Upstroke Time Research Articles

Effects of acute creatine supplementation on cardiac and vascular responses in older men; a randomized controlled trial

In the recent years creatine has been shown promising results in patients with neurodegenerative diseases, myopathies and dystrophies. Cardiovascular diseases could be another pathology that can benefit from creatine supplementation, considering the influence on the risk factors associated with the development of cardiovascular diseases including reduction in chronic inflammation, and improved control of hyperglycemia and dyslipidemia The aim of the present study was to investigate the impact of short-term creatine supplementation on cardiac and vascular health in older adults. Males between the ages of 55-80 were randomly assigned to three groups: creatine, placebo and control. Creatine or placebo was provided for 7-day supplementation, at a dose of 20g/day. Testing was performed at the same time of the day at baseline and on the eighth day. Vascular responses were assessed using an arterial pulse wave velocity equipment, while cardiac assessment was performed using an impedance cardiography device. The placebo group was older (71.1±8.2yr) compared to creatine (61.4±5.2yr) and control (62.5±7.1yr). Cardio-ankle vascular index improved just in the creatine group (8.7±0.5 to 8.2±0.5, p=0.03). While the upstroke time of the placebo and control groups did not change after 7 days, the creatine group had a nonsignificant reduction, 178.9±26.5ms to 158.4±28.6ms, p=0.07. Similar tendency was seen with the systolic blood pressures, while the placebo and control did not change, the creatine group showed nonsignificant improvement, especially on the right, 144.0±12.7mmHg to 136.1±13.4mmHg, p=0.08. All three groups had similar responses in stroke volume (p=0.61), contractility index (p=0.64) and ejection fraction (p=0.72). In older adults, acute creatine supplementation can positively affect vascular parameters of arterial stiffness and atherosclerosis. Creatine supplementation has the potential to serve as a potent adjuvant in the management of CVD for older adults. clinicaltrials.gov; ID: NCT05329480.

Fundamentals of utilizing upstroke time and percentage mean arterial pressure of ankle pulse volume recording as cardiovascular indexes.

Fundamentals of utilizing upstroke time and percentage mean arterial pressure of ankle pulse volume recording as cardiovascular indexes.

Upstroke time is a more useful marker of atherosclerosis than percentage of mean arterial pressure for detecting coronary artery disease in subjects with a normal ankle-brachial index

Upstroke time (UT) and percentage of mean arterial pressure (%MAP) at the ankle have been shown to serve as atherosclerotic markers. The purpose of this study was to directly compare the diagnostic accuracy of UT with that of %MAP for clinical coronary artery disease (CAD) in subjects with a normal ankle-brachial index (ABI) in both legs. We measured UT and %MAP in 1953 subjects with a normal ABI. The optimal cutoff values of UT and %MAP derived from a receiver operating characteristic (ROC) curve to diagnose CAD were 148 ms and 40.4%, respectively. Multivariable analyses revealed that both UT ≥ 148 ms (odds ratio [OR], 2.72; p < 0.001) and %MAP ≥ 40.4% (OR, 1.28; p = 0.003) were significantly associated with CAD. When the subjects were divided into four groups according to the cutoff values of UT and %MAP, there was no significant difference in the risk of CAD between subjects with UT ≥ 148 ms and %MAP < 40.4% and those with UT ≥ 148 ms and %MAP ≥ 40.4% (OR, 1.45; p = 0.09). ROC curve analyses revealed that the area under the curve value of UT was significantly higher than that of %MAP (0.69 vs. 0.53, p < 0.001). The addition of UT to traditional risk factors significantly improved the diagnostic accuracy for CAD (0.82 to 0.84, p = 0.004), whereas the addition of %MAP to traditional risk factors did not improve the diagnostic accuracy for CAD (0.82 to 0.82, p = 0.84). UT is more useful than %MAP for identifying individuals with CAD among those with a normal ABI.

Non-invasive estimation of sbp pressure using a single ppg sensor and self-calibration

This paper presents an efficient approach to the non-invasive estimation of Systolic Blood Pressure (SBP) using just a single photoplethysmography (PPG) sensor and self-calibration procedure. In this scheme, two features of the measured PPG signal, which are systolic upstroke time (SUT) and PPG inter-beat interval (IBI), are extracted to be used in the estimation model. Here, for each individual, a unique model is self-calibrated in order to provide better accuracy. The experimental results demonstrated the merits and promising potentials for future application of the proposed approach.

