Measurement of pulmonary arterial elastance in patients with systolic heart failure using Doppler echocardiography

Science.gov (United States)

Taghavi, Sepideh; Esmaeilzadeh, Maryam; Amin, Ahmad; Naderi, Nasim; Abkenar, Hooman Bakhshandeh; Maleki, Majid; Mitra, Chitsazan

2016-01-01

Objective: A reliable and easy-to-perform method for measuring right ventricular (RV) afterload is desirable when scheduling patients with systolic heart failure to undergo heart transplantation. The present study aimed to investigate the accuracy of echocardiographically-derived pulmonary arterial elastance as a measurement of pulmonary vascular resistance by comparing it with invasive measures. Methods: Thirty-one patients with moderate to severe systolic heart failure, including 22 (71%) male patients, with a mean age of 41.16±15.9 years were enrolled in the study. Right heart catheterization and comprehensive echocardiography during the first hour after completion of cardiac catheterization were performed in all the patients. The pulmonary artery elastance was estimated using the ratio of end-systolic pressure (Pes) over the stroke volume (SV) by both cardiac catheterization [Ea (PV)-C] and echocardiography [Ea (PV)-E]. Results: The mean Ea (PV)-C and Ea (PV)-E were estimated to be 0.73±0.49 mm Hg/mL and 0.67±0.44 mm Hg/mL, respectively. There was a significant relation between Ea (PV)-E and Ea (PV)-C (r=0.897, pechocardiography and catheterization methods for estimating Ea (PV), investigated by the Bland-Altman method, showed a mean bias of -0.06, with 95% limits of agreement from -0.36 mm Hg/mL to 0.48 mm Hg/mL. Conclusion: Doppler echocardiography is an easy, non-invasive, and inexpensive method for measuring pulmonary arterial elastance, which provides accurate and reliable estimation of RV afterload in patients with systolic heart failure. PMID:26467379

Axial flow velocity patterns in a normal human pulmonary artery model: pulsatile in vitro studies.

Science.gov (United States)

Sung, H W; Yoganathan, A P

1990-01-01

It has been clinically observed that the flow velocity patterns in the pulmonary artery are directly modified by disease. The present study addresses the hypothesis that altered velocity patterns relate to the severity of various diseases in the pulmonary artery. This paper lays a foundation for that analysis by providing a detailed description of flow velocity patterns in the normal pulmonary artery, using flow visualization and laser Doppler anemometry techniques. The studies were conducted in an in vitro rigid model in a right heart pulse duplicator system. In the main pulmonary artery, a broad central flow field was observed throughout systole. The maximum axial velocity (150 cm s-1) was measured at peak systole. In the left pulmonary artery, the axial velocities were approximately evenly distributed in the perpendicular plane. However, in the bifurcation plane, they were slightly skewed toward the inner wall at peak systole and during the deceleration phase. In the right pulmonary artery, the axial velocity in the perpendicular plane had a very marked M-shaped profile at peak systole and during the deceleration phase, due to a pair of strong secondary flows. In the bifurcation plane, higher axial velocities were observed along the inner wall, while lower axial velocities were observed along the outer wall and in the center. Overall, relatively low levels of turbulence were observed in all the branches during systole. The maximum turbulence intensity measured was at the boundary of the broad central flow field in the main pulmonary artery at peak systole.

Systolically gated 3D phase contrast MRA of mesenteric arteries in suspected mesenteric ischemia

Energy Technology Data Exchange (ETDEWEB)

Wasser, M.N.; Schultze Kool, L.J.; Roos, A. de [Leiden Univ. Hospital (Netherlands)] [and others

1996-03-01

Our goal was to assess the value of MRA for detecting stenoses in the celiac (CA) and superior mesenteric (SMA) arteries in patients suspected of having chronic mesenteric ischemia, using an optimized systolically gated 3D phase contrast technique. In an initial study in 24 patients who underwent conventional angiography of the abdominal vessels for different clinical indications, a 3D phase contrast MRA technique (3D-PCA) was evaluated and optimized to image the CAs and SMAs. Subsequently, a prospective study was performed to assess the value of systolically gated 3D-PCA in evaluation of the mesenteric arteries in 10 patients with signs and symptoms of chronic mesenteric ischemia. Intraarterial digital subtraction angiography and surgical findings were used as the reference standard. In the initial study, systolic gating appeared to be essential in imaging the SMA on 3D-PCA. In 10 patients suspected of mesenteric ischemia, systolically gated 3D-PCA identified significant proximal disease in the two mesenteric vessels in 4 patients. These patients underwent successful reconstruction of their stenotic vessels. Cardiac-gated MRA may become a useful tool in selection of patients suspected of having mesenteric ischemia who may benefit from surgery. 16 refs., 6 figs., 4 tabs.

Doppler sonographic evaluation of ophthalmic arterial flow pattern in hypertensive patients

International Nuclear Information System (INIS)

Ryu, Dae Sik; Kim, Young Goo

1994-01-01

To compare the Doppler velocity waveform pattern of ophthalmic artery of hypertensive patients with that of normotensive subjects. Doppler velocity waveform was obtained from ophthalmic artery in 45 hypertensive patients and 60 normotensive subjects. Both hypertensives and normotensive subjects were classified according to age into those younger than and those older than 45 years. Doppler indices(pulsatility index(PI), resistance index(RI), the first systolic peak/the second systolic peak(S1/S2), the first systolic peak/diastolic peak(S1/D)) measured in hypertensive patients were compared with normotensive subjects. Among the various doppler indices, only S1/S2 showed significant difference(P < 0.05) between the hypertensive patients and normotensive subjects younger than 45 years. Doppler velocity waveform of hypertensive patients older than 45 years showed no significant difference from that of normotensive subjects with corresponding age. Doppler velocity waveform of ophthalmic artery in hypertensive patients younger than 45 years shows pattern with S2 higher than that of normotensive subjects. High S2 component(reflective-wave) may represent increased vascular impedance due to vasococonstriction of retinal arterioles in hypertensive patients

Right Heart End-Systolic Remodeling Index Strongly Predicts Outcomes in Pulmonary Arterial Hypertension: Comparison With Validated Models.

Science.gov (United States)

Amsallem, Myriam; Sweatt, Andrew J; Aymami, Marie C; Kuznetsova, Tatiana; Selej, Mona; Lu, HongQuan; Mercier, Olaf; Fadel, Elie; Schnittger, Ingela; McConnell, Michael V; Rabinovitch, Marlene; Zamanian, Roham T; Haddad, Francois

2017-06-01

Right ventricular (RV) end-systolic dimensions provide information on both size and function. We investigated whether an internally scaled index of end-systolic dimension is incremental to well-validated prognostic scores in pulmonary arterial hypertension. From 2005 to 2014, 228 patients with pulmonary arterial hypertension were prospectively enrolled. RV end-systolic remodeling index (RVESRI) was defined by lateral length divided by septal height. The incremental values of RV free wall longitudinal strain and RVESRI to risk scores were determined. Mean age was 49±14 years, 78% were female, 33% had connective tissue disease, 52% were in New York Heart Association class ≥III, and mean pulmonary vascular resistance was 11.2±6.4 WU. RVESRI and right atrial area were strongly connected to the other right heart metrics. Three zones of adaptation (adapted, maladapted, and severely maladapted) were identified based on the RVESRI to RV systolic pressure relationship. During a mean follow-up of 3.9±2.4 years, the primary end point of death, transplant, or admission for heart failure was reached in 88 patients. RVESRI was incremental to risk prediction scores in pulmonary arterial hypertension, including the Registry to Evaluate Early and Long-Term PAH Disease Management score, the Pulmonary Hypertension Connection equation, and the Mayo Clinic model. Using multivariable analysis, New York Heart Association class III/IV, RVESRI, and log NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) were retained (χ 2 , 62.2; P right heart metrics, RVESRI demonstrated the best test-retest characteristics. RVESRI is a simple reproducible prognostic marker in patients with pulmonary arterial hypertension. © 2017 American Heart Association, Inc.

Echocardiographic assessment of systolic pulmonary arterial pressure in HIV-positive patients.

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Mehrnaz Rasoulinejad

2014-11-01

Full Text Available Pulmonary hypertension is rare but is one of the complications that occur due to HIV infection. Symptoms of HIV-associated pulmonary arterial hypertension are often non-specific but the main symptom of the disease is dyspnea. In this cross-sectional study, we measured systolic pulmonary arterial pressure (SPAP by echocardiographic methods among HIV-positive patients who received ART. This research is a descriptive, cross-sectional study of 170 HIV-positive patients that was conducted in Imam-Khomeini hospital, Tehran, Iran during 2011-2013. All patients regularly received antiretroviral therapy at least for recent 2 years. There were not any cardiopulmonary symptoms (cough, dyspnea, exertional fatigue and chest discomfort in these patients. All participants underwent echocardiography to estimate SPAP. The participants comprised 108 males (63.5% and 62 females (46.5%. The mean age of patients was 41 years old, and the mean duration of HIV infection was 5.5 years. The mean CD4 cell count was 401 cell/µl. The principal regimen of antiretroviral therapy included two nucleoside reverse transcriptase inhibitor (NRTI and one non-nucleoside reverse transcriptase inhibitor (NNRTI in the hospital. The mean of systolic pulmonary arterial pressure was 25 mmHg in the participants; 156 (93.4% of them had SPAP ≤ 30 mmHg (normal, six (3.6% had SPAP: 31-35 mmHg (borderline and five (3% had SPAP > 35 mmHg (pulmonary hypertension. Our results indicated a significant increase of pulmonary hypertension in asymptomatic HIV-positive patients that had no association with any other risk factor. Also, antiretroviral therapy was not a risk factor for pulmonary hypertension in this study.

Doppler ultrasound study of penis in men with systemic sclerosis: a correlation with Doppler indices of renal and digital arteries.

Science.gov (United States)

Rosato, E; Barbano, B; Gigante, A; Cianci, R; Molinaro, I; Quarta, S; Digiulio, M A; Messineo, D; Pisarri, S; Salsano, F

2013-01-01

Erectile dysfunction (ED) prevalence in male systemic sclerosis (SSc) is high and its pathogenesis is unclear. The aim of the study is to assess correlation between Doppler ultrasound indices of penis and kidneys or digital arteries in male systemic sclerosis. Fourteen men with systemic sclerosis were enrolled in this study. Erectile function was investigated by the International Index of Erectile Function-5. Peak systolic velocity, end diastolic velocity, resistive index, pulsative index, and systolic/diastolic ratio were measured on the cavernous arteries at the peno-scrotal junction in the flaccid state, on the interlobar artery of both kidneys and all ten proper palmar digital arteries. Ten (71 percent) patients have an International Index of Erectile Function-5 less than 21. Reduction of penis peak systolic velocity was observed in all SSc subjects. Doppler indices of cavernous arteries correlate with the International Index of Erectile Function-5. The renal and digital arteries resistive index demonstrated a good correlation (p less than 0.0001) with International Index of Erectile Function-5. A positive correlation exists between penis and kidney arteries Doppler indices: end diastolic velocity (p less than 0.05, r=0.54), resistive index (p less than 0.0001, r=0.90), systolic/diastolic ratio (p less than 0.01, r=0.69). A positive correlation was observed between penis and digital arteries Doppler indices: peak systolic velocity (p less than 0.01, r=0.68), end diastolic velocity (p less than 0.01, r=0.75), resistive index (p less than 0.001, r=0.79), systolic/diastolic ratio (p less than 0.05, r=0.59). A correlation exists between arterial impairment of penis and renal or digital arteries.

Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome.

Science.gov (United States)

Fournier, Sara B; Reger, Brian L; Donley, David A; Bonner, Daniel E; Warden, Bradford E; Gharib, Wissam; Failinger, Conard F; Olfert, Melissa D; Frisbee, Jefferson C; Olfert, I Mark; Chantler, Paul D

2014-01-01

Metabolic syndrome (MetS) is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular (LV) systolic dysfunction. However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. Accordingly, the objective of this study was to examine comprehensively the LV and arterial responses to exercise in individuals with MetS without diabetes and/or overt cardiovascular disease in comparison to a healthy control population. Cardiovascular function was characterized using Doppler echocardiography and gas exchange in individuals with MetS (n = 27) versus healthy control subjects (n = 20) at rest and during peak exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects. During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects. These findings are of clinical importance, because they provide insight into the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of cardiovascular morbidity and mortality.

Resting early peak diastolic filling rate: a sensitive index of myocardial dysfunction in patients with coronary artery disease

International Nuclear Information System (INIS)

Polak, J.F.; Kemper, A.J.; Bianco, J.A.; Parisi, A.F.; Tow, D.E.

1982-01-01

Resting first-pass radionuclide angiocardiography (RNA) was used to derive left-ventricular (LV) peak diastolic filling rates (PFR) in normals (Group 1:N . 12) and in patients with coronary artery disease (CAD), both without (Group 2:N . 27) and with previous myocardial infarction (Group 3:N . 23). Resting peak filling rates were significantly depressed in both Group 2 (1.61 +/- 0.36; p less than 0.01) and Group 3 (1:35 +/- 0.26; p less than 0.001) patients when compared with Group 1, normals (2.14 +/- 0.63). Even though LV systolic function of Group 2 patients was normal and comparable to that in Group 1 (EF . 0.55 +/- 0.06 against EF 0.55 +/- 0.06 NS), diastolic dysfunction [PFR less than 1.61 end diastolic volume/sec (EDV/sec)] was present at rest in 14 of 27 (52%). Depressed PFR values was also seen in 20 of 23 Group 3 patients (87%). It appears that (a) resting PFR is a sensitive and easily obtainable parameter of the diastolic dysfunction associated with CAD; (b) abnormal PFR values are seen in almost all patients with previous myocardial damage, and (c) a significant proportion of CAD patients without any evidence of abnormal systolic function have depressed resting PFR of the LV

Ischemic preconditioning of the lower extremity attenuates the normal hypoxic increase in pulmonary artery systolic pressure.

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Foster, Gary P; Westerdahl, Daniel E; Foster, Laura A; Hsu, Jeffrey V; Anholm, James D

2011-12-15

Ischemic pre-condition of an extremity (IPC) induces effects on local and remote tissues that are protective against ischemic injury. To test the effects of IPC on the normal hypoxic increase in pulmonary pressures and exercise performance, 8 amateur cyclists were evaluated under normoxia and hypoxia (13% F(I)O(2)) in a randomized cross-over trial. IPC was induced using an arterial occlusive cuff to one thigh for 5 min followed by deflation for 5 min for 4 cycles. In the control condition, the resting pulmonary artery systolic pressure (PASP) increased from a normoxic value of 25.6±2.3 mmHg to 41.8±7.2 mmHg following 90 min of hypoxia. In the IPC condition, the PASP increased to only 32.4±3.1 mmHg following hypoxia, representing a 72.8% attenuation (p=0.003). No significant difference was detected in cycle ergometer time trial duration between control and IPC conditions with either normoxia or hypoxia. IPC administered prior to hypoxic exposure was associated with profound attenuation of the normal hypoxic increase of pulmonary artery systolic pressure. Published by Elsevier B.V.

Coronary Flow Reserve Predicts Cardiopulmonary Fitness in Patients with Coronary Artery Disease Independently of Systolic and Diastolic Function

DEFF Research Database (Denmark)

Snoer, Martin; Olsen, Rasmus Huan; Monk-Hansen, Tea

2014-01-01

Aims Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome...... in CAD patients. The aim of this study was to examine the relationship among CFR, systolic and diastolic function, peripheral vascular function, and cardiopulmonary fitness in CAD patients. Methods and Results Forty patients with median left ventricular ejection fraction (LVEF) 49 (interquartile 46....... Conclusions Coronary flow reserve measured noninvasively predicts cardiopulmonary fitness independently of resting systolic and diastolic function in CAD patients, indicating that cardiac output during maximal exercise is dependent on the ability of the coronary circulation to adapt to the higher metabolic...

Increased augmentation index and central systolic arterial pressure are associated with lower school and motor performance in young adolescents.

