Pulsatility Index In Patients Research Articles

Pulmonary artery pulsatility index in patients with tricuspid valve regurgitation: a simple non-invasive tool for risk stratification.

Tricuspid valve regurgitation (TR) is a common valvular disease associated with increased mortality. There is a need for tools to assess the interaction between the pulmonary artery (PA) circulation and the right ventricle in patients with TR and to investigate their association with outcomes. The pulmonary artery pulsatility index (PAPi) has emerged as a haemodynamic risk predictor in left heart disease and pulmonary hypertension (PH). Whether PAPi discriminates risk in unselected patients with greater than or equal to moderate TR is unknown. In 5079 patients with greater than or equal to moderate TR (regardless of aetiology) and PA systolic and diastolic pressures measured on their first echocardiogram, we compared all-cause mortality at 5 years based on the presence or absence of PH and PAPi levels. A total of 2741 (54%) patients had PH. The median PAPi was 3.0 (IQR 1.9, 4.4). Both the presence of PH and decreasing levels of PAPi were associated with larger right ventricles, worse right ventricular systolic function, higher NT-pro BNP levels, greater degrees of right heart failure, and worse survival. In a subset of patients who had an echo and right heart catheterization within 24 h, the correlation of non-invasive to invasive PA pressures and PAPi levels was very good (r = 0.76). In patients with greater than or equal to moderate TR with and without PH, lower PAPi is associated with right ventricular dysfunction, right heart failure, and worse survival. Incorporating PA pressure and PAPi may help stratify disease severity in patients with greater than or equal to moderate TR regardless of aetiology.

Relationship between hypertension and pulsatility index in acute ischemic stroke patients

Hypertension is one of the risk factors for stroke. In the United States, stroke is the third leading cause of death, with a death rate of 146,664 people. Pulsatility index (PI) examination on transcranial Doppler is a value generated by blood flow velocity and blood viscosity. Methods: Retrospective analytic observational study with a cross-sectional study design in patients with acute thrombotic stroke with hypertension according to JNC VIII criteria. Data were obtained from secondary data from medical records of patients treated in the nervous room of Dr RSUD. Soetomo, in the period from February 2019 to February 2022, met the inclusion criteria, namely being over 18 years old, undergoing a TCD examination and having a stroke for the first time. Statistical analysis using Spearman correlation test with a significance value <0.05. Results: A total of 46 subjects met the inclusion and exclusion criteria. Tension with a mean of 152.00 ± 20.87 and a mean value of PI 1.08 ± 0.73. The Spearman statistical test showed a positive correlation with a substantial and statistically significant relationship level (rho = 0.712, p=0.002). Conclusion: there is a strong significant relationship between hypertension and the pulsatility index in patients with acute thrombotic stroke

Diagnostic Value of Portal Venous Pulsatility Index in Patients with High-Risk Nonalcoholic Fatty Liver Disease

Diagnostic Value of Portal Venous Pulsatility Index in Patients with High-Risk Nonalcoholic Fatty Liver Disease

Prognostic Impact of the Pulmonary Artery Pulsatility Index in Patients with Chronic Heart Failure and Severe Mitral Regurgitation Undergoing Percutaneous Edge-to-Edge Repair

