1
|
Martins JG, Kawakita T, Barake C, Gould L, Baraki D, Connell P, Sinkovskaya E, Abuhamad A. Rate of deterioration of umbilical artery Doppler indices in fetuses with severe early-onset fetal growth restriction. Am J Obstet Gynecol MFM 2024; 6:101283. [PMID: 38219949 DOI: 10.1016/j.ajogmf.2024.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Incorporation of umbilical artery Doppler in the surveillance of fetal growth restriction has been shown to reduce the risk of perinatal deaths. Systole/Diastole ratio, Pulsatility Index and Resistance Index are obtained upon Doppler interrogation of the umbilical artery however it is unknown which index predicts more advanced stages of placental deterioration. OBJECTIVE This study aimed to examine risk factors for the development of absent or reversed end-diastolic velocity and the time intervals of deterioration from normal umbilical artery end-diastolic velocity (indicated by systole/diastole ratio, pulsatility index, or resistance index) to decreased and absent or reversed end-diastolic velocity in fetuses with early-onset severe fetal growth restriction. STUDY DESIGN This was a retrospective cohort study performed from 2005 to 2020. All singleton pregnancies with severe (estimated fetal weight or abdominal circumference below the third percentile) and early-onset (diagnosed between 20 0/7 and 31 6/7 weeks of gestation) fetal growth restriction were included. Patients with fetal genetic or structural anomalies, suspected congenital infections, absent or reversed end-diastolic velocity at diagnosis, poor pregnancy dating, and absence of follow-up ultrasounds were excluded. Estimated fetal weight, abdominal circumference, and Doppler indices were reviewed longitudinally from diagnosis to delivery. To examine risk factors for absent or reversed end-diastolic velocity, we performed backward stepwise logistic regression and calculated odds ratios with 95% confidence intervals. Kaplan-Meier curves were compared using log-rank tests. RESULTS A total of 985 patients met the inclusion criteria, and 79 (8%) progressed to absent or reversed end-diastolic velocity. Factors associated with development of absent or reversed end-diastolic velocity included gestational age at diagnosis (adjusted odds ratio, 4.88 [95% confidence interval, 2.55-9.37] at 20 0/7 to 23 6/7 weeks; adjusted odds ratio, 1.56 [95% confidence interval, 0.86-2.82] at 24 0/7 to 27 6/7 weeks compared with 28 0/7 to 31 6/7 weeks) and presence of chronic hypertension (adjusted odds ratio, 2.37 [95% confidence interval, 1.33-4.23]). Rates of progression from diagnosis of fetal growth restriction with normal umbilical artery Doppler to absent or reversed end-diastolic velocity were significant after 4 weeks from diagnosis (5.84% [95% confidence interval, 4.50-7.57]). Regarding the Doppler indices, the progression from normal values to abnormal indices was similar at 1 and 2 weeks. However, the rate of progression from normal to abnormal systole/diastole ratio compared with the rates of progression from normal to abnormal pulsatility index or resistance index was higher at 4 and 6 weeks. Deterioration from abnormal indices to absent or reversed end-diastolic velocity was shorter with abnormal resistance index and pulsatility index when compared with the systole/diastole ratio at 2, 4, and 6 weeks after diagnosis and at 6 weeks, respectively. CONCLUSION Earlier gestational age at diagnosis and chronic hypertension are considered as risk factors for Doppler deterioration and development of absent or reversed end-diastolic velocity in the umbilical artery. With normal Doppler indices, significant deterioration and progression to absent or reversed end-diastolic velocity is unlikely until 4 weeks after diagnosis. Abnormal systole/diastole ratio seems to appear first. However, abnormal pulsatility index or resistance index was associated with absent or reversed end-diastolic velocity.
Collapse
Affiliation(s)
- Juliana Gevaerd Martins
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad).
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
| | - Carole Barake
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX (Dr Barake)
| | - Lindsay Gould
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
| | - Dana Baraki
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH (Dr Baraki)
| | - Phillip Connell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Connell)
| | - Elena Sinkovskaya
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Gevaerd Martins, Kawakita, Gould, Sinkovskaya, and Abuhamad)
| |
Collapse
|
2
|
Bourquin C, Porée J, Rauby B, Perrot V, Ghigo N, Belgharbi H, Bélanger S, Ramos-Palacios G, Cortes N, Ladret H, Ikan L, Casanova C, Lesage F, Provost J. Quantitative pulsatility measurements using 3D dynamic ultrasound localization microscopy. Phys Med Biol 2024; 69:045017. [PMID: 38181421 DOI: 10.1088/1361-6560/ad1b68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/05/2024] [Indexed: 01/07/2024]
Abstract
A rise in blood flow velocity variations (i.e. pulsatility) in the brain, caused by the stiffening of upstream arteries, is associated with cognitive impairment and neurodegenerative diseases. The study of this phenomenon requires brain-wide pulsatility measurements, with large penetration depth and high spatiotemporal resolution. The development of dynamic ultrasound localization microscopy (DULM), based on ULM, has enabled pulsatility measurements in the rodent brain in 2D. However, 2D imaging accesses only one slice of the brain and measures only 2D-projected and hence biased velocities . Herein, we present 3D DULM: using a single ultrasound scanner at high frame rate (1000-2000 Hz), this method can produce dynamic maps of microbubbles flowing in the bloodstream and extract quantitative pulsatility measurements in the cat brain with craniotomy and in the mouse brain through the skull, showing a wide range of flow hemodynamics in both large and small vessels. We highlighted a decrease in pulsatility along the vascular tree in the cat brain, which could be mapped with ultrasound down to a few tens of micrometers for the first time. We also performed an intra-animal validation of the method by showing consistent measurements between the two sides of the Willis circle in the mouse brain. Our study provides the first step towards a new biomarker that would allow the detection of dynamic abnormalities in microvessels in the brain, which could be linked to early signs of neurodegenerative diseases.
Collapse
Affiliation(s)
- Chloé Bourquin
- Department of Engineering Physics, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
| | - Jonathan Porée
- Department of Engineering Physics, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
| | - Brice Rauby
- Department of Engineering Physics, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
| | - Vincent Perrot
- Department of Engineering Physics, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
| | - Nin Ghigo
- Department of Engineering Physics, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
| | - Hatim Belgharbi
- Department of Engineering Physics, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC 27599, United States of America
| | | | | | - Nelson Cortes
- School of Optometry, University of Montreal, Montréal, QC H3T 1P1, Canada
| | - Hugo Ladret
- School of Optometry, University of Montreal, Montréal, QC H3T 1P1, Canada
- Institut de Neurosciences de la Timone, UMR 7289, CNRS and Aix-Marseille Université, Marseille, F-13005, France
| | - Lamyae Ikan
- School of Optometry, University of Montreal, Montréal, QC H3T 1P1, Canada
| | - Christian Casanova
- School of Optometry, University of Montreal, Montréal, QC H3T 1P1, Canada
| | - Frédéric Lesage
- Department of Electrical Engineering, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
- Montreal Heart Institute, Montréal, QC H1T 1C8, Canada
| | - Jean Provost
- Department of Engineering Physics, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada
- Montreal Heart Institute, Montréal, QC H1T 1C8, Canada
| |
Collapse
|
3
|
Patel K, Dan Y, Kunselman AR, Clark JB, Myers JL, Ündar A. The effects of pulsatile versus nonpulsatile flow on cerebral pulsatility index, mean flow velocity at the middle cerebral artery, regional cerebral oxygen saturation, cerebral gaseous microemboli counts, and short-term clinical outcomes in patients undergoing congenital heart surgery. JTCVS Open 2023; 16:786-800. [PMID: 38204706 PMCID: PMC10775072 DOI: 10.1016/j.xjon.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/30/2023] [Accepted: 08/18/2023] [Indexed: 01/12/2024]
Abstract
Objective The objective of this retrospective review was to evaluate whether or not pulsatile flow improves cerebral hemodynamics and clinical outcomes in pediatric congenital cardiac surgery patients. Methods This retrospective study included 284 pediatric patients undergoing congenital cardiac surgery with cardiopulmonary bypass support utilizing nonpulsatile (n = 152) or pulsatile (n = 132) flow. Intraoperative cerebral gaseous microemboli counts, pulsatility index, and mean blood flow velocity at the right middle cerebral artery were assessed using transcranial Doppler ultrasound. Clinical outcomes were compared between groups. Results Patient demographics and cardiopulmonary bypass characteristics between groups were similar. Although the pulsatility index during aortic crossclamping was consistently higher in the pulsatile group (P < .05), a significant degree of pulsatility was also observed in the nonpulsatile group. No significant differences in mean cerebral blood flow velocity, regional cerebral oxygen saturation, or gaseous microemboli counts were observed between the perfusion modality groups. Clinical outcomes, including intubation duration, intensive care unit and hospital length of stay, and mortality within 180 days were similar between groups. Conclusions Although the pulsatility index was greater in the pulsatile group, other measures of intraoperative cerebral perfusion and short-term outcomes were similar to the nonpulsatile group. These findings suggest that while pulsatile perfusion represents a safe modality for cardiopulmonary bypass support, its use may not translate into detectably superior clinical outcomes.
Collapse
Affiliation(s)
- Krishna Patel
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Yongwook Dan
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Allen R. Kunselman
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Public Health Sciences, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Joseph B. Clark
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - John L. Myers
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| | - Akif Ündar
- Department of Pediatrics, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Surgery, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
- Department of Biomedical Engineering, Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pa
| |
Collapse
|
4
|
Lin Y, Yan R, He A, Chen J, Li R. Double-to-Single Umbilical Artery With a Low Pulsatility Index Leading to Fetal Death: A Case Report and Review of Literature. Cureus 2023; 15:e51273. [PMID: 38283532 PMCID: PMC10822057 DOI: 10.7759/cureus.51273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Single umbilical artery (SUA) may be associated with adverse pregnancy outcomes, such as fetal death, emergency cesarean section, premature delivery, small-for-gestational-age infants, and admission to neonatal intensive care unit, and some SUAs are transformed from originally double umbilical arteries (UA). The pulsatility index (PI) can reflect the resistance of UA, and clinicians attach importance to high PI but easily overlook low levels of it. We reported one case of a pregnant woman who underwent double to single UA accompanied by low UA-PI and finally had intrauterine fetal death. Additionally, the literature regarding SUA and UA-PI is reviewed. This study aims to alert clinicians to the risk of double-to-single UA with low UA-PI and strengthen fetal monitoring and timely intervention. We look forward to more clinical evidence to investigate it.
Collapse
Affiliation(s)
- Yanting Lin
- Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, CHN
| | - Ruiling Yan
- Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, CHN
| | - Andong He
- Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, CHN
| | - Jie Chen
- Obstetrics and Gynecology, The Affiliated Shunde Hospital of Jinan University, Guangzhou, CHN
| | - Ruiman Li
- Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, CHN
| |
Collapse
|
5
|
Mathewlynn S, Beriwal S, Ioannou C, Cavallaro A, Impey L. Abnormal umbilical artery pulsatility index in appropriately grown fetuses in the early third trimester: an observational cohort study. J Matern Fetal Neonatal Med 2023; 36:2152670. [PMID: 36482725 DOI: 10.1080/14767058.2022.2152670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine if appropriately grown fetuses (those that are not small-for-gestational-age) with a raised umbilical artery pulsatility index (>95th centile) in the mid third trimester are at increased risk of placental dysfunction and adverse outcome. METHODS This is a 5-year retrospective cohort study using routinely collected data. Inclusion criteria were singleton, non-anomalous pregnancies having a growth scan with umbilical artery Doppler velocimetry between 28 + 0 and 33 + 6 weeks' gestation. Small-for-gestational-age fetuses were excluded. Cases were classified as group 1 (those with an umbilical artery pulsatility index >95th centile at any scan during target window) or group 2 (those where the umbilical artery pulsatility index was ≤95th centile at all scans). p-Values and odds ratios were calculated. Logistic regression was used to compute odds ratios adjusted for baseline estimated weight z-score, gestational age at delivery, and labor induction. RESULTS After exclusions, there were 202 pregnancies in group 1 and 7950 in group 2. Differences in baseline characteristics between the groups include age (median age was 30 for group 1 and 32 for group 2, p < .001), smoking (group 1 were more likely to smoke, p < .001) and labor induction (more common in group 1, p = .03). Among those delivering ≥34 + 0, group 1 were more likely to be small-for-gestational-age and have an abnormal cerebro-placental ratio at the final scan (OR 6.76, CI 4.23-10.80 and OR 5.07, CI 3.37-7.63 respectively), and to develop features of growth restriction (OR 9.85, CI 6.27-15.49). Group 1 were also more likely to deliver <37 + 0 weeks' gestation (OR 1.71, CI 1.13-2.58) and to have birthweight <10th or <3rd centile (OR 5.26, CI 3.65-7.58 and OR 6.13, CI 3.00-12.54 respectively). These associations remained significant when adjusted for estimated weight at the initial scan. CONCLUSIONS These data suggest that raised umbilical artery pulsatility index in an appropriately grown fetus at 28 + 0 to 33 + 6 weeks' gestation is associated with subsequent development of growth restriction markers and an increased risk of moderate and severe small-for-gestational-age at birth. This is independent of the estimated weight of these babies at the index scan.
