Pulsatility Index Values Research Articles

RENAL HEMODYNAMICS IN PATIENTS WITH HYPERTENSION AND STAGE II–III CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study is to assess the changes in renal blood flow during the combined course of essential hypertension and stage II-III chronic obstructive pulmonary disease. Participants and methods. The study included 60 patients, divided into three clinical groups: Group 1 involved 15 patients with stage II essential hypertension (mean age 52.87 ± 1.36 years; male-to-female ratio 73.33%/26.67%); Group 2 included 15 patients with stage II–III chronic obstructive pulmonary disease (COPD) (mean age 48.01 ± 2.75 years; male-to-female ratio 86.67%/13.33%); Group 3 included 30 patients with stage II–III COPD combined with stage II essential hypertension and stage I–III arterial hypertension (23 men and 7 women; mean age 57.49 ± 2.39 years). These patients had no other clinically significant concomitant pathologies and had not received systematic antihypertensive therapy. A control group of 20 healthy donors was also examined. Results. The study of renal blood flow dynamics at the levels of the common trunk, segmental, and interlobar branches of the renal artery revealed statistically significant changes, particularly in the presence of comorbidity. A notable increase in the parameters Vmax, Vmin, and Vaverage, as well as the resistive index (RI) and pulsatility index (PI), was observed in patients with chronic obstructive pulmonary disease (COPD) combined with essential hypertension. These changes indicate impaired renal hemodynamics, characterized by increased microvascular resistance in the interlobar branches. The severity of disturbances in key Doppler parameters of renal blood flow at the levels of the common trunk, segmental, and interlobar branches was associated with elevated RI and PI values in patients with the comorbidity of essential hypertension and COPD (p<0.05), as well as in those with essential hypertension alone (p<0.05). In contrast, patients with COPD alone exhibited higher values of Vmax, Vmin, and Vaverage at these levels of the renal artery. Conclusions. The evolution of linear velocity and vascular resistance indices in the renal vessels across the studied patient groups showed a consistent, proportional pattern, with more pronounced renal blood flow impairment observed in patients with the comorbidity of essential hypertension and chronic obstructive pulmonary disease, based on key Doppler criteria.

The Impact of Intraoperative Transit-Time Flow Measurement on Off-Pump and On-Pump Bypass Surgery Based on Three Months: A Propensity Score Matching Study

Background: The goal of this study was to investigate how transit-time flow measurement (TTFM) parameters influenced the success of coronary bypass surgeries using the on-pump coronary artery bypass (ONCAB) and off-pump coronary artery bypass (OPCAB) techniques and to compare the rates of early graft failure and major adverse cardiac and cerebrovascular events (MACCE). Methods: We retrospectively analyzed subjects who underwent coronary bypass surgery at our institution between 2017 and 2023 and compared the TTFM data of patients divided into two groups based on the surgical method: ONCAB and OPCAB. We compared the postoperative and first three months' MACCE data to assess the impact of TTFM on the two surgical methods. Results: Of the 2032 patients who underwent coronary bypass, we analyzed data from 1540 patients in the ONCAB group and 194 patients in the OPCAB group. After propensity score matching, the TTFM data of 192 patients in both groups were compared. In the ONCAB group, a mean of 3.28 ± 0.7 grafts per patient was used, while 2.22 ± 0.6 grafts were used in the OPCAB group (p = 0.001). TTFM identified problems with 19 (4.7%) grafts in the ONCAB group and 29 (8%) grafts in the OPCAB group, leading to their revision (p = 0.001). Overall, the pulsatile index (PI) values in the OPCAB group were significantly higher than in the ONCAB group. Hospital mortality was 3.1% in the ONCAB group and 2.6% in the OPCAB group (p = 0.286). MACCE and graft failure rates were similar in the first three months. Conclusions: Utilizing TTFM to assess graft quality during surgery enhances coronary bypass surgery in both ONCAB and OPCAB procedures. The enhanced results are particularly crucial for a process like OPCAB surgery, which necessitates the expertise and experience of a surgeon and is challenging to execute.

Diagnostic Accuracy of Spectral Doppler Indices and Sonoelastography in Predicting Malignancy in Breast Imaging Reporting and Database System 3 Breast Lesions With Histopathology as the Reference Standard.