Science.gov (United States)

Vogrin, Bernarda; Slak Rupnik, Marjan; Mičetić-Turk, Dušanka

2017-12-01

Objective In adults, improper arterial function has been linked to cognitive impairment. The pulse wave velocity (PWV), augmentation index (AIx) and other vascular parameters are useful indicators of arterial health. In our study, we monitored arterial properties, body constitution, school success, and motor skills in young adolescents. We hypothesize that reduced cognitive and motor abilities have a vascular origin in children. Methods We analysed 81 healthy school children aged 11-16 years. Anthropometry central systolic arterial pressure, body mass index (BMI), standard deviation scores (SDS) BMI, general school performance grade, and eight motor tests were assessed. PWV, AIx, and central systolic arterial pressure (SBPao) were measured. Results AIx and SBPao correlated negatively with school performance grades. Extremely high AIx, PWV and SBPao values were observed in 5% of children and these children had average to low school performance. PWV correlated significantly with weight, height, and waist and hip circumference. AIx, PWV, school success, and BMI correlated strongly with certain motor functions. Conclusions Increased AIx and SBPao are associated with lower school and motor performance in children. PWV is influenced by the body's constitution.

Right ventricular systolic and diastolic function at rest in patients with coronary artery disease

International Nuclear Information System (INIS)

Caglar, N.M.; Araki, Haruo; Taira, Yuji; Fukuyama, Takaya; Nakamura, Motoomi

1985-01-01

Right ventricular systolic and diastolic function was studied in patients with ischemic heart disease using equilibrium radionuclide ventriculography. In patients with inferior myocardial infarction and proximal right coronary lesions, the right ventricular ejection fraction (0.43+-0.06, n=10, mean+-SD) and peak filling rate (1.7+-0.4 EDV/sec) were lower than normals (0.57+-0.07 and 2.7+-0.4 EDV/sec, n=10, p<0.001, respectively). In these patients, the right ventricular time to peak filling rate was longer than in normals (225+-36 msec vs 136+-45 msec, p<0.001), while the left ventricular ejection fraction remained normal. In patients with inferior myocardial infarction and distal right coronary lesions, the right ventricular ejection fraction, peak filling rate and time to peak filling rate were not different from those in normals. Even in patients with proximal right coronary lesions, the right ventricular ejection fraction was normal unless they had an inferior myocardial infarction. A decreased left ventricular ejection fraction and abnormal motion of the ventricular septum did not affect the right ventricular ejection fraction. The present results suggest that patients with an inferior myocardial infarction and proximal right coronary lesion often develop right ventricular systolic and diastolic dysfunction. (author)

Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

DEFF Research Database (Denmark)

Krähenbühl, B; Nielsen, S L; Lassen, N A

1977-01-01

by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure......Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers...... also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients...

Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis.

Science.gov (United States)

Bulut, Mehmet Deniz; Alpayci, Mahmut; Şenköy, Emre; Bora, Aydin; Yazmalar, Levent; Yavuz, Alpaslan; Gülşen, İsmail

2016-02-15

BACKGROUND Because loss of cervical lordosis leads to disrupted biomechanics, the natural lordotic curvature is considered to be an ideal posture for the cervical spine. The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. The aim of this study was to compare the vertebral artery values between subjects with and without loss of cervical lordosis. MATERIAL AND METHODS Thirty patients with loss of cervical lordosis and 30 controls matched for age, sex, and body mass index were included in the study. Sixty vertebral arteries in patients with loss of cervical lordosis and 60 in controls without loss of cervical lordosis were evaluated by Doppler ultrasonography. Vertebral artery hemodynamics, including lumen diameter, flow volume, peak systolic velocity, end-diastolic velocity, and resistive index, were measured, and determined values were statistically compared between the patient and the control groups. RESULTS The means of diameter (p=0.003), flow volume (p=0.002), and peak systolic velocity (p=0.014) in patients were significantly lower as compared to controls. However, there was no significant difference between the 2 groups in terms of the end-diastolic velocity (p=0.276) and resistive index (p=0.536) parameters. CONCLUSIONS The present study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity. Further studies are required to confirm these findings and to investigate their possible clinical implications.

Additional diagnostic value of systolic dysfunction induced by dipyridamole stress cardiac magnetic resonance used in detecting coronary artery disease.

Science.gov (United States)

Husser, Oliver; Bodí, Vicente; Sanchís, Juan; Mainar, Luis; Núñez, Julio; López-Lereu, María P; Monmeneu, José V; Ruiz, Vicente; Rumiz, Eva; Moratal, David; Chorro, Francisco J; Llácer, Angel

2009-04-01

Dipyridamole stress perfusion cardiovascular magnetic resonance (CMR) is used to detect coronary artery disease (CAD). However, few data are available on the diagnostic value of the systolic dysfunction induced by dipyridamole. This study investigated whether the induction of systolic dysfunction supplements the diagnostic information provided by perfusion imaging in the detection of CAD. Overall, 166 patients underwent dipyridamole CMR and quantitative coronary angiography, with CAD being defined as a stenosis > or =70%. Systolic dysfunction at rest, systolic dysfunction with dipyridamole, induced systolic dysfunction, and stress first-pass perfussion deficit (PD) and delayed enhancement were quantified. In the multivariate analysis, PD (hazard ratio [HR]=1.6; 95% confidence interval [CI], 1.33-1.91;Pstatistic for predicting CAD (0.81 vs. 0.87; P=.02). Combining induced systolic dysfunction with perfusion imaging increases the diagnostic accuracy of detecting CAD and enables patients with severe ischemia and a high probability of CAD to be identified.

Is the measurement of inferior thyroid artery blood flow velocity by color-flow Doppler ultrasonography useful for differential diagnosis between gestational transient thyrotoxicosis and Graves' disease? A prospective study.

Science.gov (United States)

Zuhur, Sayid Shafi; Ozel, Alper; Velet, Selvinaz; Buğdacı, Mehmet Sait; Cil, Esra; Altuntas, Yüksel

2012-01-01

To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy. The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography. The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease. This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.

Effect of atrial systole on canine and porcine coronary blood flow.

Science.gov (United States)

Bellamy, R F

1981-09-01

A feature of phasic coronary flow patterns recorded in conscious chronically instrumented dogs is the atrial cove--a transient depression of arterial flow that occurs during atrial systole. The association between the hemodynamic effects of atrial systole and the atrial cove was studied in anesthetized dogs and pigs with complete heart block. Many atrial coves are available for study in these preparations because atrial activity continues unabated during the diastolic ventricular arrest that follows cessation of electrical pacing. The effect of atrial systole is to translate the pressure-flow relation found during diastole to a higher intercept pressure without change in slope. The increase in the intercept pressure equals the increase in intramyocardial pressure measured with microtransducers embedded in the left ventricular wall. The decrement in flow during the atrial cove is a direct function of the change in intramyocardial pressure and an inverse function of coronary vascular resistance. Each atrial systole is associated with a forward flow transient in the coronary veins, the peak of which occurs at the same instant as does the nadir of atrial flow. These data suggest that the coronary vessels are acting as collapsible tubes and that the waterfall model of the coronary circulation is applicable. The following sequence is proposed to account for the atrial cove. Atrial systole ejects a bolus of blood into the left ventricle increasing both ventricular cavity and intramyocardial pressures. The increase in intramyocardial pressure raises the back pressure opposing coronary flow, reducing the arterial perfusion pressure gradient and causing flow to fall.

Can middle cerebral artery peak systolic velocity predict polycythemia in monochorionic-diamniotic twins? Evidence from a prospective cohort study.

Science.gov (United States)

Fishel-Bartal, M; Weisz, B; Mazaki-Tovi, S; Ashwal, E; Chayen, B; Lipitz, S; Yinon, Y

2016-10-01

The antenatal diagnosis of twin anemia-polycythemia sequence (TAPS) in monochorionic-diamniotic (MCDA) twin pregnancies is based on elevated peak systolic velocity in the middle cerebral artery (MCA-PSV) in the donor twin and decreased MCA-PSV in the recipient twin. However, the association between these parameters and polycythemia has not yet been established. The aim of this study was to determine whether MCA-PSV can predict polycythemia in MCDA pregnancies. This was a prospective cohort study of MCDA pregnancies recruited at 14-18 weeks' gestation from a single tertiary care center between January 2011 and June 2014. Fetal MCA Doppler waveforms were recorded every 2 weeks from 18 weeks' gestation until delivery. Only those with an MCA-PSV measurement within 1 week of delivery were included in the analysis. Neonatal hematocrit level was determined in all twins from venous blood obtained within 4 h of delivery. Polycythemia was defined as a hematocrit of > 65%, and anemia as a hematocrit of  8 g/dL and reticulocyte count ratio of > 1.7 were observed. Of 162 MCDA pregnancies followed during the study period, 69 had an MCA-PSV measurement within 1 week of delivery and were included in the study. Twenty-five neonates were diagnosed with polycythemia and nine twin pairs met the criteria for TAPS. In a pooled analysis, MCA-PSV was negatively correlated with neonatal hematocrit (P = 0.017, r = -0.215) and was significantly higher in anemic fetuses than in normal controls (1.15 multiples of the median (MoM) vs 1.02 MoM, respectively; P = 0.001). However, MCA-PSV was similar among polycythemic and normal fetuses (0.95 MoM vs 1.02 MoM, respectively; P = 0.47). Intertwin difference in MCA-PSV (delta MCA-PSV) was positively correlated with intertwin hematocrit difference (P = 0.002, r = 0.394). Moreover, twin pregnancies with an intertwin hematocrit difference of > 24% had a significantly greater delta MCA-PSV than did those with an intertwin hematocrit

Value of systolic pulmonary arterial pressure as a prognostic factor of death in the systemic sclerosis EUSTAR population

DEFF Research Database (Denmark)

Hachulla, Eric; Clerson, Pierre; Airò, Paolo

2015-01-01

OBJECTIVE: The aim of this study was to assess the prognostic value of systolic pulmonary artery pressure (sPAP) estimated by echocardiography in the multinational European League Against Rheumatism Scleroderma Trial and Research (EUSTAR) cohort. METHODS: Data for patients with echocardiography...

Systolic hypertension: an increasing clinical challenge in Asia

Science.gov (United States)

Park, Jeong Bae; Kario, Kazuomi; Wang, Ji-Guang

2015-01-01

Systolic hypertension, the predominant form of hypertension in patients aged over 50–60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications. PMID:25503845

Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

Science.gov (United States)

Deng, Yan; Peng, Long; Liu, Yuan-Yuan; Yin, Li-Xue; Li, Chun-Mei; Wang, Yi; Rao, Li

2017-09-01

The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild single vessel coronary artery stenosis, and locate stenosis coronary artery accordingly. © 2017, Wiley Periodicals, Inc.

Head-to-head comparison of peak supine bicycle exercise echocardiography and treadmill exercise echocardiography at peak and at post-exercise for the detection of coronary artery disease.

Science.gov (United States)

Peteiro, Jesús; Bouzas-Mosquera, Alberto; Estevez, Rodrigo; Pazos, Pablo; Piñeiro, Miriam; Castro-Beiras, Alfonso

2012-03-01

Supine bicycle exercise (SBE) echocardiography and treadmill exercise (TME) echocardiography have been used for evaluation of coronary artery disease (CAD). Although peak imaging acquisition has been considered unfeasible with TME, higher sensitivity for the detection of CAD has been recently found with this method compared with post-TME echocardiography. However, peak TME echocardiography has not been previously compared with the more standardized peak SBE echocardiography. The aim of this study was to compare peak TME echocardiography, peak SBE echocardiography, and post-TME echocardiography for the detection of CAD. A series of 116 patients (mean age, 61 ± 10 years) referred for evaluation of CAD underwent SBE (starting at 25 W, with 25-W increments every 2-3 min) and TME with peak and postexercise imaging acquisition, in a random sequence. Digitized images at baseline, at peak TME, after TME, and at peak SBE were interpreted in a random and blinded fashion. All patients underwent coronary angiography. Maximal heart rate was higher during TME, whereas systolic blood pressure was higher during SBE, resulting in similar rate-pressure products. On quantitative angiography, 75 patients had coronary stenosis (≥50%). In these patients, wall motion score indexes at maximal exercise were higher at peak TME (median, 1.45; interquartile range [IQR], 1.13-1.75) than at peak SBE (median, 1.25; IQR, 1.0-1.56) or after TME (median, 1.13; IQR, 1.0-1.38) (P = .002 between peak TME and peak SBE imaging, P peak TME (median, 5; IQR, 2-12) compared with peak SBE (median, 3; IQR, 0-8) or after TME (median, 2; IQR, 0-4) (P peak TME and peak SBE imaging, P peak TME, peak SBE, and post-TME echocardiography for CAD was 84%, 75%, and 60% (P = .001 between post-TME and peak TME echocardiography, P = .055 between post-TME and peak SBE echocardiography), with specificity of 63%, 80%, and 78%, respectively (P = NS) and accuracy of 77%, 77%, and 66%, respectively (P = NS). Peak TME

Treatment of an Unusual Occurrence of a Complex Left Subclavian Artery/Left Internal Mammary Artery Bifurcation Stenosis in the Setting of Coronary Subclavian Steal Syndrome and Ischemic Left Ventricular Systolic Dysfunction

Directory of Open Access Journals (Sweden)

Michael J. Martinelli

2018-01-01

Full Text Available This case will illustrate the clinical and unique technical challenges, not previously reported, in a patient with a history of progressive left ventricular (LV systolic dysfunction, congestive heart failure (CHF, myocardial infarction (MI, and a complex bifurcation lesion of the left subclavian artery (SA involving the left internal mammary artery (LIMA in the setting of coronary subclavian steal syndrome (CSSS. The approach to this lesion is complicated by significant LIMA involvement requiring intervention directed toward both the SA and the LIMA in the presence of severe LV systolic dysfunction. This clinical scenario necessitates a careful technique, utilizing bifurcation methods similar to those used in coronary intervention.

Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

DEFF Research Database (Denmark)

Køber, Lars; Thune, Jens J; Nielsen, Jens C

2016-01-01

Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due...... to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). Methods In a randomized, controlled trial, 556 patients with symptomatic systolic heart.......6%) in the control group (P=0.29). Conclusions In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic...

Comparing the Efficacy of Tadalafil Versus Placebo on Pulmonary Artery Systolic Pressure and Right Ventricular Function in Patients with Beta-Thalassaemia Intermedia.

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Jalalian, Rozita; Moghadamnia, Ali Akbar; Tamaddoni, Ahmad; Khafri, Soraya; Iranian, Mohammadreza

2017-07-01

Conventional oral therapies in the management of pulmonary hypertension in people without haemoglobinopathies are of limited value in thalassaemia patients because of toxicity and poor effectiveness. This study was conducted to assess the effect of tadalafil on pulmonary artery pressure and right ventricular systolic function in patients with beta-thalassaemia intermedia. Forty-four patients with beta-thalassaemia intermedia with pulmonary hypertension based on transthoracic echocardiography (TTE) were entered in the study. Patients with hepatic or renal insufficiency and also patients who were treated with organic nitrates or alpha-blockers were excluded. The patients were randomly divided into two groups (n=22) and they were treated for six weeks with tadalafil (40mg daily) or placebo. The pulmonary artery systolic pressure (PASP), tricuspid regurgitation velocity (TRV) and parameters related to systolic function of the right ventricle were measured by the TTE before and after treatment. Significant improvement in TRV (3.02±0.02 m/s-2.52±0.06 m/s), PASP (45.31±0.66 mmHg-34.26±1.15mmHg) and parameters related to systolic function of the right ventricle were observed in the group who received tadalafil compared to placebo (pintermedia. Likewise, tadalafil improved right ventricular systolic function in the patients. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Carotid stenosis measurement on colour Doppler ultrasound: Agreement of ECST, NASCET and CCA methods applied to ultrasound with intra-arterial angiographic stenosis measurement

International Nuclear Information System (INIS)

Wardlaw, Joanna M.; Lewis, Steff

2005-01-01

Purpose: Carotid stenosis is usually determined on Doppler ultrasound from velocity readings. We wondered if angiography-style stenosis measurements applied to ultrasound images improved accuracy over velocity readings alone, and if so, which measure correlated best with angiography. Materials and methods: We studied prospectively patients undergoing colour Doppler ultrasound (CDU) for TIA or minor stroke. Those with 50%+ symptomatic internal carotid artery (ICA) stenosis had intra-arterial angiography (IAA). We measured peak systolic ICA velocity, and from the ultrasound image, the minimal residual lumen, the original lumen (ECST), ICA diameter distal (NASCET) and CCA diameter proximal (CCA method) to the stenosis. The IAAs were measured by ECST, NASCET and CCA methods also, blind to CDU. Results: Amongst 164 patients (328 arteries), on CDU the ECST, NASCET and CCA stenosis measures were similarly related to each other (ECST = 0.54 NASCET + 46) as on IAA (ECST = 0.6 NASCET + 40). Agreement between CDU- and IAA-measured stenosis was similar for ECST (r = 0.51), and CCA (r = 0.48) methods, and slightly worse for NASCET (r = 0.41). Adding IAA-style stenosis to the peak systolic ICA velocity did not improve agreement with IAA over peak systolic velocity alone. Conclusion: Angiography-style stenosis measures have similar inter-relationships when applied to CDU, but do not improve accuracy of ultrasound over peak systolic ICA velocity alone

Measuring systolic arterial blood pressure. Possible errors from extension tubes or disposable transducer domes.