Collapse
Affiliation(s)
- Sam Mathewlynn
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Sridevi Beriwal
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Christos Ioannou
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Angelo Cavallaro
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Lawrence Impey
- Fetal Medicine Unit, Level 6, Women's Centre, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
6
|
Kovács Z, Hegyi G, Szőke H. The Effect of Exercise on Pulsatility Index of Uterine Arteries and Pain in Primary Dysmenorrhea. J Clin Med 2023; 12:7021. [PMID: 38002635 PMCID: PMC10671949 DOI: 10.3390/jcm12227021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Primary dysmenorrhea (PD) is one of the most common diseases in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute exercise intervention could result in a difference in the pulsatility index (PI) of the uterine arteries (UAs) and level of menstrual pain in patients with PD. METHODS In our prospective observational trial, the observation period included one spontaneous menstrual cycle and the consecutive time of the next menstruation of all participants, aged 18-44, with no extensive sports experience. In total, 73 volunteers were enrolled: 38 persons in the intervention group (IG) and 35 in the control group (CG). The intervention program was accompanied by music, performed in groups under the supervision of a qualified instructor in Hungary. The primary outcome was the difference between the IG and CG regarding the PI values of UAs at the 1st and the 2nd ultrasound (US) Doppler flowmetry. The secondary outcome was the difference between the IG and CG regarding the PI of UAs and menstrual pain measured by using the Numeric Rating Scale and adherence to the intervention. Statistical tests such as an independent-samples t-test, chi-square test, Mann-Whitney test and analysis of covariance (ANCOVA) were used during the analyses. RESULTS Examining the mean of the PI of UAs in the IG and the CG at the 1st and the 2nd US measurement, a significant difference was found in the change in the measured value (Z = -2.545; p = 0.011). The IG showed a significantly higher increase in the mean of the PI of UAs (Median = 0.825) than the CG (Median = 0.130). The difference in the PI of the UAs of the IG and the CG is not related to the level of pain in any group (p = 0.336) and not related to the whole sample (p = 0.354); furthermore, the level of pain did not significantly differ between the two groups. CONCLUSIONS Our study is the first to document the significant effects of mild-to-moderate exercise training on the change in the PI of the UAs in individuals with PD. The IG had a reduced blood flow due to circulatory redistribution after exercise. The level of menstrual pain of primary dysmenorrhea patients is independent of the level of blood circulation regarding the PI of the UAs. Randomized controlled studies with more participants and a longer research period are needed to confirm our findings regarding the association between regular exercise and the PI of UAs. The study was registered at clinicaltrials.gov: NCT04618172.
Collapse
Affiliation(s)
- Zoltán Kovács
- Department of Obstetrics, Robert Hospital, 1135 Budapest, Hungary
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (G.H.); (H.S.)
| | - Gabriella Hegyi
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (G.H.); (H.S.)
| | - Henrik Szőke
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (G.H.); (H.S.)
- Department of Integrative Medicine, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| |
Collapse
|
7
|
Hong J, Crawford K, Cavanagh E, da Silva Costa F, Kumar S. Placental biomarkers and fetoplacental Dopplers in combination reliably predict preterm birth in pregnancies complicated by fetal growth restriction. Ultrasound Obstet Gynecol 2023. [PMID: 37820083 DOI: 10.1002/uog.27513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To assess the association between placental biomarkers (placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio) and fetoplacental Dopplers - Umbilical Artery Pulsatility Index (UA PI) and Uterine Artery Pulsatility Index (UtA PI) in various combinations for the likelihood of preterm birth (PTB) in women with fetal growth restriction (FGR). METHODS A prospective cohort study of pregnancies complicated by FGR. Maternal serum PlGF levels, sFlt-1/PlGF ratio, UA PI and UtA PI were measured at 4-weekly intervals from recruitment to delivery. Harrell's concordance statistic was used to evaluate various combinations of placental biomarkers and fetoplacental Dopplers to ascertain the ideal combination to predict PTB (<37 weeks). Multivariable Cox regression was used as time-varying covariates. RESULTS There were 320 pregnancies in the study cohort - 179 (55.9%) were FGR and 141 (44.1%) were AGA. In the FGR cohort, both low PlGF levels and elevated sFlt-1/PlGF ratio significantly affected time to PTB. Low PlGF was a better predictor of PTB than either sFlt-1/PlGF ratio or combination of PlGF and sFlt-1/PlGF ratio (Harrell's C 0.81, 0.79, 0.75 respectively). Similarly, although both UA PI and UtA PI >95th centile for gestation significantly affected the time to PTB, in combination, they were better predictors than either measure alone (Harrell's C 0.82, 0.75, 0.76 respectively). The predictive utility was highest when PlGF <100ng/L, UA PI and UtA PI >95th centile was combined (Harrell's C 0.88) (HR 32.99 95% CI 10.74, 101.32). CONCLUSIONS Low maternal PlGF levels (<100ng/L) and abnormal fetoplacental Dopplers (UA PI and UtA PI >95th centile) in combination have greatest predictive utility for PTB in pregnancies complicated with FGR and may help guide clinical management of these complex pregnancies. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- J Hong
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - K Crawford
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - E Cavanagh
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - F da Silva Costa
- School of Medicine and Dentistry, Griffith University and Maternal Fetal Medicine Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
- NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
8
|
Rekova P, Dostalova G, Rob D, Vaneckova M, Pavlicova M, Linhart A, Kemlink D. Cerebrovascular Phenotype in Fabry Disease Patients Assessed by Ultrasound. J Ultrasound Med 2023; 42:2315-2330. [PMID: 37209359 DOI: 10.1002/jum.16254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/01/2023] [Accepted: 04/25/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Fabry disease (FD) is a rare X-linked lysosomal storage disorder with variable phenotypes, including neurological symptoms. These can be influenced by vascular impairment. Extracranial and transcranial vascular sonography is an effective and noninvasive method for measuring arterial structures and blood flow. The study aims to investigate cerebrovascular phenotype characteristics in FD patients compared to controls using neurosonology. METHODS This is a single-center, cross-sectional study of 130 subjects-65 patients (38 females), with genetically confirmed FD, and 65 sex- and age-matched controls. Using ultrasonography, we measured structural and hemodynamic parameters, including distal common carotid artery intima-media thickness, inner vertebral artery diameter, resting blood flow velocity, pulsatility index, and cerebral vasoreactivity (CVR) in the middle cerebral artery. To assess differences between FD and controls and to identify factors influencing investigated outcomes, unadjusted and adjusted regression analyses were performed. RESULTS In comparison to sex- and age-matched controls, FD patients displayed significantly increased carotid artery intima-media thickness (observed FD 0.69 ± 0.13 mm versus controls 0.63 ± 0.12 mm; Padj = .0014), vertebral artery diameter (observed FD 3.59 ± 0.35 mm versus controls 3.38 ± 0.33 mm; Padj = .0002), middle cerebral artery pulsatility index (observed FD 0.98 ± 0.19 versus controls 0.87 ± 0.11; Padj < .0001), and significantly decreased CVR (observed FD 1.21 ± 0.49 versus controls 1.35 ± 0.38; Padj = .0409), when adjusted by age, BMI, and sex. Additionally, FD patients had significantly more variable CVR (0.48 ± 0.25 versus 0.21 ± 0.14; Padj < .0001). CONCLUSIONS Our results suggest the presence of multiple vascular abnormalities and changes in hemodynamic parameters of cerebral arteries in patients with FD.
Collapse
Affiliation(s)
- Petra Rekova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Gabriela Dostalova
- Second Department of Internal-Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Daniel Rob
- Second Department of Internal-Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Ales Linhart
- Second Department of Internal-Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| |
Collapse
|
9
|
Chaemsaithong P, Gil MM, Chaiyasit N, Cuenca-Gomez D, Plasencia W, Rolle V, Poon LC. Accuracy of placental growth factor alone or in combination with soluble fms-like tyrosine kinase-1 or maternal factors in detecting preeclampsia in asymptomatic women in the second and third trimesters: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:222-247. [PMID: 36990308 DOI: 10.1016/j.ajog.2023.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE This study aimed to: (1) identify all relevant studies reporting on the diagnostic accuracy of maternal circulating placental growth factor) alone or as a ratio with soluble fms-like tyrosine kinase-1), and of placental growth factor-based models (placental growth factor combined with maternal factors±other biomarkers) in the second or third trimester to predict subsequent development of preeclampsia in asymptomatic women; (2) estimate a hierarchical summary receiver-operating characteristic curve for studies reporting on the same test but different thresholds, gestational ages, and populations; and (3) select the best method to screen for preeclampsia in asymptomatic women during the second and third trimester of pregnancy by comparing the diagnostic accuracy of each method. DATA SOURCES A systematic search was performed through MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform databases from January 1, 1985 to April 15, 2021. STUDY ELIGIBILITY CRITERIA Studies including asymptomatic singleton pregnant women at >18 weeks' gestation with risk of developing preeclampsia were evaluated. We included only cohort or cross-sectional test accuracy studies reporting on preeclampsia outcome, allowing tabulation of 2×2 tables, with follow-up available for >85%, and evaluating performance of placental growth factor alone, soluble fms-like tyrosine kinase-1- placental growth factor ratio, or placental growth factor-based models. The study protocol was registered on the International Prospective Register Of Systematic Reviews (CRD 42020162460). METHODS Because of considerable intra- and interstudy heterogeneity, we computed the hierarchical summary receiver-operating characteristic plots and derived diagnostic odds ratios, β, θi, and Λ for each method to compare performances. The quality of the included studies was evaluated by the QUADAS-2 tool. RESULTS The search identified 2028 citations, from which we selected 474 studies for detailed assessment of the full texts. Finally, 100 published studies met the eligibility criteria for qualitative and 32 for quantitative syntheses. Twenty-three studies reported on performance of placental growth factor testing for the prediction of preeclampsia in the second trimester, including 16 (with 27 entries) that reported on placental growth factor test alone, 9 (with 19 entries) that reported on the soluble fms-like tyrosine kinase-1-placental growth factor ratio, and 6 (16 entries) that reported on placental growth factor-based models. Fourteen studies reported on performance of placental growth factor testing for the prediction of preeclampsia in the third trimester, including 10 (with 18 entries) that reported on placental growth factor test alone, 8 (with 12 entries) that reported on soluble fms-like tyrosine kinase-1-placental growth factor ratio, and 7 (with 12 entries) that reported on placental growth factor-based models. For the second trimester, Placental growth factor-based models achieved the highest diagnostic odds ratio for the prediction of early preeclampsia in the total population compared with placental growth factor alone and soluble fms-like tyrosine kinase-1-placental growth factor ratio (placental growth factor-based models, 63.20; 95% confidence interval, 37.62-106.16 vs soluble fms-like tyrosine kinase-1-placental growth factor ratio, 6.96; 95% confidence interval, 1.76-27.61 vs placental growth factor alone, 5.62; 95% confidence interval, 3.04-10.38); placental growth factor-based models had higher diagnostic odds ratio than placental growth factor alone for the identification of any-onset preeclampsia in the unselected population (28.45; 95% confidence interval, 13.52-59.85 vs 7.09; 95% confidence interval, 3.74-13.41). For the third trimester, Placental growth factor-based models achieved prediction for any-onset preeclampsia that was significantly better than that of placental growth factor alone but similar to that of soluble fms-like tyrosine kinase-1-placental growth factor ratio (placental growth factor-based models, 27.12; 95% confidence interval, 21.67-33.94 vs placental growth factor alone, 10.31; 95% confidence interval, 7.41-14.35 vs soluble fms-like tyrosine kinase-1-placental growth factor ratio, 14.94; 95% confidence interval, 9.42-23.70). CONCLUSION Placental growth factor with maternal factors ± other biomarkers determined in the second trimester achieved the best predictive performance for early preeclampsia in the total population. However, in the third trimester, placental growth factor-based models had predictive performance for any-onset preeclampsia that was better than that of placental growth factor alone but similar to that of soluble fms-like tyrosine kinase-1-placental growth factor ratio. Through this meta-analysis, we have identified a large number of very heterogeneous studies. Therefore, there is an urgent need to develop standardized research using the same models that combine serum placental growth factor with maternal factors ± other biomarkers to accurately predict preeclampsia. Identification of patients at risk might be beneficial for intensive monitoring and timing delivery.
Collapse
Affiliation(s)
- Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - María M Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain; Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Noppadol Chaiyasit
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Diana Cuenca-Gomez
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - Walter Plasencia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Valeria Rolle
- Biostatistics and Epidemiology Unit, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
| |
Collapse
|
10
|
Albaiges G, Papastefanou I, Rodriguez I, Prats P, Echevarria M, Rodriguez MA, Rodriguez Melcon A. External validation of Fetal Medicine Foundation competing-risks model for midgestation prediction of small-for-gestational-age neonates in Spanish population. Ultrasound Obstet Gynecol 2023; 62:202-208. [PMID: 36971008 DOI: 10.1002/uog.26210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To examine the external validity of the new Fetal Medicine Foundation (FMF) competing-risks model for prediction in midgestation of small-for-gestational-age (SGA) neonates. METHODS This was a single-center prospective cohort study of 25 484 women with a singleton pregnancy undergoing routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation. The FMF competing-risks model for the prediction of SGA combining maternal factors and midgestation estimated fetal weight by ultrasound scan (EFW) and uterine artery pulsatility index (UtA-PI) was used to calculate risks for different cut-offs of birth-weight percentile and gestational age at delivery. The predictive performance was evaluated in terms of discrimination and calibration. RESULTS The validation cohort was significantly different in composition compared with the FMF cohort in which the model was developed. In the validation cohort, at a 10% false-positive rate (FPR), maternal factors, EFW and UtA-PI yielded detection rates of 69.6%, 38.7% and 31.7% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks' gestation, respectively. The respective values for SGA < 3rd percentile were 75.7%, 48.2% and 38.1%. Detection rates in the validation cohort were similar to those reported in the FMF study for SGA with delivery at < 32 weeks but lower for SGA with delivery at < 37 and ≥ 37 weeks. Predictive performance in the validation cohort was similar to that reported in a subgroup of the FMF cohort consisting of nulliparous and Caucasian women. Detection rates in the validation cohort at a 15% FPR were 77.4%, 50.0% and 41.5% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks, respectively, which were similar to the respective values reported in the FMF study at a 10% FPR. The model had satisfactory calibration. CONCLUSION The new competing-risks model for midgestation prediction of SGA developed by the FMF performs well in a large independent Spanish population. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- G Albaiges
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - I Papastefanou
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - I Rodriguez
- Epidemiological Unit, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quiron Dexeus, Barcelona, Spain
| | - P Prats
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - M Echevarria
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - M A Rodriguez
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - A Rodriguez Melcon
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| |
Collapse
|
11
|
Rane BM, Malau-Aduli BS, Alele F, O'Brien C. Prognostic Accuracy of Antenatal Doppler Ultrasound Measures in Predicting Adverse Perinatal Outcomes for Pregnancies Complicated by Diabetes: A Systematic Review. AJOG Glob Rep 2023; 3:100241. [PMID: 37396341 PMCID: PMC10310483 DOI: 10.1016/j.xagr.2023.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE This study aimed to assess the prognostic accuracies of Doppler ultrasound measures in predicting adverse perinatal outcomes for pregnancies complicated with preexisting or gestational diabetes mellitus. DATA SOURCES An online database search of MEDLINE, Cochrane, Embase, CINAHL, Scopus, and Emcare from inception to April 2022 was conducted. STUDY ELIGIBILITY CRITERIA Studies reporting singleton, nonanomalous fetuses of women with either preexisting (type 1 or 2 diabetes mellitus) or gestational diabetes mellitus during pregnancy were included. In addition, the included studies assessed cerebroplacental ratio and middle cerebral artery and/or umbilical artery pulsatility index in the prediction of either: preterm birth, cesarean delivery for fetal distress, APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score <7 at 5 minutes, neonatal intensive care unit admission (>24 hours), acute respiratory distress syndrome, jaundice, hypoglycemia, hypocalcemia, or neonatal death. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and 610 articles were identified, of which 15 were included. Two authors independently extracted prognostic data from each article and assessed the study applicability and risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) scoring criteria. RESULTS A total of 15 studies were included in the review and comprised prospective (n=10; 66%) and retrospective (n=5; 33%) cohorts. Sensitivity and positive predictive values varied widely across each Doppler measurement. Umbilical artery sensitivities were higher than those of cerebroplacental ratio and middle cerebral artery for hypoglycemia, jaundice, neonatal intensive care unit admission, respiratory distress, and preterm birth. Cerebroplacental ratio was the most reported index test; however, prognostic accuracy was worse than that of umbilical artery and middle cerebral artery Doppler across all adverse perinatal outcomes. Significant risk of bias was present in 14 (94%) studies, with substantial heterogeneity observed across studies in terms of study design and outcomes assessed. CONCLUSION Abnormal umbilical artery pulsatility index may be of more clinical value in predicting adverse perinatal outcomes compared with cerebroplacental ratio and middle cerebral artery pulsatility index in diabetic pregnancies. Further evaluation of umbilical artery Doppler measurements in diabetic pregnancies using standardized variables across studies is required for broader clinical application. The significant association between abnormal Doppler measurement and hypoglycemia may warrant further investigation.
