Relation between Fetal Renal Artery Doppler ‎Indices and Non-PROM Oligohydramnios in ‎Third Trimester of Pregnancy

Background: Amniotic fluid is the liquid which surround the fetus after the first few weeks of gestation. Amniotic fluid is derived mostly from the fetus and has many functions that are essential for normal growth and development. The aim of this work is to study the relation between fetal renal artery flow velocity waveforms and amniotic fluid volume in normal pregnancies and those complicated by oligohydramnios. Methods: This prospective observational study was carried out on 40pregnant women (10) of them were with normal amount of amniotic fluid (group I), while (30) of them suffered from oligohydramnios (group II).By using color doppler ultrasound imaging, the fetal renal circulation can be assessed. Intermittent assessment of renal artery flow velocity waveforms during the early stages of pregnancy may help in predicting changes in amniotic fluid dynamics. Results: There was a non-significant difference between cases with normal amount of amniotic fluid and cases with oligohydramnios in Gestational age, Maternal age, fetal femur length, bi parietal diameter, abdominal circumference and Fetal weight. There were increased values of fetal renal artery Resistance index (RI) and Pulsatility index (PI) in cases of oligohydramnios than cases with normal amount of amniotic fluid. There was no correlation between Peak systolic velocity (PSV) and Amniotic fluid index (AFI). There was a significant difference in End diastolic velocity (EDV) between cases with normal amount of amniotic fluid and cases with oligohydramnios. Also, there was a significant difference in Systolic diastolic ratio (S/D) and Amniotic fluid index (AFI) between cases with normal amount of amniotic fluid and cases with oligohydramnios. Conclusions: There is a relation between renal artery flow velocity waveforms and oligohydramnios using Pulsed wave Doppler Ultrasonography. There are higher values of renal artery Resistance index and Pulsatility index in cases of oligohydramnios more than cases with normal amount of amniotic fluid.

Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

Background: Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients. Methods: Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses. Results: Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs (p < 0.001, p = 0.001, and p < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155–2.428, p = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death. Conclusions: Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission.

To Balloon or Not to Balloon? The Effects of an Intra-Aortic Balloon-Pump on Coronary Artery Flow during Extracorporeal Circulation Simulating Normal and Low Cardiac Output Syndromes

ECMO is the most frequently used mechanical support for patients suffering from low cardiac output syndrome. Combining IABP with ECMO is believed to increase coronary artery blood flow, decrease high afterload, and restore systemic pulsatile flow conditions. This study evaluates that combined effect on coronary artery flow during various load conditions using an in vitro circuit. In doing so, different clinical scenarios were simulated, such as normal cardiac output and moderate-to-severe heart failure. In the heart failure scenarios, we used peripheral ECMO support to compensate for the lowered cardiac output value and reach a default normal value. The increase in coronary blood flow using the combined IABP-ECMO setup was more noticeable in low heart rate conditions. At baseline, intermediate and severe LV failure levels, adding IABP increased coronary mean flow by 16%, 7.5%, and 3.4% (HR 60 bpm) and by 6%, 4.5%, and 2.5% (HR 100 bpm) respectively. Based on our in vitro study results, combining ECMO and IABP in a heart failure setup further improves coronary blood flow. This effect was more pronounced at a lower heart rate and decreased with heart failure, which might positively impact recovery from cardiac failure.

Okuläres Ischämiesyndrom: Diagnostik und Therapie

<b>Background:</b> Treatment of cervical internal carotid artery (ICA) stenosis has contributed to the improvement of ocular ischemic syndrome. However, there have been few cases of visual impairment caused by ocular ischemic syndrome due to intracranial ICA stenosis, which improved through intracranial stent placement. <b>Cas description:</b> A 76-year-old man presented with right-sided paralysis. Radiographic examination revealed severe stenosis of the left intracranial ICA (distal cavernous-infraclinoid portion) and a watershed infarction of the left cerebral hemisphere. Conservative therapy including antiplatelet drugs was initiated, but severe visual acuity disturbance in his left eye occurred 1 month after onset. The antegrade ocular artery flow recovered after urgent intracranial stent placement, and his vision improved immediately after the procedure. <b>Conclusion:</b> Visual impairment presenting as ocular ischemic syndrome can occur due to severe stenosis of the intracranial ICA, and treatment of these lesions could improve the symptoms.

Pulmonary Vascular Resistance Estimated by Echocardiography in Dogs With Myxomatous Mitral Valve Disease and Pulmonary Hypertension Probability