Background: Pulmonary artery (PA) pulsatility index (PAPi), calculated as (PA systolic pressure – PA diastolic pressure)/right atrial pressure, emerged as a novel predictor of right ventricular failure in patients with acute inferior myocardial infarction, advanced heart failure, and severe pulmonary hypertension. However, the prognostic utility of PAPi in transcatheter mitral valve repair (TMVR) using the MitraClip® system has never been tested. Objective: To assess the prognostic impact of PAPi in patients with severe functional mitral regurgitation (MR) and chronic heart failure (CHF) undergoing TMVR. Methods: Consecutive patients with severe functional MR (grade 3+ or 4+) and CHF who underwent successful TMVR (MR ≤2+ at discharge) were enrolled and divided into 3 groups according to PAPi (A: low PAPi ≤2.2; B: intermediate PAPi 2.21–3.99; C: high PAPi ≥4.0). The primary endpoint was a composite of all-cause mortality and rehospitalization due to CHF during a mean follow-up period of 16 ± 4 months. The impact of PAPi on prognosis was assessed by a receiver-operating characteristic (ROC) analysis and a multivariable Cox proportional hazard regression analysis investigating independent predictors for outcome. Results: 78 patients (A: n = 27, B: n = 28, C: n = 23) at high operative risk (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation] 18.8 vs. 21.5 vs. 20.6%; nonsignificant) were enrolled. Mean PAPi was 1.6 ± 0.41 vs. 2.9 ± 0.53 vs. 6.8 ± 3.5; p < 0.001). Patients with low PAPi showed significantly higher rates of early rehospitalization for heart failure at the 30-day follow-up (14.9 vs. 7.1 vs. 4.3%; p = 0.04). In the long term, a significantly lower event-free survival for the combined primary endpoint was observed in the low PAPi group (44.4 vs. 25.0 vs. 20.3%; log-rank p = 0.016). ROC curve analysis revealed that optimal sensitivity and specificity were achieved using a PAPi cutoff of 2.46 (sensitivity 83%, specificity 78.3%, area under the curve 0.82 [0.64–0.99]; p = 0.01). In Cox regression analysis, PAPi ≤2.46 was an independent predictor for the combined primary endpoint (hazard ratio 2.85; 95% confidence interval 1.15–7.04; p = 0.023). Conclusions: PAPi is strongly associated with clinical outcome among patients with CHF and functional MR undergoing TMVR. A PAPi value ≤2.46 predicts a worse prognosis independent of other important clinical, echocardiographic, and hemodynamic factors. Therefore, PAPi may serve as a new parameter to improve patient selection for TMVR.

Association between splenic volume and pulsatility index in patients with left ventricular assist devices

The spleen serves as a blood volume reservoir for systemic volume regulation in heart failure (HF) patients. Changes are seen in spleen size in advanced HF patients after left ventricular assist device (LVAD) implantation. The pulsatility index (PI) is an indicator of native heart contractility with hemodynamic changes in patients using LVAD. We hypothesized that the splenic volume was associated with the PI, reflecting the hemodynamics in advanced HF patients with LVADs. Herein, we investigated the relationship between splenic volume and PI in these patients. Forty-four patients with advanced HF underwent implantation of HeartMate II® (Abbott, Chicago, IL, USA) as a bridge to heart transplantation at the Nagoya University Hospital between October 2013 and June 2019. The data of 27 patients (21 men, median age 46 years) were analyzed retrospectively. All patients underwent blood tests, echocardiography, right heart catheterization, and computed tomography (CT). Spleen size was measured via CT volumetry; the splenic volume (median: 190 mL) correlated with right arterial pressure (r = 0.431, p = 0.025) and pulmonary capillary wedge pressure (r = 0.384, p = 0.048). On multivariate linear regression analysis, the heart rate (β = -0.452, p = 0.003), pump power (β = -0.325, p = 0.023), and splenic volume (β = 0.299, p = 0.038) were independent determinants of PI. The splenic volume was associated with PI, reflecting the cardiac preload in advanced HF patients with LVADs. Thus, spleen measurement using CT may help estimate the systemic volume status and understand the hemodynamic conditions in LVAD patients.

Relationship between aortic pulse wave velocity and mid cerebral artery pulsatility index in patients with chronic obstructive pulmonary disease; pilot data from the ARCADE Study

BackgroundChronic obstructive pulmonary disease (COPD) is an inflammatory condition associated with increased cardiovascular risk. COPD patients have increased aortic stiffness and increased risk of stroke. In addition, increased mid cerebral artery pulsatility index (MCAPI) is associated with increased arterial stiffness and risk of stroke in patients with Diabetes. However, the mechanisms relating to the increased risk of stroke in COPD remain unclear. Therefore, this study aims to investigate the relationship between aortic pulse wave velocity (aPWV) and the MCAPI in COPD patients.MethodsThis Cross-sectional evaluation included 20 COPD patients (mean ±SD, age 69.0 ±6.3 years) from the ACRADE study. aPWV was measured using the SphygmoCor system and MCAPI using transcranial Doppler ultrasound. In addition, forced expiratory volume in the first second/ forced vital capacity (FEV1/FVC) was measured using spirometry and quality of life was assessed using the St George’s Respiratory Questionnaire (SGRQ). Measures of frailty were assessed using Time-Up-and-Go test (TUG) and the Comprehensive Geriatric Assessment (CGA).ResultsMCAPI was significantly associated with aPWV (r = 0.518, P = 0.033). aPWV was significantly associated with SGRQ disease impact (r = 0.604, P = 0.010) and also associated with TUG (r=0.561, P=0.019) and CGA (r = 0.639, P = 0.006).ConclusionsThese pilot data highlight the association between increased aortic stiffness and increased pulsatile flow velocity transmitted to the cerebral circulation of COPD patients. In addition, COPD symptoms, impact and frailty are both associated with increased aortic stiffness. However, more research is needed to investigate cause and effect between COPD symptoms, impact and its relationship between aPWV and cerebral flow pulsatility.

