Pulsed Doppler Study Research Articles

CORRELATION OF ABNORMAL UTERINE ARTERY DOPPLER IN THE SECOND TRIMESTER OF PREGNANCY WITH MATERNAL AND FETAL OUTCOME.

Introduction: Maternal – fetal circulation can be studied non-invasively by using doppler which can be used as a screening tool for fetal and maternal disease. Morphological changes in the uterine vasculature can be demonstrated by colour and pulsed doppler studies. The majority of the studies on uterine artery doppler have focused on a high risk population. The effectiveness of the uterine artery doppler to predict pre eclampsia or FGR in a low risk population has been shown to have a low to moderate predictive value1. Also the criteria for normal and abnormal uterine artery doppler continue to vary with no well accepted denition. Aim: To nd out the correlation between abnormal uterine artery doppler in the second trimester of pregnancy between 18-22 weeks, with the subsequent development of pre eclampsia and FGR. Materials and methods: This is a prospective cohort study carried out in the Department of Obstetrics and Gynecology for a period of one year. Antenatal patients in the age group of 18-35 years, between 18-22 weeks of gestation, who were included in the study underwent a uterine artery doppler. They were followed up until delivery. SPSS software was used to analyze the data. Results: 193 Obstetric patients in the age group 18-35 years were evaluated with uterine artery doppler. 77.7% had normal doppler indices. In the abnormal doppler group, 81.4% were in the high risk category and 48.8% of those with abnormal dopplers developed pre eclampsia and 34.9% with abnormal dopplers developed FGR. Conclusion: Patients with abnormal uterine artery doppler indices in the second trimester of pregnancy, had an 18 times increased risk of developing pre eclampsia and a 6 times increased risk of developing FGR when compared to those with normal doppler indices.

Characteristics of Isolated Ventricular Septal Defects Less Likely to Close In Utero.

To determine the characteristics of fetal ventricular septal defects (VSDs) that will be less likely to close prenatally. In this 4-year retrospective cohort study, 148 fetuses had a diagnosis of a VSD during a comprehensive fetal anatomy survey. The VSD diagnosis was confirmed by color and pulsed wave Doppler studies. These fetuses were followed monthly until their birth. They had postnatal echocardiography performed within 1 month of age to assess the persistence of a VSD. Fisher exact, Wilcoxon rank sum, and log rank tests and bivariate and multivariate logistic regressions were used to examine the association of each individual variable with prenatal VSD closure. One hundred twenty-five of 148 fetuses (84%) had prenatal VSD closure at a mean gestational age ± SD of 26.9 ± 4.5 weeks. Fetuses with a persistent VSD more frequently had other cardiac defects than the closed VSD group (12 of 23 versus 5 of 125; P < .001). Fetuses having a persistent VSD more frequently had an abnormal karyotype (9 of 23 versus 5 of 125; P < .001). The persistent VSDs were larger in their initial size (5.9 ± 8.4 mm versus 2.7 ± 0.8 mm; P = .002) and in their maximal prenatal size (6.0 ± 9.1 mm versus 2.9 ± 0.9 mm; P < .001). The presence of associated cardiac defects (adjusted odds ratio = 0.071; P = .031) and an abnormal karyotype (adjusted odds ratio = 0.058; P = .021) were significantly associated with a lower likelihood of prenatal VSD closure. All VSDs with a maximal size of 2 mm or less closed prenatally. Fetuses with a complex cardiac defect or an abnormal karyotype were less likely to have prenatal VSD closure.

0009: Contribution of right ventricular echocardiographic parameters in evaluation of the prognosis of dilated cardiomyopathy

Introduction The evaluation of the prognosis of patients with dilated cardiomyopathy (DCM) is an essential step in their care but the study ultrasound of the right ventricle (RV) is not a part of the practice of the cardiologist. Purpose Determine which of the RV echocardiographic parameters those predicting the occurrence of secondary cardiac events (death, hospitalization for decompensated heart failure and ventricular arrhythmias poorly tolerated) in patients with DCM. Materials and methods Prospective study in 61 patients with DCM. All patients received a conventional echocardiographic examination with emphasis on studying the RV parameters: fractional shortening surface (FRSRV), the systolic excursion of the tricuspid annulus inTM (TAPS) and systolic pulmonary artery pressure (SPAP), completed by a tissue pulsed Doppler study at the tricuspid annulus (Sa, Ea and Aa). We studied the correlation between echocardiographic parameters of RV and the occurrence of secondary cardiac events. Results The average age of patients was 62±9 years with a sex-ratio of 2/1. Forty-eight percent of patients were in NYHA class III. The average fractional ejection of left ventricle was 29±7,2%. DCM was ischemic in 59% of cases. During follow-up (11±5 months), 5 patients died, 22 were hospitalized for decompensated heart failure and 2 patients had a ventricular tachycardia. We have shown that the parameters predictors of mortality are: TAPS 42mmHg, RV FRS 42mmHg, a TAPS