Introduction Breast cancer is a significant health concern in India, representing a large portion of all cancers affecting women and ranking as one of the most common cancers overall. Reliable diagnostic tools are essential for accurately predicting malignancy and reducing the need for unnecessary biopsies. A Breast Imaging Reporting and Database System (BI-RADS) 3 designation suggests a low likelihood of cancer, indicating that findings are likely benign. For these cases, short-term follow-up imaging is generally preferred over immediate biopsyas the probability of malignancy is minimal. This study evaluates the effectiveness of strain elastography, specifically the strain ratio, in predicting malignancy in BI-RADS 3 breast lesions in a cohort of 50 patients. Additionally, it examines the role of Doppler indices, including the Pulsatility Index (PI) and Resistance Index (RI). Histopathological analysis was used as the reference standard. Methods A descriptive cross-sectional study was conducted on 50 patients presenting with palpable breast lumps or abnormalities detected via ultrasonography or mammography. Conventional B-mode ultrasound examinations were performed on all the patients, and those with BI-RADS 3 lesions were identified. The Doppler technique was employed to calculate PI and RI values, followed by strain elastography to determine the strain ratio. Histopathological confirmation was performed for all patients. Results Histopathological analysis revealed that 92% (N=46) of the lesions were benign, while 8% (N=4) were malignant. For strain elastography, the sensitivity was 75%, specificity was 97.83%, positive predictive value (PPV) was 75%, negative predictive value (NPV) was 97.83%, and the diagnostic accuracy was 96%. For Doppler PI, the sensitivity was 75%, specificity was 95.65%, PPV was 60%, NPV was 97.78%, and the overall diagnostic accuracy was 94%. Similarly, for Doppler RI, the sensitivity was 75%, specificity was 95.65%, PPV was 60%, NPV was 97.78%, and the overall diagnostic accuracy was 94%. Conclusion B-mode ultrasound remains the first-line imaging investigation for evaluating breast masses. In BI-RADS 3 lesions, where the likelihood of malignancy is minimal, the combined use of strain elastography and Doppler PI and RI indices can serve as a valuable adjunct in predicting malignancy and reducing the need for unnecessary biopsies. Moreover, strain elastography demonstrates higher diagnostic accuracy compared to Doppler PI and RI.

Dynamic monitoring of the endothelium function in pregnant women at high risk of preeclampsia during pathogenetic prevention of its development

BACKGROUND: Today, preclinical diagnosis of preeclampsia presents significant difficulties. In widespread practice, it is diagnosed based on existing clinical signs and laboratory and functional research methods. Most of them are invasive and expensive, which makes it difficult to use them in widespread clinical practice for diagnosis and, especially, for monitoring the effectiveness of therapy over the dynamics of the disease. It is known that the pathogenesis of preeclampsia can have two independent development paths, converging in a common resulting link — the formation of endothelial dysfunction. Methods for studying endothelial function include determining markers of its imbalance in blood samples and non-invasive functional tests. Non-invasive diagnosis of endothelial dysfunction using the EndoPAT test allows us to quantify endothelium-mediated changes in vascular tone during 5-minute occlusion of the brachial artery. AIM: The aim of this study was to evaluate the method for determining the endothelium function in the first, second and third trimesters of pregnancy during ongoing pathogenetic prevention of preeclampsia. MATERIALS AND METHODS: This interventional uncontrolled study of the effectiveness of preventing preeclampsia using non-invasive assessment of vascular endothelial dysfunction during pregnancy was conducted at the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, St. Petersburg, Russia. The study involved 108 pregnant women at high risk of developing preeclampsia. All pregnant women underwent a cuff test to determine endothelial dysfunction using the peripheral arterial tonometry technique on the Endo-PAT 2000 device. The dynamic study was carried out in the first, second and third trimesters of pregnancy. As a result of the study, when endothelial dysfunction was detected [logarithmic transformation of reactive hyperemia peripheral arterial tonometry index (LnRHI) less 0.51], a complex glycosaminoglycan was additionally added to the basic prophylaxis with acetylsalicylic acid at a dosage of 250 MU (one capsule three times a day for eight weeks), then a cuff test was monitored after 6–12 weeks. Statistical analysis was performed using the IBM SPSS Statistics 20 software. All tests for significance were two-tailed, and differences were considered significant at p 0.05. RESULTS: Endothelial dysfunction was detected in the first trimester in 59 (55%) patients, then during ongoing complex therapy in the second trimester (n = 72) in 46 (64%) patients and in the third trimester (n = 46) in 4 (1%) patients. Moderate preeclampsia in the third trimester (35–39 weeks of gestation) developed in 28 (25.9%) patients out of 108. At the same time, at the start of the study, 15 patients with endothelial dysfunction received complex therapy, and 13 individuals only took acetylsalicylic acid. Among 46 patients who observed the dynamics of the entire pregnancy, only 4 (8.7%) women developed preeclampsia. After complex treatment prescribed based on the first trimester parameters, out of 36 patients who discontinued complex therapy and did not undergo a functional test subsequently, preeclampsia developed in 16 (44.4%) women. In the second trimester, out of 26 patients who stopped complex therapy, preeclampsia developed in 8 (30.8%) people. Thus, constant monitoring and complex therapy reduced the frequency of preeclampsia. In the group with a history of preeclampsia, the disease developed in 13 (39.4%) women. In the group with a high risk of preeclampsia according to the results of combined prenatal screening in the first trimester, with the exception of a history of preeclampsia (blood pressure test, placental growth factor level in the blood serum, lowest uterine artery pulsatility index value calculated to assess the individual risk of preeclampsia with a titer less than 1 : 100), preeclampsia occurred in 4 (13.3%) women. In the group with extragenital pathology associated with the risk of preeclampsia, including obesity, pregestational diabetes mellitus, chronic arterial hypertension, and chronic kidney disease, with the exception of a history of preeclampsia and a high risk of preeclampsia according to the results of perinatal screening, preeclampsia occurred in 11 (24.4%) women. In the high–risk groups for preeclampsia, we identified the highest-risk group, namely, one with the presence of preeclampsia in the anamnesis. CONCLUSIONS: The effectiveness of the functional method for determining endothelial dysfunction in the first, second and third trimesters of pregnancy during pathogenetic prevention of preeclampsia has been proven.