Collapse
Affiliation(s)
- Ben M. Rane
- Corresponding author: Ben M. Rane, MBBS, College of Medicine and Dentistry.
| | | | | | | |
Collapse
|
12
|
Gowtham M, Gugapriya TS, Umredkar AA, Deulkar S. The Impact of COVID-19-Related Psychological Stress on Fetoplacental Circulation: A Doppler Scan of Umbilical Vessels in Third-Trimester Antenatal Women. Cureus 2023; 15:e41517. [PMID: 37551208 PMCID: PMC10404444 DOI: 10.7759/cureus.41517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION The placenta is an important organ of pregnancy. A multitude of physiological and pathological factors influence blood flow in the placenta during pregnancy. However, the fetal effects of maternal psychological stress were inconclusive. The recent COVID-19 pandemic had unprecedented economic, social, and psychological effects. The effect of COVID-19-induced psychological stress in antenatal women and its resultant fetal impact were studied by observing the Doppler waveforms of the uterine and umbilical arteries. METHODS The cross-sectional study was conducted on 26 healthy third-trimester antenatal women who satisfied pre-set inclusion and exclusion criteria. A pandemic-related pregnancy stress scale (PREPS) was used to evaluate the stress in pregnant women and categorize it into mild, moderate, and severe levels. The Doppler ultrasound of the uterine and umbilical vessels was done along with a routine growth scan in the third trimester of pregnancy. The arterial waveforms, Pulsatility index (PI) of uterine and umbilical arteries, umbilical vein blood flow, and biometric parameters of the fetus were recorded and analyzed. RESULTS Seventeen of the 26 participants were found to be moderately stressed. Among the three dimensions of the PREPS tool, the perinatal infection stress dimension was expressed predominantly. A strong expression of the positive affirmation dimension was seen in antenatal women. The mean Pulsatility index in the mild, moderate, and severe groups was 0.74, 0.93, and 0.63, respectively. The association between the PREPS score and the Pulsatility index of the umbilical artery alone was found to be significant at p=0.02. CONCLUSION The COVID-19 pandemic caused moderate to severe levels of psychological stress in pregnant women. The statistically significant association between the PREPS score and the umbilical artery PI indicates possible fetoplacental compromise, suggesting the need for cognitive therapy to manage psychological stress in antenatal women.
Collapse
Affiliation(s)
- M Gowtham
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - T S Gugapriya
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - Ashwini A Umredkar
- Radio-diagnosis, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - Snehal Deulkar
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| |
Collapse
|
13
|
Hajiahmadi S, Adariani AR, Amini E, Rasti S. Reference values for ductus venosus Doppler velocity indices between 11 and 13+6 weeks of gestation: A single-center prospective study in Iran. J Res Med Sci 2023; 28:55. [PMID: 37496642 PMCID: PMC10366976 DOI: 10.4103/jrms.jrms_808_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/12/2023] [Accepted: 03/22/2023] [Indexed: 07/28/2023]
Abstract
Background This study aimed to investigate reference Doppler velocimetry indices (DVIs) of the fetal ductus venosus (DV) during 11-13 + 6 gestational weeks. Materials and Methods In a prospective observation over referrals to a single tertiary care center in a 2-year interval, normal singleton pregnancies with fetal crown-rump lengths (CRLs) of 43-80 mm were examined by a single experienced sonographer for their DV pulsatility index (DVPI), DV resistance index (DVRI), and S-wave maximum velocity/A-wave minimum velocity (S/A ratio). Multinomial and quantile regression functions were used to analyze the effect of gestational age (estimated by CRL) on reference values (5th and 95th percentiles of the distribution in each gestational day/week). P < 0.05 was considered significant. Results Over a sample of 415 participants with a mean/median gestational age of 12 + 1 weeks, no significant correlations were found between the CRL and DVIs using multinomial regression functions (linear model best fitted for all [DVPI: B coefficient = 0.001, P = 0.235] [DVRI: B coefficient = 0.001, P = 0.287] [DV S/A: B coefficient = 0.010, P = 283]). Quantile regression analyses of DVIs' reference values were nonsignificant across the CRL range except for the DVRI ([5th regression line: coefficient = -0.004, P = 0.018] [95th regression line: coefficient = -0.001, P = 0.030]). Conclusion Reference values for DVPI, DVRI, and DV S/A ratios were established as 0.80-1.39, 0.62-0.88, and 2.57-6.70, respectively. Future meta-analyses and multicenter studies are required to incorporate DV DVIs into an updated universal version of the practice.
Collapse
Affiliation(s)
- Somayeh Hajiahmadi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ehsan Amini
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Rasti
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
14
|
Amini Masouleh S, Nasrollahzadeh Masouleh M, Vazir B, Bokaie S. Effects of oral propranolol on the resistive and pulsatility indices of major abdominal vasculatures in domestic short-haired cats. Vet Med Sci 2023. [PMID: 37311923 DOI: 10.1002/vms3.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/27/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND No study has been performed regarding the effects of oral administration of propranolol on pulse-wave spectral Doppler indices of major abdominal vessels in healthy adult cats. OBJECTIVE The objective of this study was to assess the pulse-wave spectral Doppler indices of abdominal aorta, caudal vena cava, and portal vein in clinically normal adult domestic short-haired (DSH) cats, before and after propranolol ingestion. METHODS Twenty intact adult client-owned DSH cats were evaluated (10 males and 10 females). A duplex Doppler ultrasonography machine with a 10-MHz frequency linear transducer was used. Peak systolic velocity, end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), and pressure gradient were measured. All the cats received 1 mg/kg of propranolol tablet, and after 2 h, ultrasonography measurements were repeated. RESULTS The mean RI of the aorta and caudal vena cava significantly decreased in male cats following oral administration of propranolol after 2 h (p = 0.03, p = 0.02). In the caudal vena cava, the PI decreased from 2.98 ± 0.62 to 1.15 ± 0.19 post-propranolol ingestion (p = 0.01). The mean EDV in the caudal vena cava of males and portal veins of females significantly decreased after propranolol ingestion (p = 0.04, p = 0.02). CONCLUSIONS This study showed that propranolol decreased the PI of the aorta and PI and RI of the caudal vena cava in healthy normal cats 2 h post-propranolol ingestion at the dosage of 1 mg/kg.
Collapse
Affiliation(s)
- Shima Amini Masouleh
- Department of Clinical Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Bita Vazir
- Department of Physiology, Science and Research Branch, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Saied Bokaie
- Department of Epidemiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| |
Collapse
|
15
|
Spiliopoulos S, Georgiadou M, Karahaliou A, Grigoriadis S, Palialexis K, Reppas L, Brountzos E. Feasibility and Clinical Value of Intraprocedural Doppler Ultrasonography Blood Flow Parameters During Peripheral Endovascular Procedures for Limb Salvage: A Pilot Study. J Endovasc Ther 2023:15266028231179838. [PMID: 37288498 DOI: 10.1177/15266028231179838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate whether Doppler ultrasound (DUS) blood flow parameters could serve as quantifiable functional endpoints of peripheral endovascular arterial procedures for chronic limb-threatening ischemia (CLTI), influencing wound healing. METHODS This is a prospective single-center study investigating intraprocedural DUS parameters (pulsatility index [PI] and pedal acceleration time [PAT]) in quantifying immediate hemodynamic alterations in consecutive CLTI patients with wound, ischemia, and foot infection wound class ≥1 undergoing endovascular interventions. Primary endpoints were feasibility of preendovascular and postendovascular treatment measurements of PI/PAT, quantification of immediate PI/PAT modifications of the posterior and anterior foot circulation following revascularization, the correlation between PI and PAT, and 6-month complete wound healing. Secondary endpoints included the 6-month limb salvage (no major amputation) and complete and partial wound healing rates. RESULTS A total of 28 patients (75.0% male) were enrolled, and 68 vessels were treated. The overall mean PAT values significantly decreased from 154.15±70.35 ms preprocedural to 107.21±49.6 ms postprocedural (p<0.01), and the mean PI values significantly increased from 0.93±0.99 to 1.92±1.96 (p<0.01). Postprocedural PAT at the anterior tibial (r2=0.804; p=0.346) and the posterior tibial arteries (r2=0.784; p=0.322) had a strong correlation and postprocedural PI at the anterior tibial (r2=0.704; p=0.301) and the posterior tibial arteries (r2=0.707; p=0.369) had a good correlation with 6-month complete wound healing. The 6-month complete and partial wound healing rates were 38.1% and 47.6%, respectively. Limb salvage was 96.4% and 92.4% at 6 and 12 months of follow-up, respectively. CONCLUSIONS Pedal acceleration time and PI accurately detected immediate hemodynamic changes of foot perfusion following revascularization and could serve as prognostic factors of wound healing in patients with CLTI. CLINICAL IMPACT Intraprocedural measurement of simple Doppler ultrasound blood flow parameters, Pulsatility Index (PI) and Pedal Acceleration Time (PAT), accurately detected immediate hemodynamic changes of foot perfusion following endovascular revascularization and could therefore serve as intraprocedural prognostic factors of wound healing in patients with chronic limb-threatening ischemia. This is the first time that PI has been proposed as a hemodynamic index of successful angioplasty outcome. The optimization of intraprocedural PAT and PI could be used to guide angioplasty and predict clinical success.
Collapse
Affiliation(s)
- Stavros Spiliopoulos
- Division of Interventional Radiology, 2nd Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Magdalini Georgiadou
- Division of Interventional Radiology, 2nd Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Karahaliou
- Division of Interventional Radiology, 2nd Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Grigoriadis
- Division of Interventional Radiology, 2nd Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Palialexis
- Division of Interventional Radiology, 2nd Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Reppas
- Division of Interventional Radiology, 2nd Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- Division of Interventional Radiology, 2nd Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
16
|
Al-Thuwaynee S. Assessing the efficacy and safety of Sildenafil vs. Nifedipine in improving endometrial blood flow and thickness in women with recurrent first-trimester miscarriage. J Med Life 2023; 16:890-894. [PMID: 37675159 PMCID: PMC10478652 DOI: 10.25122/jml-2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/10/2023] [Indexed: 09/08/2023] Open
Abstract
Endometrial thickness and uterine blood flow influence pregnancy continuation until term. Nifedipine, a type II calcium channel blocker, and Sildenafil, a type 5-specific phosphodiesterase inhibitor, have shown the potential to improve these factors. This study aims to compare the safety and efficacy of Nifedipine and Sildenafil in improving endometrial blood flow and thickness in Iraqi women with recurrent first-trimester miscarriages. Women with unexplained recurrent pregnancy loss in the first trimester (non-pregnant during the study) were randomly assigned to two groups. Transvaginal color Doppler ultrasound assessed uterine artery pulsatility, resistance indexes, and endometrial thickness during the second phase of the menstrual cycle (day 15 to day 25). The first group received oral Nifedipine (10 mg) twice daily, while the second group received oral Sildenafil citrate (20 mg) every 8 hours from day 5 to day 25. Baseline measurements showed no significant differences in pulsatility index between the groups (2.02±0.52 for Nifedipine, 2.03±0.49 for Sildenafil, p=0.927). Sildenafil treatment resulted in a more noticeable reduction in the pulsatility index. The resistive index had a significant difference in baseline readings (0.98±0.14 for Nifedipine, 1.06±0.14 for Sildenafil, p=0.033), with Sildenafil showing a more pronounced reduction. Post-treatment, Sildenafil demonstrated a greater improvement in endometrial thickness than Nifedipine (10.09±0.74 mm vs. 9.34±0.50 mm, respectively; p<0.001). Both medications were safe and effective in improving endometrial blood flow and thickness in women with recurrent pregnancy miscarriages, with Sildenafil showing greater efficacy.