PO-01-217 FUNCTIONAL CHARACTERIZATION OF CALCIUM HANDLING KINETICS IN RE-ENGINEERED CARDIOMYOCYTES FROM A PATIENT WITH TYPE 2 LONG QT SYNDROME

Type 2 long QT syndrome (LQT2) is caused by pathogenic variants in the KCNH2-encoded Kv11.1 K+ channel resulting in prolongation of the action potential duration (APD) at the cellular level and QT prolongation in the patient, predisposing LQT2 patients to potentially lethal ventricular arrhythmias. Limited evidence, namely prolonged Ca2+ transient in human induced pluripotent stem cell derived cardiomyocytes (iPSC-CMs) and enhanced Ca2+ leak in transgenic LQT2 rabbit model, suggests that KCNH2 pathogenic variants may be associated with perturbations in intracellular Ca2+ handling. To characterize the APD and Ca2+ handling properties of an iPSC-CM model of LQT2. iPSC-CMs were generated from a patient with a pathogenic KCNH2 frame-shift variant (p.Q901fs/71) and an unrelated healthy control. Confocal imaging of FluoVolt voltage dye was used to measure the APD at 90% repolarization (APD90) in iPSC-CMs. Ca2+ kinetics was characterized using Ca2+ sensing dye Fluo4-AM before and after treatment with 100 nM isoproterenol (ISO). Q901fs/71-iPSC-CMs had a significantly prolonged APD90 compared to wild-type (WT) iPSC-CMs (444 ±9 ms vs 631±8 ms, p<0.001). Q901fs/71-iPSC-CMs had a higher Ca2+ amplitude (DF/F0) before (0.423±0.043 vs 0.97±0.07, p=0.001) and after ISO treatment (0.602±0.051 vs 1.056 ±0.06, p<0.001) compared to WT. The Ca2+ transient duration (CTD90) was longer in Q901fs/71-iPSC-CMs than in WT before (1.062±0.041 s vs 1.306±0.038 s, p=0.01), but not after ISO (1.071±0.062 s vs 1.092±0.044 s, p=0.96). Peak to 90% Ca2+ decay time was increased in Q901fs/71-iPSC-CMs before (0.785±0.04 s vs 0.942±0.033 s, p=0.028), but not after ISO (0.748±0.054 s vs 0.767±0.038 s, p=0.95). Upstroke time was longer in Q901fs/71-iPSC-CMs compared to WT before (0.281±0.006 s vs 0.364±0.014 s; p=0.002) but not after ISO (0.327±0.014 s vs 0.344±0.025 s; p=0.88). Upstroke velocity (DF/F0/t) was increased in Q901fs/71-iPSC-CMs before (1.092±0.122 vs 2.278±0.278, p<0.001) and after ISO (1.310±0.117 vs 2.2±0.139, p=0.005). Ca2+ leak from sarcoplasmic reticulum was higher in Q901fs/71-iPSC-CMs before (16% vs 38%) and after ISO (16% vs 55%). We show that iPSC-CMs derived from the patient with a truncating LQT2-causative variant (yielding likely Kv11.1 channel haploinsufficiency) have prolonged APD90 and display abnormal Ca2+ handling properties such as higher amplitude, increase in Ca2+ leak, prolonged transient duration, Ca2+ decay time, and upstroke velocity compared to WT iPSC-CMs.

PS-C20-11: ANTIHYPERTENSIVE TREATMENT IMPROVES LEFT VENTRICULAR DIASTOLIC FUNCTION AND INDICES OF ARTERIAL STIFFNESS IN YOUNGER MEN WITH GRADE 1 HYPERTENSION