Foetal cerebral blood redistribution in idiopathic polyhydramnios and the impact on perinatal outcomes

Background Idiopathic polyhydramnios is associated with adverse neonatal outcome. The aim of this study was to examine the value of the middle cerebral artery pulsatility index (MCA-PI) in predicting adverse perinatal outcome in pregnancies affected by idiopathic polyhydramnios. Methods A retrospective study was performed during 2013–2022 at a tertiary-care university affiliated hospital. The study included singleton pregnancies with idiopathic polyhydramnios. Obstetrical and perinatal outcomes were compared between women with MCA-PI <10th percentile and women with MCA-P ≥ 10th percentile. A composite adverse perinatal outcome was defined as an Apgar score <7 at 5 minutes, umbilical artery pH <7.15, emergent caesarean delivery (CD) or operative delivery due to foetal distress, neonatal intensive care admission or foetal death. Results Among 45,459 pregnancies, 128 (0.3%) had idiopathic polyhydramnios; 27 exhibited MCA-PI <10th percentile. Among the latter, compared to pregnancies with MCA-PI ≥10th percentile group, the rates were higher of emergent CD (25.9% vs. 7.9%, p = 0.017) and adverse perinatal outcomes (37.0% vs. 15.8%, p = 0.020). These differences persisted in a subgroup analysis of women with moderate or severe polyhydramnios. In the MCA-PI <10th percentile group, the median MCA-PI and cerebroplacental ratio were lower: 0.9 vs. 1.7, p < 0.001 and 0.7 vs. 2.1, p < 0.001, respectively. Receiver operating characteristic curve analysis indicated a significant association of MCA-PI with emergent CD/operative delivery for foetal distress (area under curve = 0.672, p = 0.031); the sensitivity was 46.7% and specificity 82.3%. Cerebroplacental ratio values were not associated with adverse perinatal outcomes. Conclusions Idiopathic polyhydramnios might be associated with foetal cerebral blood flow redistribution, potentially contributing to an increased risk of adverse neonatal outcomes. Prospective studies are required to establish the role of foetal Doppler studies in the antenatal surveillance of idiopathic polyhydramnios, and to determine whether evidence of abnormal MCA-PI serves as a reliable predictor of perinatal outcomes, potentially necessitating labour induction.

Correlation Between Serum Markers and Midluteal Phase Doppler Assessment of Uterine Arterial Blood Flow in Unexplained Recurrent Pregnancy Loss

This study aimed to determine changes in uterine artery Doppler parameters in unexplained recurrent pregnancy loss (URPL) and to explore serum markers possibly associated with them. This retrospective case–control study included 107 URPL women and 107 control women. The mean pulsatility index (PI), resistive index (RI), and systolic-to-diastolic values for uterine arteries in URPL women were significantly higher than those in the controls (P < 0.05). The cutoff values of PI and RI differentiating the women with URPL from the controls were confirmed by ROC and Youden’s index. Given a PI cutoff value of 2.6, the prevalence of URPL was significantly elevated in the high-PI group (74.58%) compared with that in the low-PI group (40.65%, P < 0.0001), with sensitivity and specificity of 63% and 69%, respectively. With an RI cutoff value of 0.86, the prevalence of URPL in the high-RI group (65.28%) was significantly elevated compared with that in the low-RI group (42.25%, P = 0.001), with sensitivity and specificity of 66% and 75%, respectively. The levels of serum D-dimers and anticardiolipin antibody (ACA)-IgM in URPL women were significantly higher than those in the controls. A positive correlation existed between the levels of ACA-IgM and uterine artery RI in URPL women (r = 0.43, P < 0.01). These results indicated that URPL women may be at a relatively high risk of a prothrombotic state, and the increased ACA-IgM deserves attention for its role in the elevated uterine artery Doppler parameters in URPL women.

Assessment of diaphyseal long bone fracture healing in cats using radiography, ultrasonography and doppler impedance index

ABSTRACT Color Doppler ultrasonography evaluates blood flow and neovascularization in vessels, assessing Pulsatility Index (PI) and Resistive Index (RI) values. The primary objective of this study is to monitor the healing periods of fractures using color Doppler ultrasonography index values, thereby preventing complications through objective data. The emphasis is particularly on establishing the foundation for studies aimed at early detection of delays in vascularization associated with fracture healing. The research involved 20 cats of various breeds and genders, aged 1 to 4 years, diagnosed with femur and tibia diaphyseal fractures. Mediolateral and anteroposterior radiographs were taken on postoperative days 0, 10, 20, and 30. The fracture site was examined using color Doppler ultrasonography. As a result of the study, using Doppler ultrasonography and radiography, neovascular areas from fracture formation to callus formation were converted into objective data through vascular indices. Particularly noteworthy was a significant increase in RI and PI values observed on the postoperative 10th day. It was deduced that the detection of fracture healing could occur earlier with the assistance of these index values when compared to radiographs taken on the 10th and 30th days. In conclusion, PI and RI values may be important parameters in evaluating the healing process in complex fractures, especially in determining complications and monitoring the progress of healing. Moreover, Doppler indices might be employed to complement traditional diagnostic approaches in the early detection of pathological bone conditions.