Collapse
Affiliation(s)
- Saba Al-Thuwaynee
- Department of Obstetrics and Gynecology, College of Medicine, University of Al-Qadisiyah, Al Diwaniyah, Iraq
| |
Collapse
|
17
|
Saadatnia M, Zandifar A, Alizadeh M, Kim JDU, Shafaat O, Tierradentro-García LO, Manouchehri N, Khorvash F. Application of the Intracranial Arterial Pulsatility Index for Determination of Prognosis after Lacunar Infarct. Adv Biomed Res 2023; 12:136. [PMID: 37434927 PMCID: PMC10331555 DOI: 10.4103/abr.abr_69_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 07/13/2023] Open
Abstract
Background We aimed to investigate the usefulness of intracranial arterial pulsatility index to assess the prognosis of lacunar infarcts. Materials and Methods Forty-nine patients with confirmed acute lacunar infarct were enrolled in the study. A transcranial color-coded sonography was performed to assess the pulsatility index of bilateral middle cerebral, posterior cerebral, vertebral, and proximal internal carotid arteries. Patients' clinical status was assessed using a modified Rankin scale. Spearman correlation was used for reporting the relation between quantitative data. Statistical significance was defined as a two-tail p-value of less than 0.05. Results The mean age ± standard deviation was 64.1 ± 9.07 years old, and 57.1% of the patients were male. Upon discharge, only 8.2% of the patients were ranked as 0 on the modified Rankin scale; however, after a 6-month follow-up period, this number increased to 49%. There were no significant differences between the left and right pulsatility index measurements in any of the assessed arteries. Patients with vertebral artery pulsatility indexes >1 on their primary assessment had significantly worse outcomes during the first, third, and sixth months follow-up (all r > 0.3, p-values < 0.01). Pulsatility indexes from other arteries did not predict the prognosis. Conclusion Sonography-assisted assessment of the vertebral artery blood flow during the early stage of lacunar infarct provides a reliable reference for prognosis estimation.
Collapse
Affiliation(s)
- Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Zandifar
- Department of Radiology, Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maryam Alizadeh
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jorge Du Ub Kim
- Department of Radiology, Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Omid Shafaat
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Navid Manouchehri
- Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
18
|
Palaiodimou L, Papagiannopoulou G, Bakola E, Papadopoulou M, Kokotis P, Moschovos C, Vrettou AR, Kapsia E, Petras D, Anastasakis A, Lionaki S, Vlachopoulos C, Boletis IN, Zompola C, Tsivgoulis G. Impaired cerebral autoregulation in Fabry disease: A case-control study. J Neuroimaging 2023. [PMID: 37147184 DOI: 10.1111/jon.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease is a common manifestation among patients with Fabry disease (FD). As a biomarker of cerebral small vessel disease, the prevalence of impaired cerebral autoregulation as assessed by transcranial Doppler (TCD) ultrasonography was evaluated in FD patients and healthy controls. METHODS TCD was performed to assess pulsatility index (PI) and vasomotor reactivity expressed by breath-holding index (BHI) for the middle cerebral arteries of included FD patients and healthy controls. Prevalence of increased PI (>1.2) and decreased BHI (<0.69) and ultrasound indices of cerebral autoregulation were compared in FD patients and controls. The potential association of ultrasound indices of impaired cerebral autoregulation with white matter lesions and leukoencephalopathy on brain MRI in FD patients was also evaluated. RESULTS Demographics and vascular risk factors were similar in 23 FD patients (43% women, mean age: 51 ± 13 years) and 46 healthy controls (43% women, mean age: 51 ± 13 years). The prevalence of increased PI (39%; 95% confidence interval [CI]: 20%-61%), decreased BHI (39%; 95% CI: 20%-61%), and the combination of increased PI and/or decreased BHI (61%; 95% CI: 39%-80%) was significantly (p < .001) higher in FD patients compared to healthy controls (2% [95% CI: 0.1%-12%], 2% [95% CI: 0.1%-12%], and 4% [95% CI: 0.1%-15%], respectively). However, indices of abnormal cerebral autoregulation were not associated independently with white matter hyperintensities and presented a low-to-moderate predictive ability for the discrimination of FD patients with and without white matter hyperintensities. CONCLUSIONS Impaired cerebral autoregulation as assessed by TCD appears to be highly more prevalent among FD patients compared to healthy controls.
Collapse
Affiliation(s)
- Lina Palaiodimou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Papagiannopoulou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kokotis
- First Department of Neurology, "Eginition" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Moschovos
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Agathi-Rosa Vrettou
- Second Department of Cardiology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Kapsia
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece
| | - Dimitrios Petras
- Nephrology Department, Hippokration General Hospital, Athens, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Sophia Lionaki
- Second Department of Propaedeutic Internal Medicine, Section of Nephrology, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioannis N Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
19
|
Sedaghati F, Gleason RL. A mathematical model of vascular and hemodynamics changes in early and late forms of preeclampsia. Physiol Rep 2023; 11:e15661. [PMID: 37186372 PMCID: PMC10132946 DOI: 10.14814/phy2.15661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/17/2023] Open
Abstract
Preeclampsia-eclampsia syndrome is a leading cause of maternal mortality. The precise etiology of preeclampsia is still not well-defined and different forms exist, including early and late forms or preeclampsia, which may arise via distinctly different mechanisms. Low-dose aspirin administered at the end of the first trimester in women identified as high risk has been shown to reduce the incidence of early, but not late, preeclampsia; however, current risk factors show only fair predictive capability. There is a pressing need to develop accurate descriptions for the different forms of preeclampsia. This paper presents 1D fluid, solid, growth, and remodeling models for pregnancies complicated with early and late forms of preeclampsia. Simulations affirm a broad set of literature results that early forms of preeclampsia are characterized by elevated uterine artery pulsatility index (UA-PI) and total peripheral resistance (TPR) and lower cardiac output (CO), with modestly increased mean arterial blood pressure (MAP) in the first half of pregnancy, with elevation of TPR and MAP beginning at 20 weeks. Conversely, late forms of preeclampsia are characterized by only slightly elevated UA-PI and normal pre-term TPR, and slightly elevated MAP and CO throughout pregnancy, with increased TPR and MAP beginning after 34 weeks. Results suggest that preexisting arterial stiffness may be elevated in women that develop both early forms and late forms of preeclampsia; however, data that verify these results are lacking in the literature. Pulse wave velocity increases in early- and late-preeclampsia, coincident with increases in blood pressure; however, these increases are mainly due to the strain-stiffening response of larger arteries, rather than arterial remodeling-derived changes in material properties. These simulations affirm that early forms of preeclampsia may be associated with abnormal placentation, whereas late forms may be more closely associated with preexisting maternal cardiovascular factors; simulations also highlight several critical gaps in available data.
Collapse
Affiliation(s)
- Farbod Sedaghati
- The George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Rudolph L. Gleason
- The George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
- The Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| |
Collapse
|
20
|
Cavoretto PI, Salmeri N, Candiani M, Farina A. Reference ranges of uterine artery pulsatility index from first to third trimester based on serial Doppler measurements: longitudinal cohort study. Ultrasound Obstet Gynecol 2023; 61:474-480. [PMID: 36206548 DOI: 10.1002/uog.26092] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To provide gestational-age (GA)-specific reference ranges for mean uterine artery (UtA) pulsatility index (PI) based on longitudinal data assessment throughout pregnancy. METHODS This was a prospective longitudinal cohort study of singleton low-risk pregnancies with adequate health and nutritional status at the time of enrolment and without fetal anomaly, receiving prenatal care between January 2018 and July 2021 at the Maternal Fetal Medicine Unit of IRCCS San Raffaele Scientific Institute, Milan, Italy. Women were recruited at ≤ 12 + 6 weeks' gestation and underwent serial standardized ultrasound monitoring, including UtA-PI measurement, by experienced certified operators until delivery. Association of UtA-PI with GA was modeled with fractional polynomial regression. Equations for mean ± SD of the estimated curves were calculated, as well as GA-specific reference charts of centiles for UtA-PI from 10 + 0 to 39 + 0 gestational weeks. RESULTS We included 476 healthy, low-risk pregnant women and a total of 2045 ultrasound scans (median, 4 (range, 3-9) per patient) were available for analysis. Mean UtA-PI was 1.84 ± 0.55, 1.07 ± 0.38 and 0.78 ± 0.23 in the first, second and third trimesters of pregnancy, respectively. Goodness-of-fit assessment revealed that second-degree smoothing was the most accurate fractional polynomial for describing the course of UtA-PI throughout gestation; therefore, it was modeled in a multilevel framework for the construction of UtA-PI curves. We observed a rapid and substantial decrease in mean UtA-PI before 16 weeks, with subsequent smoother decrement of the slope and more stable values from 20 until 39 weeks. The 3rd , 5th , 10th , 25th , 50th , 75th , 90th , 95th and 97th centiles according to GA for UtA-PI are provided, as well as equations to allow calculation of any value as a centile. CONCLUSIONS UtA-PI shows a progressive non-linear decrease throughout pregnancy. The new reference ranges for GA-specific mean UtA-PI constructed using rigorous methodology may have a better performance compared with previous models for screening for placenta-associated diseases in the early stages of pregnancy and for evaluating the potential risk for pregnancy-induced hypertension and/or small-for-gestational age later in pregnancy. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- P I Cavoretto
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Gynecology and Obstetrics, Vita-Salute San Raffaele University, Milan, Italy
| | - N Salmeri
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Gynecology and Obstetrics, Vita-Salute San Raffaele University, Milan, Italy
| | - M Candiani
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Gynecology and Obstetrics, Vita-Salute San Raffaele University, Milan, Italy
| | - A Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
21
|
Tica OS, Tica AA, Cojocaru D, Tica I, Petcu CL, Cojocaru V, Alexandru DO, Tica VI. Maternal Steroids on Fetal Doppler Indices, in Growth-Restricted Fetuses with Abnormal Umbilical Flow from Pregnancies Complicated with Early-Onset Severe Preeclampsia. Diagnostics (Basel) 2023; 13:diagnostics13030428. [PMID: 36766533 PMCID: PMC9914710 DOI: 10.3390/diagnostics13030428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Corticoids are largely used for fetal interest in expected preterm deliveries. This study went further, evaluating the effect of maternal administration of dexamethasone (Dex) on the umbilical artery (UA), middle cerebral artery (MCA), and ductus venous (DV) spectrum, in growth-restricted fetuses, with the absent end-diastolic flow (AEDF) in UA, from singleton early-onset severe preeclamptic pregnancies. Supplementary, the impact on both uterine arteries (UTAs) flow was also evaluated. In 68.7% of cases, the EDF was transiently restored (trAEDF group), in the rest of 31.2% remained persistent absent (prAEDF group). UA-PI significantly decreased in the first day after Dex (day 1/0; p < 0.05), reaching its minimum during day 2 (day 2/1; p > 0.05), revealing a significant recovery to day 4 (day 4/2; p < 0.05), in both groups. The MCA-PI decreased from day 1 until day 3 in both groups, but significantly only in the trAEDF group (p = 0.030 vs. p = 0.227. The DV-PI's decrease (during day 1) and the CPR's increase (between days 0 and 2) were not significant in both groups. UTAs-PIs did not vary. The prAEDF group had a significantly increased rate of antenatal worsening Doppler and a poorer perinatal outcome compared with the trAEDF group. In conclusion, Dex transiently restored the AEDF in UA in the majority of cases, a "positive" effect being a useful marker for better perinatal prognosis. UA-PI significantly decreased in all cases. The improvement in umbilical circulation probably was responsible for the short but not significant DV-PI reduction. MCA-PI decreased only in sensitive cases, probably due to an already cerebral "full" vasodilation in the prAEDF group. Furthermore, the CPR's nonsignificant improvement was the result of a stronger effect of Dex on UA-PI than on MCA-PI. Finally, despite the same etiology, it was only a weak correlation between the severity of the umbilical and uterine abnormal spectrum.
Collapse
Affiliation(s)
- Oana Sorina Tica
- Department of “Mother and Child”, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Craiova County Emergency Hospital, 200642 Craiova, Romania
| | - Andrei Adrian Tica
- Craiova County Emergency Hospital, 200642 Craiova, Romania
- Department of Pharmacology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (A.A.T.); (I.T.)
| | - Doriana Cojocaru
- Department of Anesthesiology and Intensive Care, “Nicolae Testemitanu” State University of Medicine and Pharmacy Chisinau, 2004 Chisinau, Moldova
- “Timofei Mosneaga” Republican Clinical Hospital, 2025 Chisinau, Moldova
| | - Irina Tica
- Department of Internal Medicine, Faculty of Medicine, University “Ovidius” Constanta, 900527 Constanța, Romania
- Constanta County Emergency Hospital, 900591 Constanța, Romania
- Correspondence: (A.A.T.); (I.T.)
| | - Cristian Lucian Petcu
- Department of Biophysics, Faculty of Dental Medicine, University “Ovidius” Constanta, 900527 Constanța, Romania
| | - Victor Cojocaru
- Department of Anesthesiology and Intensive Care, “Nicolae Testemitanu” State University of Medicine and Pharmacy Chisinau, 2004 Chisinau, Moldova
- “Timofei Mosneaga” Republican Clinical Hospital, 2025 Chisinau, Moldova
| | - Dragos Ovidiu Alexandru
- Department of Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Vlad Iustin Tica
- Constanta County Emergency Hospital, 900591 Constanța, Romania
- Department of Obstetrics and Gynecology, Faculty of Medicine, University “Ovidius” Constanta, 900527 Constanța, Romania
| |
Collapse
|
22
|
Evangelista GC, Dornelas LR, Cintra CC, Valente FL, Favarato ES, da Fonseca LA, Reis EC. Evaluating feline lower urinary tract disease: Doppler ultrasound of the kidneys. J Feline Med Surg 2023; 25:1098612X221145477. [PMID: 36649073 DOI: 10.1177/1098612x221145477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Ultrasonography is used in the evaluation of urinary disorders, and the resistivity index (RI) and pulsatility index (PI) have been successfully used to detect early hemodynamic changes in the course of kidney diseases in humans and dogs. The aim of this study was to investigate RI and PI in cats with feline lower urinary tract disease (FLUTD). METHODS Twenty-nine client-owned cats were selected and divided into a control group (CG; n = 10), a group of animals with obstructive FLUTD (OG; n = 11) and non-obstructive FLUTD (nOG; n = 8). Clinical, laboratory and ultrasound evaluations were performed in all cats. RESULTS RI and PI values for cats in the CG were below the upper limit of normal suggested in other studies, while cats with FLUTD showed significantly higher values in the assessment of RI (P = 0.027 and P = 0.034, respectively) and PI (P = 0.044 and P = 0.048, respectively) of the right and left kidneys. CONCLUSIONS AND RELEVANCE Alteration in renal blood flow was observed in cats with lower urinary tract disorders, even in the nOG group. To the best of our knowledge, this is the first report of renal blood flow changes related to non-obstructive FLUTD.