Background: Hypertension is a major risk factor for diastolic dysfunction which, once established, is essentially irreversible. However, it is unclear whether early manifestations of diastolic dysfunction in younger people with mild hypertension can improve with antihypertensive treatment. Objectives: Evaluate whether one-year antihypertensive treatment in younger men (age &lt; 55 years) with low-risk (no evidence of hypertension mediated organ damage) grade 1 hypertension improves diastolic function and indices of arterial stiffness. Methods: 105 treatment-naive men (mean age: 47 ± 6 years) with grade 1 hypertension (confirmed on ABPM) were recruited. Patients were randomised using a PROBE design to one-year antihypertensive treatment (ARB and/or CCB) or no treatment (control). Cardiac function was assessed at baseline and study end via 1.5-Tesla cMRI (MAGNETOM Avanto; Siemens Healthineers AG, Germany) using prospectively gated mid-left-ventricular golden angle tissue phase mapping (primary outcome). Arterial stiffness was measured using CAVI device (VS-1500N; Fukuda Denshi, Japan). Results: Diastolic (longitudinal E/A ratio) and systolic (longitudinal S peak velocity) function improved with treatment (n = 38; 0.11 ± 0.24 and 0.38 ± 1.19 cm.s−1, P = 0.01 and 0.05, respectively) but deteriorated in the control group (n = 44; -0.06 ± 0.33 and -0.13 ± 1.12 cm.s−1, P = 0.01 and 0.05, respectively). Improvement in diastolic function was significantly influenced by baseline bodyfat % and BMI (20 ± 8 versus 27 ± 10%, P = 0.04 and 27.8 ± 3.4 versus 31.0 ± 5.3 kg.m−2, P = 0.03, respectively). CAVI pre-ejection period (-9 ± 15 versus 1 ± 13 ms, P = 0.006), pre-ejection-period.ejection-time−1 (-0.03 ± 0.06 versus 0.00 ± 0.05, P = 0.02), upstroke time (-33 ± 50 versus -8 ± 45 ms, P = 0.03), pulse wave velocity (-0.89 ± 0.64 versus -0.02 ± 0.64 m.s−1, P &lt; 0.001), CAVI (-0.40 ± 0.65 versus 0.03 ± 0.62, P = 0.005) and CAVI estimated vascular age (-3 ± 7 versus 1 ± 7 years old, P = 0.02) all improved with TREATMENT (n = 40) versus CONTROL (n = 44). Conclusions: Early treatment of Grade 1 hypertension improves left ventricular diastolic function. Treated patients with E/A improvements were leaner, which highlights the importance of a healthy lifestyle. Treatment also improved arterial stiffness, however it is unclear whether those changes were predominantly structural and/or functional. Further work is warranted to establish whether an even earlier intervention is needed to restore diastolic function to the level of normotensive age-matched controls.

Abstract 11976: Functional Characterization of Calcium Handling Kinetics in Patient-Derived Ipsc-Cm Models of Pkp2-Mediated Arrhythmogenic Right Ventricular Cardiomyopathy

Introduction: Pathogenic variants in PKP2 -encoded plakophilin 2 cause arrhythmogenic right ventricular cardiomyopathy (ARVC). Electrocardiographically, PKP2 -mediated ARVC may mimic RYR2 -mediated catecholaminergic polymorphic ventricular tachycardia (CPVT). We compare the underlying mechanism of arrhythmia in ARVC and CPVT using induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs). Methods: iPSC-CMs were generated from 2 ARVC patients with different PKP2 variants [E149X (PKP2-1) and c.2146-1G&gt;C (PKP2-2)], 1 patient with a CPVT variant [RyR2-R176Q (CPVT1)], and a wild-type (WT) control. Fluo-4 AM calcium dye was used to assess calcium kinetics in iPSC-CMs before and during treatment with 100 nM isoproterenol (ISO) at 8-10 min. Results: Compared to WT, PKP2 and RYR2 iPSC-CMs had a greater amplitude before (WT: 0.331±0.031, PKP2-1: 1.048±0.074, PKP2-2: 1.076±0.095, CPVT1: 0.966±0.061; P&lt;0.0001) and during ISO (WT: 0.277±0.022, PKP2-1: 0.971±0.069, PKP2-2: 0.622±0.041, CPVT1: 0.756±0.051; P&lt;0.0001). The Ca 2+ transient duration (CTD100) was longer in PKP2 and RYR2 iPSC-CMs compared to WT before (WT: 1.01±0.05 s, PKP2-1: 1.84±0.01 s, PKP2-2: 1.76±0.02 s, CPVT1: 1.81±0.02 s; P&lt;0.0001) and during ISO (WT: 1.38±0.05 s, PKP2-1: 1.65±0.03 s, PKP2-2: 1.71±0.03 s, CPVT1: 1.61±0.05 s; P&lt;0.001). Before (WT: 259±13 ms, PKP2-1: 538±23 ms, PKP2-2: 493±28 ms, CPVT1: 586±24 ms; P&lt;0.0001) and during ISO (WT: 311±19 ms, PKP2-1: 406±21 ms, P=0.0172, PKP2-2: 487±28 ms, P&lt;0.0001, CPVT1: 453±21 ms, P=0.0001), peak to 50% decay time was slower in PKP2 and RYR2 iPSC-CMs compared with WT. Upstroke time was longer in PKP2 and RYR2 iPSC-CMs compared to WT before (WT: 205±5 ms, PKP2-1: 539±13 ms, PKP2-2: 429±19 ms, CPVT1: 455±12 ms; P&lt;0.0001) and during ISO (WT: 213±7 ms, PKP2-1: 375±16 ms, PKP2-2: 416±20 ms, CPVT1: 389±10 ms; P&lt;0.0001). Conclusion: Here, iPSC-CMs, derived from patients with either PKP2 -mediated ARVC or RYR2 -mediated CPVT, display similar abnormal calcium handling properties such as greater amplitude, longer CTD100, and slower peak to 50% decay time and upstroke time compared to WT iPSC-CMs before and during ISO treatment. This may explain why patients with PKP2 -mediated ARVC often mimic the treadmill stress test seen in patients with CPVT1.