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Rothe, C F; Kim, K C

1980-11-01

The purpose of this study was to evaluate the magnitude of possible error in the measurement of systolic blood pressure if disposable, built-in diaphragm, transducer domes or long extension tubes between the patient and pressure transducer are used. Sinusoidal or arterial pressure patterns were generated with specially designed equipment. With a long extension tube or trapped air bubbles, the resonant frequency of the catheter system was reduced so that the arterial pulse was amplified as it acted on the transducer and, thus, gave an erroneously high systolic pressure measurement. The authors found this error to be as much as 20 mm Hg. Trapped air bubbles, not stopcocks or connections, per se, lead to poor fidelity. The utility of a continuous catheter flush system (Sorenson, Intraflow) to estimate the resonant frequency and degree of damping of a catheter-transducer system is described, as are possibly erroneous conclusions. Given a rough estimate of the resonant frequency of a catheter-transducer system and the magnitude of overshoot in response to a pulse, the authors present a table to predict the magnitude of probable error. These studies confirm the variability and unreliability of static calibration that may occur using some safety diaphragm domes and show that the system frequency response is decreased if air bubbles are trapped between the diaphragms. The authors conclude that regular procedures should be established to evaluate the accuracy of the pressure measuring systems in use, the transducer should be placed as close to the patient as possible, the air bubbles should be assiduously eliminated from the system.

Arterial wave intensity and ventricular-arterial coupling by vascular ultrasound: rationale and methods for the automated analysis of forwards and backwards running waves.

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Rakebrandt, F; Palombo, C; Swampillai, J; Schön, F; Donald, A; Kozàkovà, M; Kato, K; Fraser, A G

2009-02-01

Wave intensity (WI) in the circulation is estimated noninvasively as the product of instantaneous changes in pressure and velocity. We recorded diameter as a surrogate for pressure, and velocity in the right common carotid artery using an Aloka SSD-5500 ultrasound scanner. We developed automated software, applying the water hammer equation to obtain local wave speed from the slope of a pressure/velocity loop during early systole to separate net WI into individual forwards and backwards-running waves. A quality index was developed to test for noisy data. The timing, duration, peak amplitude and net energy of separated WI components were measured in healthy subjects with a wide age range. Age and arterial stiffness were independent predictors of local wave speed, whereas backwards-travelling waves correlated more strongly with ventricular systolic function than with age-related changes in arterial stiffness. Separated WI offers detailed insight into ventricular-arterial interactions that may be useful for assessing the relative contributions of ventricular and vascular function to wave travel.

Increased dependence on slow filling for left ventricular diastolic filling in patients with coronary artery disease and a depressed systolic function

International Nuclear Information System (INIS)

Yamagishi, Takashi; Ozaki, Masaharu; Furutani, Yuhji; Yamamoto, Kouzo; Saeki, Atsushi; Satoh, Shinichi; Kusukawa, Reizo

1990-01-01

Contributions of rapid filling, slow filling and atrial systole to the left ventricular(LV) filling volume were analyzed with the use of radionuclide ventriculography at rest, both globally and regionally, in 34 patients with isolated disease of the left anterior descending coronary artery. The patients included 17 with a normal ejection fraction (EF≥50%; group 1) and 17 with a depressed EF (<50%; group 2), and the data were compared with those obtained from 13 normal subjects. A computer program subdivided the LV image into 4 regions, and time-activity curves were constructed globally and regionally by reverse-gating from the R wave. In both groups the contribution of rapid filling to the LV filling volume was decreased significantly in the affected septal and apical regions, and in the global left ventricle compared with that in normal subjects. In group 1, the contribution of atrial systole showed an increase in these affected regions and in the global left ventricle. In contrast, in group 2, the atrial contribution was not increased globally or regionally as much as was expected. However, the contribution of slow filling was either increased significantly or tended to increase in the affected regions and in the global left ventricle. There were negative correlations between the contribution of rapid filling and that of slow filling in the global left ventricle (r=-0.73, p<0.001) and in each of the septal, apical and lateral regions (r≥-0.60, p<0.001), which suggested that the contribution of slow filling as well as of atrial systole undergoes an increase as rapid filling is impaired. Thus, in patients with coronary artery disease, the left ventricle relies on slow filling as well as atrial systole to affect diastolic LV filling in the affected regions and in the global left ventricle in the presence of LV systolic dysfunction. (author)

Advanced Age Attenuates Left Ventricular Filling Efficiency Quantified Using Vortex Formation Time: A Study of Octogenarians With Normal Left Ventricular Systolic Function Undergoing Coronary Artery Surgery.

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Pagel, Paul S; Dye, Lonnie; Boettcher, Brent T; Freed, Julie K

2018-03-07

Blood flow across the mitral valve during early left ventricular (LV) filling produces a 3-dimensional rotational fluid body, known as a vortex ring, that enhances LV filling efficiency. Diastolic dysfunction is common in elderly patients, but the influence of advanced age on vortex formation is unknown. The authors tested the hypothesis that advanced age is associated with a reduction in LV filling efficiency quantified using vortex formation time (VFT) in octogenarians undergoing coronary artery bypass graft (CABG) surgery. Observational study. Veterans Affairs medical center. After institutional review board approval, octogenarians (n = 7; 82 ± 2 year [mean ± standard deviation]; ejection fraction 56% ± 7%) without valve disease or atrial arrhythmias undergoing CABG were compared with a younger cohort (n = 7; 55 ± 6 year; ejection fraction 57% ± 7%) who were undergoing coronary revascularization. None. All patients were monitored using radial and pulmonary arterial catheters and transesophageal echocardiography. Peak early LV filling (E) and atrial systole (A) blood flow velocities and their corresponding velocity-time integrals were obtained using pulse-wave Doppler echocardiography to determine E/A, atrial filling fraction (β), and E wave deceleration time. Pulse-wave Doppler also was used to measure pulmonary venous blood flow during systole and diastole. Mitral valve diameter (D) was calculated as the average of major and minor axis lengths obtained in the midesophageal LV bicommissural and long-axis transesophageal echocardiography imaging planes, respectively. VFT was calculated as 4 × (1 - β) × SV/(πD 3 ), where SV is the stroke volume measured using thermodilution. Systemic and pulmonary hemodynamics, LV diastolic function, and VFT were determined during steady-state conditions 30 minutes before cardiopulmonary bypass. A delayed relaxation pattern of LV filling (E/A 0.81 ± 0.16 v 1.29 ± 0.19, p = 0.00015; β 0.44 ± 0.05 v 0.35 ± 0.03, p = 0

Flow-related Right Ventricular - Pulmonary Arterial Pressure Gradients during Exercise.

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Wright, Stephen P; Opotowsky, Alexander R; Buchan, Tayler A; Esfandiari, Sam; Granton, John T; Goodman, Jack M; Mak, Susanna

2018-06-06

The assumption of equivalence between right ventricular and pulmonary arterial systolic pressure is fundamental to several assessments of right ventricular or pulmonary vascular hemodynamic function. Our aims were to 1) determine whether systolic pressure gradients develop across the right ventricular outflow tract in healthy adults during exercise, 2) examine the potential correlates of such gradients, and 3) consider the effect of such gradients on calculated indices of right ventricular function. Healthy untrained and endurance-trained adult volunteers were studied using right-heart catheterization at rest and during submaximal cycle ergometry. Right ventricular and pulmonary artery pressures were simultaneously transduced, and cardiac output was determined by thermodilution. Systolic pressures, peak and mean gradients, and indices of chamber, vascular, and valve function were analyzed offline. Summary data are reported as mean ± standard deviation or median [interquartile range]. No significant right ventricular outflow tract gradients were observed at rest (mean gradient = 4 [3-5] mmHg), and calculated effective orifice area was 3.6±1.0 cm2. Right ventricular systolic pressure increases during exercise were greater than that of pulmonary artery systolic pressure. Accordingly, mean gradients developed during light exercise (8 [7-9] mmHg) and increased during moderate exercise (12 [9-14] mmHg, p < 0.001). The magnitude of the mean gradient was linearly related to cardiac output (r2 = 0.70, p < 0.001). In healthy adults without pulmonic stenosis, systolic pressure gradients develop during exercise, and the magnitude is related to blood flow rate.

Estimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation.

Science.gov (United States)

Ko, Sae Hee; Bandyk, Dennis F; Hodgkiss-Harlow, Kelley D; Barleben, Andrew; Lane, John

2015-06-01

This study validated duplex ultrasound measurement of brachial artery volume flow (VF) as predictor of dialysis access flow maturation and successful hemodialysis. Duplex ultrasound was used to image upper extremity dialysis access anatomy and estimate access VF within 1 to 2 weeks of the procedure. Correlation of brachial artery VF with dialysis access conduit VF was performed using a standardized duplex testing protocol in 75 patients. The hemodynamic data were used to develop brachial artery flow velocity criteria (peak systolic velocity and end-diastolic velocity) predictive of three VF categories: low (800 mL/min). Brachial artery VF was then measured in 148 patients after a primary (n = 86) or revised (n = 62) upper extremity dialysis access procedure, and the VF category correlated with access maturation or need for revision before hemodialysis usage. Access maturation was conferred when brachial artery VF was >600 mL/min and conduit imaging indicated successful cannulation based on anatomic criteria of conduit diameter >5 mm and skin depth 800 mL/min was predicted when the brachial artery lumen diameter was >4.5 mm, peak systolic velocity was >150 cm/s, and the diastolic-to-systolic velocity ratio was >0.4. Brachial artery velocity spectra indicating VF 800 mL/min. Duplex testing to estimate brachial artery VF and assess the conduit for ease of cannulation can be performed in 5 minutes during the initial postoperative vascular clinic evaluation. Estimation of brachial artery VF using the duplex ultrasound, termed the "Fast, 5-min Dialysis Duplex Scan," facilitates patient evaluation after new or revised upper extremity dialysis access procedures. Brachial artery VF correlates with access VF measurements and has the advantage of being easier to perform and applicable for forearm and also arm dialysis access. When brachial artery velocity spectra criteria confirm a VF >800 mL/min, flow maturation and successful hemodialysis are predicted if anatomic criteria

Myocardial Strain Analysis by 2-Dimensional Speckle Tracking Echocardiography Improves Diagnostics of Coronary Artery Stenosis in Stable Angina Pectoris

DEFF Research Database (Denmark)

Biering-Sørensen, Tor; Hoffmann, Soren; Mogelvang, Rasmus

2014-01-01

BACKGROUND: Two-dimensional strain echocardiography detects early signs of left ventricular dysfunction; however, it is unknown whether myocardial strain analysis at rest in patients with suspected stable angina pectoris predicts the presence of coronary artery disease (CAD). METHODS AND RESULTS...... echocardiography was performed in the 3 apical projections. Peak regional longitudinal systolic strain was measured in 18 myocardial sites and averaged to provide global longitudinal peak systolic strain. Duke score, including ST-segment depression, chest pain, and exercise capacity, was used as the outcome...

Etiology and diagnosis of systolic murmurs in adults.

Science.gov (United States)

McGee, Steven

2010-10-01

It is unknown whether echocardiography can provide insights into the origin of systolic murmurs and the modern value of bedside cardiovascular diagnosis. The author examined 376 inpatients and compared their physical findings to transthoracic echocardiography, exploring the associations between echocardiography and systolic murmurs and investigating the diagnostic accuracy of physical examination for pathologic murmurs. Four echocardiographic variables predict the presence of systolic murmurs: peak aortic velocity (P onomatopoeia and classifying systolic murmurs into 1 of 6 patterns is diagnostically helpful. Copyright © 2010. Published by Elsevier Inc.

Choice of marker for assessment of RV dysfunction in acute pulmonary embolism : NT-proBNP, pulmonary artery systolic pressure, mean arterial pressure, or blood pressure index.

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Ates, H; Ates, I; Kundi, H; Yilmaz, F M

2017-12-01

We aimed to examine the value of NT-proBNP, pulmonary artery systolic pressure (PASP), blood pressure index (BPI), and mean arterial pressure (MAP) in the determination of right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). A total of 547 patients diagnosed with APE were included in the study. Demographic characteristics and comorbid conditions of patients were recorded in patient files. For blood pressure measurement, a calibrated digital blood pressure monitor was used at regular intervals. Blood samples were taken from patients at the time of admission for hemogram, biochemical, and hemostasis blood tests. Echocardiography was performed on all patients to detect RVD and evaluate pulmonary artery pressure. PASP (p blood pressure (p blood cell (p AUC ± SE = 0.975 ± 0.006; p < 0.001) was found to be the best predictor of RVD with a higher sensitivity (92.8%) and specificity (100%). We found that BPI had a better diagnostic discrimination for RVD compared with PASP and NT-proBNP.

Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients

International Nuclear Information System (INIS)

Dormagen, Johann B.; Gaarder, Christine; Sandvik, Leiv; Naess, Paal A.; Kloew, Nils E.

2008-01-01

We studied the changes in proximal embolization of the splenic artery to the intraparenchymal blood flow with Doppler ultrasound. Seventeen trauma patients with spleen injury OIS grade 2-5 underwent embolization of the splenic artery. Peak-systolic velocity (PSV) and end-diastolic velocity (EDV) were measured in intrasplenic arteries initially 1 day after embolization, at early follow-up after 7 days, at intermediate follow-up after 10 weeks, and at late follow-up after 10 months. Resistance index (RI), systolic/diastolic ratio (S/D ratio), acceleration (AC), and acceleration time (AT) were calculated. The results were compared to values from 17 volunteers. RI increased from 0.39 initially to 0.49 (P = 0.002) at intermediate and to 0.52 (P 2 initially to 1.89 m/s 2 at late follow-up (P = 0.01). AC at late follow-up was not different from reference group (2.33 m/s 2 ). In conclusion, Doppler ultrasound is a useful tool in the evaluation of improvable intraparenchymal blood flow over time after central splenic artery embolization. (orig.)

[CHANGES OF CAROTID AND VERTEBRAL ARTERIES IN PATENTS WITH ARTERIAL HYPERTENSION AND HEPATOBILIARY PATHOLOGY].

Science.gov (United States)

Polyakov, V Ya; Nikolaev, Yu A; Pegova, S V; Matsievskaya, T R; Obukhov, I V

2016-01-01

The study included 1172 patients (410 men and 762 women) at the mean age of 60.3 ± 10.4 years with grade I-II (stage I-II) arterial hypertension (AH) admitted to the clinic of Institute of Experimental Medicine. The patients were divided into 2 groups based on the results of clinical and laboratory diagnostics. Group 1 (n = 525) included patients with AH and hepatobiliary system (HBS) diseases, group 2 (n = 647) patients with AH without HBS diseases. The patients group 1 had a thicker intima-media complex of carotid arteries, higher peak systolic bloodflow rate in the internal and vertebral carotid arteries, more pronounced coiling of internal carotid arteries than patients of group 2. Patients with AH and HBS diseases exhibited correlation between bloodflow rate in external carotid arteries and atherogenicity coefficient. Duplex scanning of neck vessels of in patients with AH without HBS diseases revealed peculiar changes of the intima-media thickness and hemodynamically significant changes of the blood flow in the internal carotid arteries that may be of prognostic value in this nosological syntropy and require the personified approach to diagnostics, treatment, and prevention of these conditions.

Simultaneous inter-arm and inter-leg systolic blood pressure differences to diagnose peripheral artery disease: a diagnostic accuracy study.