Post-capillary pulmonary hypertension (PH) is a life-threatening complication in dogs with myxomatous mitral valve disease (MMVD). An increase in pulmonary vascular resistance (PVR) is associated with post-capillary PH progression. In humans, PVR estimated by echocardiography (PVRecho) enables the non-invasive assessment of PVR in patients with PH. This study aimed to evaluate the clinical utility of PVRecho in dogs with MMVD, PH probability, and right-sided congestive heart failure (R-CHF). Dogs with MMVD and detectable tricuspid valve regurgitation were included in the study. Dogs were classified into three PH probability groups (low/intermediate/high) and according to the presence or absence of R-CHF. All dogs underwent echocardiographic measurements for right ventricular (RV) morphology and function. PVRecho was calculated by two methods using tricuspid valve regurgitation velocity and velocity–time integral of the pulmonary artery flow (PVRecho and PVRecho2). RV size indicators were significantly higher with a higher probability of PH. RV strain and velocity–time integral of the pulmonary artery flow in the high probability group were significantly lower than those in the other groups. Tricuspid valve regurgitation velocity, PVRecho, and PVRecho2 were significantly higher with an increase in PH probability. Logistic regression analysis revealed a significant association between the presence of R-CHF and increased PVRecho2 and end-diastolic RV internal dimension normalized by body weight. PVRecho and PVRecho2 showed significant differences among the PH probability groups. These non-invasive variables may be useful for the diagnosis and stratification of PH and the determination of the presence of R-CHF in dogs with MMVD.

Soluble Endoglin and Uterine Artery Flow Doppler Ultrasonography as Markers of Progression to Preeclampsia in Women with Gestational Hypertension

<b><i>Introduction:</i></b> Gestational hypertension (GH) pregnancies are at a high risk of developing adverse outcomes, including progression to preeclampsia. Prediction of GH-related adverse outcomes is challenging because there are no available clinical tests that may predict their occurrence. <b><i>Objective:</i></b> The aim of the study was to determine the clinical usefulness of the soluble endoglin (sEng) and parameters of uterine artery flow (UtAF) measured by Doppler ultrasonography as markers of progression to preeclampsia in women with GH. <b><i>Setting:</i></b> Mexico City, Mexico. <b><i>Material and Methods:</i></b> We included 77 singleton pregnant women with GH in a nested case-control study. Cases were women who progressed to preeclampsia (<i>n</i> = 36), and controls were those who did not <b>(</b><i>n</i> = 41). Serum sEng and UtAF measurements were performed at enrollment. The main outcomes measured were progression to preeclampsia and occurrence of preterm delivery (PD) &#x3c;37 and &#x3c;34 weeks of gestation, small for gestational age infant (SGA), and fetal growth restriction (FGR). <b><i>Results:</i></b> Women with sEng values in the highest tertile had higher risk of progression to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, and fetal growth restriction, odds ratios (ORs) ≥3.7. Patients with abnormal UtAF Dopp­ler-pulsatility index had higher risk of progression to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, small for gestational age infant, and fetal growth restriction (ORs ≥3.3). The presence of notch was associated with higher risk of progression to preeclampsia, preterm delivery &#x3c;37 and &#x3c;34 weeks of gestation, SGA infant, and fetal growth restriction (ORs ≥2.9). However, logistic regression analysis revealed that only serum sEng was a significant and independent risk factor for progression of GH to preeclampsia, preterm delivery &#x3c;34 weeks of gestation, and fetal growth restriction (ORs ≥3.1). <b><i>Conclusions:</i></b> In GH pregnancies, UtAF Doppler ultrasonography is associated with increased risk of adverse outcomes and progression to preeclampsia. However, serum sEng concentration appears to be a better predictor to assess the risk of adverse maternal and perinatal outcomes and progression to preeclampsia.

Effect of exercise training on vascular function and endothelial repair in heart failure with preserved ejection fraction: results from the OptimEx trial

Background Exercise training improves peak oxygen uptake (VO2) in heart failure with preserved ejection fraction (HFpEF), but the underlying mechanisms are unknown. In other cardiovascular diseases, exercise training improves vascular function and increases levels of circulating endothelium-repairing cells. We aimed to investigate the effects of moderate continuous training (MCT) and high intensity interval training (HIIT) on vascular function and cellular endothelial repair in HFpEF. Methods This was a prespecified subanalysis of the Optimizing Exercise Training in Prevention and Treatment of Diastolic Heart Failure randomized trial. HFpEF patients (n=180) were randomized to HIIT, MCT or attention control. At baseline and after 12 weeks, we measured peak VO2, fingertip arterial tonometry (n=109), brachial artery flow-mediated dilation (n=59), aortic pulse wave velocity (n=94), and flow cytometry (n=136) for endothelial progenitor cells (CD45dimCD34+VEGFR2+) and angiogenic T cells (CD3+CD31+CD184+). Changes in these parameters were compared between groups using linear mixed models. Parameters were correlated using Spearman's rho. Results At 3 months, we did not observe significant differences between HIIT, MCT and control group regarding changes in vascular function throughout the vascular tree (fingertip arterial tonometry, brachial artery flow-mediated dilation and central arterial stiffness, Table 1) or levels of circulating endothelium-repairing cells (endothelial progenitor cells and angiogenic T cells, Table 1). Results were similar at 12 months and when restricting analysis to patients with at least 70% adherence to training sessions. Patients with higher peak VO2 at baseline had lower numbers of circulating endothelial progenitor cells (rho=−0.22, p=0.011). Conclusions In patients with HFpEF, exercise training did not change vascular function or levels of endothelium-repairing cells. Thus, improved vascular function likely does not contribute to the change in peak VO2 after training. These findings are in contrast with the benefits of exercise on vascular function in heart failure with reduced ejection fraction and coronary artery disease. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU Framework Programme 7 Table 1