The Safe Use of Diagnostic Ultrasound in Obstetrics and Gynecology

ABSTRACT The diagnostic ultrasound was considered safe after the intensity threshold was known and the output intensity (Ispta) was regulated to be less than 10 mW/cm2 in diagnostic devices in Japan, and diagnostic ultrasound was thought safe in USA when both thermal index (TI) and mechanical index were less than 1.0 in the obstetrical setting. Simple B-mode machine was not concerned from the thermal reason due to its extremely low ultrasound intensity, while the exposure was recommended within 30 minutes. Diagnostic ultrasound should be used after obstetrical setting in fetal study. The TI will be higher in febrile cases than nonfebrile, and the surface temperature of transvaginal scan (TVS) probe should be lower than 41°C. Simple three-dimensional or four-dimensional ultrasound imaging without pulsed Doppler studies will be as safe as Bmode when the study is within 30 minutes, because they are composed of simple B-mode images. The spectral Doppler study was not routinely used and its exposure should be short in 11 to 13 weeks of pregnancy in the statements of WFUMB and ISUOG, because experimentally early fetal animal tissue was sensitive to the studies. The use of diagnostic ultrasound should be limited for medical purposes, but not for the entertainment or keepsake of pregnancy. How to cite this article Maeda K, Kurjak A. The Safe Use of Diagnostic Ultrasound in Obstetrics and Gynecology. Donald School J Ultrasound Obstet Gynecol 2012;6(3):313-317.

Temporal differences in ejection between right and left ventricles in chronic pulmonary hypertension: a pulsed Doppler study

Chronic pulmonary hypertension (cPH) is known to alter right ventricular (RV) deformation and cause mechanical dyssynchrony. Since not all echocardiographic laboratories are equipped with sophisticated imaging tools, we decided to determine if Doppler would be useful to detect temporal differences between the ejection of the right and left ventricle (LV) as a result of cPH using pulsed outflow tract (RVOT and LVOT) spectral signals. Data was collected from 30 patients without PH (Group I: 53 ± 7 years and 31 ± 5 mmHg) and from 40 patients with cPH (Group II: 53 ± 13 years; P = NS and 82 ± 24 mmHg; P < 0.00001). Group II patients had a longer temporal delay from onset between RVOT and LVOT (23 ± 12 ms vs. 0 ± 0 ms; P < 0.0001) with a significantly shorter temporal difference between RVOT and LVOT spectral signals to reach maximum peak of ejection (27 ± 24 ms vs. 61 ± 23 ms; P < 0.0001) than Group I. In addition, Group II had a statistically lower RVOT VTI value (0.14 ± 0.05 cm vs. 0.17 ± 0.03 cm; P < 0.01). Our data seems to suggest that increasing severity of PH mainly affects ejection of the RV resulting in noticeable temporal alterations in both time of onset as well as time to reach maximum peak ejection between RV and LV. More studies are now required to determine the utility of obtaining these measurements prospectively in the follow-up and treatment of cPH patients.

Early Echocardiographic Findings in β-Thalassemia Intermedia Patients Using Standard and Tissue Doppler Methods