Science.gov (United States)

Herráiz-Adillo, Ángel; Soriano-Cano, Alba; Martínez-Hortelano, José Alberto; Garrido-Miguel, Miriam; Mariana-Herráiz, Julián Ángel; Martínez-Vizcaíno, Vicente; Notario-Pacheco, Blanca

2018-04-01

Inter-arm systolic blood pressure differences (IASBPD) and inter-leg systolic blood pressure differences (ILSBPD) have arisen as potential tools to detect peripheral artery disease (PAD) and individuals at high cardiovascular risk. This study aims to evaluate the diagnostic accuracy of IASBPD and ILSBPD to detect PAD, and whether IASBPD or ILSBPD improves diagnostic accuracy of the oscillometric ankle-brachial index (ABI). In this prospective study, eligible for inclusion were consecutive adults, with at least one of the following cardiovascular risk factors: diabetes, dyslipidemia, hypertension, smoking habit or age ≥65. IASBPD, ILSBPD and ankle-brachial index (ABI) were measured in all participants through four-limb simultaneous oscillometric measurements and compared with Doppler ABI (reference test, positive cut-off: ≤ 0.9). Of 171 subjects included, PAD was confirmed in 23 and excluded in 148. Thirteen and 38 subjects had IASBPD and ILSBPD ≥10 mmHg, respectively. Pearson correlation with Doppler ABI of IASBPD and ILSBPD was 0.073 (P = .343) and -0.628 (P blood pressure measurements in upper limbs are not possible.

Arterial pulse wave velocity, inflammatory markers, pathological GH and IGF states, cardiovascular and cerebrovascular disease

Directory of Open Access Journals (Sweden)

Michael R Graham

2008-12-01

Full Text Available Michael R Graham1, Peter Evans2, Bruce Davies1, Julien S Baker11Health and Exercise Science Research Unit, Faculty of Health Sport and Science, University of Glamorgan, Pontypridd, Wales, United Kingdom; 2Royal Gwent Hospital, Newport, Gwent, United KingdomAbstract: Blood pressure (BP measurements provide information regarding risk factors associated with cardiovascular disease, but only in a specific artery. Arterial stiffness (AS can be determined by measurement of arterial pulse wave velocity (APWV. Separate from any role as a surrogate marker, AS is an important determinant of pulse pressure, left ventricular function and coronary artery perfusion pressure. Proximal elastic arteries and peripheral muscular arteries respond differently to aging and to medication. Endogenous human growth hormone (hGH, secreted by the anterior pituitary, peaks during early adulthood, declining at 14% per decade. Levels of insulin-like growth factor-I (IGF-I are at their peak during late adolescence and decline throughout adulthood, mirror imaging GH. Arterial endothelial dysfunction, an accepted cause of increased APWV in GH deficiency (GHD is reversed by recombinant human (rh GH therapy, favorably influencing the risk for atherogenesis. APWV is a noninvasive method for measuring atherosclerotic and hypertensive vascular changes increases with age and atherosclerosis leading to increased systolic blood pressure and increased left ventricular hypertrophy. Aerobic exercise training increases arterial compliance and reduces systolic blood pressure. Whole body arterial compliance is lowered in strength-trained individuals. Homocysteine and C-reactive protein are two infl ammatory markers directly linked with arterial endothelial dysfunction. Reviews of GH in the somatopause have not been favorable and side effects of treatment have marred its use except in classical GHD. Is it possible that we should be assessing the combined effects of therapy with rhGH and rh

VASOMOTOR ENDOTHELIAL FUNCTION AND MICROCIRCULATION IN ELDERLY PATIENTS WITH ISOLATED SYSTOLIC ARTERIAL HYPERTENSION: INFLUENCE OF "DRY" CARBONIC BATHS AND GENERAL LOW-FREQUENCY MAGNETOTHERAPY

OpenAIRE

Alypova, Elena

2013-01-01

Abstract. The comparative estimation of influence of the general low-frequency magnetotherapy (GLMT) and "dry" carbonic baths (DCB) on indicators of vasomotor endothelial function and microcirculation in elderly patients with isolated systolic (ISAH) arterial hypertension has been studied. The efficiency of application the combined use of the GLMT and "dry" carbonic baths DCB for correction of revealed disorders in comparing to the monovariant use of thees medical physical factors is establis...

Relationship between the Direction of Ophthalmic Artery Blood Flow and Ocular Microcirculation before and after Carotid Artery Stenting.

Science.gov (United States)

Ishii, Masashi; Hayashi, Morito; Yagi, Fumihiko; Sato, Kenichiro; Tomita, Goji; Iwabuchi, Satoshi

2016-01-01

When internal carotid artery stenosis is accompanied by ocular ischemic syndrome, intervention is recommended to prevent irreversible visual loss. In this study, we used laser speckle flowgraphy to measure the ocular microcirculation in the optic nerve head before and after carotid artery stenting (CAS) of 40 advanced internal carotid stenosis lesions from 37 patients. The aim was to investigate the relationship between ocular microcirculation and the direction of ophthalmic artery blood flow obtained by angiography. We found that there was a significant increase in blood flow after CAS ( P = 0.003). Peak systolic velocity as an indicator of the rate of stenosis was also significantly higher in the group with retrograde/undetected flow of the ophthalmic artery than in the group with antegrade flow ( P = 0.002). In all cases where retrograde flow of the ophthalmic artery was observed before stenting, the flow changed to antegrade after stenting. Through the use of laser speckle flowgraphy, this study found that CAS can improve ocular microcirculation. Furthermore, while patients displaying retrograde flow of the ophthalmic artery before stenting have a poor prognosis, CAS corrected the flow to antegrade, suggesting that visual loss can be prevented by improving the ocular microcirculation.

Arterial stiffening precedes systolic hypertension in diet-induced obesity.

Science.gov (United States)

Weisbrod, Robert M; Shiang, Tina; Al Sayah, Leona; Fry, Jessica L; Bajpai, Saumendra; Reinhart-King, Cynthia A; Lob, Heinrich E; Santhanam, Lakshmi; Mitchell, Gary; Cohen, Richard A; Seta, Francesca

2013-12-01

Stiffening of conduit arteries is a risk factor for cardiovascular morbidity. Aortic wall stiffening increases pulsatile hemodynamic forces that are detrimental to the microcirculation in highly perfused organs, such as the heart, brain, and kidney. Arterial stiffness is associated with hypertension but presumed to be due to an adaptive response to increased hemodynamic load. In contrast, a recent clinical study found that stiffness precedes and may contribute to the development of hypertension although the mechanisms underlying hypertension are unknown. Here, we report that in a diet-induced model of obesity, arterial stiffness, measured in vivo, develops within 1 month of the initiation of the diet and precedes the development of hypertension by 5 months. Diet-induced obese mice recapitulate the metabolic syndrome and are characterized by inflammation in visceral fat and aorta. Normalization of the metabolic state by weight loss resulted in return of arterial stiffness and blood pressure to normal. Our findings support the hypothesis that arterial stiffness is a cause rather than a consequence of hypertension.

Serum Endoglin Levels in Patients Suffering from Systemic Sclerosis and Elevated Systolic Pulmonary Arterial Pressure

Directory of Open Access Journals (Sweden)

Paola Ximena Coral-Alvarado

2010-01-01

Full Text Available Background. Pulmonary arterial hypertension (PAH is the main cause of morbimortality in systemic sclerosis (SSc. Increased Eng expression has been demonstrated in SSc patients. Objective. Ascertaining serum levels of Eng in SSc patients with and without elevated systolic pulmonary arterial pressure (sPAP and comparing them with that of healthy volunteers. Methods. A cross-sectional study was carried out. A commercial ELISA kit was used for measuring serum concentrations of Eng in 60 subjects: 40 patients with SSc with and without elevated sPAP, compared to 20 healthy control subjects. Elevated sPAP was detected by echocardiogram. Results. No association between positive Eng and elevated sPAP was found when compared to the SSc without elevated sPAP group (OR=2.85; 0.65–12.88 95% CI; P=.11; however, an association was found between positive Eng and elevated sPAP compared to healthy controls (OR=23.22; 2.46–1050.33 95% CI; P=.001, and weak association was found between the positive Eng with SSc without elevated sPAP group compared to healthy controls (OR=8.14, 0.8–393.74 95% CI; P=.046. Conclusion. Raised serum levels of Eng in SSc patients compared to healthy controls were found, suggesting a role for Eng in SSc vasculopathy and not just in elevated sPAP. However, prospective studies are needed to verify such observations.

Arterial pressure measurement: Is the envelope curve of the oscillometric method influenced by arterial stiffness?

International Nuclear Information System (INIS)

Gelido, G; Angiletta, S; Pujalte, A; Quiroga, P; Cornes, P; Craiem, D

2007-01-01

Measurement of peripheral arterial pressure using the oscillometric method is commonly used by professionals as well as by patients in their homes. This non invasive automatic method is fast, efficient and the required equipment is affordable with a low cost. The measurement method consists of obtaining parameters from a calibrated decreasing curve that is modulated by heart beats witch appear when arterial pressure reaches the cuff pressure. Diastolic, mean and systolic pressures are obtained calculating particular instants from the heart beats envelope curve. In this article we analyze the envelope of this amplified curve to find out if its morphology is related to arterial stiffness in patients. We found, in 33 volunteers, that the envelope waveform width correlates to systolic pressure (r=0.4, p<0.05), to pulse pressure (r=0.6, p<0.05) and to pulse pressure normalized to systolic pressure (r=0.6, p<0.05). We believe that the morphology of the heart beats envelope curve obtained with the oscillometric method for peripheral pressure measurement depends on arterial stiffness and can be used to enhance pressure measurements

The influence of the maximal value and peak enhancement value of arterial and venous enhancement curve on CT perfusion parameters and signal-to-noise ratio

International Nuclear Information System (INIS)

Ju Haiyue; Gao Sijia; Xu Ke; Wang Qiang

2007-01-01

Objective: To explore the influence of the maximal value and peak enhancement value of arterial and venous enhancement curve on CT perfusion parameters and signal-to-noise ratio (SNR). Methods: Seventeen patients underwent brain CT perfusion scanning. All row data were analyzed with perfusion software for 6 times, and get different arterial and venous enhancement curves for each patient. The maximal values and peak enhancement values of each arterial and venous enhancement curves, as well as mean perfusion parameters including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), permeability surface area product (PS), and their standard deviations (SD) in homolateral white and gray matter were measured and recorded. SNR was calculated by dividing the mean perfusion parameter value by its SD. Pearson correlation analysis and two-tailed paired Student t test were used for statistics. Results: The maximal values and peak enhancement values of arterial and venous curves were correlated with mean SNR CBF , SNR CBV and SNR MTT in both white matter and gray matters (r value range: 0.332-0.922, P PS in white matter(r=0.256, P PS (in both white matter and gray matters) and arterial peak enhancement values, the maximal values and venous peak enhancement values, or between SNR PS (in gray matter) and the maximal values of venous curve(r value range: -0.058-0.210, P>0.05). (2) Mean CBF, CBV and PS values in the group with low venous peak enhancement values were significantly different from the group with high venous peak enhancement values in both white and gray matters (t value range: 3.830-5.337, P 0.05). Conclusions: The mean perfusion parameters and SNR are influenced by the maximal values and peak enhancement values of the arterial and venous curves. Peak enhancement of arterial and venous curves should be adjusted to higher level to make parameter values more reliable and increase the SNR. (authors)

MR measurement of coronary arterial blood flow velocity. Evaluation of age, stenosis and drugs as factors affecting coronary blood flow

International Nuclear Information System (INIS)

Taoka, Yoshiaki; Harada, Masafumi; Nishitani, Hiromu; Yukinaka, Michiko; Nomura, Masahiro

1998-01-01

Coronary arterial blood flow velocity was measured using MRI. Two types of phase contrast methods were used for the measurements, one of which exhibited good resolving power whereas the other provided more distinct images acquired while the subject patients held their breath. Before measuring coronary arterial blood flow velocity, accuracy of the two phase contrast methods was evaluated using a phantom. The results obtained with both methods largely agreed with the values obtained using the phantom. Using both methods, the patterns of coronary arterial blood flow over one cardiac cycle were essentially identical. A peak was noted in late systole or in early diastole in the right coronary artery, whereas in the left coronary artery, a peak was noted somewhat later in diastole. In healthy volunteers, no significant difference in the maximal flow velocity in the coronary arteries was found from one age group to another. Among patients with coronary arterial stenosis, coronary arterial blood flow velocity central to the area of stenosis was lower than that observed in the healthy volunteers. Coronary arterial blood flow velocity was observed to decrease after administration of isosorbide dinitrate and increased following administration of nifedipine. (author)

Analysis of cardiac diastolic function: application in coronary artery disease

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Miller, T.R.; Goldman, K.J.; Sampathkumaran, K.S.; Biello, D.R.; Ludbrook, P.A.; Sobel, B.E.

1983-01-01

Separation of systolic and diastolic parameters in gated cardiac blood-pool imaging (RVG) was achieved with the retention of two harmonics in the Fourier-series representation of the time-activity curve. Regional and global analysis of left-ventricular peak filling rate (PFR) and time to peak filling (TPF) was performed in 18 control subjects, 20 patients with coronary artery disease (CAD) but with normal RVG (normal regional wall motion and ejection fraction, and 16 CAD patients with abnormal RVG. In regional analysis of CAD patients, the standard deviation of the TPF histogram identified 13/20 (65%) of normal RVG patients and 12/16 (75%) of abnormal RVG patients as abnormal. In global analysis of CAD patients, PFR values identified 10/20 (50%) of normal RVG patients and 11/16 (69%) of abnormal RVG patients as abnormal. Thus, left-ventricular systolic and diastolic parameters can be separately measured with retention of higher-order harmonics in the Fourier transform, and regional inhomogeneity of diastolic filling can be detected in CAD patients with normal resting ejection fraction and wall motion

SYSTOLIC HYPERTENSION. IMPACT ON CEREBROVASCULAR DISEASE

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Juan Eloy Cruz Quesada

2011-08-01

Full Text Available Background: Atherosclerosis is a multifactor process in which several risk factors are involved. It is the leading cause of death and morbidity in hospital admitted patients, and it may cause a marked decrease in blood flow to all organs of the body.Objective: To determine the impact of systolic hypertension on cerebrovascular disease.Methods: A cross-sectional, observational and analytical study was conducted in 59 death patients who suffered from hypertension. Cerebral arteries were analyzed and atherosclerotic lesion and its variety were quantified by using the atherometric system. The different types of hypertension were considered. Statistical (central tendency measures and comparative (comparison test based on Student’s arithmetic t-test procedures were used.Results: Recent strokes were more frequent in systodiastolic hypertensive patients. There was no significant difference in the injury onset age for both sexes, but women with systolic hypertension were significantly more damaged (from a morphometric point of view. Significant correlation for both groups of hypertensive patients was observed between type of stroke and atherometric system variables.Conclusions: Systolic hypertension is an important factor in the genesis of cerebrovascular disease and is associated with the progression of atherosclerotic plaque.

Maximum home systolic blood pressure is a useful indicator of arterial stiffness in patients with type 2 diabetes mellitus: post hoc analysis of a cross-sectional multicenter study.

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Ushigome, Emi; Fukui, Michiaki; Hamaguchi, Masahide; Tanaka, Toru; Atsuta, Haruhiko; Mogami, Shin-ichi; Tsunoda, Sei; Yamazaki, Masahiro; Hasegawa, Goji; Nakamura, Naoto

2014-09-01

Maximum (max) home systolic blood pressure (HSBP) as well as mean HSBP or HSBP variability was reported to increase the predictive value of target organ damage. Yet, the association between max HSBP and target organ damage in patients with type 2 diabetes has never been reported. The aim of this study was to investigate the association between max HSBP and pulse wave velocity (PWV), a marker of arterial stiffness which in turn is a marker of target organ damage, in patients with type 2 diabetes. We assessed the relationship of mean HSBP or max HSBP to PWV, and compared area under the receiver-operating characteristic curve (AUC) of mean HSBP or max HSBP for arterial stiffness in 758 patients with type 2 diabetes. In the univariate analyses, age, duration of diabetes mellitus, body mass index, mean clinic systolic blood pressure (SBP), mean HSBP and max HSBP were associated with PWV. Multivariate linear regression analyses indicated that mean morning SBP (β=0.156, P=0.001) or max morning SBP (β=0.146, P=0.001) were significantly associated with PWV. AUC (95% CI) for arterial stiffness, defined as PWV equal to or more than 1800 cm per second, in mean morning SBP and max morning SBP were 0.622 (0.582-0.662; P<0.001) and 0.631 (0.591-0.670; P<0.001), respectively. Our findings implicate that max HSBP as well as mean HSBP was significantly associated with arterial stiffness in patients with type 2 diabetes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Left Ventricular Function after Arterial Switch Operation as Assessed by Two-Dimensional Speckle-Tracking Echocardiography in Patients with Simple Transposition of the Great Arteries.