Correlation of Grayscale Ultrasound and Doppler Evaluation with Histopathological Diagnosis in Cases of Tubercular Cervical Lymphadenitis

ABSTRACT Introduction: Cervical lymphadenopathy is a relatively common clinical presentation that can have varied causes including reactive, inflammatory, tubercular, or neoplastic etiologies. Sonography is most often the first line of investigation used in clinical practice to characterize the enlarged nodes with respect to their location, number, size, and morphological imaging characteristics and determine the differential etiological possibilities. Materials and Methods: The present study was conducted involving 434 patients who presented over a period of 3 years to radiology departments of three multispecialty hospitals for the evaluation of cervical swellings. The study aimed to establish the correlation between the ultrasound and Doppler parameters used in clinical practice and the final histological diagnosis in cases of tubercular cervical lymphadenitis. Results: Overall, a female predisposition was observed in the proportion of patients who presented with cervical lymphadenopathy. A similar increased female percentage was also observed in cases finally detected to have tubercular pathology. The highest diagnostic indices were obtained for two ultrasound parameters of “matted nodes” and “caseous necrosis with posterior acoustic enhancement.” Although other features such as hypoechoic nodes, Doppler findings of peripheral vascularity, and high resistive index (RI)/pulsatility index (PI) values demonstrated high sensitivity, they showed poor specificity, positive predictive values, and low accuracy. Conclusion: In ultrasound scans for suspected cases of tubercular cervical lymphadenitis, the maximum weightage should be given to “matted nodes” and “caseous necrosis with posterior acoustic enhancement” parameters to differentiate the tubercular etiology from other potential causes. These parameters demonstrate high sensitivity, specificity, positive predictive value, and accuracy. Hence, they can be relied upon to start timely anti-tubercular treatment and follow-up with patients on a clinical-radiological basis. This can supplement waiting for suboptimal cytology reports that are difficult to arrive at, specifically in tubercular cervical lymphadenitis cases. The same applies as well to biopsy specimens that are hard to obtain from cervical nodes with associated potential grave complications.

Collateral flow and pulsatility during large vessel occlusions: insights from a quantitative in vitro study.

Acute ischemic stroke caused by large vessel occlusions is being increasingly treated with neurovascular interventions. The hemodynamics within the collateral system of the circle of Willis (CoW) hemodynamics play a fundamental role in therapy success. However, transient in vivo data on pathological collateral flow during large vessel occlusions are not available. Moreover, there are no flow models that accurately simulate the hemodynamic conditions in the CoW during large vessel occlusions. We used a circulatory loop to generate highly reproducible cerebrovascular-like flows and pressures and used non-invasive flow visualization and high-resolution flow and pressure measurements to acquire detailed, time-dependent hemodynamics inside an anatomical phantom of the CoW. After calibrating a physiological reference case, we induced occlusions in the 1. middle cerebral artery, 2. terminal carotid artery, and 3. basilar artery; and measured the left posterior communicating artery flow. Mean arterial pressure and pulse pressure remained unchanged in the different occlusion cases compared to the physiological reference case, while total cerebral flow decreased by up to 19%. In all three occlusion cases, reversed flow was found in the left posterior communicating artery compared to the reference case with different flow magnitudes and pulsatility index values. The experimental results were compared with clinical findings, demonstrating the capability of this realistic cerebrovascular flow setup. This novel cerebrovascular flow setup opens the possibility for investigating different topics of neurovascular interventions under various clinical conditions in controlled preclinical laboratory studies.

O-290 Reduced uterine artery pulsatility index (UtAPI) in artificial frozen embryo transfer pregnancies leads to underestimation of 1st-trimester preeclampsia risk. An analysis of over 30,000 pregnancies