Heart complications are among the serious problems of patients with β-thalassemia intermedia. This study aimed to evaluate myocardial function in these patients. Clinical parameters and both standard Doppler and pulsed Doppler tissue imaging parameters were compared in 51 β-thalassemia intermedia patients (mean age, 17.05 ± 5.8 years) and 20 normal subjects (mean age, 17.81 ± 7.35 years, p = 0.98). In 11 patients (21.5%), pulmonary artery hypertension was detected. M-mode echocardiographic findings such as ejection fraction and fractional shortening did not show statistically significant changes (p > 0.005). Pulsed Doppler showed a significant difference in the early (E) to late diastolic (A) velocity ratio of the tricuspid and mitral valve between the patients and the control subjects (p < 0.05). In the pulsed tissue Doppler study, the peak systolic velocity of the septum (Ss), the peak atrial velocity of the septum (Aas), the peak systolic velocity of the tricuspid annulus (St), the peak early diastolic velocity of the tricuspid annulus (Eat), and the peak late diastolic velocity of the tricuspid annulus (Aat) were increased significantly (p < 0.05). The pulse tissue Doppler of the lateral mitral annulus did not change significantly (p > 0.005). The peak systolic velocity of the posterior wall and the peak late diastolic velocity of the anterior wall changed significantly (p < 0.05). This study showed that β-thalassemia intermedia patients with normal M-mode and two-dimensional echocardiography had statistically significant changes in pulsed Doppler and pulsed tissue Doppler imaging.

Abstract 4852: High Resting Velocity in Intramyocardial Coronary Artery is Related to Elevated Plasma Brain Natriuretic Peptide Levels in Patients With Hypertension

Narrowings in intramyocardial coronary arteries (IMCA) and elevated plasma brain natriuretic peptide (BNP) levels have been demonstrated in hypertensive heart disease. To clarify the relation between abnormalities in IMCA and plasma BNP levels, 228 consecutive patients with hypertension were studied using high-frequency transthoracic Doppler echocardiography. We defined IMCA flow as abnormal one if acceleration flow in IMCA, indicating the presence of vessel narrowing, was detected by color flow mapping and the pulsed Doppler study demonstrated higher peak diastolic flow velocity than 32cm/sec (i.e. normal value + 2SD) in the site. Such abnormal flow in IMCA was demonstrated in 59 (56%) of 102 hypertensive patients with left ventricular hypertrophy (LVH) and in 36 (24%) of the other 126 hypertensive patients without LVH. Independent of LVH, the 95 hypertensive patients with abnormal IMCA flow had higher peak diastolic velocities in the IMCA (47.9±16.5 cm/s vs. 24.3±5.4 cm/s, p&lt;0.01) and more elevated plasma BNP levels (131.0±24.4 pg/ml vs. 45.8±5.7 pg/ml, p&lt;0.01) than those without abnormal IMCA flow. Furthermore, peak diastolic velocities had a significant correlation with log BNP values (p&lt;0.01). The index of % area stenosis (IAS) estimated by the continuity equation was 46±14% at the site of acceleration flow, indicating the presence of mild to moderate lumen narrowing in the IMCA. The patients with the IAS of 50% and over had significantly higher log BNP values as compared to those with the IAS of less than 50% (p&lt;0.05), indicating plasma BNP levels may be elevated by factors associated with lumen narrowing in the IMCA. Conclusions: High resting velocity in IMCA is at least partly related to elevated BNP levels in patients with hypertension independent of LVH.

Link between diabetes and diastolic dysfunction and the diagnostic role of echocardiography

Diabetes mellitus, a disease that has been reaching epidemic proportions, is an important risk factor to the development of cardiovascular complication. The left ventricular diastolic dysfunction represents the earliest pre-clinical manifestation of diabetic cardiomyopathy, preceding systolic dysfunction and being able to evolve to symptomatic heart failure. In early stages, these changes appear reversible with tight metabolic control, but as pathologic processes become organized, the changes are irreversible and contribute to an excess risk of heart failure among diabetic patients. Doppler echocardiography provides reliable data in the stages of diastolic function, as well as for systolic function. Combination of pulsed tissue Doppler study of mitral annulus with transmitral inflow may be clinically valuable for obtaining information about left ventricular filling pressure and unmasking Doppler inflow pseudonormal pattern, a hinge point for the progression toward advanced heart failure. Subsequently we give an overview about diabetes and its complications, their clinical relevance and the role of echocardiography in detection of diastolic heart failure in diabetes.