Evaluation of the role of combining inter-arm systolic pressure difference and derivatives of pulse volume recording in detecting subclavian artery stenosis.

BackgroundSubclavian artery stenosis (SAS) is a peripheral arterial disease of asymptomatic appearance and disastrous consequences. The traditional screening method remains unsatisfactory.ObjectiveThe study aimed to assess the diagnostic performances of inter-arm systolic pressure difference (IASBPD), derivatives of pulse volume recording (PVR), and their combination in detecting subclavian artery stenosis.Materials and methodsThe present study was a retrospective analysis of clinical data from inpatients suspected of supra-arch artery stenosis in Fuwai hospital during 1 year, who underwent selective arterial angiographies. We obtained simultaneous blood pressure measurements on four limbs and pulse waves for calculating IASBPD and PVR derivatives prior to the angiographies. We utilized the receiver operating characteristic curve (ROC) to calculate the optimal cut-off value of IASBPD, upstroke time (UT), and upstroke time per cardiac cycle (UTCC) for detecting SAS. Moreover, we compared the sensitivity and specificity of IASBPD, UT, UTCC, and their combinations for diagnosing SAS (Clinical trial number: NCT03521739).ResultsWe consecutively enrolled 320 eligible patients. Based on SAS’s definition of stenosis above 50%, the area under the curve of IASBPD, UT, and UTCC were 0.84, 0.76, and 0.80 (P < 0.001). And their corresponding cut-off points were 9 mmHg, 202 milliseconds, and 23.2%. The sensitivity and specificity of IASBPD ≥ 9 mmHg were 57.0 and 94.1%. UT ≥ 202 ms and UTCC ≥ 23.2% yielded similar sensitivity (72.6 vs. 72.6%, P > 0.05), but UTCC had higher specificity (81.1 vs. 72.4%, P < 0.05). The sensitivity of the combination of IASBPD and UT (85.2%) or UTCC (78.5%) was significantly higher than IASBPD alone (57%, P < 0.05). The specificity of either combination decreased to 67.6 and 76.8% (P < 0.05).ConclusionsThis present study showed that the combinations of IASBPD and PVR-derived parameters promoted diagnostic sensitivity and preserved adequate specificity than those alone for detecting SAS.

Assessment of the PPG up-stroke time to predict peripheral lower limb arterial occlusive disease (PAOD): Application to the pOpmetre ®

Screening for peripheral lower limb arterial occlusive disease (PAOD) is a major challenge for the prevention, management and treatment of patients with arteriosclerosis. The Ankle Brachial Index (ABI) is the reference method, it requires expertise and time which are limiting factors for systematic screening. The analysis of a photoplethysmographic (PPG) wave form in the lower limb can be an interesting alternative. In a retrospective pilot study we analyzed the possibility of detecting PAOD by measuring the up-stroke time wave form (UTP) at the toe by PPG method. The ABI (minimum of 2 leg arteries) and the UTP (pOpmeter® - Axelife - France) were collected in 54 patients during a vascular assessment and presenting different stages of PAOD. Of the 108 lower limbs registered, 25 were excluded for technical difficulties (very severe PAOD, mediacalcosis, toe amputation). 83 lower limbs were analyzed. Mean age was 69 ± 12; 75% men, 28% diabetics, 47% hypertensive. 17% without PAOD (stage 0); 44% stage 1; 23% stage 2; and 2% Stage 3. The 200 milliseconds UTP threshold identifies PAOD from stage 1 with: sensitivity 77%, specificity 94%, a positive predictive value 96% and negative predictive value 68% (Yule Q = 0.96). UTP makes it possible to identify an PAOD in 100% of patients with mediacalcosis (ABPI > 1.4, n = 3, diabetic = 2). The UTP measured by PPG at the toe is a simple and rapid method (< 2 min) detects the PAOD stages 1 to 3 with 94% specificity, 77% sensitivity that must be improved by using other thresholds to optimize the test. These results have to be confirmed with a prospective study.