Abstract Study question Does the mode of conception (spontaneous, ovulation induction, fresh or frozen embryo transfer) impact Uterine Artery Pulsatility Index (UtAPI) values in 1st-trimester preeclampsia screening? Summary answer A significant reduction in UtAPI during 1st-trimester screening is observed in artificial frozen embryo transfer (AC-FET) pregnancies, resulting in underestimated preeclampsia risk. What is known already Accumulating evidence indicates that AC-FET cycles are associated with an increased risk of preeclampsia. Uterine artery (UtA) Doppler is a crucial biomarker for first-trimester preeclampsia screening, along with maternal factors and serum biomarkers, identifying “high-risk” patients. Guidelines strongly recommend the administration of aspirin(150mg/day) in these women, owing to robust evidence demonstrating a 40% reduction in the incidence of preeclampsia. Despite small studies suggesting a lower UtAPI after frozen ET, no previous studies explored the impact of the type of endometrial preparation in UtAPI Doppler or its influence on estimating preeclampsia risk Study design, size, duration This is a retrospective single-center study including 33880 singleton pregnancies (spontaneous or after ART) who underwent the 1st-trimester ultrasound screening at our University Hospital between January 2010 - May 2023. Overall, 33880 pregnancies were included: 29709 spontaneous, 429 ovulation induction, 1015 fresh ET and 2727 after frozen ET pregnancies (326/2727 in NC-FET and 2401 in AC-FET). Participants/materials, setting, methods The study included only singleton pregnancy for which a first trimester ultrasound (11+0- 13+6 wks) with UtA Doppler was performed. The primary aim of the study was to assess whether there was an association between the mode of conception and the UtA Doppler and whether UtAPI differed according to the type the endometrial preparation for FET. Continuous variables were expressed as mean ± SD. ANOVA test and multivariate regression analysis were performed. Main results and the role of chance Overall, the 1st-trimester UtAPI in pregnancies conceived after AC-FET was 1,036±0,160 [CI95%:0,723;1,349], after NC-FET 1,354±0,162 [CI95%:1,037;1,671], Fresh-ET 1,418 ±0,161 [CI95%:1,104;1,733], OI 1,413±0,162 [CI95%:1,096;1,730] and spontaneous pregnancies 1,373 ± 0,160 [CI95%:1,060;1,686]. A multivariable regression analysis, adjusting for confounding factors (age, weight, smoking, and oocyte donation), demonstrated that the value of uterine artery UtAPI is significantly lower when artificial cycle for frozen embryo transfer is performed compared with spontaneous pregnancies (-0,337 ± 0,014 [CI95%:-0,378;-0,297]), ovulation induction (-0,377 ± 0,028 [CI95%:-0,455; -0,298]) Fresh-ET (-0,383 ±0,021 [CI95%:-0,442; -0,323]), and NC-FET (-0,318 ± 0,029[CI95%:-0,401; -0,23]). On the contrary none of the other modes of conception are different in terms of UtAPI as compared with spontaneous pregnancies. Among screened patients, the number of patients classified at high risk for preeclampsia was significantly lower in pregnancies following AC-FET 7.8%(156/2002) as compared to NC-FET 15.9%(46/289), fresh-ET 11.0%(58/527), ovulation induction 10.5%(26/248) and spontaneous pregnancies (1452/15624) p &amp;lt; 0.001. Nonetheless, despite the lower number of high-risk patients in the AC-FET group, the actual incidence of PE was more than three times higher in AC-FET group 5.2%(125/2401) as compared with spontaneous 1.5%(431/29709), ovulation induction 1.4%(6/429) or NC-FET pregnancies 1.5%(5/326) and more than two times higher when compared to fresh-ET pregnancies 2.3%(23/1015) p &amp;lt; 0.001. Limitations, reasons for caution Despite employing a robust methodology with a substantial sample size and multivariate statistical analysis to address confounding factors, it’s essential to acknowledge the possibility of residual bias. However, its impact on the presented outcomes is anticipated to be minimal. Wider implications of the findings Existing 1st-trimester preeclampsia screening calculators overlook the notably lower UtAPI in AC-FET pregnancies, as discovered in our study. This poses a threat of underestimating high-risk patients and neglecting prophylactic aspirin. Algorithms should be adjusted to accurately assess risk for those undergoing AC-FET Trial registration number Not applicable

Role of Uterine Artery Doppler Study Between 11 and 14 Weeks as a Predictor of Preeclampsia.

Introduction Preeclampsia is a serious complication marked by antepartum hemorrhage, resulting in severe maternal and fetal complications. Predicting this condition using placental dysfunction assessments, such as uterine artery Doppler ultrasound, is challenging due to the placenta's evolving structural and biochemical characteristics throughout different stages of pregnancy. Objectives To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the uterine artery Doppler Pulsatility Index (PI) and Resistive Index (RI) in predicting preeclampsia. To compare the Doppler ultrasound measurements between normal pregnancies and those that develop preeclampsia. To assess the diagnostic accuracy of uterine artery Doppler ultrasound in predicting gestational hypertension in addition to preeclampsia. Methodology Conducted as a prospective study, 116 antenatal mothers with computed gestational ages and scan gestational ages between 11 and 14 weeks, and a previous history of preeclampsia were included. Subjects with chronic hypertension or multiple gestations were excluded. Participants underwent uterine artery Doppler screening, during which the PI and RI were measured upon obtaining three consecutive similar waveforms, and the mean PI of the left and right arteries was calculated. The outcomes of patients with normal pregnancies and those who developed preeclampsia were compared. Data were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA). Results The mean PI among participants was 1.75 (±0.38), with a range from 1 to 2.75. The mean RI was 0.58 (±0.08), ranging from 0.45 to 0.8. The cutoff for the mean PI in predicting preeclampsia was 2.27, which showed a sensitivity of 92.9%, specificity of 97.1%, PPV of 81.47%, NPV of 99.01%, and a diagnostic accuracy of 96.59% (area under the curve (AUC): 0.982). The cutoff for the mean RI for predicting preeclampsia was 0.695, with a sensitivity of 85.7%, specificity of 98%, PPV of 85.47%, NPV of 98.04%, and diagnostic accuracy of 96.52% (AUC: 0.965). In predicting gestational hypertension, the cutoff for the mean PI was 1.975, with a sensitivity of 80%, specificity of 82.9%, PPV of 17.41%, NPV of 98.92%, and diagnostic accuracy of 82.78% (AUC: 0.848). The cutoff for the mean RI in predicting gestational hypertension was 0.615, showing a sensitivity of 80%, specificity of 80.2%, PPV of 15.4%, NPV of 98.89%, and diagnostic accuracy of 80.19% (AUC: 0.767). Conclusion The research demonstrated that aberrant readings in uterine Doppler ultrasound, specifically in the PI and RI, possess strong overall validity in forecasting the occurrence of preeclampsia.