The impact of ageing on right ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study

To evaluate the influence of age on pulsed Tissue Doppler-derived measurements of right ventricular (RV) tricuspid annulus in a population of healthy subjects and to propose reference values according to age decades. Two hundred and ninety-eight healthy subjects (M/F = 186/112) underwent Doppler echocardiography and pulsed Tissue Doppler of tricuspid annulus in apical four-chamber view. Tricuspid annular plane systolic excursion (TAPSE), Doppler indexes of RV outflow tract and of tricuspid inflow, right atrial dimension and inferior vena cava size, and collapsibility were measured. Pulsed Tissue Doppler lateral corner of the tricuspid annulus was also recorded and annular systolic (Sa), early diastolic (Ea), and atrial (Aa) peak velocities and Ea/Aa ratio determined. The ratio of tricuspid E peak velocity and Ea (E/Ea ratio) was calculated as an index of right atrial pressure. The population was divided in seven age decades: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and >70 years. TAPSE, Sa, Ea, and Ea/Aa ratio were progressively reduced and both Aa and E/Ea ratio increased with the increasing age groups (all P < 0.0001). E/Ea ratio was 4.1 +/- 0.9 in the age decade 11-20 years and 5.4 +/- 1.5 in subjects >70 years (P < 0.0001). By multi-linear regression analyses, after adjusting for heart rate and body mass index, age was the main independent predictor of average Sa, Ea, and Aa velocities and of E/Ea ratio. Ageing shows an independent impact on pulsed Tissue Doppler-derived indexes of RV myocardial function in healthy subjects. Our data provide reference values of pulsed Tissue Doppler of the right ventricle for age decades.

The Pulsed Doppler Predictors of Intra Dialysis Hypotension and Relationship between Doppler Indices and Net Fluid Loss after Dialysis in Patients with End Stage Renal Disease: Pulsed Doppler Study

Background: In patients with end stage renal disease (ESRD) on regular haemodialysis (HD), fluid status in the body has an important impact on the left ventricular (LV) filling and it can lead to intra-dialysis hypotension. The aim of the study is to study the pattern of diastolic pulsed Doppler filling in patients who had hypotension during HD and to correlate that with the net fluid loss at end of dialysis session. Material: Fifty two patients with (ESRD) on regular HD, 34 male, with mean age of 45.5 ± 13 year were studied. Each patient had pulsed Doppler study before and immediately after HD. Each patient was observed for the development of acute clinical events and hypotension defi ned as systolic blood pressure of less than 90 mmHg. Patients were divided into two groups according to the amount of net ultra fi ltrate loss after HD, group I (n = 25) with fluid loss of 2 litres. Results: The mean age was 45 ± 12 year for group I and 46 ± 11 year for group II. In the study group, 11 out of 52 (21%) patients developed systolic hypotension less than 90 mmHg during HD compared to those without, no patient necessitate HD discontinuation. The mean pre dialysis pulsed Doppler Early filling to late filling wave (E/A ratio) of those who developed hypotension was (0.7 ± 0.2 vs. 1.1 ± 0.2.1, p < 0.001) and the mean of Deceleration time of E wave (DT) (246 ± 40 vs. 224 ± 34 m.sec, p < 0.05) respectively. The mean difference between pre and post HD pulsed Doppler indices in group II compared with group I were as follow: the mean reduction of E wave velocity (32 ± 17 vs. 12 ± 15 m.sec, p < 0.01), the mean reduction of A wave velocity (13 ± 17 vs. 11 ± 16 m.sec, p = NS), E/A ratio reduced to 0.14 ± 0.03 vs. 0.01 ± 0.04, p < 0.05), the mean DT of E wave increase from (43 ± 51 vs. 16 ± 64 m.sec, p < 0.05). Conclusion: In patient ESRD on regular hemodialysis, the prolonged DT >246 m.sec of E wave and E/A ratio less than 0.7 both may be used as a predictors of asymptomatic hypotension during HD. The net fluid loss during HD is directly proportional to the reduction of left ventricle Doppler diastolic indices.

The impact of aging on left ventricular longitudinal function in healthy subjects: A pulsed Tissue Doppler study

To evaluate the influence of age on average values of pulsed tissue Doppler recorded at the septal and lateral mitral annulus in a population of healthy subjects and to propose reference values according to different age decades. Two hundred and forty-six healthy subjects (M/F = 160/86, mean age 40.9 years) underwent Doppler-echocardiography and pulsed tissue Doppler of the septal and lateral mitral annulus. S(m), E(m), A(m) peak velocities were measured at both the annular sides and average values obtained. The ratio of transmitral E peak velocity and average E(m) peak velocity (lateral E(m) + septal E(m)/2) was calculated as an index of left ventricular filling pressure. The population was divided into seven age decades: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69 years and >70 years. E(m) was progressively reduced and A(m) increased with increasing age at both the annular sides as well as average values. S(m) reduction with advancing age was significant only at the lateral mitral annulus and as average values. Average E/E(m) ratio was particularly higher in the last three age decades. By multilinear regression analyses, age was the main independent predictor of average E(m), A(m) and E/E(m) ratio, while heart rate was the most important contributor to average S(m), with the additional contribution of age. Aging shows an independent impact on average tissue Doppler indexes of septal and lateral mitral annulus in normal subjects. Our data also provide reference values of tissue Doppler average variables for age decades.