Photoplethysmography Fast Upstroke Time Intervals Can Be Useful Features for Cuff-Less Measurement of Blood Pressure Changes in Humans.

Photoplethysmography (PPG) waveform analysis is being increasingly investigated for continuous, non-invasive, and cuff-less blood pressure (BP) measurement. However, the efficacy of this approach and the useful features and models remain largely unclear. The objectives were to develop easy-to-understand models relating PPG waveform features to BP changes (after a cuff calibration) and to determine their value in BP measurement accuracy. The study data comprised finger, toe, and ear PPG waveforms, an ECG waveform, and reference manual cuff BP measurements from 32 human subjects (25% hypertensive) before and after slow breathing, mental arithmetic, cold pressor, and nitroglycerin administration. Stepwise linear regression was employed to create parsimonious models for predicting the intervention-induced BP changes from popular PPG waveform features, pulse arrival time (PAT, time delay between ECG R-wave and PPG foot), and subject demographics. Leave-one-subject-out cross validation was applied to compare the BP change prediction root-mean-squared-errors (RMSEs) of the resulting models to reference models in which PPG waveform features were excluded. Finger b-time (PPG foot to minimum second derivative time interval) and ear "STT" (PPG amplitude divided by maximum derivative), when combined with PAT, reduced the systolic BP change prediction RMSE of reference models by 6-7% (p 0.022). Ear STT together with pulse width reduced the diastolic BP change prediction RMSE of the reference model by 13% (p = 0.003). The two PPG fast upstroke time intervals can offer some added value in cuff-less BP trending. This study offers important information towards achieving non-invasive and passive BP monitoring without a cuff.

Falsely normalized ankle-brachial index despite the presence of lower-extremity peripheral artery disease: two\xa0case reports\xa0

BackgroundThe ankle-brachial index measurement is used for screening and diagnosis of lower-extremity peripheral artery disease and cardiovascular risk assessment. However, the value is occasionally unreliable since the oscillometric ankle-brachial index can be elevated and falsely normalized despite the presence of lower-extremity peripheral artery disease because of the incompressibility of infrapopliteal arteries at the ankle, potentially leading to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk.Case presentationWe report two cases of lower extremity peripheral artery disease with normal ankle-brachial index (a 76-year-old Asian man and a 66-year-old Asian man). In both cases, the ankle-brachial index was within the normal range (1.00–1.40) despite the presence of lower-extremity peripheral artery disease, whereas upstroke time at the ankle calculated from the pulse volume waveform simultaneously obtained by plethysmography during the ankle-brachial index measurement was prolonged (≥ 180 milliseconds). Diagnostic imaging tests revealed the presence of occlusive arterial disease in the lower extremity and severe calcification of infrapopliteal arteries.ConclusionsIn both cases, the oscillometric ankle-brachial index might have been falsely normalized despite the presence of lower-extremity peripheral artery disease because of calcified incompressible infrapopliteal arteries. Sole reliance on the ankle-brachial index value may lead to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk. Upstroke time at the ankle was helpful for suspecting the presence of lower-extremity peripheral artery disease in both patients with normal ankle-brachial index. In addition to history-taking and vascular examination, upstroke time at the ankle should be carefully checked for accurate diagnosis of peripheral artery disease and cardiovascular risk assessment in patients with normal ankle-brachial index.

Retinal Blood Velocity Waveform Characteristics With Aging and Arterial Stiffening in Hypertensive and Normotensive Subjects.