The significance of pulsatility indices in the middle cerebral, internal carotid, and common carotid arteries for small vessel disease in the brain: A retrospective cross-sectional study

Background and objectives. The pulsatility index (PI) indicates the resistance in distant blood vessels and the stiffness of major arteries outside the brain. For cerebral small vessel disease (CSVD), our aim is to enhance our comprehension of the Pulsatility Index (PI) in the common carotid artery (CCA), internal carotid artery (ICA), and middle cerebral artery (MCA). Materials and methods. This study is a cross-sectional retrospective research, which was conducted between January 2020 and June 2020 at the Dr. Cipto Mangunkusumo National Hospital, Indonesia. Patients were divided into groups with CSVD and without CSVD. Univariate and bivariate analyses, along with Spearman correlation and multivariate regression, were conducted to assess the mean difference. The overall score for CSVD was determined based on findings from brain MRI scans. Results. The median age of the 79 participants was 60 years (49-66). CSVD made up 54.4% of the total. The median (interquartile range) PI values for the CCA, ICA, and MCA in cases of CSVD were 1.48 (1.3-1.68), 1.12±0.3, and 1.11 (0.95-1.38), respectively. Despite this, no significant differences in PI were observed between the groups. In cases of total stroke, the PI of the CCA showed a moderate correlation with the PI of the MCA (B 0.4, p=0.001) and the PI of the ICA (B 0.34, p=0.005). However, no correlation was found between PI and either the burden of CSVD or the total score for small vessel disease. Conclusions. The pulsatility indices for the CCA, ICA, and MCA generally rise in cases of CSVD, indicating heightened resistance in distal blood vessels and increased stiffness in the large arteries outside the skull. This highlights the potential use of PI measurement as a promising adjunctive screening and evaluation tool in CSVD.

Verification of a simplified aneurysm dimensionless flow parameter to predict intracranial aneurysm rupture status.

Aneurysm number (An) is a novel prediction tool utilizing parameters of pulsatility index (PI) and aneurysm geometry. An has been shown to have the potential to differentiate intracranial aneurysm (IA) rupture status. The objective of this study is to investigate the feasibility and accuracy of An for IA rupture status prediction using Australian based clinical data. A retrospective study was conducted across three tertiary referral hospitals between November 2017 and November 2020 and all saccular IAs with known rupture status were included. Two sets of An values were calculated based on two sets of PI values previously reported in the literature. Five hundred and four IA cases were included in this study. The results demonstrated no significant difference between ruptured and unruptured status when using An ≥1 as the discriminator. Further analysis showed no strong correlation between An and IA subtypes. The area under the curve (AUC) indicated poor performance in predicting rupture status (AUC1 = 0.55 and AUC2 = 0.56). This study does not support An ≥1 as a reliable parameter to predict the rupture status of IAs based on a retrospective cohort. Although the concept of An is supported by hemodynamic aneurysm theory, further research is needed before it can be applied in the clinical setting. This study demonstrates that the novel prediction tool, An, proposed in 2020 is not reliable and that further research of this hemodynamic model is needed before it can be incorporated into the prediction of IA rupture status.

Assessment of Dynamic Cerebral Autoregulation During Long-Term Exposure to High Altitude in Normal Subjects by Ultrasonography.

To evaluate changes in dynamic cerebral autoregulation (CA) during short-term and long-term exposure to high altitude with ultrasonography, and also study the sex differences in the response of CA to altitude. We assessed the differences in dynamic CA and measured with Doppler ultrasound of the bilateral internal carotid artery (ICA), vertebral artery (VA), and middle cerebral artery (MCA) and the values of basic information within 48 hours and at 2 years after arrival at Tibet in 65 healthy Han young Chinese volunteers, meanwhile, we compared the resistance index (RI) and pulsatility index (PI) of the right MCA at inhale oxygen 8 minutes when a newcomer with 2 years after arrival at Tibet. With 2 years of altitude exposure, the SaO2 of all subjects was above 90%, the mean PEF, DAP, and HR values decreased, HGB increased compared within 48 hours in same-gender groups. Comparisons of cerebral hemodynamics between before 2 years and after 2 years within male and female groups, the mean RI and PI values of bilateral MCA after 2 years were significantly higher than before 2 years, at the same time, the mean RI and PI values of bilateral ICA were significant differences (P < .05) between male groups, with regard to female groups, showed that the mean RI and PI values of bilateral VA were significant differences (P < .05). Comparisons of Right MCA hemodynamics between after oxygen uptake 8 minutes and 2 years, the mean RI and PI values were no significant difference within male and female groups (P > .05). Acute mountain sickness could result from an alteration of dynamic autoregulation of cerebral blood flow, but the impaired autoregulation may be corrected with the extension of time, furthermore, the response of CA to altitude in males and females are different.