An Increased Thermal Index Can Be Achieved When Performing Doppler Studies in Obstetric Sonography

The present study was aimed at evaluating acoustic outputs during clinical ultrasound examinations, as expressed by the thermal index (TI) and the mechanical index (MI), during the second half of pregnancy and comparing acoustic outputs between B-mode and Doppler examinations. Patients with suspected fetal growth problems undergoing Doppler studies of the fetal circulation in addition to B-mode sonography were selected. Examinations took place between 21 and 40 weeks' gestation. An obstetrician collected data prospectively. Sonographers were unaware of the data being sought. The analysis of variance test was applied for differences in continuous variables. A total of 63 examinations were evaluated. The mean gestational age +/- SD was 31.6 +/- 5.1 weeks. The mean duration of the total examinations was 17.6 +/- 8.6 minutes, whereas the Doppler studies lasted 0.9 +/- 0.8 minutes. The TI was significantly higher in the pulsed wave Doppler studies (mean, 1.5 +/- 0.5; range, 0.9-2.8) and color flow imaging studies (mean, 0.8 +/- 0.1; range, 0.6-1.2) compared with B-mode sonography (mean, 0.3 +/- 0.1; range, 0.1-0.7; P < .01). During the examination, 190 B-mode MI variations were recorded (mean, 1.1 +/- 0.1), which were comparable with those of the 31 color flow Doppler studies (mean, 1.0 +/- 0.1; P = .09) but higher than the 190 pulsed wave Doppler MI variations (mean 0.9 +/- 0.2; P < .001). Increased acoustic output levels, as expressed by TI levels, are reached during obstetric Doppler studies. In particular, TI levels may reach 1.5 and higher. Doppler procedures should be performed with caution and be as brief as possible during obstetric sonography.

Review Article

Doppler echocardiography has largely contributed to show the existence of a distinct diabetic cardiomyopathy. Several studies have pointed out the evidence of left ventricular (LV) remodeling and hypertrophy in alterations of both midwall systolic mechanics and LV diastolic filling in diabetes mellitus (DM), independent of the coexistence of concomitant risk factors. Further progress will be provided by new ultrasound technologies in this clinical setting. The combination of pulsed tissue Doppler study of mitral annulus with transmitral inflow may be clinically valuable for obtaining information about left ventricular filling pressure (LVFP) and unmasking Doppler inflow pseudonormal pattern, a hinge point for the progression toward advanced heart failure. In the absence of epicardial coronary artery stenosis, the ultrasound assessment of coronary flow reserve (CFR) may identify the dysfunction of coronary microcirculation, in relation with glycemic levels, insulin resistance, sympathetic overdrive, endothelial dysfunction, abnormalities of the angiotensin-renin system, and LV remodeling/hypertrophy. Diastolic dysfunction and impairment of CFR may be associated in DM, with a likely common origin. In this view, a comprehensive transthoracic Doppler evaluation of diabetic patients should include the assessment of diastolic function and estimation of LVFP by tissue Doppler, and coronary microvascular function by CFR test. Additional analysis of regional wall motion during a stress test would be required in patients with suspected coronary artery disease, another cause of diastolic dysfunction.

The Impact of Marathon Running Upon Ventricular Function as Assessed by 2D, Doppler, and Tissue‐Doppler Echocardiography