PurposeWe aimed to explore the velocity waveform characteristics of the retinal artery associated with age and the cardio-ankle vascular index (CAVI) as a conventional arterial stiffness marker by applying the Doppler optical coherence tomography (DOCT) flowmeter.MethodsIn this cross-sectional study, DOCT flowmeter imaging was performed in 66 participants aged 21 to 83 years (17 men, 49 women) with no history of eye diseases and no systemic diseases, except for hypertension. Retinal blood velocity waveform was analyzed where several parameters in time (upstroke time, T1, T2, T3, and T4) and area under the waveform (area elevation, area declination, A1, A2, A3, and A4) were extracted. Systolic blood pressure–adjusted Pearson's coefficients were calculated to determine the correlations of each parameter with age or CAVI.ResultsCorrected upstroke time (UTc) was the waveform parameter most positively correlated with age (r = 0.497, P < 0.001). Area declination was the waveform parameter most negatively correlated with age (r = −0.682, P < 0.001) and CAVI (r = −0.601, P < 0.001).ConclusionsWe extracted the waveform parameters associated with the risks of arterial stiffening. The velocity waveform analysis of the retinal artery with DOCT flowmeter potentially could become a new method for arterial stiffness identification.Translational RelevanceDOCT flowmeter could evaluate arterial stiffening in a different way from the conventional method of measuring arterial stiffening using pressure waveform. Because the DOCT flowmeter can easily, quickly, and noninvasively provide a retinal blood velocity waveform, this system could be useful as a routine medical examination for arterial stiffening.

Abstract 13976: Upstroke Time per Cardiac Cycle: Screening Index for Severe Aortic Stenosis

Introduction: AS is one of the most common valvular heart diseases in the elderly population. Since the TAVR era, the indications for AS invasive treatment have expanded to patients at high risk of surgery and even those at moderate risk. Therefore, a simplified screening test is needed to extract patients with severe AS. Hypothesis: Brachial-ankle pulse wave analysis, which is a non-invasive well-established test, is useful for screening patients with severe AS in routine clinical practice. Methods: We recruited patients who were admitted to Hiroshima University Hospital for scrutiny of AS. Severe AS was defined as an aortic valve area (AVA) of &lt;1.0 cm 2 or peak transaortic velocity &gt;4 m/s or a mean pressure gradient of &gt;40 mmHg. Pulse wave measurement was performed with the VP-1000 device (Omron, Kyoto, Japan), and upstroke time per cardiac cycle (UTCC; [upstroke time/cardiac cycle] x 100%) was calculated. We excluded patients with peripheral artery disease (ABI &lt;0.9) or lack of UTCC data. Results: A total of 235 patients with AVA and UTCC available data were analyzed. In these patients, UTCC was correlated with AVA (r = -0.279; p &lt;0.001, Figure). In 121 patients who underwent TAVR and had available data of UTCC before and after TAVR, UTCC was significantly shortened after TAVR (from 20.7% [IQR; 18.6, 23.3] to 18.7% [16.7, 21.0]; p &lt;0.001). After adjustment by LVEF, LVEDV, BSA, and AF, UTCC was still correlated with AVA (β= -0.012, p = 0.001). Conclusions: UTCC from brachial-ankle pulse wave analysis might help identify severe AS patients in routine clinical practice.

Upstroke time as a marker of atherosclerosis in patients with diabetes mellitus who have a normal ankle-brachial index.

We measured upstroke time in 509 patients with diabetes who had a normal ankle-brachial index (ABI) (1.00≤ABI≤1.40) (443 men and 66 women; mean age: 67.6±10.8years). The prevalence of cardiovascular disease was significantly higher in patients with prolonged upstroke time at the ankle than in patients with normal upstroke time. The association between prolonged upstroke time and a higher risk of cardiovascular disease remained significant after adjusting for confounders.

Analyzing the correlation between uterine involution and blood flow in post-partum dairy cows

The objective of this study was to assess the applicability of trans-rectal color Doppler ultrasonography for quantification of uterine blood flow in 30 healthy lactating Jersey cows on a weekly interval from days 0 to 56 after parturition (day 0). Significantly higher time average mean velocity (TAMEAN), time average maximum velocity (TAMAX) and blood flow volume (BFV-TAMEAN and BFV-TAMAX) in artery ipsilateral to previous gravid uterine horn (PGUH) was found as compared to contralateral middle uterine artery (MUA) on day 0 to 14 postpartum. Similarly, transverse diameter (D) of ipsilateral MUA was significantly higher as compared to contralateral MUA during first two weeks after parturition. Clinical uterine involution completed on day 32.47±0.85 postpartum as demonstrated by B-mode ultrasonography and a significant correlation (r= 0.31–0.44 from day 7–28) between size of PGUH and BFV-TAMAX was found. Also, significant correlation between transverse diameter of ipsilateral (r=0.56–0.80) and contralateral (r=0.51–0.79) MUA-D and BFV-TAMAX was found on different examination days. In conclusion, trans-rectal Doppler ultrasonography was a useful tool to investigate haemodynamic changes whereas PI, RI, Doppler pulse duration and systolic upstroke time were found unsuitable to indagate alterations in uterine perfusion during post-partum period.