Fetal Splenic Artery Pulsatility Index May Predict the Need for Neonatal Intensive Care in Gestational Diabetes Class A1 Cases.

The fetal splenic artery pulsatility index is a parameter that reflects fetal well-being and has been used as a predictor of adverse pregnancy outcomes. The aim of this study was to investigate the predictive value of the splenic artery pulsatility index in gestational diabetes mellitus class A1 cases for intensive care unit admission. In this prospective case-controlled study, only sixty single pregnancy cases diagnosed with gestational diabetes mellitus class A1 were evaluated. Fetal splenic artery Doppler parameters such as peak systolic velocity, pulsatility index, resistivity index, and end-diastolic velocity were measured in all cases. The rate of requirements for the neonatal intensive care unit was noted. In cases requiring fetal intensive care, the fetal splenic pulsatility index was found to be statistically significantly lower than in healthy cases without it (0.94 ± 0.29 vs. 1.70 ± 0.53, respectively, p < 0.001, Student's t-test). When the fetal splenic PI cutoff value was selected as 1.105 cm3, the sensitivity was calculated as 97.9% and the specificity as 58.3% for predicting the need for fetal intensive care (AUC 0.968, p < 0.001, 95% CI 0.929-0.998). The use of a low fetal splenic artery PI parameter is a significant and good indicator for predicting the need for fetal intensive care according to the binary logistic regression analysis result (p = 0.006). This study suggests that evaluation of fetal splenic artery Doppler in mothers with gestational diabetes mellitus may be used to predict neonates requiring a newborn intensive care unit. Therefore, it is recommended that obstetricians use this simple, rapid, and valuable evaluation of fetal splenic artery Doppler and alert the neonatologist that a newborn intensive care unit may be required.

Bridging the notch: quantification of the end diastolic notch to better predict fetal growth restriction.

We aimed to evaluate several quantitative methods to describe the diastolic notch (DN) and compare their performance in the prediction of fetal growth restriction. Patients who underwent a placental scan at 16-26 weeks of gestation and delivered between Jan 2016 and Dec 2020 were included. The uterine artery pulsatility index was measured for all of the patients. In patients with a DN, it was quantified using the notch index and notch depth index. Odds ratios for small for gestational age neonates (defined as birth weight <10th and <5th percentile) were calculated. Predictive values of uterine artery pulsatility, notch, and notch depth index for fetal growth restriction were calculated. Overall, 514 patients were included, with 69 (13.4%) of them delivering a small for gestational age neonate (birth weight<10th percentile). Of these, 20 (20.9%) had a mean uterine artery pulsatility index >95th percentile, 13 (18.8%) had a unilateral notch, and 11 (15.9%) had a bilateral notch. 16 patients (23.2%) had both a high uterine artery pulsatility index (>95th percentile) and a diastolic notch. Comparison of the performance between uterine artery pulsatility, notch, and notch depth index using receiver operating characteristic curves to predict fetal growth restriction <10th percentile found area under the curve values of 0.659, 0.679, and 0.704, respectively, with overlapping confidence intervals. Quantifying the diastolic notch at 16-26 weeks of gestation did not provide any added benefit in terms of prediction of neonatal birth weight below the 10th or 5th percentile for gestational age, compared with uterine artery pulsatility index.

The pattern of renal artery Doppler indices in patients with sickle cell disease.

To evaluate the pattern of renal artery Doppler indices in patients with sickle cell disease who do not have laboratory evidence of renal impairment. A case-control study was carried out after enrolling 50 patients with sickle cell disease (HbSS phenotype) (sickle cell disease group) and 50 control subjects (control group). All the participants underwent ultrasound and color Doppler examination, and the pulsatility index and resistive index values of the main renal artery, segmental artery, and interlobar artery in both kidneys were recorded and compared. The Doppler measurements of the main renal artery, segmental artery, and interlobar artery were compared between the control and sickle cell disease groups. It was found that both pulsatility index and resistive index were significantly higher in the sickle cell disease group, as compared to the control group, for the main renal artery, segmental artery, and interlobar artery (p <0.0001, p <0.0001, and p <0.0001, respectively). The optimal cut-off points for mean pulsatility index and resistive index, as measured by the Youden index, were found to be >1.08 (72% sensitivity and 88% specificity) and >0.635 (66% sensitivity and 98% specificity), respectively. Resistive index and pulsatility index values in renal Doppler sonography can serve as early radiologic predictors of renal vascular changes in sickle cell disease patients who do not have laboratory evidence of renal impairment.