Collapse
Affiliation(s)
| | | | - Cristiane Cv Cintra
- Department of Veterinary Medicine, Federal University of Viçosa, Viçosa, Brazil
| | - Fabrício L Valente
- Department of Veterinary Medicine, Federal University of Viçosa, Viçosa, Brazil
| | - Evandro S Favarato
- Department of Veterinary Medicine, Federal University of Viçosa, Viçosa, Brazil
| | | | - Emily Cc Reis
- Department of Veterinary Medicine, Federal University of Viçosa, Viçosa, Brazil
| |
Collapse
|
23
|
Bill O, Mazya MV, Michel P, Prazeres Moreira T, Lambrou D, Meyer IA, Hirt L. Intima-Media Thickness and Pulsatility Index of Common Carotid Arteries in Acute Ischaemic Stroke Patients with Diabetes Mellitus. J Clin Med 2022; 12:jcm12010246. [PMID: 36615047 PMCID: PMC9821495 DOI: 10.3390/jcm12010246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Ultrasonographic parameters such as the common carotid artery (CCA) pulsatility index (PI) and CCA intima-media thickness (IMT) have been associated with an increased mortality and risk of recurrent stroke, respectively. We hypothesized that these ultrasonographic parameters may be useful for monitoring diabetic patients after an acute stroke. We analysed retrospective data of consecutive acute ischaemic stroke patients from the ASTRAL registry who underwent pre-cerebral ultrasonographic evaluation within 7 days of symptom onset. We compared clinical, demographic, radiological and ultrasonographic parameters in diabetic versus non-diabetic patients (univariable and multivariable analyses) and the association of these parameters with CCA PI and CCA IMT. We analysed 1507 carotid duplex ultrasound examinations from patients with a median age of 74 years. Cardiovascular co-morbidities, including hypertension, hypercholesterolemia, obstructive sleep apnoea syndrome, higher body-mass index (BMI) and peripheral artery disease, were associated with diabetes mellitus (DM). Diabetics were more often under antiplatelet therapy and had atrial fibrillation at admission. Diabetic patients showed an increased CCA PI and IMT in line with more atherosclerotic changes on acute CTA compared to non-diabetic patients. Taking IMT as the dependent variable in a second analysis, DM, higher age, hypertension, smoking and CCA PI were associated with higher IMT. Taking CCA PI as the dependent variable in a third analysis, DM, higher age and higher NIHSS at admission were associated with higher CCA PI values. Increased IMT was also associated with higher PI. We show that CCA PI and IMT are higher in diabetic patients in the first week after an initial stroke.
Collapse
Affiliation(s)
- Olivier Bill
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: (O.B.); (L.H.)
| | - Michael V. Mazya
- Department of Neurology, Karolinska University Hospital, 171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Tiago Prazeres Moreira
- Department of Neurology, Karolinska University Hospital, 171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Dimitris Lambrou
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Ivo A. Meyer
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Department of Old Age Psychiatry and Psychotherapy, University of Bern, 3012 Bern, Switzerland
| | - Lorenz Hirt
- Department of Neurology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: (O.B.); (L.H.)
| |
Collapse
|
24
|
Yang Z, Lv W, Zhao B, Yao J, Yang Y, Yin Z. Uteroplacental-Cerebral Ratio: A Doppler Parameter for Prognostic Prediction of Late-Onset Fetal Growth Restriction: Single Center Prospective Cohort Study. J Clin Med 2022; 12. [PMID: 36615075 DOI: 10.3390/jcm12010275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose: This study aimed to elucidate the accuracy of Doppler parameters in predicting the prognosis of late-onset fetal growth restriction (FGR). Methods: This was a prospective study of 114 pregnancies. Doppler parameters, including the cerebroplacental ratio and pulsatility index (PI) in the middle cerebral, umbilical, uterine artery, were recorded. The new uteroplacental−cerebro ratio (UPCR) was constructed as the ratio of (umbilical artery + mean of the left and right uterine artery) to middle cerebral artery PI. Logistic regression analyses and receiver operating characteristic curves were performed. Results: Adverse outcomes occurred in 37 (32%) neonates. The z values of the middle cerebral artery PI and cerebroplacental ratio were lower (p < 0.001), while the z values of the umbilical artery PI, mean uterine artery PI, and UPCR (p < 0.001) were higher in late-onset FGR in those with compared to those without adverse outcomes. Multivariate logistic regression revealed that only UPCR was independently associated with adverse outcomes (p < 0.001). For predicting the prognosis of late-onset FGR, UPCR showed a fair degree of accuracy (area under the curve [AUC], 0.824). Conclusion: The new UPCR, reflecting the impact of placental impedance from both fetal and maternal sides on fetal well-being, improves the accuracy of prognostic prediction for late-onset FGR.
Collapse
|
25
|
Ravikanth R, Majumdar P. Role of Bedside Transcranial Ultrasonography in the Assessment of Cerebral Hemodynamics in Decompressive Craniectomy Patients with Cranioplasty: A Single Centre Experience. Neurol India 2022; 70:1840-1845. [PMID: 36352576 DOI: 10.4103/0028-3886.359228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intracerebral hemorrhage is a leading cause of death and disability worldwide. After intracerebral hemorrhage, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post-injury. Identification of such hemodynamic disturbances can be used to predict outcome immediately post-injury when indices are measured using transcranial doppler ultrasonography (TCD). TCD permits non-invasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome. AIM To investigate the effect of cerebral hemodynamics after cranioplasty in decompressive craniectomy patients using pre and postoperative TCD. MATERIALS AND METHODS This study is a prospective study of 3 years duration undertaken on 64 patients. All the patients were evaluated by TCDbefore and after decompressive craniectomy.All patients were evaluated by transcranial Doppler (TCD) 1 week before and 7-15 days after cranioplasty. TCD results were obtained though trans-temporal approach. RESULTS Statistically significant differences between the values before and after craniectomy were detected in Peak Systolic Volume (PSV) for the Anterior Cerebral Artery (ACA) (P = 0.001), in PSV for the Middle Cerebral Artery (MCA) (P < 0.004), in Mean Bloodflow Velocity (MV) for the MCA (P < 0.003), and in PSV for the Posterior Cerebral artery (PCA) (P = 0.001) on the ipsilateral side. There were statistically significant differences between the values before and after cranioplasty in PSV for the PCA (P = 0.004), on contralateral side.After decompressive craniectomy, the PI values for the MCA decreased, on average, to 31+/- 33% of the pre-surgical value in the treated side and to 28+/- 31% on the opposite side. On the other hand, the mean PI values for the extracranial ICA reduced to 34+/- 21% of the initial values in the treated side, and to 21+/- 31% on the opposite side.Cranioplasty improved CBF velocities in all major intracrainal arteries, not only on the side of the lesion adjacent to the cranioplasty, but also in distant regions, such as in the contralateral hemisphere. CONCLUSION Decompressive craniectomy significantly improves cerebral hemodynamics both on ipsilateral and contralateral cerebral hemispheres.Concomitantly, PI values on TCD decrease significantly postoperatively, mainly in the decompressed cerebral hemisphere, indicating reduction in cerebrovascular resistance. We conclude that cranioplasty improves neurological status and the mechanism of postoperative improvement of neurological status may be due to increased CBF velocity.
Collapse
Affiliation(s)
- Reddy Ravikanth
- Department of Radiology, Holy Family Hospital, Thodupuzha, Kerala, India
| | - Pooja Majumdar
- Department of Medicine, Indian Naval Hospital Ship (INHS) Kalyani, Gandhigram P.O, Visakhapatnam, Andhra Pradesh, India
| |
Collapse
|
26
|
Shono Y, Mezuki S, Akahoshi T, Nishihara M, Kaku N, Maki J, Tokuda K, Kitazono T. Prediction of intracranial lesions in patients with consciousness disturbance by ultrasonography in the intensive care unit. J Int Med Res 2022; 50:3000605221119358. [PMID: 36124942 PMCID: PMC9500273 DOI: 10.1177/03000605221119358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to evaluate the correlation between parameters
measured by bedside ultrasonography and detection of intracranial organic
lesions in patients with impaired consciousness in an intensive care unit
(ICU) setting. Methods We retrospectively reviewed the medical records of patients who were admitted
to our ICU from April 2017 to July 2019. Patients who underwent computed
tomography or magnetic resonance imaging examination and measurement of the
flow velocity of the carotid and intracranial arteries and the optic nerve
sheath diameter by ultrasonography were selected for analysis. Results In total, 64 patients were analyzed in this study. Of these, intracranial
lesions were detected by computed tomography or magnetic resonance imaging
in 17 (27%) patients. The left:right ratio of the end-diastolic velocity of
the bilateral common carotid artery (CCA-ED ratio) and the pulsatility index
of the middle cerebral artery (MCA-PI) were significantly higher in patients
with than in those without intracranial lesions. The cut-off value of the
CCA-ED ratio was 1.55 (sensitivity, 66.7%; specificity, 81.6%), and that of
the MCA-PI was 1.21 (sensitivity, 57.1%; specificity, 76.7%). Conclusion Bedside ultrasonography is useful for predicting intracranial lesions
requiring therapeutic intervention in ICU patients with impaired
consciousness.
Collapse
Affiliation(s)
- Yuji Shono
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Satomi Mezuki
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tomohiko Akahoshi
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaaki Nishihara
- Emergency and Critical Care Center, Kyushu University Hospital, Japan
| | - Noriyuki Kaku
- Emergency and Critical Care Center, Kyushu University Hospital, Japan
| | - Jun Maki
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Kentaro Tokuda
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Takanari Kitazono
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| |
Collapse
|
27
|
Jaiman S, Romero R, Bhatti G, Jung E, Gotsch F, Suksai M, Gallo DM, Chaiworapongsa T, Kadar N. The role of the placenta in spontaneous preterm labor and delivery with intact membranes. J Perinat Med 2022; 50:553-566. [PMID: 35246973 PMCID: PMC9189066 DOI: 10.1515/jpm-2021-0681] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine whether placental vascular pathology and impaired placental exchange due to maturational defects are involved in the etiology of spontaneous preterm labor and delivery in cases without histologic acute chorioamnionitis. METHODS This was a retrospective, observational study. Cases included pregnancies that resulted in spontaneous preterm labor and delivery (<37 weeks), whereas uncomplicated pregnancies that delivered fetuses at term (≥37-42 weeks of gestation) were selected as controls. Placental histological diagnoses were classified into three groups: lesions of maternal vascular malperfusion, lesions of fetal vascular malperfusion, and placental microvasculopathy, and the frequency of each type of lesion in cases and controls was compared. Moreover, we specifically searched for villous maturational abnormalities in cases and controls. Doppler velocimetry of the umbilical and uterine arteries were performed in a subset of patients. RESULTS There were 184 cases and 2471 controls, of which 95 and 1178 had Doppler studies, respectively. The frequency of lesions of maternal vascular malperfusion was greater in the placentas of patients with preterm labor than in the control group [14.1% (26/184) vs. 8.8% (217/2471) (p=0.023)]. Disorders of villous maturation were more frequent in the group with preterm labor than in the control group: 41.1% (39/95) [delayed villous maturation in 31.6% (30/95) vs. 2.5% (13/519) in controls and accelerated villous maturation in 9.5% (9/95) vs. none in controls]. CONCLUSIONS Maturational defects of placental villi were associated with approximately 41% of cases of unexplained spontaneous preterm labor and delivery without acute inflammatory lesions of the placenta and with delivery of appropriate-for-gestational-age fetuses.
Collapse
Affiliation(s)
- Sunil Jaiman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA,Detroit Medical Center, Detroit, Michigan, USA,Corresponding Author: Roberto Romero, MD, DMedSci, Chief, Perinatology Research Branch, NICHD/NIH/DHHS, Hutzel Women’s Hospital, 3990 John R Street, 4 Brush, Detroit, Michigan 48201, USA. (313) 993-2700;
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, MI, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Manaphat Suksai
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dahiana M. Gallo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | |
Collapse
|
28
|
Zhao W, Liu R, Yu W, Wu L, Wu C, Li C, Li S, Chen J, Song H, Hua Y, Ma Q, Ji X. Elevated pulsatility index is associated with poor functional outcome in stroke patients treated with thrombectomy: A retrospective cohort study. CNS Neurosci Ther 2022; 28:1568-1575. [PMID: 35707901 PMCID: PMC9437234 DOI: 10.1111/cns.13888] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 01/20/2023] Open
Abstract
Aims To evaluate pulsatility index (PI) in patients with acute ischemic stroke (AIS) who underwent endovascular thrombectomy (EVT). Methods Patients were retrospectively recruited if their stroke were secondary to middle cerebral artery (MCA) occlusion and achieved full recanalization after EVT. Transcranial Doppler was performed within 24‐hour post‐EVT. The primary outcome was correlation between the MCA‐PI on the affected side and 3‐month functional outcome, with modified Rankin scale (mRS) ≥5 indicated extremely poor functional outcomes. Results Totally, 170 patients were included. High MCA‐PI was positively related to the 3‐month mRS score (r = 0.288, p < 0.001). The highest quartile of the MCA‐PI was associated with a high incidence of extremely poor functional outcomes (adjusted OR, 13.33; 95% CI, 2.65–67.17; adjusted p = 0.002) after adjusting for confounding factors. The predictive capacity of the MCA‐PI for extremely poor functional outcomes was good (area under the curve, 0.755; 95% CI, 0.655–0.854; p < 0.001), and its cutoff value for predicting extremely poor outcomes was 1.04, with a sensitivity of 65.6% and specificity of 78.3%. Conclusion The MCA‐PI on the affected side is a prognostic biomarker in patients who have undergone stroke thrombectomy. An elevated MCA‐PI may be prognostically valuable for predicting extremely poor functional outcomes.