Usefulness of Upstroke Time per Cardiac Cycle for Cardiovascular and All-Cause Mortality Prediction in Patients with Normal Ankle-Brachial Index.

Aim: Abnormal ankle-brachial index (ABI) is regarded as peripheral artery disease and can be used to predict cardiovascular (CV) outcomes. However, the usefulness of ABI for the prediction of CV outcome in patients with normal ABI is limited. Upstroke time per cardiac cycle (UTCC) is recently reported to be associated with mortality in patients with acute myocardial infarction and the elderly. Therefore, we aimed to evaluate UTCC, left ventricular ejection fraction (LVEF), brachial-ankle pulse wave velocity (baPWV), and ABI for the prediction of mortality in patients with normal ABI. Methods: Patients arranged for echocardiographic examinations were enrolled, and 1076 patients with normal ABI were included. ABI, baPWV, and UTCC were measured by an ABI-form device. Results: The median follow-up to mortality was 95 months. There were 88 CV and 244 all-cause deaths. After multivariate analysis, UTCC was associated with increased CV and all-cause mortality ( P ≤ 0.004). Age, diabetes, heart failure, left ventricular hypertrophy, baPWV, and LVEF were also independent predictors of CV and all-cause mortality, but ABI was not. Furthermore, UTCC had a better additive predictive value than ABI, baPWV, and LVEF for CV mortality ( P ≤ 0.012). It also had a better additive predictive value than ABI and LVEF for all-cause mortality ( P ≤ 0.013). Conclusions: UTCC is an independent predictor for CV and all-cause mortality in patients with normal ABI. It also has a better additive predictive value of CV and all-cause mortality than ABI and LVEF. Therefore, UTCC is a simple, novel, and useful parameter for identifying high-risk patients with normal ABI.

Upstroke Time Is a Useful Vascular Marker for Detecting Patients With Coronary Artery Disease Among Subjects With Normal Ankle-Brachial Index.

BackgroundUpstroke time is the transit time from the nadir to peak of the waveform of pulse volume recording. The purpose of this study was to determine whether upstroke time at the ankle is a useful vascular marker for detecting patients with advanced atherosclerosis in combination with ankle‐brachial index (ABI).Methods and ResultsWe measured upstroke time and ABI in 2313 subjects (mean age, 61.2±15.3 years). The prevalence of coronary artery disease (CAD) was significantly higher in patients with prolonged upstroke time (≥180 ms) than in subjects with normal upstroke time (<180 ms) (29.6% versus 11.8%; P<0.001), with a significant association between prolonged upstroke time and an increased risk of CAD (odds ratio [OR], 1.61; 95% CI, 1.07–2.44; P=0.02). In 1954 subjects with normal ABI (1.00 ≤ ABI ≤ 1.40), the prevalence of CAD was significantly higher in patients with prolonged upstroke time than in subjects with normal upstroke time (29.5% versus 10.6%; P<0.001), with a significant association between prolonged upstroke time and CAD (OR, 2.33; 95% CI, 1.41–3.87; P=0.001), whereas there was no significant association between upstroke time and CAD in subjects with low ABI (<1.00) (OR, 1.24; 95% CI, 0.72–2.16; P=0.44).ConclusionsUpstroke time may be a useful vascular marker for detecting patients with CAD, especially in subjects with normal ABI who are usually considered not to have advanced atherosclerosis by ABI measurement alone. More attention should be paid to upstroke time for detecting patients with advanced atherosclerosis.RegistrationURL: https://www.umin.ac.jp; Unique identifier: UMIN000039512.

Upstroke Time as a Novel Predictor of Mortality in Patients with Chronic Kidney Disease.