Evaluating the accuracy of cerebrovascular computational fluid dynamics modeling through time-resolved experimental validation

Accurate modeling of cerebral hemodynamics is crucial for better understanding the hemodynamics of stroke, for which computational fluid dynamics (CFD) modeling is a viable tool to obtain information. However, a comprehensive study on the accuracy of cerebrovascular CFD models including both transient arterial pressures and flows does not exist. This study systematically assessed the accuracy of different outlet boundary conditions (BCs) comparing CFD modeling and an in-vitro experiment. The experimental setup consisted of an anatomical cerebrovascular phantom and high-resolution flow and pressure data acquisition. The CFD model of the same cerebrovascular geometry comprised five sets of stationary and transient BCs including established techniques and a novel BC, the phase modulation approach. The experiment produced physiological hemodynamics consistent with reported clinical results for total cerebral blood flow, inlet pressure, flow distribution, and flow pulsatility indices (PI). The in-silico model instead yielded time-dependent deviations between 19–66% for flows and 6–26% for pressures. For cerebrovascular CFD modeling, it is recommended to avoid stationary outlet pressure BCs, which caused the highest deviations. The Windkessel and the phase modulation BCs provided realistic flow PI values and cerebrovascular pressures, respectively. However, this study shows that the accuracy of current cerebrovascular CFD models is limited.

Transit time flow measurement in off-pump surgery: is it a functional index of the biological graft integrity?

Transit-time flow measurement (TTFM) represents a valid tool in the assessment of the quality of the anastomosis during coronary artery bypass graft (CABG). Nevertheless, a high variability limits its standardized use, lacking univocally accepted cut-off flow values. Our study analyzes TTFM data collected from a study population that underwent off-pump CABG (OP-CABG), with the aim to differentiate into subgroups according to the presence of diabetes mellitus. Patients referred to the Cardiovascular Unit of S. Michele Hospital (Caserta, Italy) for coronary artery disease (CAD) and underwent OP-CABG between January 2015 and December 2019 were enrolled, and intraoperative TTFMs data were recruited and evaluated. Mean graft flow (MGF) and pulsatility index (PI) values were collected and analyzed. The study population was composed of 342 patients who underwent OP-CABG with TTFM data regarding 824 grafts. Diabetic patients shared a higher cardiovascular risk profile. The TTFM assessment showed better results for the use of the arterial grafts in diabetic patients, especially for those insulin-dependent; conversely, venous grafts showed worse data with lower MGF and higher PI values. In particular, the anastomoses of the saphenous vein graft with marginal obtuse (MO) coronary artery showed worse MGF results in the insulin-dependent rather than normoglycemic subgroup (28.66 vs. 38.44, p=0.003). Diabetic patients, especially in the insulin-dependent subgroups, have demonstrated lower MGF and higher PI values collected from venous anastomoses with, conversely, inverse results from the arterial one. These results might be correlated to an altered biological adaptability caused by the effects of the diabetic endocrine disorder.

The association between discordant umbilical arterial resistance in growth-restricted fetuses and adverse outcomes

Assessing the umbilical artery pulsatility index via Doppler measurements plays a crucial role in evaluating fetal growth impairment. This study aimed to investigate perinatal outcomes associated with discordant pulsatility indices of umbilical arteries in fetuses with growth restriction. In this retrospective cohort study, all singleton pregnancies were included if their estimated fetal weight and/or abdominal circumference fell below the 10th percentile for gestational age (2017-2022). Eligible cases included singleton pregnancies with concurrent sampling of both umbilical arteries within 14 days of birth at the ultrasound evaluation closest to delivery. The exclusion criteria included births before 22 weeks of gestation, evidence of absent or reverse end-diastolic flow in either umbilical artery, and known fetal genetic or structural anomalies. The study compared cases with discordant umbilical artery pulsatility index values (defined as 1 umbilical artery pulsatility index at ≤95th percentile and the other umbilical artery pulsatility index at >95th percentile for gestational age) to pregnancies where both umbilical artery pulsatility indices had normal pulsatility index values and those with both umbilical arteries displaying abnormal pulsatility index values. The primary outcome assessed was the occurrence of composite adverse neonatal outcomes. Multivariable logistic regressions were performed, adjusting for relevant covariates. The study encompassed 1014 patients, including 194 patients (19.1%) with discordant umbilical artery pulsatility index values among those who had both umbilical arteries sampled close to delivery, 671 patients (66.2%) with both umbilical arteries having normal pulsatility index values, and 149 patients (14.7%) with both umbilical arteries exhibiting abnormal values. Pregnancies with discordant umbilical artery pulsatility index values displayed compromised sonographic parameters compared with those with both umbilical arteries showing normal pulsatility index values. Similarly, the number of abnormal umbilical artery pulsatility index values was associated with adverse perinatal outcomes in a dose-response manner. Cases with 1 abnormal (discordant) umbilical artery pulsatility index value showed favorable sonographic parameters and perinatal outcomes compared with cases with both abnormal umbilical artery pulsatility index values, and cases with both abnormal umbilical artery pulsatility index values showed worse sonographic parameters and perinatal outcomes compared with cases with discordant UA PI values. Multivariate analysis revealed that discordant umbilical artery pulsatility indices were significantly and independently associated with composite adverse perinatal outcomes, with an adjusted odds ratio of 1.75 (95% confidence interval, 1.24-2.47; P = .002). Evaluating the resistance indices of both umbilical arteries may provide useful data and assist in assessing adverse perinatal outcomes among fetuses with growth restriction.