomenorrhea or amenorrhea, clinical or Laboratory findings based on increase in blood level androgen (testosterone) and ultrasound confirmation of PCOS. Exclusion criteria were Pregnancy, lactation, Dopamine Agonist Therapy. After selection of intervention and placebo groups, primary control Doppler ultrasound was done for both groups. Then a weekly dose of Cabergoline 0.5 mg was administered to intervention group for duration of 12 weeks. Placebo group were administered placebo in the same fashion. At the end of 12 weeks, Doppler ultrasound was performed and the results were recorded in the check lists. No significant difference was noticed in both groups with respect to their age, employment, level of education, type of infertility, duration of marriage, and results of RI and PI before intervention. Later PCOS patients under the treatment of Cabergoline showed a significant increase in uterine blood flow Pulsatility Index (PI) before 2.65±0.52 and after 1.98±0.52 and RI before 0.85 and after intervention 0.77), yet no significant difference were found in PCOS patient under the treatment of placebo. PCOS patients were shown to have more resistance in uterine blood flow than healthy people; however, Cabergoline administration proved to increase uterine blood perfusion and regulate menstruation cycle.