The impact of prolonged exercise upon right ventricular (RV) function is poorly understood and to date no studies have utilized tissue-Doppler imaging (TDI). Thirty-five marathon runners (age range 18-50 years) volunteered for the study. Two-dimensional, pulsed Doppler, and TDI studies were performed one day before and immediately following race completion. Right and left ventricular (LV) longitudinal TDI myocardial velocities were acquired from the tricuspid annulus and mitral annulus, providing velocity data during systole (S'), early diastole (E'), and late diastole (A'). Transtricuspid and transmitral, early diastolic (E), and late diastolic (A) velocities and ratios were assessed using conventional pulsed-wave Doppler. RV and LV fractional area changes (FAC) were calculated from RV and LV end-diastolic and end-systolic areas recorded from 2D scans in a subsample (n = 23). RV myocardial velocities were unchanged pre-post race in S' (21.1 +/- 2.7 to 21.7 +/- 4.5 cm s(-1), P > 0.05), reduced in E' (23.3 +/- 3.5 to 19.9 +/- 5.3 cm s(-1), P < 0.05), increased in A' (19.1 +/- 3.6 to 23.7 +/- 6.8 cm s(-1), P < 0.05) with a resultant decline in E'/A' (1.28 +/- 0.36 to 0.94 +/- 0.45, P < 0.05). This pattern of data was mirrored in the LV. Similarly both pulsed-Doppler tricuspid and mitral E/A ratios decreased from pre- to postrace (P < 0.05). FAC for the RV and LV were unaltered postrace (P > 0.05). The impact of differing age, finishing time (173-330 min), hemodynamic loading and heart rate upon RV and LV function pre- to postrace was negligible. In conclusion, TDI and 2D data, for both the RV and LV demonstrated little change in systolic function after a marathon race. Conversely, a reduction in diastolic function was observed in both ventricles for which a mechanism has yet to be deduced.

661 Impact of aging of left ventricular longitudinal function in a healthy reference population: a pulsed tissue Doppler study

Conclusions: We found significant correlations between EF by ERNA and all newer indexes of LV systolic function based on TVI and AVPD. However, the mea- surement of peak systolic TV in the basal septum correlated best with EF by ERNA, and may be a useful simple tool in the evaluation of CHF patients. Purpose: Although pulsed Tissue Doppler (TD) of left ventricular (LV) mitral an- nulus can be used to quantify global LV longitudinal function and provides infor- mation on both systolic and diastolic function,, little is known about normal values and determinants of mitral annular TD. In this study we assessed demographic and echecardiographic correlates of TD-derived longitudinal myocardial function in a healthy reference population. Methods: Standard echocardiographic examination and pulsed TD of the left ventricle were performed in 131 healthy, normoweight, normotensive subjects (M/F=87/44). TD was recorded by placing the sample volume at the level of LV lateral mitral annulus. Myocardial systolic and diastolic velocities (Em, Am. Em/Am ratio) and myocardial time intervals (relaxation time (RTm), pre-contraction and contraction time) were measured. The ratio between transmitral Doppler E peak velocity and TD-derived Em (E/Em ratio) was calculated as an index of LV filling pressure. Blood pressure (BP), heart rate and anthropometric measurements were also taken, and body mass index computed. Results: The age of the study population was 33-- 14 years (range = 12 - 71 years), body mass index was 23±3 kg/m 2, blood pressure = 117±12/73±8 mmHg, heart rate = 72±11.5 bpm. LV ejection fraction was 62±9% and transmitral E/A ratio 1.4--0.4. No sex-specific significant difference of TD measurements was found. By dividing the population according to age, subjects >-50 years evidenced lower Era, Em/Am and Sm (all p 50 years and 5.54-1.7 <50 years (p<0.005). In the overall population ejection fraction was related positively with Em (r = 0.19) and negatively with RTm (r = -0.18) (both p<0.05). Significant relations of age were observed with Em (r = -0.64, p<0.0001), Em/Am ratio (r = -0.64, p<0.0001), RTm (r = 0.17, p<O.05) and Sm (r = -0.31, p<O.O001). Aging was also associated to a higher E/Em ratio (r = 0.40, p<0.0001). All these associations remained significant even after adjusting for heart rate and body mass index.

RETRACTED: Age dependency in the timing of mitral annular motion in relation to ventricular filling in healthy subjects - A pulsed and tissue Doppler study.

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A short period of apnoea causes a marked increase in coronary flow velocity: a transthoracic pulsed wave Doppler study

Coronary artery flow velocity during a short period of apnoea was investigated by transthoracic Doppler recording in 10 healthy men, aged 24-52. During breath holding for 29 +/- 6 s the oxygen saturation in the finger, measured by pulse oxymetry, decreased from 97.5 +/- 0.8 to 90.0 +/- 3.2% (P < 0.001). The maximal coronary blood flow velocity in the left anterior descending artery increased by 62% from 0.26 +/- 0.09 to 0.42 +/- 0.10 m s(-1) and the mean diastolic flow velocity by 47% from 0.19 +/- 0.04 to 0.28 +/- 0.08 m s(-1) (P < 0.001). In most subjects the increase of velocity started already after a few seconds of apnoea. Besides theoretical implications the results show that it is very important to be aware of the higher velocity during apnoea in order to avoid misinterpretation when using breath holding during magnetic resonance imaging or Doppler recording of coronary flow.