Collapse
Affiliation(s)
- Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Liu
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wantong Yu
- Department of Neurology, Xuanwu Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Longfei Wu
- Department of Neurology, Xuanwu Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
29
|
Cahill LS, Mercer GV, Jagota D, Ravi Chandran A, Milligan N, Shinar S, Whitehead CL, Hobson SR, Serghides L, Parks WT, Macgowan CK, Kingdom JC, Sled JG, Baschat AA. Doppler Ultrasound of the Fetal Descending Aorta: An Objective Tool to Assess Placental Blood Flow Resistance in Pregnancies With Discordant Umbilical Arteries. J Ultrasound Med 2022; 41:899-905. [PMID: 34228375 PMCID: PMC8733057 DOI: 10.1002/jum.15773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/10/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine the relationship between blood flow in the fetal descending aorta and discordant umbilical arteries (UAs). METHODS Pulsed wave Doppler of both UAs and the descending aorta was performed at 4-weekly intervals between 14 and 40 weeks of gestation in 209 pregnant women. In datasets with discordant UAs, a linear mixed effects model was used to determine the categorical relationship between the UA pulsatility index (PI) (high, low and average) and the descending aorta PI. RESULTS Of the 209 cases, 81 had a discordance of greater than 25% in UA PI during one of their visits. There were no differences in birth outcomes between the groups with concordant and discordant UA PIs. In the cases with discordant UA PIs, the descending aorta PI was most strongly associated with both the average UA PI (P = .008), and with the UA with the lower PI (P = .008). CONCLUSIONS The relationship between blood flow in the descending aorta and UAs is consistent with the law for combining resistances in parallel. Measurements of the descending aorta PI, particularly in a scenario with discordant UAs, may inform the stability of the feto-placental circulation where discordant UA PIs are found.
Collapse
Affiliation(s)
- Lindsay S Cahill
- Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Grace V Mercer
- Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Dakshita Jagota
- Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | | | - Natasha Milligan
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Clare L Whitehead
- Pregnancy Research Centre, Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | | | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - W Tony Parks
- Department of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John C Kingdom
- Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - John G Sled
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ahmet A Baschat
- Centre for Fetal Therapy, Johns Hopkins Medicine, Baltimore, Maryland, USA
| |
Collapse
|
30
|
Cheuiche AV, da Silveira LG, Escott GM, Lucena IRS, Puñales M, Costenaro F, Kopacek C, de Paula LP, Silveiro SP. Accuracy of Doppler assessment of the uterine arteries in healthy girls for the diagnosis of pubertal onset. Endocrine 2022; 76:172-178. [PMID: 34846680 DOI: 10.1007/s12020-021-02948-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the accuracy of the uterine artery pulsatility index (PI) for the diagnosis of pubertal onset in girls. METHODS Cross-sectional study of girls with normal pubertal development. Puberty was diagnosed by the presence of Tanner breast development score ≥2. All girls underwent pelvic ultrasound and Doppler imaging of the uterine arteries. We evaluated the uterine artery PI and uterine, endometrial, and ovarian measurements. We used ROC curves with cutoffs determined by Youden index for data analysis. RESULTS We included 169 girls aged 5-16 years who underwent 202 pelvic ultrasound examinations. Prepubertal girls had a significantly higher mean PI (6.70 ± 2.15) than girls in initial puberty (4.14 ± 1.55) and in late puberty (2.81 ± 1.05) (P < 0.001 for all comparisons), which reflects a progressive increase in blood flow to the uterus with the progression of puberty. ROC curve analysis showed that the PI was able to identify the onset of puberty with a mean area under the curve of 0.838 ± 0.04 (P < 0.001), and the PI cutoff point of 5.05 had a sensitivity of 77%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 79%. The combination of PI < 5.05 plus uterine volume >3.75 cm³ had a sensitivity of 73%, specificity of 95%, PPV of 97%, and accuracy of 79% to detect initial puberty. CONCLUSIONS We found a significant reduction in the PI during pubertal development, which can possibly be a valuable noninvasive tool in the evaluation of pubertal disorders, alone or in combination with uterine and ovarian volumes.
Collapse
Affiliation(s)
- Amanda Veiga Cheuiche
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Gustavo Monteiro Escott
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Márcia Puñales
- Instituto da Criança com Diabetes and Hospital Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | | | - Cristiane Kopacek
- Pediatric Endocrinology Division, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Leila Pedroso de Paula
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra Pinho Silveiro
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| |
Collapse
|
31
|
Kuroda T, Miyamoto T, Miyagi C, Polakowski AR, Flick CR, Kuban BD, Voros GB, Such K, Fukamachi K, Karimov JH. Pulsatility hemodynamics during speed modulation of continuous-flow total artificial heart in a chronic in vivo. Artif Organs 2022; 46:1555-1563. [PMID: 35318688 PMCID: PMC9543567 DOI: 10.1111/aor.14237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Background The evaluation of pulsatile flow created by the new Cleveland Clinic continuous‐flow total artificial heart (CFTAH100), which has a re‐designed right impeller and motor, had not been tested in vivo. The purpose of this study was to evaluate the feasibility of pulsatility with the CFTAH100 during the application of pump speed modulation protocols in a chronic animal model. Methods A 30‐day chronic animal experiment was conducted with a calf. Five pulsatile studies were performed on the alert animal. The mean pump speed was set at 2800 rpm, and modulated sinusoidally within a range of 0 to ± 35% of mean speed, in increments of 5% at 80 beats per minute (bpm). The pressures and pump flow were collected and a pulsatility index (PI) was calculated. Results The calf was supported with the CFTAH100 without any major complications. The maximum and minimum pump flows changed significantly from baseline in all conditions, while the mean pump flow did not change. All flow pulsatility (FP) readings in all conditions significantly increased from baseline, and the percent modulation (%S) and FP had a strong positive correlation (r = 0.99, p < 0.01). The PI also increased significantly in all conditions (maximum at %S of 35%, 2.2 ± 0.05, p < 0.01), and a positive correlation between %S and PI (r = 0.99, p < 0.01) was observed. Conclusion The CFTAH100 showed the feasibility of creating pulsatile circulation with sinusoidal pump speed modulation.
Collapse
Affiliation(s)
- Taiyo Kuroda
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Takuma Miyamoto
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Chihiro Miyagi
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Anthony R Polakowski
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Christine R Flick
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Barry D Kuban
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - George B Voros
- Biological Resources Unit, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kimberly Such
- Biological Resources Unit, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jamshid H Karimov
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
32
|
Gokce S, Herkiloglu D. Increased clitoral artery pulsatility index and decreased sexual desire level in women with polycystic ovary syndrome. Ginekol Pol 2022; 93:473-477. [PMID: 35315011 DOI: 10.5603/gp.a2021.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Polycystic ovary syndrome (PCOS) is claimed to effect the sexual desire, and recently, blood flow in the clitoral artery (CA) was measured by Doppler ultrasound (USG) examination and the level of sexual desire was objectively demonstrated by determining the pulsatility index (PI). In the present study, it was aimed to quantitatively determine the sexual desire levels in women with PCOS using Doppler USG and to compare the data with healthy women. MATERIAL AND METHODS The study included 71 patients diagnosed with PCOS and 78 healthy women who applied to our tertiary hospital gynecology clinics and for control purposes. Pulsatility indices were determined by measuring blood flows in the clitoral artery, uterine artery, ovarian artery and labial artery using Doppler USG in all participants. The clitoral artery pulsatility index was found to be increased significantly in women with PCOS. RESULTS The mean age was 28.5 ± 3.7 in the polycystic ovary syndrome group and 30.0 ± 5.2 in the control group.The mean clitoral artery pulsatility index (1.4 ± 0.5 cm/sec) in the PCOS group was significantly higher than the control group (1.2 ± 0.4 cm/sec) (p = 0.033 cm/sec).The mean ovarian artery pulsatility index (0.8 ± 0.2 cm/sec) in the PCOS group was also significantly higher than the control group (0.7 ± 0.2 cm/sec) (p = 0.015 cm/sec). PCOS is showed to influence sexual desire with an objective measurement. Since trying to obtain objective data about the level of sexual desire, questionnaires were not applied to the participants and no questions were asked. CONCLUSIONS In our study, it was found that the clitoral artery pulsatility index, that is, the rate of resistance in the blood flow to the clitoral region, increased significantly in women with PCOS. This finding shows that the level of sexual desire in women with PCOS has decreased compared to healthy women.
Collapse
|
33
|
Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Am J Obstet Gynecol 2022; 226:S1071-S1097.e2. [PMID: 32682859 DOI: 10.1016/j.ajog.2020.07.020] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early-onset disease requiring preterm delivery is associated with a higher risk of complications in both mothers and babies. Evidence suggests that the administration of low-dose aspirin initiated before 16 weeks' gestation significantly reduces the rate of preterm preeclampsia. Therefore, it is important to identify pregnant women at risk of developing preeclampsia during the first trimester of pregnancy, thus allowing timely therapeutic intervention. Several professional organizations such as the American College of Obstetricians and Gynecologists (ACOG) and National Institute for Health and Care Excellence (NICE) have proposed screening for preeclampsia based on maternal risk factors. The approach recommended by ACOG and NICE essentially treats each risk factor as a separate screening test with additive detection rate and screen-positive rate. Evidence has shown that preeclampsia screening based on the NICE and ACOG approach has suboptimal performance, as the NICE recommendation only achieves detection rates of 41% and 34%, with a 10% false-positive rate, for preterm and term preeclampsia, respectively. Screening based on the 2013 ACOG recommendation can only achieve detection rates of 5% and 2% for preterm and term preeclampsia, respectively, with a 0.2% false-positive rate. Various first trimester prediction models have been developed. Most of them have not undergone or failed external validation. However, it is worthy of note that the Fetal Medicine Foundation (FMF) first trimester prediction model (namely the triple test), which consists of a combination of maternal factors and measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has undergone successful internal and external validation. The FMF triple test has detection rates of 90% and 75% for the prediction of early and preterm preeclampsia, respectively, with a 10% false-positive rate. Such performance of screening is superior to that of the traditional method by maternal risk factors alone. The use of the FMF prediction model, followed by the administration of low-dose aspirin, has been shown to reduce the rate of preterm preeclampsia by 62%. The number needed to screen to prevent 1 case of preterm preeclampsia by the FMF triple test is 250. The key to maintaining optimal screening performance is to establish standardized protocols for biomarker measurements and regular biomarker quality assessment, as inaccurate measurement can affect screening performance. Tools frequently used to assess quality control include the cumulative sum and target plot. Cumulative sum is a sensitive method to detect small shifts over time, and point of shift can be easily identified. Target plot is a tool to evaluate deviation from the expected multiple of median and the expected median of standard deviation. Target plot is easy to interpret and visualize. However, it is insensitive to detecting small deviations. Adherence to well-defined protocols for the measurements of mean arterial pressure, uterine artery pulsatility index, and placental growth factor is required. This article summarizes the existing literature on the different methods, recommendations by professional organizations, quality assessment of different components of risk assessment, and clinical implementation of the first trimester screening for preeclampsia.
Collapse
|
34
|
Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol 2022; 226:S1108-S1119. [PMID: 32835720 DOI: 10.1016/j.ajog.2020.08.045] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/02/2023]
Abstract
Preeclampsia is defined as hypertension arising after 20 weeks of gestational age with proteinuria or other signs of end-organ damage and is an important cause of maternal and perinatal morbidity and mortality, particularly when of early onset. Although a significant amount of research has been dedicated in identifying preventive measures for preeclampsia, the incidence of the condition has been relatively unchanged in the last decades. This could be attributed to the fact that the underlying pathophysiology of preeclampsia is not entirely understood. There is increasing evidence suggesting that suboptimal trophoblastic invasion leads to an imbalance of angiogenic and antiangiogenic proteins, ultimately causing widespread inflammation and endothelial damage, increased platelet aggregation, and thrombotic events with placental infarcts. Aspirin at doses below 300 mg selectively and irreversibly inactivates the cyclooxygenase-1 enzyme, suppressing the production of prostaglandins and thromboxane and inhibiting inflammation and platelet aggregation. Such an effect has led to the hypothesis that aspirin could be useful for preventing preeclampsia. The first possible link between the use of aspirin and the prevention of preeclampsia was suggested by a case report published in 1978, followed by the first randomized controlled trial published in 1985. Since then, numerous randomized trials have been published, reporting the safety of the use of aspirin in pregnancy and the inconsistent effects of aspirin on the rates of preeclampsia. These inconsistencies, however, can be largely explained by a high degree of heterogeneity regarding the selection of trial participants, baseline risk of the included women, dosage of aspirin, gestational age of prophylaxis initiation, and preeclampsia definition. An individual patient data meta-analysis has indicated a modest 10% reduction in preeclampsia rates with the use of aspirin, but later meta-analyses of aggregate data have revealed a dose-response effect of aspirin on preeclampsia rates, which is maximized when the medication is initiated before 16 weeks of gestational age. Recently, the Aspirin for Evidence-Based Preeclampsia Prevention trial has revealed that aspirin at a daily dosage of 150 mg, initiated before 16 weeks of gestational age, and given at night to a high-risk population, identified by a combined first trimester screening test, reduces the incidence of preterm preeclampsia by 62%. A secondary analysis of the Aspirin for Evidence-Based Preeclampsia Prevention trial data also indicated a reduction in the length of stay in the neonatal intensive care unit by 68% compared with placebo, mainly because of a reduction in births before 32 weeks of gestational age with preeclampsia. The beneficial effect of aspirin has been found to be similar in subgroups according to different maternal characteristics, except for the presence of chronic hypertension, where no beneficial effect is evident. In addition, the effect size of aspirin has been found to be more pronounced in women with good compliance to treatment. In general, randomized trials are underpowered to investigate the treatment effect of aspirin on the rates of other placental-associated adverse outcomes such as fetal growth restriction and stillbirth. This article summarizes the evidence around aspirin for the prevention of preeclampsia and its complications.
Collapse
|
35
|
Belkin MN, Kagan V, Labuhn C, Pinney SP, Grinstein J. Physiology and Clinical Utility of HeartMate Pump Parameters. J Card Fail 2021:S1071-9164(21)00481-4. [PMID: 34980564 DOI: 10.1016/j.cardfail.2021.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/10/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022]
Abstract
The HeartMate 3 left ventricular assist device (LVAD) is now the only centrifugal pump intended for durable support being actively manufactured and implanted for adults in the United States. The changes in preload and afterload that accompany common clinical scenarios experienced by patients with an LVAD will cause specific changes to the LVAD pump parameters, namely, the pump power, pulsatility index, and flow. Appropriate care of this unique, and growing, population requires a full understanding of these variables as well as the underlying physiologic principles governing their derivation. The aim of this review is to focus on the updated functionality of the HeartMate 3, specifically in comparison to the HeartMate II, as well as the application of pump parameter interpretation to common clinical scenarios.