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Malakan Rad, Elaheh; Ghandi, Yazdan; Kocharian, Armen; Mirzaaghayan, Mohammadreza

2016-07-06

Background: The late postoperative course for children with transposition of the great arteries (TGA) with an intact ventricular septum (IVS) is very important because the coronary arteries may be at risk of damage during arterial switch operation (ASO). We sought to investigate left ventricular function in patients with TGA/IVS by echocardiography. Methods: From March 2011 to December 2012, totally 20 infants (12 males and 8 females) with TGA/IVS were evaluated via 2-dimensional speckle-tracking echocardiography (2D STE) more than 6 months after they underwent ASO. A control group of age-matched infants and children was also studied. Left ventricular longitudinal strain (S), strain rate (SR), time to peak systolic longitudinal strain (TPS), and time to peak systolic longitudinal strain rate (TPSR) were measured and compared between the 2 groups. Results: Mean ± SD of age at the time of study in the patients with TGA/IVS was 15 ± 5 months, and also age at the time of ASO was 12 ± 3 days. Weight was 3.13 ± 0.07 kg at birth and 8.83 ± 1.57 kg at the time of ASO. Global strain (S), Time to peak strain rate (TPSR), and Time to peak strain (TPS) were not significantly different between the 2 groups, whereas global strain rate (SR) was significantly different (p value < 0.001). In the 3-chamber view, the values of S in the lateral, septal, inferior, and anteroseptal walls were significantly different between the 2 groups (p value < 0.001), and SR in the posterior wall was significantly different between the 2 groups (p value < 0.001). There were no positive correlations between S and SR in terms of the variables of heart rate, total cardiopulmonary bypass time, and aortic cross-clamp time. There were no statistically significant differences between the 2 groups regarding S, SR, TPS, and TPSR in the anteroseptal and posterior walls in the 3-chamber view and in the lateral and septal walls in the 4-chamber view. Conclusion: We showed that between 6 and 18 months after

Resting multilayer 2D speckle-tracking TTE for detection of ischemic segments confirmed by invasive FFR part-2, using post-systolic-strain-index and time from aortic-valve-closure to regional peak longitudinal-strain.

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Ozawa, Koya; Funabashi, Nobusada; Nishi, Takeshi; Takahara, Masayuki; Fujimoto, Yoshihide; Kamata, Tomoko; Kobayashi, Yoshio

2016-08-15

This study evaluated the post-systolic strain index (PSI), and the time interval between aortic valve closure (AVC) and regional peak longitudinal strain (PLS), measured by transthoracic echocardiography (TTE), for detection of left ventricular (LV) myocardial ischemic segments confirmed by invasive fractional flow reserve (FFR). 39 stable patients (32 males; 65.8±11.9years) with 46 coronary arteries at ≥50% stenosis on invasive coronary angiography underwent 2D speckle tracking TTE (Vivid E9, GE Healthcare) and invasive FFR measurements. PSI, AVC and regional PLS in each LV segment were calculated. FFR ≤0.80 was detected in 27 LV segments. There were no significant differences between segments supplied by FFR ≤0.80 and FFR >0.80 vessels in either PSI or the time interval between AVC and regional PLS. To identify LV segments±FFR ≤0.80, the receiver operator characteristic (ROC) curves for PSI, and the time interval between AVC and regional PLS had areas under the curve (AUC) values of 0.58 and 0.57, respectively, with best cut-off points of 12% (sensitivity 70.4%, specificity 57.9%) and 88ms (sensitivity 70.4%, specificity 52.6%), respectively, but the AUCs were not statistically significant. In stable coronary artery disease patients with ≥50% coronary artery stenosis, measurement of PSI, and the time interval between AVC and regional PLS, on resting TTE, enabled the identification of LV segments with FFR ≤0.80 using each appropriate threshold for PSI, and the time interval between AVC and regional PLS, with reasonable diagnostic accuracy. However, the AUC values were not statistically significant. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Heart rate and flow velocity variability as determined from umbilical Doppler velocimetry at 10-20 weeks of gestation.

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Ursem, N T; Struijk, P C; Hop, W C; Clark, E B; Keller, B B; Wladimiroff, J W

1998-11-01

1. The aim of this study was to define from umbilical artery flow velocity waveforms absolute peak systolic and time-averaged velocity, fetal heart rate, fetal heart rate variability and flow velocity variability, and the relation between fetal heart rate and velocity variables in early pregnancy.2.A total of 108 women presenting with a normal pregnancy from 10 to 20 weeks of gestation consented to participate in a cross-sectional study design. Doppler ultrasound recordings were made from the free-floating loop of the umbilical cord.3. Umbilical artery peak systolic and time-averaged velocity increased at 10-20 weeks, whereas fetal heart rate decreased at 10-15 weeks of gestation and plateaued thereafter. Umbilical artery peak systolic velocity variability and fetal heart rate variability increased at 10-20 and 15-20 weeks respectively.4. The inverse relationship between umbilical artery flow velocity and fetal heart rate at 10-15 weeks of gestation suggests that the Frank-Starling mechanism regulates cardiovascular control as early as the late first and early second trimesters of pregnancy. A different underlying mechanism is suggested for the observed variability profiles in heart rate and umbilical artery peak systolic velocity. It is speculated that heart rate variability is mediated by maturation of the parasympathetic nervous system, whereas peak systolic velocity variability reflects the activation of a haemodynamic feedback mechanism.

Right ventricle performances with echocardiography and 99mTc myocardial perfusion imaging in pulmonary arterial hypertension patients.

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Liu, Jie; Fei, Lei; Huang, Guang-Qing; Shang, Xiao-Ke; Liu, Mei; Pei, Zhi-Jun; Zhang, Yong-Xue

2018-05-01

Right heart catheterization is commonly used to measure right ventricle hemodynamic parameters and is the gold standard for pulmonary arterial hypertension diagnosis; however, it is not suitable for patients' long-term follow-up. Non-invasive echocardiography and nuclear medicine have been applied to measure right ventricle anatomy and function, but the guidelines for the usefulness of clinical parameters remain to be established. The goal of this study is to identify reliable clinical parameters of right ventricle function in pulmonary arterial hypertension patients and analyze the relationship of these clinical parameters with the disease severity of pulmonary arterial hypertension. In this study, 23 normal subjects and 23 pulmonary arterial hypertension patients were recruited from January 2015 to March 2016. Pulmonary arterial hypertension patients were classified into moderate and severe pulmonary arterial hypertension groups according to their mean pulmonary arterial pressure levels. All the subjects were subjected to physical examination, chest X-ray, 12-lead electrocardiogram, right heart catheterization, two-dimensional echocardiography, and technetium 99m ( 99m Tc) myocardial perfusion imaging. Compared to normal subjects, the right heart catheterization indexes including right ventricle systolic pressure, right ventricle end diastolic pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary vascular resistance, and right ventricle end systolic pressure increased in pulmonary arterial hypertension patients and were correlated with mean pulmonary arterial pressure levels. Echocardiography parameters, including tricuspid regurgitation peak velocity, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion and fractional area, right ventricle-myocardial performance index, were significantly associated with the mean pulmonary arterial pressure levels in pulmonary arterial hypertension patients

Cardiac systolic function in cirrhotic patients’ candidate of liver trans-plantation compared with control group

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Roya Sattarzadeh-Badkoubeh

2017-02-01

Full Text Available Background: We assessed different systolic cardiac indices to describe left and right ventricular dysfunction in cirrhotic patients before liver transplantation. Methods: In this case-control study, eighty-one consecutive individuals with the confirmed hepatic cirrhosis and candidate for liver transplantation in the Imam Khomeini Hospital between March 2008 and March 2010 were selected. Thirty-two age and gender cross-matched healthy volunteers were also selected as the control group. A detailed two-dimensional and Doppler echocardiography was obtained in all patients and controls performed by the same operator on the day of admission. Results: Dimensions of both left and right atriums as well as left ventricular end-diastolic volume and basal right ventricular dimension in the cirrhotic group were significantly higher than control group. Left ventricular end-systolic dimensions as well as aortic annulus diameter were not different between the two study groups. Left ventricular outflow tract velocity time integral, isovolumic pre-ejection time, isovolumic relaxation time, stroke volume, left ventricular ejection fraction, IVCT+IVRT+ET, systolic velocity of tricuspid annulus, systolic velocity of basal segment of RV free wall, systolic velocity of basal segment of septal wall, peak strain of septal margin (base, peak strain of septal margin (midpoint, peak strain of lateral margin (midpoint, strain rate of septal margin (base, strain rate of septal margin (midpoint, strain rate of lateral margin (base, strain rate of lateral margin (midpoint, Tei index (left and right ventricles, systolic time interval and tricuspid annular plane systolic excursion were higher in cirrhotic group, significantly, (P< 0.05. Left ventricular ejection time and systolic velocity of mid segment of lateral wall were lower in cirrhotic group, significantly, (P< 0.05. Conclusion: In this study, the effects of liver on heart were volume overload, hyperdynamic state and

Systolic hypertension in adult nigerians with hypertension

International Nuclear Information System (INIS)

Opadijo, O.G.; Salami, T.A.T.; Sanya, E.O.; Omotoso, A.B.O.

2007-01-01

To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension. Newly diagnosed adult hypertensives, with blood pressure 140/90mm Hg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role. Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension. Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ

Computer model analysis of the radial artery pressure waveform.

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Schwid, H A; Taylor, L A; Smith, N T

1987-10-01

Simultaneous measurements of aortic and radial artery pressures are reviewed, and a model of the cardiovascular system is presented. The model is based on resonant networks for the aorta and axillo-brachial-radial arterial system. The model chosen is a simple one, in order to make interpretation of the observed relationships clear. Despite its simplicity, the model produces realistic aortic and radial artery pressure waveforms. It demonstrates that the resonant properties of the arterial wall significantly alter the pressure waveform as it is propagated from the aorta to the radial artery. Although the mean and end-diastolic radial pressures are usually accurate estimates of the corresponding aortic pressures, the systolic pressure at the radial artery is often much higher than that of the aorta due to overshoot caused by the resonant behavior of the radial artery. The radial artery dicrotic notch is predominantly dependent on the axillo-brachial-radial arterial wall properties, rather than on the aortic valve or peripheral resistance. Hence the use of the radial artery dicrotic notch as an estimate of end systole is unreliable. The rate of systolic upstroke, dP/dt, of the radial artery waveform is a function of many factors, making it difficult to interpret. The radial artery waveform usually provides accurate estimates for mean and diastolic aortic pressures; for all other measurements it is an inadequate substitute for the aortic pressure waveform. In the presence of low forearm peripheral resistance the mean radial artery pressure may significantly underestimate the mean aortic pressure, as explained by a voltage divider model.

[Ultrasonographic study of blood flow in the renal arteries of patients with arterial hypertension].

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Makarenko, E S; Dombrovskiĭ, V I; Nelasov, N Iu

2012-01-01

Vascular duplex ultrasound duplex with simultaneous ECG registration was made to estimate the quantitative and time parameters of blood flow in the renal arteries with grade 1-2 arterial hypertension. There were increases in vascular resistance indices and acceleration phase index and a reduction in systolic phase index. There were correlations of the time parameters of blood flow in the renal arteries with age and lipidogram values.

Intraparenchymal Doppler ultrasound after proximal embolization of the splenic artery in trauma patients

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Dormagen, Johann B. [Ullevaal University Hospital, Department of Radiology, Oslo (Norway); Gaarder, Christine [Ullevaal University Hospital, Department of Gastrointestinal Surgery, Oslo (Norway); Sandvik, Leiv [Ullevaal University Hospital, Center for Clinical Research, Oslo (Norway); Naess, Paal A. [Ullevaal University Hospital, Department of Pediatric Surgery, Oslo (Norway); Kloew, Nils E. [Ullevaal University Hospital, Department of Cardiovascular Radiology, Oslo (Norway)

2008-06-15

We studied the changes in proximal embolization of the splenic artery to the intraparenchymal blood flow with Doppler ultrasound. Seventeen trauma patients with spleen injury OIS grade 2-5 underwent embolization of the splenic artery. Peak-systolic velocity (PSV) and end-diastolic velocity (EDV) were measured in intrasplenic arteries initially 1 day after embolization, at early follow-up after 7 days, at intermediate follow-up after 10 weeks, and at late follow-up after 10 months. Resistance index (RI), systolic/diastolic ratio (S/D ratio), acceleration (AC), and acceleration time (AT) were calculated. The results were compared to values from 17 volunteers. RI increased from 0.39 initially to 0.49 (P = 0.002) at intermediate and to 0.52 (P < 0.001) at late follow-up. S/D ratio increased from 1.68 initially to 1.99 (P = 0.002) and to 2.10 (P < 0.001) at intermediate and late follow-up, respectively. Follow-up results of RI and S/D ratio differed significantly from the reference group. AC increased from 1.06 m/s{sup 2} initially to 1.89 m/s{sup 2} at late follow-up (P = 0.01). AC at late follow-up was not different from reference group (2.33 m/s{sup 2}). In conclusion, Doppler ultrasound is a useful tool in the evaluation of improvable intraparenchymal blood flow over time after central splenic artery embolization. (orig.)

Thoracodorsal artery examination with doppler ultrasound in healthy volunteers in a level three hospital

International Nuclear Information System (INIS)

Vasquez Rangel, Wolfgang Ignacio; Daza, Gabriel Fernando; Escobar Rojas, William

2011-01-01

Introduction: The thoracodorsal artery is a branch of the subscapular artery, which in turn is a branch of the axillary artery. The importance of this artery is that it supplies the latissimus dorsi muscle, used as a muscle-skin flap for breast reconstruction after mastectomy, mainly in patients with poor local tissues, in particular after receiving radiotherapy. Objective: to describe the physical characteristics of the thoracodorsal artery using Doppler ultrasound evaluation in healthy volunteers at Hospital Universitario del Valle. Materials and methods: We conducted a descriptive pilot study, because, after reviewing the medical literature, we did not find any reports assessing the thoracodorsal artery with the use of Doppler ultrasound. Results: we evaluated 51 patients, 50.9% female. The average age of the patients was 28.78 years. the axillary, subscapular and thoracodorsal arteries were identified in all patients. The characteristics of the thoracodorsal artery were as follows: Diameter 1.88 mm, peak systolic velocity 28.45 cm/s, peak diastolic velocity 2.03 cm/s, resistance index 0.94, pulsatility index 4.02. Although the study did not include anthropometric measurements, we found that the artery was more conspicuous in patients with developed muscle mass and in patients with low adiposity. Conclusions: The thoracodorsal artery was identified in all patients, and ultrasound localization is a procedure that is easy to perform and provides vital information about the presence of the vascular pedicle required to perform a latissimus dorsi muscle-skin flap. Additional studies in post mastectomy patients are required in order to assess postoperative changes associated with the presence and physical characteristics of the thoracodorsal artery.

Color Doppler measurement of blood flow in the inferior thyroid artery in patients with autoimmune thyroid diseases

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Caruso, Giuseppe; Attard, Marco; Caronia, Aurelio; Lagalla, Roberto

2000-10-01

Purpose: The aim of the study is to find out whether the measurement of peak systolic velocity in the inferior thyroid artery (ITA) is a valuable parameter to differentiate autoimmune thyroid diseases (hyper-, normo- or hypofunctional) and to evaluate the efficacy of medical treatment. Material and methods: The ITA of 31 patients (eight with Graves' disease, 23 with subclinical hypothyroidism) was examined with color Doppler and pulsed Doppler. The final diagnosis was obtained by citology and by hormonal and antibodies assays. The patients were monitorized by ultrasound for a period of 8 months. Results: In all the patients with Graves' disease the peak systolic velocity was always over 150 cm/s, while in other autoimmune thyroiditis the peak systolic velocity was within the normal range, and never exceeding 65 cm/s. In the first group, the measurement taken in the ITA showed also the efficacy of the pharmacological treatment earlier and more reliably than the color Doppler pattern obtained in the parenchyma. Conclusions: The color Doppler measurement of the ITA seems to be a promising technique with low-cost and easy approach. In our experience, the color Doppler of the ITA could have a clinical role in the differential diagnosis of diffuse thyroid diseases and in the follow-up of the Graves' disease during medical treatment.