Upstroke time (UT), measured from the foot-to-peak peripheral pulse wave, is a merged parameter used to assess arterial stiffness and target vascular injuries. In this study, we aimed to investigate UT for the prediction of cardiovascular and all-cause mortality in patients with chronic kidney disease (CKD). This longitudinal study enrolled 472 patients with CKD. Blood pressure, brachial pulse wave velocity (baPWV), and UT were automatically measured by a Colin VP-1000 instrument. During a median follow-up of 91 months, 73 cardiovascular and 183 all-cause mortality instances were recorded. Multivariable Cox analyses indicated that UT was significantly associated with cardiovascular mortality (hazard ratio (HR) = 1.010, p = 0.007) and all-cause mortality (HR = 1.009, p < 0.001). The addition of UT into the clinical models including traditional risk factors and baPWV further increased the value in predicting cardiovascular and all-cause mortality (both p < 0.001). In the Kaplan–Meier analyses, UT ≥ 180 ms could predict cardiovascular and all-cause mortality (both log-rank p < 0.001). Our study found that UT was a useful parameter in predicting cardiovascular and all-cause mortality in CKD patients. Additional consideration of the UT might provide an extra benefit in predicting cardiovascular and all-cause mortality beyond the traditional risk factors and baPWV.

Upstroke Time Per Cardiac Cycle as A Novel Parameter for Mortality Prediction in Patients with Acute Myocardial Infarction.

Background: Acute myocardial infarction (AMI) is one of the leading causes of death in the world. How to simply predict mortality for AMI patients is important because the appropriate treatment should be done for the patients with higher risk. Recently, a novel parameter of upstroke time per cardiac cycle (UTCC) in lower extremities was reported to be a good predictor of peripheral artery disease and mortality in elderly. However, there was no literature discussing the usefulness of UTCC for prediction of cardiovascular (CV) and overall mortality in AMI patients. Methods: 184 AMI patients admitted to the cardiac care unit were enrolled. Ankle-brachial index (ABI) and UTCC were measured by an ABI-form device in the same day of admission. Results: The median follow-up to mortality was 71 months. There were 36 CV and 124 overall mortality. Higher UTCC was associated with increased CV and overall mortality after multivariable analysis (P = 0.033 and P < 0.001, respectively). However, ABI was only associated with CV mortality and overall mortality in the univariable analysis but became insignificant after the multivariable analysis. In addition, after adding UTCC into a basic model including important clinical parameters, left ventricular ejection fraction, Charlson comorbidity index, and ABI, we found the basic model + UTCC had a better predictive value for overall mortality than the basic model itself (P < 0.001). Conclusions: Our study is the first one to evaluate the usefulness of UTCC in AMI patients for prediction of long-term mortality. Our study showed UTCC was an independent predictor of long-term CV and overall mortality and had an additive predictive value for overall mortality beyond conventional parameters. Therefore, screening AMI patients by UTCC might help physicians to identify the high-risk group with increased mortality.

Correlations Between the Ankle-Brachial Index, Percentage of Mean Arterial Pressure, and Upstroke Time for Endovascular Treatment.

BackgroundThe ankle-brachial index (ABI), percentage of mean arterial pressure (%MAP), and upstroke time (UT) are indicators to diagnose lower-extremity peripheral artery disease (PAD). However, the respective relationship between these parameters is unknown. In this study, we analyzed the correlations between ABI, %MAP, and UT and examined their clinical usefulness for endovascular treatment (EVT).MethodsSixty-three consecutive subjects who underwent successful EVT for aortoiliac to femoropopliteal artery diseases were analyzed. The ABI, %MAP, and UT were measured using an automated oscillometric device.ResultsThere were significant correlations between the ABI and %MAP (r = -0.425, P < 0.001), the ABI and UT (r = -0.304, P = 0.017), and %MAP and UT (r = 0.368, P = 0.003). In terms of lesion length, there was a significant difference in %MAP after EVT (focal, 42.6%; short, 44.5%; intermediate, 47.1%; long, 49.1%; P = 0.015). There was minimal %MAP improvement in the case of a long lesion length (focal, -8.83%; short, -5.10%; intermediate, -3.00%; long, -1.50%; P = 0.006). Excessive lesion calcification also hindered %MAP improvement (grade 0, -7.16%; grade 1, -5.52%; grade 2, -4.71%; grade 3, -2.80%; grade 4, -1.00%; P = 0.049). Patients who underwent re-EVT (an average of 10.1 months after initial EVT) had minimal %MAP improvement (-2.76% vs. -5.95%, P = 0.035) at the first outpatient visit (an average of 3.3 weeks after EVT).ConclusionsIn conclusion, the ABI, %MAP, and UT are correlated with each other. If the length of the lesion is long and there is excessive calcification, %MAP improvement is minimal. Moreover, minimal %MAP improvement may be an indicator of future restenosis.