Collapse
|
36
|
Ryu YG, Lee DK. nOutcomes of autogenous radiocephalic versus brachiocephalic arteriovenous fistula surgery based on transit-time flowmeter assessment: A retrospective study. Ann Vasc Surg 2021:S0890-5096(21)00950-X. [PMID: 34936890 DOI: 10.1016/j.avsg.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/20/2022]
|
37
|
Liu XJ, Che P, Xing M, Tian XB, Gao C, Li X, Zhang N. Cerebral Hemodynamics and Carotid Atherosclerosis in Patients With Subcortical Ischemic Vascular Dementia. Front Aging Neurosci 2021; 13:741881. [PMID: 34880744 PMCID: PMC8645960 DOI: 10.3389/fnagi.2021.741881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence indicates that atherosclerosis is correlated with cerebral small vessel disease and contributes to cognitive decline. This study aimed to explore the characteristics and contributions of intracranial hemodynamics and carotid atherosclerosis to cognitive dysfunction in subjects with subcortical ischemic vascular dementia (SIVD). Notably, 44 patients with SIVD, 30 patients with Alzheimer's disease (AD), and 30 healthy controls (HCs) were recruited from our longitudinal MRI study for AD and SIVD (ChiCTR1900027943). The cerebral mean flow velocity (MFV) and pulsatility index (PI) of both anterior and posterior circulations, artery plaque, and lumen diameter in carotid arteries were investigated using transcranial Doppler and carotid ultrasound, respectively. Their correlations with cognitive function were analyzed in patients with dementia. Decreased MFV and increased PI were found in patients with SIVD and AD. Patients with SIVD showed lower MFV and higher PI in the bilateral posterior cerebral arteries compared to patients with AD. Increases in lumen diameter, number of arteries with plaque, and total carotid plaque score were found in patients with SIVD. The Mini-Mental State Examination score was positively correlated with the MFV and negatively correlated with the PI of most major cerebral arteries, while it was negatively correlated with the lumen diameter of the common carotid artery, number of arteries with plaque, and total carotid plaque score in patients with dementia. There were also correlations between these parameters of some arteries and memory and executive function. Our results provide additional evidence suggesting that the pathological changes in macrovascular structure and function are correlated with cognitive impairment in dementia patients with SIVD and to a lesser extent AD.
Collapse
Affiliation(s)
- Xiao-Jiao Liu
- Department of Neurology, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Ping Che
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Mengya Xing
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiao-Bing Tian
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunli Gao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiuyan Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Nan Zhang
- Department of Neurology, Tianjin Medical University General Hospital Airport Site, Tianjin, China.,Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
38
|
Chang T, Yan X, Zhao C, Zhang Y, Wang B, Gao L. Noninvasive evaluation of intracranial pressure in patients with traumatic brain injury by transcranial Doppler ultrasound. Brain Behav 2021; 11:e2396. [PMID: 34725957 PMCID: PMC8671786 DOI: 10.1002/brb3.2396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The purpose of this study was to investigate the relationship between pulsatility index (PI) or optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with traumatic brain injury (TBI), and the ability of ONSD and ICP to predict intracranial hypertension. METHODS A total of 68 patients with TBI were included in this retrospective study. After receiving surgery treatment, they underwent transcranial Doppler ultrasound (TCD). The statistical correlation between PI or ONSD and ICP 1 week after surgery was analyzed. Furthermore, the areas under the curve (AUCs) of ONSD or PI or a combination of them were calculated to predict intracranial hypertension. RESULTS There was a correlation between ONSD and ICP. This correlation still remained at ONSD ≥ 5 mm. Furthermore, there was a strong correlation between PI and ICP. There was a moderate correlation between ICP and PI on days 3, 4, and 5 after surgery (r = 0.508, p < .001), and a strong correlation on days 6 and 7 after surgery (r = 0.645, p < .001). Moreover, for predicting intracranial hypertension with PI ≥ 1.2 mm or ONSD ≥ 5 mm or a combination of them, the AUC was 0.729, 0.900, and 0.943, respectively (p < .001). CONCLUSIONS The correlation between ONSD or PI and invasive ICP was different with different levels of ICP in different periods in patients with TBI after surgery. When ONSD ≥ 5 mm and PI ≥ 1.2, it could predict elevated ICP more accurately.
Collapse
Affiliation(s)
- Tao Chang
- Department of Emergency, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Xigang Yan
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Chao Zhao
- Department of Neurology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yufu Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Bao Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Li Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| |
Collapse
|
39
|
Kang H, Cai Q, Gong L, Wang Y. Nomogram Prediction of Short-Term Outcome After Intracerebral Hemorrhage. Int J Gen Med 2021; 14:5333-5343. [PMID: 34522130 PMCID: PMC8434878 DOI: 10.2147/ijgm.s330742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background The early symptoms of patients with elevated intracranial pressure (ICP) after intracerebral hemorrhage (ICH) are easily overlooked, which will result in missing the optimal opportunity for clinical intervention. However, it is difficult for ICH patients admitted to the neurology department to receive invasive ICP monitoring, although it is crucial for the early identification of neurologic deterioration (ND). Objective The aim of this study is to investigate the association between the changes of transcranial Doppler (TCD) variables and ND after onset and establish a nomogram for predicting the short-term outcome of ICH. Methods A total of 297 patients were recruited and their clinical characteristics and the changes of TCD variables were recorded. The independent prognostic factors for the ND after onset in the ICH patients were screened from multivariate Logistic regression analysis, which were served as inputs for the nomogram construction. Discrimination and calibration validations were performed to assess the performance of the nomogram [concordance index (C-index) for discrimination and Hosmer–Lemeshow (HL) test for calibration] and the decision curve analysis was applied to assess the clinical suitability. Results ΔaPI [defined as the change of pulsatility index (PI) between the 1st and 3rd day after onset for affected hemisphere] was independently associated with the ND after onset. Moreover, hematoma volume, presence of intraventricular hemorrhage, and Glasgow coma scale were also the independent prognostic factors of ND. The developed nomogram incorporating ΔaPI showed good discrimination (C-index: 0.916 after 1000 bootstrapping) and calibration (P=0.412, HL test) and yielded net benefits. Conclusion The nomogram incorporating ΔaPI might be useful in predicting the risk of ND within 14 days after onset, which might help identify patients in the neurology department in need of further care.
Collapse
Affiliation(s)
- Huili Kang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Qiuqiong Cai
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Liang Gong
- Department of Neurosurgery, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Ying Wang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| |
Collapse
|
40
|
Emekçi Özay Ö, Özay AC. Smoking reduces ovarian stromal blood flow in polycystic ovary syndrome patients. Ginekol Pol 2021; 91:201-206. [PMID: 32374020 DOI: 10.5603/gp.2020.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/22/2020] [Accepted: 02/29/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The objective of the current research is to compare hormonal, metabolic and ovarian stromal blood flow outcomes in smoking versus non-smoking polycystic ovary syndrome (PCOS) patients. MATERIAL AND METHODS 79 PCOS women (Group 1) and 79 healthy subjects (Group 2) were recruited. Both groups were subdivided according to their smoking habits. Ovarian stromal blood flow was assessed with pulsatility and resistance index for both ovaries and compared among smoking women. RESULTS The smokers in the PCOS group had statistically significant higher levels of pulsatility and resistance index in both ovaries compared to nonsmoker PCOS patients (p < 0.001). Comparison of ovarian stromal blood flow indexes shows that pulsatility and resistance index for both ovaries is statistically significantly high in smoking healthy patients compared to the nonsmoking group (p < 0.001). There is a positive correlation between smoking and free androgen index (r = 0.866, p < 0.001) for PCOS patients and healthy women. CONCLUSIONS Smoking reduces ovarian blood flow in PCOS patients and healthy subjects. Smoke components effect the vascular structure and form endothelial injuries that may reduce ovarian tissue perfusion. In this study, the positive correlation between smoking and free androgen index shows that the main effect of smoking on ovarian blood flow may be through androgen metabolism.
Collapse
Affiliation(s)
- Özlen Emekçi Özay
- Department of Obstetrics and Gynecology, Near East University, Nicosia, Cyprus, Nicosia, Cyprus.
| | - Ali Cenk Özay
- Department of Obstetrics and Gynecology, Near East University, Nicosia, Cyprus, Nicosia, Cyprus
| |
Collapse
|
41
|
Abstract
BACKGROUND Modern ventricular assist devices (VADs) use a continuous flow design. It has been suggested that a lack of pulsatility contributes to a range of adverse outcomes including pump thrombus, gastrointestinal bleeding and stroke. To better assess the role of pulsatility in these adverse events, we first require a clear definition of 'pulsatility' in the setting of a severely impaired ventricle and a modern continuous flow VAD. METHODS A literature review was conducted to elucidate the understanding of pulsatility in modern VAD literature. Search engines used included PUBMED, EMBASE and the Cochrane library. Articles were appraised on three aspects: Whether they mentioned pulsatility; whether they mentioned which pulsatility measure was used and finally which methodology was used to obtain the value. RESULTS Of 354 articles reviewed, only 13 met our broad inclusion criteria. Of these articles, the most cited measure was pulsatility index (PI) - used by 11 of the publications. The methodology used to obtain the value was not uniform and five articles did not clearly state it. Other measures included pulse pressure and surplus haemodynamic energy. The majority of articles did not directly discuss pulsatility in the setting of patient-pump interaction. CONCLUSION Most publications did not provide a definition for pulsatility. In those that did, the most common measure was PI. Measuring PI was not standardised. Few papers addressed the impact of intrinsic ventricular function and arterial compliance on pulsatility. We suggest that future publications adopt a uniform definition which encompasses both patient and pump characteristics.
Collapse
Affiliation(s)
- Sam Emmanuel
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Paul Jansz
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,School of Medicine, University of Notre Dame, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Christopher Hayward
- St Vincent's Hospital (Sydney), Darlinghurst, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, Australia.,Victor Chang Cardiac Research Institute, Sydney, Australia
| |
Collapse
|
42
|
Abstract
Previous studies have investigated whether migraine is a circulatory disorder, as migraineurs are at heightened risk of cerebrovascular disease. However, in most cases, systemic vascular function was evaluated, which may not reflect abnormalities in the cerebral circulation. Therefore, we aimed to determine whether cerebrovascular function differs between migraineurs and controls. A systematic literature search was conducted across three electronic databases to search for studies that compared cerebrovascular function in migraineurs to controls. Where applicable, meta-analyses were used to determine standardised mean differences (SMD) between migraineurs and controls. Seventy articles were identified, 40 of which contained quantitative data. Meta-analyses showed pulsatility index (PI) was higher (SMD = 0.23; 95%CI = 0.05 to 0.42, P = 0.01) and cerebrovascular responsiveness (CVR) to hypercapnia was lower (SMD=-0.34; 95%CI=-0.67 to -0.01, P = 0.04) in the posterior circulation of migraineurs, particularly those without aura. The meta-analyses also indicated that migraineurs have higher resting mean blood flow velocity in both anterior (SMD = 0.14; 95%CI = 0.05 to 0.23, P = 0.003) and posterior circulations (SMD = 0.20; 95%CI = 0.05 to 0.34, P = 0.007). Compared to healthy controls, migraineurs have altered cerebrovascular function, evidenced by elevated PI (representing arterial stiffness) and impaired CVR to hypercapnia (representing cerebral vasodilator function). Future studies should investigate whether improvement of cerebrovascular function is able to alleviate migraine.
Collapse
Affiliation(s)
- Jemima Sa Dzator
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
| | - Peter Rc Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.,Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Rachel Hx Wong
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.,Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| |
Collapse
|
43
|
Contag S, Visentin S, Goetzinger K, Cosmi E. Use of the Renal Artery Doppler to Identify Small for Gestational Age Fetuses at Risk for Adverse Neonatal Outcomes. J Clin Med 2021; 10:jcm10091835. [PMID: 33922550 PMCID: PMC8122939 DOI: 10.3390/jcm10091835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: To measure the sensitivity and positive predictive value (PPV) for an adverse neonatal outcome among growth-restricted fetuses (FGR) comparing the cerebral–placental ratio (CPR) with the cerebral–renal ratio (CRR). Methods: Retrospective analysis of 92 women who underwent prenatal ultrasound at the University of Maryland and the University of Padua. Renal, middle cerebral and umbilical artery Doppler waveforms were recorded for all scans during the third trimester. The last scan prior to delivery was included for analysis. We calculated the test characteristics of the pulsatility indices (PI) of the umbilical and renal arteries in addition to the derived CPR and CRR to detect a composite adverse neonatal outcome. Results: The test characteristics of the four Doppler ratios to detect increased risk for the composite neonatal outcome demonstrated that the umbilical artery pulsatility index had the best test performance (sensitivity 64% (95% CI: 47–82%), PPV 24% (95% CI: 21–27), and positive likelihood ratio 2.7 (95% CI: 1.4–5.2)). There was no benefit to using the CRR compared with the CPR. The agreement between tests was moderate to poor (Kappa value CPR compared with CRR: 0.5 (95%CI 0.4–0.70), renal artery PI:−0.1 (95% CI −0.2–0.0), umbilical artery PI: 0.5 (95% CI 0.4–0.7)). Only the umbilical artery had an area under the receiver operating curve that was significantly better compared with the CPR as a reference (p-value < 0.01). Conclusions: The data that we present do not support the use of renal artery Doppler as a useful clinical test to identify a fetus at risk for an adverse neonatal outcome. Within the various indices applied to this population, umbilical artery Doppler performed the best in identifying the fetuses at risk for an adverse perinatal outcome.