Color Doppler measurement of blood flow in the inferior thyroid artery in patients with autoimmune thyroid diseases

International Nuclear Information System (INIS)

Caruso, Giuseppe; Attard, Marco; Caronia, Aurelio; Lagalla, Roberto

2000-01-01

Purpose: The aim of the study is to find out whether the measurement of peak systolic velocity in the inferior thyroid artery (ITA) is a valuable parameter to differentiate autoimmune thyroid diseases (hyper-, normo- or hypofunctional) and to evaluate the efficacy of medical treatment. Material and methods: The ITA of 31 patients (eight with Graves' disease, 23 with subclinical hypothyroidism) was examined with color Doppler and pulsed Doppler. The final diagnosis was obtained by citology and by hormonal and antibodies assays. The patients were monitorized by ultrasound for a period of 8 months. Results: In all the patients with Graves' disease the peak systolic velocity was always over 150 cm/s, while in other autoimmune thyroiditis the peak systolic velocity was within the normal range, and never exceeding 65 cm/s. In the first group, the measurement taken in the ITA showed also the efficacy of the pharmacological treatment earlier and more reliably than the color Doppler pattern obtained in the parenchyma. Conclusions: The color Doppler measurement of the ITA seems to be a promising technique with low-cost and easy approach. In our experience, the color Doppler of the ITA could have a clinical role in the differential diagnosis of diffuse thyroid diseases and in the follow-up of the Graves' disease during medical treatment

Plasma L-arginine levels distinguish pulmonary arterial hypertension from left ventricular systolic dysfunction.

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Sandqvist, Anna; Schneede, Jörn; Kylhammar, David; Henrohn, Dan; Lundgren, Jakob; Hedeland, Mikael; Bondesson, Ulf; Rådegran, Göran; Wikström, Gerhard

2018-03-01

Pulmonary arterial hypertension (PAH) is a life-threatening condition, characterized by an imbalance of vasoactive substances and remodeling of pulmonary vasculature. Nitric oxide, formed from L-arginine, is essential for homeostasis and smooth muscle cell relaxation in PAH. Our aim was to compare plasma concentrations of L-arginine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) in PAH compared to left ventricular systolic dysfunction (LVSD) and healthy subjects. This was an observational, multicenter study comparing 21 patients with PAH to 14 patients with LVSD and 27 healthy subjects. Physical examinations were obtained and blood samples were collected. Plasma levels of ADMA, SDMA, L-arginine, L-ornithine, and L-citrulline were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Plasma levels of ADMA and SDMA were higher, whereas L-arginine and L-arginine/ADMA ratio were lower in PAH patients compared to healthy subjects (p L-arginine than patients with LVSD (p L-Arginine correlated to 6 min walking distance (6MWD) (r s  = 0.58, p = 0.006) and L-arginine/ADMA correlated to WHO functional class (r s  = -0.46, p = 0.043) in PAH. In conclusion, L-arginine levels were significantly lower in treatment naïve PAH patients compared to patients with LVSD. Furthermore, L-arginine correlated with 6MWD in PAH. L-arginine may provide useful information in differentiating PAH from LVSD.

Validation of subclavian duplex velocity criteria to grade severity of subclavian artery stenosis.

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Mousa, Albeir Y; Morkous, Ramez; Broce, Mike; Yacoub, Michael; Sticco, Andrew; Viradia, Ravi; Bates, Mark C; AbuRahma, Ali F

2017-06-01

Validation of subclavian duplex ultrasound velocity criteria (SDUS VC) to grade the severity of subclavian artery stenosis has not been established or systematically studied. Currently, there is a paucity of published literature and lack of practitioner consensus for how subclavian duplex velocity findings should be interpreted in patients with subclavian artery stenosis. The objective of the present study was to validate SDUS measurements using subclavian conventional or computed tomography angiogram (subclavian angiogram [SA])-derived measurements. Secondary objectives included measuring the correlation between SDUS peak systolic velocities and SA measurements, and to determine the optimal cutoff value for predicting significant stenosis (>70%). This is a retrospective review of all patients with suspected subclavian artery stenosis and a convenience sample of carotid artery patients who underwent SDUS and SA from May 1999 to July 2013. SA reference vessel and intralesion minimal lumen diameters were measured and compared with SDUS velocities obtained within 3 months of the imaging study. Percent stenosis was calculated using the North American Symptomatic Carotid Endarterectomy Trial method for detecting stenosis in a sufficiently large cohort. Receiver operating characteristic curves was generated for SDUS VC to predict >70% stenosis. Velocity cutoff points were determined with equal weighting of sensitivity and specificity. We examined 268 arteries for 177 patients. The majority of the arteries were for female patients (52.5%) with a mean age of 66.7 ± 11.1 years. Twenty-three arteries had retrograde vertebral artery flow and excluded from further analysis. For the remaining 245 arteries, the average peak systolic velocity was 212.6 ± 110.7 cm/s, with a range of 45-626 cm/s. Average stenosis was 25.8% ± 28.2%, with a range of 0% to 100%. Following receiver operating characteristic analysis, we found a cutoff value of >240 cm/s to be most predictive

Differential Systolic and Diastolic Regulation of the Cerebral Pressure-Flow Relationship During Squat-Stand Manoeuvres.

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Smirl, Jonathan D; Wright, Alexander D; Ainslie, Philip N; Tzeng, Yu-Chieh; van Donkelaar, Paul

2018-01-01

Cerebral pressure-flow dynamics are typically reported between mean arterial pressure and mean cerebral blood velocity. However, by reporting only mean responses, potential differential regulatory properties associated with systole and diastole may have been overlooked. Twenty young adults (16 male, age: 26.7 ± 6.6 years, BMI: 24.9 ± 3.0 kg/m 2 ) were recruited for this study. Middle cerebral artery velocity was indexed via transcranial Doppler. Cerebral pressure-flow dynamics were assessed using transfer function analysis at both 0.05 and 0.10 Hz using squat-stand manoeuvres. This method provides robust and reliable measures for coherence (correlation index), phase (timing buffer) and gain (amplitude buffer) metrics. There were main effects for both cardiac cycle and frequency for phase and gain metrics (p flow relationship. The oscillations associated with systole are extensively buffered within the cerebrovasculature, whereas diastolic oscillations are relatively unaltered. This indicates that the brain is adapted to protect itself against large increases in systolic blood pressure, likely as a mechanism to prevent cerebral haemorrhages.

Systolic blood pressure reactivity during submaximal exercise and acute psychological stress in youth

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Background: Studies in youth show an association between systolic blood-pressure (SBP) reactivity to acute psychological stress and carotid artery intima-media thickness (CIMT). However, it has not yet been determined whether SBP reactivity during submaximal exercise is also associated with CIMT i...

Spectral Doppler Waveforms for Diagnosis of Appendicitis: Potential Utility of Point Peak Systolic Velocity and Resistive Index Values.

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Shin, Lewis K; Jeffrey, R Brooke; Berry, Gerald J; Olcott, Eric W

2017-12-01

Purpose To test the hypothesis that appendiceal spectral Doppler waveforms can distinguish patients with and patients without appendicitis. Materials and Methods In this retrospective study, Doppler waveforms were obtained from intramural appendiceal arteries identified with color Doppler imaging in 60% (93 of 155) of consecutive patients whose appendices were visualized at graded compression ultrasonography (US) performed for suspected appendicitis (53 male and 40 female; age, 1-56 years; mean, 14.5 years) over the 5-month period from November 2015 through March 2016. Point, non-angle-corrected peak systolic velocity (PSV) and resistive index (RI) values were compared between patients with and patients without appendicitis by utilizing histopathologically proven appendicitis and 6-week clinical follow-up as diagnostic reference standards. Data were assessed by using the Student t test, exact binomial distribution, two-sample test of proportions, and receiver operating characteristic analysis. Results Among the 93 patients, 36 (38.7%) had proven appendicitis (mean PSV, 19.7 cm/sec; mean RI, 0.69) and 57 patients (61.2%) did not (mean PSV, 7.1 cm/sec, P appendicitis was 0.97 (95% confidence interval [CI]: 0.95, 1.00) for PSV and 0.86 (95% CI: 0.78, 0.95; P = .011) for RI. Chosen discriminatory criteria of PSV greater than 10 cm/sec and RI greater than 0.65 yielded specificity for appendicitis of 94.7% and 96.5% with sensitivity of 88.9% and 63.9% (P = .013) and negative predictive value of 93.1% and 80.9% (P = .045), respectively. Original clinical graded compression US interpretations based on established US findings demonstrated specificity of 96.2% and sensitivity of 100.0%. Considering the subset of 20 patients whose maximum outer diameter measured 6-8 mm, the discriminatory criteria of PSV greater than 10 cm/sec and RI greater than 0.65 yielded specificity for appendicitis of 88.9% each, with sensitivity of 100.0% and 63.6% and negative predictive value of 100

Prognostic value of systolic mitral annular velocity measured with Doppler tissue imaging in patients with chronic heart failure caused by left ventricular systolic dysfunction

Science.gov (United States)

Nikitin, N P; Loh, P H; de Silva, R; Ghosh, J; Khaleva, O Y; Goode, K; Rigby, A S; Alamgir, F; Clark, A L; Cleland, J G F

2006-01-01

Objective To assess the prognostic value of various conventional and novel echocardiographic indices in patients with chronic heart failure (CHF) caused by left ventricular (LV) systolic dysfunction. Methods 185 patients with a mean (SD) age of 67 (11) years with CHF and LV ejection fraction < 45% despite optimal pharmacological treatment were prospectively enrolled. The patients underwent two dimensional echocardiography with tissue harmonic imaging to assess global LV systolic function and obtain volumetric data. Transmitral flow was assessed with conventional pulse wave Doppler. Systolic (Sm), early, and late diastolic mitral annular velocities were measured with the use of colour coded Doppler tissue imaging. Results During a median follow up of 32 months (range 24–38 months in survivors), 34 patients died and one underwent heart transplantation. Sm velocity (hazard ratio (HR) 0.648, 95% confidence interval (CI) 0.463 to 0.907, p  =  0.011), diastolic arterial pressure (HR 0.965, 95% CI 0.938 to 0.993, p  =  0.015), serum creatinine (HR 1.006, 95% CI 1.001 to 1.011, p  =  0.023), LV ejection fraction (HR 0.945, 95% CI 0.899 to 0.992, p  =  0.024), age (HR 1.035, 95% CI 1.000 to 1.071, p  =  0.052), LV end systolic volume index (HR 1.009, 95% CI 0.999 to 1.019, p  =  0.067), and restrictive pattern of transmitral flow (HR 0.543, 95% CI 0.278 to 1.061, p  =  0.074) predicted the outcome of death or transplantation on univariate analysis. On multivariate analysis, only Sm velocity (HR 0.648, 95% CI 0.460 to 0.912, p  =  0.013) and diastolic arterial pressure (HR 0.966, 95% CI 0.938 to 0.994, p  =  0.016) emerged as independent predictors of outcome. Conclusions In patients with CHF and LV systolic dysfunction despite optimal pharmacological treatment, the strongest independent echocardiographic predictor of prognosis was Sm velocity measured with quantitative colour coded Doppler tissue

Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

DEFF Research Database (Denmark)

Chinali, M.; Simone, G. de; Wachtell, K.

2008-01-01

In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial...... systolic force and left ventricular geometry and function have not been investigated in high-risk hypertrophic hypertensive patients. Participants in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy without prevalent cardiovascular disease or atrial fibrillation (n...... = 567) underwent standard Doppler echocardiography. Left atrial systolic force was obtained from the mitral orifice area and Doppler mitral peak A velocity. Patients were divided into groups with normal or increased left atrial systolic force (>14.33 kdyn). Left atrial systolic force was high in 297...

Hemodynamic effects of innominate artery occlusive disease on anterior cerebral artery.

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Tan, Teng-Yeow; Lien, Li-Ming; Schminke, Ulf; Tesh, Paul; Reynolds, Patrick S; Tegeler, Charles H

2002-01-01

Stenoses of the innominate artery (IA) may affect flow conditions in the carotid arteries. However, alternating flow in ipsilateral anterior cerebral artery (ACA) due to IA stenosis is extremely rare. A 49-year-old woman who was evaluated for symptomatic cerebrovascular disease presented with right latent subclavian and right carotid system steal. Transcranial Doppler examination displayed systolic deceleration wave-forms in the right terminal internal carotid artery and alternating flow in the right ACA. Magnetic resonance angiography demonstrated tight stenosis of the right IA. For a thorough study of the hemodynamic effects of IA stenosis, a combination of duplex and transcranial Doppler examination is required.

Focused ultrasound-modulated glomerular ultrafiltration assessed by functional changes in renal arteries.

Directory of Open Access Journals (Sweden)

Feng-Yi Yang

Full Text Available This study demonstrates the feasibility of using focused ultrasound (FUS to modulate glomerular ultrafiltration by renal artery sonication and determine if protein-creatinine ratios are estimated through vascular parameters. All animal experiments were approved by our Animal Care and Use Committee. The renal arteries of Sprague-Dawley rats were surgically exposed and sonicated at various acoustic power levels using a FUS transducer with a resonant frequency of 1 MHz. The mean peak systolic velocity (PSV of the blood flow was measured by Doppler ultrasound imaging. Urinary protein-creatinine ratios were calculated during the experiments. Histological examination of renal arteries and whole kidneys was performed. The PSV, pulsatility index, and resistance index of blood flow significantly increased in the arteries after FUS sonication without microbubbles (p<0.05. The change in normalized protein-creatinine ratios significantly increased with increasing acoustic power, but such was not observed when microbubbles were administered. Furthermore, no histological changes were observed in the hematoxylin- and eosin-stained sections. Glomerular ultrafiltration is regulated temporarily by renal artery sonication without microbubbles. Monitoring vascular parameters are useful in estimating the normalized change in protein-creatinine ratios.

New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis.

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Bardelli, M; Veglio, F; Arosio, E; Cataliotti, A; Valvo, E; Morganti, A

2006-02-01

We aimed at comparing the positive and negative predictive values (PPV, NPV) of several intrarenal velocimetric indices for revealing the presence of renal artery stenosis (RAS) among hypertensive patients who underwent a renal angiography for the clinical suspicion of renovascular hypertension. In 106 patients (200 kidneys), the pulsatility index (PI) and resistive index (RI), the acceleration time (AT), and the mean systolic acceleration (ACC(sys)) were evaluated. In addition, the maximal systolic acceleration (ACC(max)), that is, the maximal slope of the acceleration phase, and the maximal acceleration index (AI(max)), that is, the ratio between ACC(max) and the relative peak systolic velocity, were calculated. On angiography, we found that 56 (28%) of the 200 arteries had a greater than 60% RAS. PI and RI had an NPV below 75%, whereas AT, ACC(sys), ACC(max), and AI(max) had an NPV always above 95%. However, ACC(max), and AI(max), at their best cutoff limits, had higher PPV than ACC(sys) and AT (60 and 70% vs 45 and 51%, respectively). Thus, in a cohort of patients with a high prevalence of RAS, PI and RI failed to reach an NPV adequate for a screening test. In contrast, all the acceleration indices we tested had a sufficiently high NPV but AI(max) appears superior to the others because of higher PPV. We propose the evaluation of AI(max) as an additional screening test in patients with hypertension and the clinical suspicion of RAS.

Classification of peripheral occlusive arterial diseases based on symptoms, signs and distal blood pressure measurements

DEFF Research Database (Denmark)

Tønnesen, K H; Noer, Ivan; Paaske, William

1980-01-01

Systolic blood pressures at toe and ankle were measured in 459 consecutive patients with occlusive arterial disease. Fifty-eight per cent had intermittent claudication with arterial disease of all degrees of severity. Seventeen per cent complained of rest pain having toe systolic pressures below 30...

Contribution of the Arterial System and the Heart to Blood Pressure during Normal Aging - A Simulation Study.