Impaired uterine perfusion associated with metabolic disorders in women with polycystic ovary syndrome

Risk factors for cardiovascular disease, including chronic anovulation, obesity, hyperandrogenism, hyperinsulinemia, and dyslipidemia, are commonly observed in women with polycystic ovary syndrome (PCOS). We evaluated uterine perfusion and its correlation with clinical and biochemical parameters in women with PCOS. We performed a pulsed Doppler study on uterine arterial blood flow in 25 women with PCOS and 45 control women with regular menstrual cycles. PCOS was diagnosed based on oligomenorrhea, polycystic ovaries determined by means of ultrasonography, and elevated luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio. Women with PCOS had a significantly higher body mass index (BMI) and serum testosterone, and showed insulin resistance and dyslipidemia, including increased total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C), and decreased high-density lipoprotein-cholesterol (HDL-C). The uterine arterial pulsatility index (PI) in women with PCOS was significantly higher than that in the control women during the follicular phase. The PI was correlated with BMI, LH/FSH ratio, or LDL-C/HDL-C ratio, whereas it was inversely correlated with the HDL-C level. Women with PCOS had reduced endometrial thickness and elevated uterine arterial PI in the luteal phase, in which implantation occurs. Elevation of uterine arterial blood flow resistance is associated with risk factors for cardiovascular events. Furthermore, the impaired uterine perfusion in the luteal phase may cause endometrial dysfunction in women with PCOS.

Clinical Significance of Preserving Spontaneous QRS Wave in the Therapy of DDD Pacing for Sick Sinus Syndrome

The aim of this clinical crossover study was to elucidate the effects of atrioventricular (AV) synchronous pacing on cardiac function in patients with sick sinus syndrome (SSS). Thirty SSS patients, each with dual chamber pacemaker (DDD), were enrolled and divided into two groups based on echocardiographic findings. Group A (n = 16) had hypertensive heart disease (wall thickness 11 approximately 12 mm) or mitral or aortic regurgitation (Grade I or II). Group B (n = 14) had no organic heart disease. Three successive 3-month pacing periods were tested. For the first 3 months, long AV delay that achieved > 80% ventricular sensing was chosen. For the next 3 months, AV delay was abbreviated to achieve > 80% ventricular pacing at an optimal AV interval. For the final 3 months, the first setting was resumed. At the end of each period, M mode echocardiography, pulsed-Doppler study, and measurement of plasma brain natriuretic peptide (BNP) level were conducted. In both groups, echocardiographic parameters were not significantly changed during the evaluation. In group A, plasma BNP level was significantly higher at the end of the short AV delay period than at the long AV delay period (P = 0.009), while in group B it did not differ during each period. AV synchronous pacing (> 80% ventricular pacing) in the SSS patients with a DDD pacemaker implanted could increase the ventricular load, and it is better to preserve the spontaneous QRS with the DDD mode with prolonged AV delay in patients with mild hypertensive or valvular disease.

Effect of radial artery harvest on collateral forearm blood flow and digital perfusion

Background: Changes describing digital and forearm circulation after radial artery harvest have been reported infrequently. Methods: This prospective study examined digital perfusion and forearm collateral circulation preoperatively and postoperatively in patients who underwent coronary artery bypass grafting with radial artery free grafts. Noninvasive evaluation was conducted with digital photoelectric plethysmography and color flow and pulsed Doppler studies. Results: Thumb perfusion index decreased from 1.25 to 0.84 (30%, P <.001) in the unoperated extremities and from 1.23 to 0.80 (36%) in the operated extremities (P <.001). Doppler studies in extremities after radial artery harvest demonstrated an increase in ulnar artery diameter from 3.87 to 4.66 mm (15.7%, P <.001) and a rise in ulnar blood flow velocity from 38.96 to 48.46 cm/s (17.4%) preoperatively to 8 weeks postoperatively (P <.001). No hand ischemia was noted. Conclusions: Our study identified a mild reduction in digital perfusion and an increase in ulnar artery flow velocity and diameter with no clinical sequelae or compromise in hand function after radial artery harvest in properly selected patients.J Thorac Cardiovasc Surg 2002;123:512-6