Collapse
Affiliation(s)
- Stephen Contag
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology and Women’s Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Silvia Visentin
- Department of Women and Child Heath, University of Padua School of Medicine, 35122 Padova, Italy;
| | - Katherine Goetzinger
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Erich Cosmi
- Department of Women and Child Heath, University of Padua School of Medicine, 35122 Padova, Italy;
- Correspondence:
| |
Collapse
|
44
|
Çintesun E, İncesu Çintesun FN, Mammadova N, Çelik Ç. The influence of vaginal progesterone on Uterine Artery Pulsatility Index. Ginekol Pol 2021:VM/OJS/J/69908. [PMID: 33757153 DOI: 10.5603/gp.a2020.0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/17/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Uterine artery Doppler is frequently used in the first trimester and it is one of the more effective measurement methods in the prediction of preeclampsia and intrauterine growth restriction (IUGR). Progesterone is a hormone that is used quite frequently in various indications in obstetrics and gynecologic practice. We aimed to investigate the influence of progesterone on the uterine artery Doppler pulsatility index (PI) at 11-14 gestational weeks. MATERIAL AND METHODS This study is a retrospective case-control study conducted in Selcuk University Faculty of Medicine between January and December 2019. Uterine artery Doppler PI values of patients using progesterone were compared with PI values of patients not using progesterone. Uterine artery PI was measured two times, left and right. Then the mean PI was calculated. All measurements were made by two operators and by the same ultrasonography machine RESULTS: A total of 288 patients, 140 patients using progesterone and 148 patients not using progesterone were included in the study. Demographic characteristics were similar between the groups (p > 0.05). There were no significant differences between the groups in the right and left uterine artery PI values. There was no significant difference for average uterine artery PI between the groups (p < 0.05). CONCLUSIONS Progesterone has no significant influence on uterine artery PI. However, more prospective studies in which all potential confounding factors are considered including serum progesterone levels are needed for this subject.
Collapse
Affiliation(s)
- Ersin Çintesun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selcuk University, Konya, Turkey.
| | | | - Nigar Mammadova
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Çetin Çelik
- Department of Obstetrics and Gynecology, Faculty of Medicine, Selcuk University, Konya, Turkey
| |
Collapse
|
45
|
Wood MD, Boyd JG, Wood N, Frank J, Girard TD, Ross-White A, Chopra A, Foster D, Griesdale DEG. The Use of Near-Infrared Spectroscopy and/or Transcranial Doppler as Non-Invasive Markers of Cerebral Perfusion in Adult Sepsis Patients With Delirium: A Systematic Review. J Intensive Care Med 2021; 37:408-422. [PMID: 33685273 PMCID: PMC8772019 DOI: 10.1177/0885066621997090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Several studies have previously reported the presence of altered cerebral perfusion during sepsis. However, the role of non-invasive neuromonitoring, and the impact of altered cerebral perfusion, in sepsis patients with delirium remains unclear. Methods: We performed a systematic review of studies that used near-infrared spectroscopy (NIRS) and/or transcranial Doppler (TCD) to assess adults (≥18 years) with sepsis and delirium. From study inception to July 28, 2020, we searched the following databases: Ovid MedLine, Embase, Cochrane Library, and Web of Science. Results: Of 1546 articles identified, 10 met our inclusion criteria. Although NIRS-derived regional cerebral oxygenation was consistently lower, this difference was only statistically significant in one study. TCD-derived cerebral blood flow velocity was inconsistent across studies. Importantly, both impaired cerebral autoregulation during sepsis and increased cerebrovascular resistance were associated with delirium during sepsis. However, the heterogeneity in NIRS and TCD devices, duration of recording (from 10 seconds to 72 hours), and delirium assessment methods (e.g., electronic medical records, confusion assessment method for the intensive care unit), precluded meta-analysis. Conclusion: The available literature demonstrates that cerebral perfusion disturbances may be associated with delirium in sepsis. However, future investigations will require consistent definitions of delirium, delirium assessment training, harmonized NIRS and TCD assessments (e.g., consistent measurement site and length of recording), as well as the quantification of secondary and tertiary variables (i.e., Cox, Mxa, MAPOPT), in order to fully assess the relationship between cerebral perfusion and delirium in patients with sepsis.
Collapse
Affiliation(s)
- Michael D Wood
- Department of Anesthesiology, Pharmacology and Therapeutics, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gordon Boyd
- Department of Critical Care Medicine, 4257Queen's University, Kingston, Ontario, Canada
| | - Nicole Wood
- Department of Physics, 8430University of Waterloo, Waterloo, Ontario, Canada
| | - James Frank
- Department of Physics, 7497Brock University, St. Catharines, Ontario, Canada
| | - Timothy D Girard
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Akash Chopra
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Denise Foster
- Division of Critical Care Medicine, Department of Medicine, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald E G Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Division of Critical Care Medicine, Department of Medicine, 8166University of British Columbia, Vancouver, British Columbia, Canada.,Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
46
|
Segev M, Weissmann-Brenner A, Weissbach T, Kassif E, Weisz B. Intra-observer variability of Doppler measurements in umbilical artery (UA) and middle cerebral artery (MCA) in uncomplicated term pregnancies. J Matern Fetal Neonatal Med 2021; 35:5653-5658. [PMID: 33715569 DOI: 10.1080/14767058.2021.1888920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the intra-observer variability of the middle cerebral artery (MCA) and umbilical artery (UA) Doppler measurement taken under optimal conditions in term, uncomplicated pregnancies. METHODS A prospective study on uncomplicated singleton term pregnancies was performed. Multiple Doppler measurements were taken in the MCA and the UA by one examiner. Intra-rater agreement was calculated. Doppler indices were correlated to fetal biometric parameters and to gestational age. RESULTS One hundred patients were recruited. MCA indices were found to have the highest strength of intra-rater/observer agreement (K = 0.888) versus only a "good" agreement for UA pulsatility index (PI) (K = 0.755).The MCA-PI was significantly correlated with BPD (r = -0.198, p = .047), EFW (r = -0.241, p = .01) and birthweight (r = -0.208, p = .03). A statistically significant decrease was found in the MCA PI (r = -.422, p < .001) and in the CPR (r = -0.444, p < .001) with advancing pregnancy, between 37 and 42 weeks gestation. The UA PI did not change significantly (p = .099) during this period. CONCLUSIONS MCA PI measured at term is reproducible with a high ICC. MCA PI significantly decreases with advancing gestation at term. No correlation was found between Doppler measurements and time to delivery.
Collapse
Affiliation(s)
- Meirav Segev
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alina Weissmann-Brenner
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
47
|
Ahn H, Cruz-Martinez R, Hernandez-Andrade E. Variation in the uterine arteries Doppler parameters when obtained transvaginally or transabdominally at different sampling locations. J Matern Fetal Neonatal Med 2021; 35:5709-5716. [PMID: 33657961 DOI: 10.1080/14767058.2021.1892062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To evaluate differences in Doppler velocimetry parameters when the uterine arteries (UtA) are evaluated transabdominally (TA) at different sampling locations and transvaginally (TV). MATERIALS AND METHODS Five hundred and fifty-seven pregnant women were evaluated between 11 and 39 weeks of gestation. The mean UtA pulsatility index (PI) and prevalence of bilateral notching were obtained at four different locations: (1) TA just above the crossing with the iliac artery; (2) TA just below the crossing with the iliac artery; (3) TA well above approximately 3 cm away from the crossing with the iliac artery; and (4) TV at the point closest to the internal cervical os. Measurements obtained just above the external iliac artery were considered the standard for comparison. Differences among different locations per gestational week were calculated. RESULTS The mean UtA-PI and prevalence of bilateral notching were similar when the uterine arteries were sampled TA just above or just below the crossing with the external iliac artery. The mean UtA-PI values and prevalence of bilateral notching were significantly higher (p < .0001) when obtained TV and significantly lower when obtained 3 cm above the crossing with the external iliac artery (p = .004), as compared to the standard plane just above the crossing. CONCLUSION The mean UtA-PI and prevalence of bilateral notching vary significantly when the uterine arteries are sampled far above the crossing with the external iliac artery or when obtained transvaginally.Key MessageThe predictive performance of the uterine arteries during pregnancy can significantly vary in relation to the approach selected for evaluation and to the location of the Doppler sampling gate.
Collapse
Affiliation(s)
- Hyunyoung Ahn
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Edgar Hernandez-Andrade
- Fetal Medicine Research Center, Fetal Medicine México, Querétaro, México.,Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
48
|
Dash SS, Jena P, Khuntia S, Pathak M, Rath SK. First- and second-trimester uterine artery pulsatility index as a combination factor in predictive diagnosis of pregnancy-induced hypertension. Int J Gynaecol Obstet 2021; 154:431-435. [PMID: 33326607 DOI: 10.1002/ijgo.13545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hypertensive disorder of pregnancy is a major cause of fetal and maternal morbidity and mortality. The current approach for pregnancy-induced hypertension (PIH) screening is complex and expensive. The present prospective cohort study assesses the advantage of combining first- and second-trimester uterine artery pulsatility index (UAPI) for predictive diagnosis of PIH. METHODS A total of 151 prenatal cases in their first trimester were studied and followed up till delivery. The mean UAPI was calculated for the first and second trimesters during the nuchal translucency and anomaly scans. Receiver operating characteristic analysis was used to calculate the cut-off of UAPI for first-trimester, second-trimester, and both trimesters combined. RESULTS Twenty-seven (17.9%) pregnant women developed PIH. Mean ± SD UAPI values for first and second trimesters were 1.92 ± 0.60 and 1.23 ± 0.36, respectively. The cut-offs for abnormal UAPI were ≥2.51, ≥1.32, and ≥1.91 for first trimester, second trimester, and both trimesters combined, respectively. The sensitivity and specificity of UAPI in predictive diagnosis of PIH were 82% and 95% for first trimester, 93% and 85% for the second trimester, and 93% and 98% for both trimesters combined. CONCLUSION Combining UAPI of first and second trimesters improves the predictive diagnosis of PIH, which can be carried out during the nuchal translucency and anomaly scans without imparting extra cost to the patient.
Collapse
Affiliation(s)
- Sonali S Dash
- Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pramila Jena
- Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Swetaparna Khuntia
- Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.,MM Medicare Hospital, Cuttack, Odisha, India
| | - Mona Pathak
- Research & Development Department, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudhanshu K Rath
- Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| |
Collapse
|
49
|
Pahlavian SH, Wang X, Ma S, Zheng H, Casey M, D’Orazio LM, Shao X, Ringman JM, Chui H, Wang DJJ, Yan L. Cerebroarterial pulsatility and resistivity indices are associated with cognitive impairment and white matter hyperintensity in elderly subjects: A phase-contrast MRI study. J Cereb Blood Flow Metab 2021; 41:670-683. [PMID: 32501154 PMCID: PMC7922759 DOI: 10.1177/0271678x20927101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Increased cerebroarterial pulsations are thought to be contributing factors in microvascular damage and cognitive impairment. In this study, we assessed the utility of two-dimensional (2D) phase-contrast MRI (PC-MRI) in quantifying cerebroarterial pulsations and evaluated the associations of pulsatile and non-pulsatile hemodynamic measures with cognitive performance and white matter hyperintensities (WMH). Neurocognitive assessments on 50 elderly subjects were performed using clinical dementia rating (CDR) and Montreal cognitive assessment (MoCA). An electrocardiogram-gated 2D PC-MRI sequence was used to calculate mean flow rate, pulsatility index (PI), and resistivity index (RI) of the internal carotid artery. For each subject, whole brain global cerebral blood flow (gCBF) and relative WMH volume were also quantified. Elevated RI was significantly associated with reduced cognitive performance quantified using MoCA (p = 0.04) and global CDR (p = 0.02). PI and RI were both significantly associated with relative WMH volume (p = 0.01, p < 0.01, respectively). However, non-pulsatile hemodynamic measures were not associated with cognitive impairment or relative WMH volume. This study showed that the cerebroarterial pulsatile measures obtained using PC-MRI have stronger association with the measures of cognitive impairment compared to global blood flow measurement and as such, might be useful as potential biomarkers of cerebrovascular dysfunction in preclinical populations.
Collapse
Affiliation(s)
- Soroush H Pahlavian
- USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Xinhui Wang
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Samantha Ma
- USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Hong Zheng
- USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
| | - Marlena Casey
- USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Lina M D’Orazio
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Xingfeng Shao
- USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - John M Ringman
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Helena Chui
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Danny JJ Wang
- USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
| | - Lirong Yan
- USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
- Department of Neurology, University
of Southern California, Los Angeles, CA, USA
- Lirong Yan, USC Stevens Neuroimaging and
Informatics Institute, Keck School of Medicine, University of Southern
California, 2025 Zonal Ave, Los Angeles, CA 90033, USA.
| |
Collapse
|
50
|
Mathur V, Saini H, Chaturvedi PK, Singh A, Bhatkoti B. Comparison of ophthalmic artery blood flow between open-angle glaucoma and nonglaucomatous eyes of Indian patients. Oman J Ophthalmol 2021; 13:112-116. [PMID: 33542597 PMCID: PMC7852412 DOI: 10.4103/ojo.ojo_16_2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/02/2020] [Accepted: 08/02/2020] [Indexed: 11/17/2022] Open
Abstract
This study was undertaken to compare ophthalmic artery blood flow in eyes having primary open angle glaucoma (POAG) with age matched non glaucomatous eyes using the technique of Color Doppler imaging in Indian patients. One hundred patients of either sex over 40 years of age were divided into two groups of 50 patients each. Group 1 included 50 patients diagnosed with POAG whereas group 2 included patients who did not have POAG. Tests like visual fields and OCT RNFL were conducted and a radiologist assessed the ophthalmic artery blood flow using Color Doppler imaging. Hemodynamic calculations of ocular blood flow were done using the parameters of resistivity index (RI) and pulsatility index (PI). Statistically significant increase in the values of RI and PI were noted in patients with POAG as compared to those who did not have POAG.
Collapse
Affiliation(s)
- Vijay Mathur
- Department of Ophthalmology, Command Hospital, Chandimandir, Haryana, India
| | - Hiteshi Saini
- Department of Ophthalmology, Command Hospital, Chandimandir, Haryana, India
| | | | - Amandeep Singh
- Department of Ophthalmology, Command Hospital, Chandimandir, Haryana, India
| | - Bhupesh Bhatkoti
- Department of Ophthalmology, Command Hospital, Chandimandir, Haryana, India
| |
Collapse
|