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Maksuti, Elira; Westerhof, Nico; Westerhof, Berend E; Broomé, Michael; Stergiopulos, Nikos

2016-01-01

During aging, systolic blood pressure continuously increases over time, whereas diastolic pressure first increases and then slightly decreases after middle age. These pressure changes are usually explained by changes of the arterial system alone (increase in arterial stiffness and vascular resistance). However, we hypothesise that the heart contributes to the age-related blood pressure progression as well. In the present study we quantified the blood pressure changes in normal aging by using a Windkessel model for the arterial system and the time-varying elastance model for the heart, and compared the simulation results with data from the Framingham Heart Study. Parameters representing arterial changes (resistance and stiffness) during aging were based on literature values, whereas parameters representing cardiac changes were computed through physiological rules (compensated hypertrophy and preservation of end-diastolic volume). When taking into account arterial changes only, the systolic and diastolic pressure did not agree well with the population data. Between 20 and 80 years, systolic pressure increased from 100 to 122 mmHg, and diastolic pressure decreased from 76 to 55 mmHg. When taking cardiac adaptations into account as well, systolic and diastolic pressure increased from 100 to 151 mmHg and decreased from 76 to 69 mmHg, respectively. Our results show that not only the arterial system, but also the heart, contributes to the changes in blood pressure during aging. The changes in arterial properties initiate a systolic pressure increase, which in turn initiates a cardiac remodelling process that further augments systolic pressure and mitigates the decrease in diastolic pressure.

Postoperative pulmonary and aortic 3D haemodynamics in patients after repair of transposition of the great arteries

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Geiger, Julia; Buerk, Jonas; Jung, Bernd; Langer, Mathias [University Medical Center Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Hirtler, Daniel; Stiller, Brigitte [University Medical Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Paediatric Cardiology, Freiburg (Germany); Arnold, Raoul [University Medical Center Heidelberg, Department of Congenital Heart Disease and Paediatric Cardiology, Heidelberg (Germany); Markl, Michael [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago (United States); Northwestern University, Department Biomedical Engineering, McCormick School of Engineering, Chicago (United States)

2014-01-15

To characterise aortic and pulmonary haemodynamics and investigate the correlation with post-surgical anatomy in patients with dextro-transposition of the great arteries (d-TGA). Four-dimensional (4D) MRI was performed in 17 patients after switch repair of TGA and 12 healthy controls (age, 11.9 ± 5.4 vs 23.3 ± 1.6 years). Patients were divided according to the pulmonary trunk (TP) position in relation to the ascending aorta (AAo): anterior (n = 10) and right/left anterior position (n = 7). Analysis included visual grading (ranking 0-2) of pulmonary and aortic vortical and helical flow, flow velocity quantification, blood-flow distribution to the right and left pulmonary arteries (flow ratio rPA:lPA), and vessel lumen areas. Anterior TP position was associated with increased vortices in six out of ten patients compared with right anterior TP position (one out of seven) and controls (none). Reduced systolic lPA and TP lumina in patients resulted in significantly increased peak systolic velocities (P < 0.001). Flow ratio rPA:lPA was more heterogeneous in patients (rPA:lPA = 1.56 ± 0.78 vs volunteers 1.09 ± 0.15; P < 0.05) with predominant flow to the rPA. Eleven patients presented increased helices in the AAo (grade 1.6). Evaluation of post-surgical haemodynamics in TGA patients revealed increased vortical flow for anterior TP position, asymmetric flow and increased systolic flow velocity in the pulmonary arteries owing to reduced vascular lumina. (orig.)

Ratio of Systolic Blood Pressure to Right Atrial Pressure, a Novel Marker to Predict Morbidity and Mortality in Acute Systolic Heart Failure.

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Omar, Hesham R; Charnigo, Richard; Guglin, Maya

2017-04-01

Congestion is the main contributor to heart failure (HF) morbidity and mortality. We assessed the combined role of congestion and decreased forward flow in predicting morbidity and mortality in acute systolic HF. The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial data set was used to determine if the ratio of simultaneously measured systolic blood pressure (SBP)/right atrial pressure (RAP) on admission predicted HF rehospitalization and 6-month mortality. One hundred ninety-five patients (mean age 56.5 years, 75% men) who received pulmonary artery catheterization were studied. The RAP, SBP, and SBP/RAP had an area under the curve (AUC) of 0.593 (p = 0.0205), 0.585 (p = 0.0359), and 0.621 (p = 0.0026), respectively, in predicting HF rehospitalization. The SBP/RAP was a superior marker of HF rehospitalization compared with RAP alone (difference in AUC 0.0289, p = 0.0385). The optimal criterion of SBP/RAP AUC 0.622, p = 0.0108, and a cut-off value of SBP/RAP <8 had a sensitivity of 61.9% and specificity 64.1% in predicting mortality. Multivariate analysis showed that an SBP/RAP <11 independently predicted rehospitalization for HF (estimated odds ratio 3.318, 95% confidence interval 1.692 to 6.506, p = 0.0005) and an SBP/RAP <8 independently predicted mortality (estimated hazard ratio 2.025, 95% confidence interval 1.069 to 3.833, p = 0.030). In conclusion, SBP/RAP ratio is a marker that identifies a spectrum of complications after hospitalization of patients with decompensated systolic HF, starting with increased incidence of HF rehospitalization at SBP/RAP <11 to increased mortality with SBP/RAP <8. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of hematocrit and systolic blood pressure on cerebral blood flow in newborn infants

International Nuclear Information System (INIS)

Younkin, D.P.; Reivich, M.; Jaggi, J.L.; Obrist, W.D.; Delivoria-Papadopoulos, M.

1987-01-01

The effects of hematocrit and systolic blood pressure on cerebral blood flow were measured in 15 stable, low birth weight babies. CBF was measured with a modification of the xenon-133 ( 133 Xe) clearance technique, which uses an intravenous bolus of 133 Xe, an external chest detector to estimate arterial 133 Xe concentration, eight external cranial detectors to measure cephalic 133 Xe clearance curves, and a two-compartmental analysis of the cephalic 133 Xe clearance curves to estimate CBF. There was a significant inverse correlation between hematocrit and CBF, presumably due to alterations in arterial oxygen content and blood viscosity. Newborn CBF varied independently of systolic blood pressure between 60 and 84 mm Hg, suggesting an intact cerebrovascular autoregulatory mechanism. These results indicate that at least two of the factors that affect newborn animal CBF are operational in human newborns and may have important clinical implications

Influence of the measurement location on the resistance index in the umbilical arteries: a hemodynamic approach.

Science.gov (United States)

Vieyres, P; Durand, A; Patat, F; Descamps, P; Gregoire, J M; Pourcelot, D; Pourcelot, L

1991-12-01

A computer model was used to study the primary factors generating the reduction in resistance index, (S-D)/S, values observed by ultrasonic Doppler measurements in the umbilical artery, from the fetal insertion to the placental insertion (S represents the amplitude of the systolic peak and D the amplitude of the diastolic peak). This hemodynamic approach shows that the placental resistance is the primary factor, the viscosity and the cord length playing secondary roles. Clinically, the position of the measurement along the cord is an important factor. To increase the sensitivity of the index, the Doppler measurement must be performed near the fetal insertion, whereas a measurement near the placental insertion will make the Doppler examination more specific.

Acute effects of repeated bouts of aerobic exercise on arterial stiffness after glucose ingestion.

Science.gov (United States)

Kobayashi, Ryota; Hashimoto, Yuto; Hatakeyama, Hiroyuki; Okamoto, Takanobu

2018-03-22

The aim of this study was to investigate the acute repeated bouts of aerobic exercise decrease leg arterial stiffness. However, the influence of repeated bouts of aerobic exercise on arterial stiffness after glucose ingestion is unknown. The present study investigates the acute effects of repeated bouts of aerobic exercise on arterial stiffness after the 75-g oral glucose tolerance test (OGTT). Ten healthy young men (age, 23.2 ± 0.9 years) performed repeated bouts of aerobic exercise trial (RE, 65% peak oxygen uptake; two 15 min bouts of cycling performed 20 min apart) and control trial (CON, seated and resting in a quiet room) at 80 min before the 75-g OGTT on separate days in a randomized, controlled crossover fashion. Carotid-femoral (aortic) and femoral-ankle (leg) pulse wave velocity, carotid augmentation index, brachial and ankle blood pressure, heart rate and blood glucose and insulin levels were measured before (baseline) and 30, 60 and 120 min after the 75-g OGTT. Leg pulse wave velocity, ankle systolic blood pressure and blood glucose levels increased from baseline after the 75-g OGTT in the CON trial, but not in the RE trial. The present findings indicate that acute repeated bouts of aerobic exercise before glucose ingestion suppress increases in leg arterial stiffness following glucose ingestion. RE trial repeated bouts of aerobic exercise trial; CON trial control trial; BG blood glucose; VO 2peak peak oxygen uptake; PWV Pulse wave velocity; AIx carotid augmentation index; BP blood pressure; HR heart rate; CVs coefficients of variation; RPE Ratings of perceived exertion; SE standard error.

[Development of an automatic pneumatic tourniquet system that determines pressures in synchrony with systolic blood pressure].

Science.gov (United States)

Liu, Hongyun; Li, Kaiyuan; Zhang, Zhengbo; Guo, Junyan; Wang, Weidong

2012-11-01

The correlation coefficients between arterial occlusion pressure and systolic blood pressure, diastolic blood pressure, limb circumference, body mass etc were obtained through healthy volunteer experiments, in which tourniquet were applied on upper/lower extremities. The prediction equations were derived from the data of experiments by multiple regression analysis. Based on the microprocessor C8051F340, a new pneumatic tourniquet system that can determine tourniquet pressure in synchrony with systolic blood pressure was developed and verified the function and stability of designed system. Results showed that the pneumatic tourniquet which automatically adjusts occlusion pressure in accordance with systolic blood pressure could stop the flow of blood to get a bloodless field.

Prevalence and implications of a difference in systolic blood pressure between one arm and the other in vascular surgical patients.

Science.gov (United States)

Durrand, J W; Batterham, A M; O'Neill, B R; Danjoux, G R

2013-12-01

Inter-arm differences in blood pressure may confound haemodynamic management in vascular surgery. We evaluated 898 patients in the vascular pre-assessment clinic to determine the prevalence of inter-arm differences in systolic and mean arterial pressure, quantify the consequent risk of clinical error in siting monitoring peri-operatively and evaluate systolic inter-arm difference as a predictor of all-cause mortality (median follow-up 49 months). The prevalence of a systolic inter-arm difference ≥ 15 mmHg was 26% (95% CI 23-29%). The prevalence of an inter-arm mean arterial pressure difference ≥ 10 mmHg was 26% (95% CI 23-29%) and 11% (95% CI 9-13%) for a difference ≥ 15 mmHg. Monitoring could be erroneously sited in an arm reading lower for systolic pressure once in every seven to nine patients. The hazard ratio for a systolic inter-arm difference ≥ 15 mmHg vs arm blood pressure differences are common in this population, with a high potential for monitoring errors. Systolic inter-arm difference was not associated with medium-term mortality. [Correction added on 17 October 2013, after first online publication: In the Summary the sentence beginning 'We evaluated 898 patients' was corrected from (median (IQR [range]) follow-up 49 months) to read (median follow up 49 months)]. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Denervation (ablation) of nerve terminalis in renal arteries: early results of interventional treatment of arterial hypertension in Poland.

Science.gov (United States)

Bartuś, Krzysztof; Sadowski, Jerzy; Kapelak, Bogusław; Zajdel, Wojciech; Godlewski, Jacek; Bartuś, Stanisław; Bochenek, Maciej; Bartuś, Magdalena; Żmudka, Krzysztof; Sobotka, Paul A

2013-01-01

Arterial hypertension is one of the main causes of cardiovascular disease morbidity and overall mortality. To report the single centre experiences with changes in arterial blood pressure (BP) in patients after intra-arterial application of radiofrequency (RF) energy to cause renal sympathetic efferent and somatic afferent nerve and report vascular and kidney safety in a six month follow up. Twenty-eight patients, with hypertension despite medical therapy (median age 52.02 years, range 42-72 years) consented to therapeutic renal nerve ablation. SIMPLICITY RF catheters and generator provided by Ardian (currently Medtronic Inc., USA) were used to perform renal artery angiography and ablation. The mean BP at baseline, and after one month, three months and six months were measured [mm Hg]: systolic 176.6; 162.3 (p = 0.004); 150.6 (p arterial renal nerve denervation was not associated with either vascular or renal complications out to six months. Nerve ablation of renal arteries led to significant reduction of mean values of arterial systolic, diastolic BP and significant reduction of pulse pressure. The Polish experience is not significantly different compared to that reported in the Symplicity I and Symplicity II international cohorts. The long term durability of this therapy and its application to earlier stages of hypertension or other disease states will require further investigation.

Detection of Obstructive Coronary Artery Disease Using Peak Systolic Global Longitudinal Strain Derived by Two-Dimensional Speckle-Tracking: A Systematic Review and Meta-Analysis.

Science.gov (United States)

Liou, Kevin; Negishi, Kazuaki; Ho, Suyen; Russell, Elizabeth A; Cranney, Greg; Ooi, Sze-Yuan

2016-08-01

Global longitudinal strain (GLS) is well validated and has important applications in contemporary clinical practice. The aim of this analysis was to evaluate the accuracy of resting peak GLS in the diagnosis of obstructive coronary artery disease (CAD). A systematic literature search was performed through July 2015 using four databases. Data were extracted independently by two authors and correlated before analyses. Using a random-effect model, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary area under the curve for GLS were estimated with their respective 95% CIs. Screening of 1,669 articles yielded 10 studies with 1,385 patients appropriate for inclusion in the analysis. The mean age and left ventricular ejection fraction were 59.9 years and 61.1%. On the whole, 54.9% and 20.9% of the patients had hypertension and diabetes, respectively. Overall, abnormal GLS detected moderate to severe CAD with a pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 74.4%, 72.1%, 2.9, and 0.35 respectively. The area under the curve and diagnostic odds ratio were 0.81 and 8.5. The mean values of GLS for those with and without CAD were -16.5% (95% CI, -15.8% to -17.3%) and -19.7% (95% CI, -18.8% to -20.7%), respectively. Subgroup analyses for patients with severe CAD and normal left ventricular ejection fractions yielded similar results. Current evidence supports the use of GLS in the detection of moderate to severe obstructive CAD in symptomatic patients. GLS may complement existing diagnostic algorithms and act as an early adjunctive marker of cardiac ischemia. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Automatic noninvasive measurement of systolic blood pressure using photoplethysmography

Directory of Open Access Journals (Sweden)

Glik Zehava

2009-10-01

Full Text Available Abstract Background Automatic measurement of arterial blood pressure is important, but the available commercial automatic blood pressure meters, mostly based on oscillometry, are of low accuracy. Methods In this study, we present a cuff-based technique for automatic measurement of systolic blood pressure, based on photoplethysmographic signals measured simultaneously in fingers of both hands. After inflating the pressure cuff to a level above systolic blood pressure in a relatively slow rate, it is slowly deflated. The cuff pressure for which the photoplethysmographic signal reappeared during the deflation of the pressure-cuff was taken as the systolic blood pressure. The algorithm for the detection of the photoplethysmographic signal involves: (1 determination of the time-segments in which the photoplethysmographic signal distal to the cuff is expected to appear, utilizing the photoplethysmographic signal in the free hand, and (2 discrimination between random fluctuations and photoplethysmographic pattern. The detected pulses in the time-segments were identified as photoplethysmographic pulses if they met two criteria, based on the pulse waveform and on the correlation between the signal in each segment and the signal in the two neighboring segments. Results Comparison of the photoplethysmographic-based automatic technique to sphygmomanometry, the reference standard, shows that the standard deviation of their differences was 3.7 mmHg. For subjects with systolic blood pressure above 130 mmHg the standard deviation was even lower, 2.9 mmHg. These values are much lower than the 8 mmHg value imposed by AAMI standard for automatic blood pressure meters. Conclusion The photoplethysmographic-based technique for automatic measurement of systolic blood pressure, and the algorithm which was presented in this study, seems to be accurate.

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

Directory of Open Access Journals (Sweden)

Ghabili K

2011-10-01

Full Text Available Abolhassan Shakeri Bavil1, Kamyar Ghabili2, Seyed Ebrahim Daneshmand3, Masoud Nemati3, Moslem Shakeri Bavil4, Hossein Namdar5, Sheyda Shaafi61Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran; 5Department of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran; 6Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial.Objectives: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA stenosis in a group of Iranian patients with peripheral arterial disease.Methods: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs and the origins of the internal and external arteries were scanned with B-mode ultrasonogaphy. Significant ICA stenosis, >70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥3.5.Results: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six

Denervation of nerve terminals in renal arteries: one-year follow-up of interventional treatment of arterial hypertension.

