Higher pulsatile index in carotid arteries is associated with adverse outcomes in patients treated by left ventricular assist device

Introduction Better understanding of vascular changes in patients after implantation of left ventricular assist devices (LVAD) is important to understand and prevent complications of this therapy. Currently, there is substantial lack of data regarding the impact of changes in carotid territory on clinical events in this population. Our aim was to analyze the association between carotid flow patterns and atherosclerotic changes with serious clinical events after LVAD implantation in a prospective single-center study. Methods Eighty five patients were included (Heart mate II, n=34; Heart mate 3, n=51; mean age 55±15 years; 13 women). Pulsatile and resistance indexes were calculated and atherosclerotic changes (Belcaro score) were assessed using triplex ultrasound at the 3rd and 6th month after LVAD implantation. Basic clinical and laboratory data were also included into the analyses. The median follow-up time was 982 days [IQR 472–1431]. Results Pulsatile and resistance index significantly increased between 3rd and 6th month (p=0.036 and p=0.012, respectively). Belcaro score did not change significantly. During the follow-up, 17 patients died, 4 due to stroke. Another 4 patients suffered from non-fatal stroke. Pulsatile index measured at 3rd month was associated with an increased risk of composite outcome of stroke, GIT hemorrhage and all-cause mortality (HR 10.6, 95% CI 2.0–55.2, p=0.005) only in the group of HeartMate 3 patients, while not in patients with HeartMate II (HR 0.96, 95% CI 0.07–12.4, p=0.97), p for interaction between groups 0.04. Association between pulsatile index and the risk of adverse events in patients with HeartMate 3 remained significant after adjustments for age, cause of heart failure and INTERMACS score. Conclusion Among patients after LVAD implantation, assessment of carotid flow patterns, pulsatile index in particular, may identify individuals at increased risk of serious clinical complications. Future studies are needed to understand mechanisms leading to increase flow pulsatility in this population. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic

Clinical Efficacy of Acupuncture Combined with Massage on Cervical Spondylopathy of Vertebral Artery Type and Its Effect on Hemodynamics of Patients

Objective: To investigate the clinical efficacy of acupuncture combined with massage on cervical spondylopathy of vertebral artery type and its effect on hemodynamics of patients. Methods: Sixty patients with vertebral artery type cervical spondylosis treated in our hospital from July 2017 to October 2019 were selected as the research subjects and randomly divided into 2 groups of 30 cases each. The control group was treated with acupuncture, and the observation group was treated with acupuncture combined with massage, and the clinical efficacy and hemodynamic index of the two groups were compared after 1 month of treatment [peak systolic blood velocity (PSV), pulsatile index (PI), time mean flow velocity (TMFV)]. Results: There was no statistical difference in the PSV, PI, and TMFV between the two groups before treatment (P> 0.05). After treatment, the observation group had a higher treatment efficacy than the control group with PSV and TMFV increasing and PI decreasing in both groups, and the change in the observation group was greater than that in the control group, and the difference was statistically significant(P<0.05). Conclusion: Acupuncture combined with massage on cervical spondylopathy of vertebral artery type can improve the clinical efficacy and improve the hemodynamic index of patients, which is worthy of clinical application.

The Role of Placental Growth Factor, Soluble Endoglin, and Uterine Artery Diastolic Notch to Predict the Early Onset of Preeclampsia

BACKGROUND: Reducing maternal mortality is one of the targets in the Millennium Development Goals (MDGs). In a systematic review, 4.6 per cent (95% CI 2.7-8.2) of pregnancies were complicated by preeclampsia worldwide. Preeclampsia occurs in around 10% of pregnancies in the world whereas developing countries contribute more than developed countries. In developing countries, there are 13 cases of preeclampsia in every 1,000 births, whereas in developed countries only 2-3 cases of preeclampsia are found in every 10,000 deliveries. Variations in prevalence among countries reflect, at least in part, differences in the distribution of maternal age and the proportion of nulliparous pregnant women in the population. AIM: We aimed to investigate the role of placental growth factor, soluble endoglin, and uterine artery diastolic notch to predict the early onset of preeclampsia. METHODS: This study used an analytical study with a nested case-control design. The study was conducted at Bunda Thamrin Hospital, Tanjung Mulia Mitra Medika Hospital, Sundari Hospital and a private clinic, from March to November 2018 with a total sample of 70 research subjects. RESULTS: Uterine artery diastolic notch was not found in 50% of subjects. A total of 27 subjects (38.6%) had a unilateral diastolic notch, and 8 subjects (11.4%) had a bilateral diastolic notch. Cut-off point PIGF levels was 441 pg/ml, and Area Under Curve (AUC) 82.5% (95% CI 61.5%-100%), with sensitivity 80% and specificity 87.7%. The levels sEng in this study could not predict the incidence of early-onset preeclampsia (p = 0.113). Combined PlGF and pulsatile index of uterine arteries may predict early onset preeclampsia with sensitivity 40% and specificity 90.77%. From these results, pregnant women o 22-24 weeks of pregnancy, the levels of PlGF and the uterine artery pulsatility index can be a predictor of early-onset preeclampsia. Examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia. CONCLUSION: From these results, it can be concluded that in pregnant women of 22-24 weeks, the diastolic notches in uterine arteries cannot predict the incidence of early-onset preeclampsia. PlGF levels and pulsatile index of uterine arteries can be used as predictors of early-onset preeclampsia although examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia.