The relationship between bone mineral density and cerebral pulsatility index in patients with acute ischemic stroke (P6.025)

The relationship between bone mineral density and cerebral pulsatility index in patients with acute ischemic stroke (P6.025)

Abstract TP190: Bone Mineral Density is Inversely Related to Cerebral Pulsatility Index in Patients With Acute Ischemic Stroke

Introduction: Atherosclerosis and osteoporosis are two major public health problems. These are both multifactorial and degenerative diseases that accompany aging. Co-morbidities are common, with a high prevalence of cardiovascular risk factors including hypertension, smoking, and sedentary lifestyle. Several studies have suggested a relationship between atherosclerosis and osteoporosis, with a significant correlation between coronary artery calcium and bone mineral density (BMD). The pulsatility index (PI) is designed to measure vascular resistance and characterizes the shape of the spectral waveform. The PI was increasing with age but alterations in PI are the reflection of multifactorial, pleiotropic events occurring in the cardio and cerebral vascular system. Atherosclerosis of the large proximal arteries and the intracranial vessels are important factors for increased PI. Hypothesis: We hypothesized that the transcranial Doppler (TCD) PI would reflect the atherosclerotic component of intracranial vessels which in turn is related to systemic atherosclerosis. In this context, we investigated the relationship between TCD PI and BMD in acute ischemic stroke patients. Methods: Patients having their first ischemic stroke within 7 days were screened for the study. Doppler signals from the main stem of the middle cerebral artery (MCA) were obtained transtemporally with a traditional 2-MHz transducer at depths of 56, 58, and 60 mm. BMD was measured at total hip and lumbar spine in the anterior-posterior projection, using dual-energy x-ray absorptiometry. Results: A total of 146 patients were enrolled in the study and the mean age was 68.3±10.34 years. Multiple linear regression analysis reveals that age (p&lt;0.001) and BMD T-score (p=0.028) were significantly associated with increased TCD PI. Old age and decreased T-score were significantly related to increased TCD PI. Age adjusted scatterplots showed that BMD T-score was inversely related to TCD PI in acute ischemic stroke patients (r=-0.202, p=0.028). Conclusions: Our findings indicate that decreased BMD may be associated with atherosclerosis in the cerebral circulation.

Serum Relaxin and Renal Vascular Resistance in Diabetic and Non-Diabetic Patients with Different Grades of Chronic Kidney Disease

<b>Objectives: </b>To<b> </b>evaluate serum relaxin and renal vascular resistance in diabetic and non-diabetic patients with different grades of chronic kidney disease and to correlate serum relaxin to various clinical and Doppler renal hemodynamic parameters. <b>Materials and methods: </b>Sixty patients with chronic kidney disease were divided into two groups: group 1 (30 patients with creatinine clearance of less than 30 ml/minute), and group 2 (30 patients with creatinine clearance of more than 30 ml/minute). Twelve patients (40%) had diabetes mellitus type 2 in group 1 and 18 (60%) in group 2. In addition, group 3 (20 healthy controls), compatible for age and gender, was included. Resistive index and pulsatility index were measured by Doppler ultrasonography of renal arteries. Serum relaxin was measured with ELISA method, and correlated with clinical and Doppler parameters. <b>Results:</b> Serum relaxin levels of groups 1 and 2 were significantly lower than group 3 and that of group 1 were significantly lower than group 2. Resistive index and pulsatility index of groups 1 and 2 were significantly higher than group 3, but there was no significant difference between group 1 and 2. There was an inverse correlation between serum relaxin levels, and serum creatinine in groups 1 and 2. In contrast, there was a positive correlation between serum relaxin and creatinine clearance in groups 1 and 2. There was an inverse correlation between serum relaxin levels, and both resistive index and pulsatility index, in group 2 but not in group 1. Finally, serum relaxin was significantly lower in diabetic compared to non-diabetic patients. <b>Conclusions: </b>We found that serum relaxin levels are significantly lower in patients with advanced stages of chronic kidney disease, as well as, in diabetic compared to non-diabetic patients. Also, serum relaxin is negatively correlated with patients’ age, resistive index and pulsatility index in patients with chronic kidney disease.