Correlation Between Fetal Weight Gain and Birth Weight with Blood Flow in the Uterine Arteries Calculated with the PixelFlux Technique

Introduction The aim was to investigate correlations between fetal weight gain/day and birthweight with blood flow estimates in the uterine arteries calculated with the PixelFlux technique and with measurements from TAmax. We also aimed to examine the agreement between estimates using the two methods. Material and methods We conducted a prospective observational pilot study in pregnancy week 24–25 in women with risk pregnancies referred to the fetal medical centre at St. Olavs Hospital, Trondheim, Norway from March 2016 to June 2016. Blood flow in the uterine arteries was calculated using time-averaged peak velocity (TAmax) and the PixelFlux technique. PixelFlux is a method based on pixelwise calculation of spatially angle-corrected velocities and areas of all pixels inside a vessel during a heart cycle. Results The mean flow calculated from PixelFlux and TAmax was 811 ml/minute and 787 ml/minute, respectively. The intra-class correlation coefficient was 0.83 (95% CI 0.72-0.90) and limits of agreement were −441 ml/minute (95% CI -558 to −324 ml/minute) to 489 ml/minute (95% CI 372 to 606 ml/minute). We observed a significant correlation between mean flow calculated from PixelFlux and birthweight (r=0.41; p<0.01) and between flow calculated from PixelFlux and weight gain/day (r=0.33; p=0.02). Calculation based on TAmax was significant correlated to birthweight (r=0.34; p=0.02), but not to weight-gain/day. Pulsatile index was not correlated to flow, birthweight or fetal weight-gain/day. Conclusions We found significant correlations between estimated blood flow in the uterine arteries using the PixelFlux technique with fetal weight-gain/day and with birthweight. Estimates from two methods showed good agreement.

Color Doppler imaging and measurements of intraovarian and intrauterine vascularization on basal ultrasound examination in spontaneous ovulatory and anovulatory cycles

Background/Aim. Any organs functioning directly depends on vascularization. It applies also to the uterus and ovary which go through changes of vascularization during a menstruation cycle. The aim of this investigation was to determine differences in intrauterine and ovarian stromal arterioral blood flow on basal ultrasound examination (day 2-4) between spontaneous ovulatory and anovulatory cycles. Methods. This prospective clinical investigation included 205 patients divided into two groups: with ovulatory and with anovulatory cycles. Results. Resistance to ovarian arterioral stromal blood flow was significantly lower in the patients with ovulatory cycles (pulsatile index - PI 0.97 ? 0.4 vs 1.93 ? 1.37; p = 0.001737; and (resistance index - RI 0.55 ? 0.12 vs 0.68 ? 0.14; p = 0.040033). There were no statistically significant differences in arcuate arterioral blood flow in the pateints with ovulatory and anovulatory cycles (PI 1.21 ? 0.34 vs 61 ? 0,61 p = 0.136161 and RI 0.64 ? 0.11 vs 0.74 ? 0.07; p = 0.136649). The patients with ovulatory cycles had lower uterine radial arterioral blood flow than the patients with anovulatory cycles (PI 1.001 ? 0.22 vs 1.61 ? 0.23 p = 0.007501 and RI 0.55 ? 0.08 vs 0.71 ? 0.12; p = 0,0460113). The patients with ovulatory cycles had lower subendometrial arterioral blood flow resistance (PI 0.69 ? 0.19 vs 1.385?0.09; p = 0.00622 and RI 0.44 ? 0.09 vs 0.65 ? 0.02; p = 0.027458). Conclusion. Color Doppler ultrasuond imaging and measurements of intrauterine and ovarian stromal arterioral blood flow on basal ultrasound examination (day 2-4), showed lower resistance to blood flow in ovulatory than in anovulatory cycles.

Correlative analyze of predictable factors of successful implantation in assisted reproduction programme

INTRODUCTION Endometrial receptivity as isolated predictive factor of successful implantation, with its specifity is determined with numbered factors. PURPOSE Purpose of this study was to evaluate significance and correlation between relevant factors using appropriate statistical analyses on term of embryo implantation. MATERIAL AND METHODS Evaluated group contained 85 women whom according different causes of infertility have been determined for assisted reproduction program. Analysed measurements were endometrial thickness, assessed hyperechogenity in relation with absolute endometrial thickness (HEA relation) and uterine blood flow (pulsatile index - Pi). Simultaneously were analyzed serum estradiol (E2; pg/ml) and progesteron (P; nmol/l) levels. After these evaluations achieved results were processed with standard statistical pack. Beside that were applied parameter and nonparameter tests with aim to test significancy of difference and multiple regressive analyse (Stepwise). RESULTS Resulted measured parameters have been presented in basic analyse as middle value (Xrs) from all measurements +SD (standard deviation) and significance of difference is tested by mentioned statistical tests (Table 1). Application of Stepwise analyse, "step by step", has used parameter by parameter based on value which has decreased variability and based on achieved correlative coefficient between dependent uneven and complex of independent uneven values. This procedure confirmes best correlation between HEA relation and serum progesteron levels and HEA relation in correlation with associated values: P, E2 and endometrial thickness (Table 1). DISCUSSION Investigation provided till now shows that embryo quality and endometrial receptivity with highest probability determine success of applied assisted reproduction, successful embryonal implantation There is assessed influence of endometrial receptivity represented trough HEA relation using manyfolded regressive analyse where qualitative endometryal value has been looked with dependency with other parameters gives picture for high determinancy with hormonal activity and with stimulative ovarian activity. This determinacy could be viewed mostly through serum progesteron levels on day of HCG administration. Correlative relation between qualitative endometrial characteristics on day of HCG administration has highes value related to progesteron levels. CONCLUSION Results presented with this research confirm once again complexity characteristic for factors that play final role in embryo implantation in IVF program. There is presented only one aspect related with this problem with aim to contribute quantification importance and assessment rate of mutual influence these factors known till now as relevant.