Evaluation of the renal resistive index and pulsatility index in patients with pleural effusion by duplex Doppler ultrasonography

The aim of the study was to evaluate the renal resistive index (RI) and pulsatility index (PI) in patients with pleural effusion (PE). We studied the mean renal RI and PI in 50 patients with PE and 30 healthy volunteers by Doppler sonography. We grouped effusion as unilateral and bilateral. Statistical analysis was done by independent t test and correlation coefficient analysis. The mean RI/PI in healthy volunteers and in PE patients was 0.58/0.93 and 0.72/1.35, respectively. We observed a significantly higher RI and PI in patients when compared with healthy volunteers (all p < 0.001). We found no difference between the renal RI or PI related to unilateral (0.71 or 1.34, respectively) or bilateral effusion (0.74 or 1.55, respectively) (p > 0.05). Pleural effusion might result in increased renal impedance as seen in cirrhosis, which is a rather complicated pathophysiological process, without causing any morphological changes in kidneys.

The role of Doppler sonography in assessment of malignant trophoblastic disease

An observational study on the role of Doppler sonography in the assessment of patients with malignant trophoblastic disease was performed in an Oncology Unit of a University teaching hospital. A total of 32 consecutive patients referred for chemotherapy were recruited. Twenty-three non-pregnant and 18 women in the first trimester of pregnancy acted as controls. The patients were prospectively followed-up for 2 years. It was found that the uterine arterial resistance index and pulsatility index in patients who required chemotherapy were significantly lower when compared with the non-pregnant and pregnant controls; (Student t-test; P < 0.001 and P < 0.01, respectively). Stepwise regression analysis of β-hCG titres on uterine artery resistance index showed significant correlation, after controlling for uterine volume (adjusted multiple R = 0.71, P < 0.00001). There were, however, no significant independent associations between the initial uterine artery resistance index and the need for chemotherapy, number of courses of chemotherapy required, duration required for the β-hCG titre to return to normal, presence of metastatic disease, or the subsequent development of drug resistance or relapse. It was concluded that uterine arterial Doppler indices are significantly correlated with trophoblastic activity (β-hCG titres) in malignant trophoblastic disease. However, their role in the prediction of subsequent tumour behaviour need to be assessed in larger series.

Prognostic appraisal of success and failure in an in vitro fertilization program by transvaginal Doppler ultrasound at the time of ovulation induction.

In 323 stimulated cycles of women participating in in vitro fertilization treatment, a transvaginal Doppler examination was performed on the day of ovulation induction to investigate the value of blood flow velocimetry of the uterine artery. The results showed a significantly lower pulsatility index in patients who conceived (n = 42) compared with those who did not become pregnant (n = 272). The differences were especially marked during the first cycles. These results suggest that studies of the uterine hemodynamic response are useful in appraising the likelihood of success of implantation after embryo transfer.

Validity of Cervical Carotid Doppler Velocimetry for Cerebral Atherosclerosis

Comparison of Doppler flow parameters measured by pulsed Doppler method with angiographic findings was studied in 77 patients (121 common carotid arteries) . A RT-3600 scanner which employs a 5-MHz transducer in the Doppler mode, was used for the duplex studies. Duplex studies were performed after cerebral angiography. All patients had images of right and/or left common carotid artery obtained by digital subtraction angiography, and conventional cerebral angiography. The severity of atheroscler-osis was scored by angiographic findings : atheromatous plaque, wall irregularity, stenosis, tortousity, and so on. Systolic velocity, diastolic velocity, mean velocity, and pulsatility index were measured by the pulsed Doppler technique in the common carotid artery. The systolic velocity, diastolic velocity, and mean velocity showed negative currelations with the atherosclerotic score on angiograms, and the pulsatility index showed positive correlation with that on angiograms. Pulsatility index in patients with cerebral infarction in the examind internal carotid artery distribution was statistically significantly higher than that in patients having no ischemic lesions. It was thought that Doppler flow parameters, such as systolic velocity, diastolic velocity, mean velocity, and pulsatility index reflected well the severity of atherosclerosis, and Doppler ultrasound was a useful method for evaluating atherosclerosis and cerebral ischemic lesions.