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Bartuś, Krzysztof; Sadowski, Jerzy; Kapelak, Bogusław; Litwinowicz, Radosław; Zajdel, Wojciech; Godlewski, Jacek; Bartuś, Magdalena; Zmudka, Krzysztof; Chrapusta, Anna; Konstanty-Kalandyk, Janusz; Węgrzyn, Piotr; Sobotka, Paul A

2014-01-01

Arterial hypertension is the most common cardiovascular system disease, affecting nearly one billion people worldwide. Despite the widespread use of antihypertensive medications, in some groups of patients an optimal blood pressure (BP) cannot be achieved. To assess BP reduction in patients with resistant hypertension after a catheter-based renal sympathetic denervation procedure and to report vascular and kidney safety in one-year follow-up. Twenty eight patients with diagnosed resistant hypertension (median age 52.02 years, range 42-72) underwent percutaneous catheter-based renal denervation of nerve terminals in renal arteries. Arterial angiography and procedure of ablation was performed by Symplicity catheters and generator provided by Ardian (currently Medtronic Inc., USA). Mean BP value before ablation was [mm Hg]: systolic 176.6, diastolic 100.28 and pulse pressure 73.4. After the procedure, reductions in the value of BP were reported [mm Hg]: systolic 154.8/152.54; diastolic 90.2/89.8, pulse pressure 64.66/62.73, respectively in nine-month and one-year follow-up. All results were statistically significant. No complications during one year observation were observed. Percutaneous renal artery ablation procedure effectively reduces systolic BP, diastolic BP, and pulse pressure. No vascular or renal complications in any of the patients were observed. The results of a Polish research group showed no significant differences compared to the results obtained in the international studies Symplicity I and Symplicity II.

Direct measured systolic pressure gradients across the aorto-iliac segment in multiple-level-obstruction arteriosclerosis

DEFF Research Database (Denmark)

Noer, Ivan; Praestholm, J; Tønnesen, K H

1981-01-01

Patients with severe ischemia due to multi-level obstructions in the leg arteries both above and below the region were assessed preoperatively by intraarterial brachial and femoral artery pressure measurements. The systolic pressure drop along aorto-iliac obstructions was compared to the angiogra....... Due to large variations, however, the angiographic information was found to be useless in the individual patient. No difference in the pressure drop was found between cases in which rich and poor collateral networks were visualized....

Effects of Sacubitril/Valsartan Versus Olmesartan on Central Hemodynamics in the Elderly With Systolic Hypertension: The PARAMETER Study.

Science.gov (United States)

Williams, Bryan; Cockcroft, John R; Kario, Kazuomi; Zappe, Dion H; Brunel, Patrick C; Wang, Qian; Guo, Weinong

2017-03-01

Effective treatment of systolic hypertension in elderly patients remains a major therapeutic challenge. A multicenter, double-blind, randomized controlled trial with sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, was conducted to determine its effects versus olmesartan (angiotensin receptor blocker) on central aortic pressures, in elderly patients (aged ≥60 years) with systolic hypertension and pulse pressure >60 mm Hg, indicative of arterial stiffness. Patients (n=454; mean age, 67.7 years; mean seated systolic blood pressure, 158.6 mm Hg; mean seated pulse pressure, 69.7 mm Hg) were randomized to receive once-daily sacubitril/valsartan 200 mg or olmesartan 20 mg, force titrated to double the initial doses after 4 weeks, before primary assessment at 12 weeks. The study extended double-blind treatment for 12 to 52 weeks, during which amlodipine (2.5-5 mg) and subsequently hydrochlorothiazide (6.25-25 mg) were added-on for patients not achieving blood pressure target (secondary assessments at week 12 (central aortic pulse pressure, -2.4 mm Hg, P blood pressure and central aortic systolic pressure, -4.1 mm Hg and -3.6 mm Hg, respectively, both P blood pressure parameters were similar between treatments ( P hypertension and stiff arteries. © 2017 American Heart Association, Inc.

Preoperative estimation of run off in patients with multiple level arterial obstructions as a guide to partial reconstructive surgery

DEFF Research Database (Denmark)

Noer, Ivan; Tønnesen, K H; Sager, P

1978-01-01

Preoperative measurements of direct femoral artery systolic pressure, indirect ankle systolic pressure and direct brachial artery systolic pressure were carried out in nine patients with severe ischemia and arterial occlusions both proximal and distal to the ingvinal ligament. The pressure......-rise at the ankle was estimated preoperatively by assuming that the ankle pressure would rise in proportion to the rise in femoral artery pressure. Thus it was predicted that reconstruction of the iliac obstruction with aorta-femoral pressure gradients from 44 to 96 mm Hg would result in a rise in ankle pressure...... of 16--54 mm Hg. The actual rise in ankle pressure one month after reconstruction of the iliac arteries ranged from 10 to 46 mm Hg and was well correlated to the preoperative estimations. In conclusion, by proper pressure measurements the run-off problem of multiple level arterial occlusions can...

[Alterations in arterial compliance of dyslipidemic patients].

Science.gov (United States)

Clara, Fernando Mario; Corral, Pablo; Blanco, Gustavo Hector; Scandurra, Adriana Graciela; Meschino, Gustavo Javier

2015-01-01

We studied the alteration on the distensibility of the arterial walls caused by dyslipidemia LDLc dependent, along the decades of life, by means of a study of the radial artery pulse wave. We made an analysis of the radial artery pulse wave records acquired by means a movement displacement sensor, placed on radial palpation area. We recruited 100 dyslipidemic men without other cardiovascular risk factors, between the 3rd and the 6th decade. We identified the reflected wave in the records and we computed the augmentation index in order to quantify its amplitude and position. This index is useful to assess the endothelial dysfunction. Besides, we defined a velocity coefficient as the ratio between the size of the individuals and the delay time between the peak of the systolic wave and the arrival of the reflected wave. Results were compared against those obtained in a group of 161 healthy volunteers. We found that dyslipidemic patients presented augmentation index values similar to controls until the fourth decade, increasing thereafter with significant differences only in the 6th decade. No significant differences were found in the velocity index in any of the ages studied. We conclude that alterations produced by dyslipidemia take decades to manifest, and they begin affecting the mechanism of vasodilation of distal arteries with highest proportion of smooth muscle, without altering the proximal conduit arteries with more elastin content. Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

Estimation of the supplementary axial wall stress generated at peak flow by an arterial stenosis

International Nuclear Information System (INIS)

Doriot, Pierre-Andre

2003-01-01

Mechanical stresses in arterial walls are known to be implicated in the development of atherosclerosis. While shear stress and circumferential stress have received a lot of attention, axial stress has not. Yet, stenoses can be intuitively expected to produce a supplementary axial stress during flow systole in the region immediately proximal to the constriction cone. In this paper, a model for the estimation of this effect is presented, and ten numerical examples are computed. These examples show that the cyclic increase in axial stress can be quite considerable in severe stenoses (typically 120% or more of the normal stress value). This result is in best agreement with the known mechanical or morphological risk factors of stenosis progression and restenosis (hypertension, elevated pulse pressure, degree of stenosis, stenosis geometry, residual stenosis, etc). The supplementary axial stress generated by a stenosis might create the damages in the endothelium and in the elastic membranes which potentiate the action of the other risk factors (hyperlipidaemia, diabetes, etc). It could thus be an important cause of stenosis progression and of restenosis

Estimation of the supplementary axial wall stress generated at peak flow by an arterial stenosis

Science.gov (United States)

Doriot, Pierre-André

2003-01-01

Mechanical stresses in arterial walls are known to be implicated in the development of atherosclerosis. While shear stress and circumferential stress have received a lot of attention, axial stress has not. Yet, stenoses can be intuitively expected to produce a supplementary axial stress during flow systole in the region immediately proximal to the constriction cone. In this paper, a model for the estimation of this effect is presented, and ten numerical examples are computed. These examples show that the cyclic increase in axial stress can be quite considerable in severe stenoses (typically 120% or more of the normal stress value). This result is in best agreement with the known mechanical or morphological risk factors of stenosis progression and restenosis (hypertension, elevated pulse pressure, degree of stenosis, stenosis geometry, residual stenosis, etc). The supplementary axial stress generated by a stenosis might create the damages in the endothelium and in the elastic membranes which potentiate the action of the other risk factors (hyperlipidaemia, diabetes, etc). It could thus be an important cause of stenosis progression and of restenosis.

Left Atrial Systolic Force in Asymptomatic Aortic Stenosis

DEFF Research Database (Denmark)

Cioffi, Giovanni; Cramariuc, Dana; Dalsgaard, Morten

2011-01-01

LASF in the total study population was 21 ± 14 kdynes/cm(2) . The determinants of LASF were higher age, heart rate, body mass index, systolic blood pressure, left ventricular (LV) mass, mitral peak early velocity, maximal LA volume, and longer mitral deceleration time (multiple R(2) = 0.37, P ...Background: There is a limited knowledge about left atrial (LA) systolic force (LASF) and its key determinants in patients with asymptomatic mild-moderate aortic stenosis (AS). Methods: We used baseline clinic and echocardiographic data from 1,566 patients recruited in the simvastatin ezetimibe...... in aortic stenosis study evaluating the effect of placebo-controlled combined simvastatin and ezetimibe treatment in asymptomatic AS. The LASF was calculated by Manning's method. Low and high LASF were defined as 95th percentile of the distribution within the study population, respectively. Results: Mean...

Determinants of global left ventricular peak diastolic filling rate during rest and exercise in normal volunteers

International Nuclear Information System (INIS)

Filiberti, A.W.; Bianco, J.A.; Baker, S.P.; Doherty; Nalivaika, L.A.; King, M.A.; Alpert, J.S.

1984-01-01

Early peak diastolic filling rate (PFR) of the left ventricle (LV) is said to be a sensitive index of LV dysfunction in patients with coronary disease, hypertension and hypertrophic cardiomyopathy. Radionuclide (RN0 multigated PFR was measured in 20 normal volunteers (13 males, 7 females, mean age 31 yrs., range 20-43) at rest and during supine bicycle exercise conducted to a symptomatic end-point. At rest, RN PFR was 3.4 +- SD 0.4 end-diastolic vols./sec (range 3.1 - 3.6). During exercise all normal volunteers had a progressive and numerically and statistically significant increase in PFR. Stepwise multiple linear regression (BMPD2R) was applied to the rest and exercise PFR data to develop a linear model describing the main determinants of the RN PFR. The potential independent variables which were included in the model were heart rate (HR), ejection fraction (EF), systolic arterial pressure, systolic ejection rate and exercise stage. Ranking of variables for prediction of RN PFR, and exclusion of less important variables, was done by F value criteria. The final multivariate equation was: LVPFR = -3.84437 + 0.03834 HR + 0.07537 LVEF. The model fit was highly significant (p<0.001), and accounted for 89 per cent of variability in the PFR. The authors conclude that the left ventricular peak filling rate is critically determined by heart rate and by ejection fraction at rest and during exercise

Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy.

Science.gov (United States)

Okada, Kazunori; Kaga, Sanae; Mikami, Taisei; Masauzi, Nobuo; Abe, Ayumu; Nakabachi, Masahiro; Yokoyama, Shinobu; Nishino, Hisao; Ichikawa, Ayako; Nishida, Mutsumi; Murai, Daisuke; Hayashi, Taichi; Shimizu, Chikara; Iwano, Hiroyuki; Yamada, Satoshi; Tsutsui, Hiroyuki

2017-05-01

We analyzed the waveform of systolic strain and strain-rate curves to find a characteristic left ventricular (LV) myocardial contraction pattern in patients with hypertrophic cardiomyopathy (HCM), and evaluated the utility of these parameters for the differentiation of HCM and LV hypertrophy secondary to hypertension (HT). From global strain and strain-rate curves in the longitudinal and circumferential directions, the time from mitral valve closure to the peak strains (T-LS and T-CS, respectively) and the peak systolic strain rates (T-LSSR and T-CSSR, respectively) were measured in 34 patients with HCM, 30 patients with HT, and 25 control subjects. The systolic strain-rate waveform was classified into 3 patterns ("V", "W", and "√" pattern). In the HCM group, T-LS was prolonged, but T-LSSR was shortened; consequently, T-LSSR/T-LS ratio was distinctly lower than in the HT and control groups. The "√" pattern of longitudinal strain-rate waveform was more frequently seen in the HCM group (74 %) than in the control (4 %) and HT (20 %) groups. Similar but less distinct results were obtained in the circumferential direction. To differentiate HCM from HT, the sensitivity and specificity of the T-LSSR/T-LS ratio patients with HCM, a reduced T-LSSR/T-LS ratio and a characteristic "√"-shaped waveform of LV systolic strain rate was seen, especially in the longitudinal direction. The timing and waveform analyses of systolic strain rate may be useful to distinguish between HCM and HT.

Improved arterial-ventricular coupling in metabolic syndrome after exercise training: a pilot study.

Science.gov (United States)

Fournier, Sara B; Donley, David A; Bonner, Daniel E; Devallance, Evan; Olfert, I Mark; Chantler, Paul D

2015-01-01

The metabolic syndrome (MetS) is associated with threefold increased risk of cardiovascular (CV) morbidity and mortality, which is partly due to a blunted CV reserve capacity, reflected by a reduced peak exercise left ventricular (LV) contractility and aerobic capacity and a blunted peak arterial-ventricular coupling. To date, no study has examined whether aerobic exercise training in MetS can reverse peak exercise CV dysfunction. Furthermore, examining how exercise training alters CV function in a group of individuals with MetS before the development of diabetes and/or overt CV disease can provide insights into whether some of the pathophysiological CV changes can be delayed/reversed, lowering their CV risk. The objective of this study was to examine the effects of 8 wk of aerobic exercise training in individuals with MetS on resting and peak exercise CV function. Twenty participants with MetS underwent either 8 wk of aerobic exercise training (MetS-ExT, n = 10) or remained sedentary (MetS-NonT, n = 10) during this period. Resting and peak exercise CV function was characterized using Doppler echocardiography and gas exchange. Exercise training did not alter resting LV diastolic or systolic function and arterial-ventricular coupling in MetS. In contrast, at peak exercise, an increase in LV contractility (40%, P < 0.01), cardiac output (28%, P < 0.05), and aerobic capacity (20%, P < 0.01), but a reduction in vascular resistance (30%, P < 0.05) and arterial-ventricular coupling (27%, P < 0.01), were noted in the MetS-ExT but not in the MetS-NonT group. Furthermore, an improvement in lifetime risk score was also noted in the MetS-ExT group. These findings have clinical importance because they provide insight that some of the pathophysiological changes associated with MetS can be improved and can lower the risk of CV disease.

Arterial And Ventricular Elastance And Ventriculo-arterial Coupling In Asthmatic Children

International Nuclear Information System (INIS)

Ozkan, E. A.; Gecit, A.; Beysel, P.

2016-01-01

Objective: To compare arterial and ventricular end-systolic elastance and ventriculo-arterial coupling between asthma and healthy children and correlate these all three parameters with pulmonary function tests in subjects with asthma. Study Design: Across-sectional analytical study. Place and Duration of Study: Department of Pediatrics, Bozok University Medical Faculty,Yozgat, Turkey, from January 2012 to November 2014. Methodology: Transthoracic and Doppler echocardiography and pulmonary function tests in patients with asthma aged 7 - 12 years and control subjects. Forty stable asthma patients on prophylactic inhaled corticosteroids and 97 healthy subjects were investigated. Both groups were matched for age, gender, blood pressure, heart rate, body surface area, echocardiographic parameters and pulmonary function tests. Results: There was no difference regarding left ventricular elastance at end-systole derived by single beat/body surface area (Ees(sb)/BSA) between asthmatic patients and healthy children (2.59 ±1.29 mmHg/ml/m2, 2.43 ±1.28 mmHg/ml/m2 respectively, p=0.504), arterial elastance/BSA(Ea/BSA) (2.10 ±0.97, 1.75 ±0.89 respectively, p=0.041), and ventriculoarterial coupling (VAC) (0.83 ±0.13, 0.74 ±0.13, respectively, p < 0.001) were higher in asthmatic group than controls. There was no correlation between Ea, Ees (sb), VAC and pulmonary function tests. Conclusion: Arterial elastance increase and stiffness decrease in asthmatic patients. This may be due to using prophylactic inhaled corticosteroids. Using inhaled corticosteroids have protective effects against atherosclerosis. As a result of this higher arterial elastance, asthmatic children had higher VAC resulting in less efficient cardiovascular function. (author)

Investigating Cardiac MRI Based Right Ventricular Contractility As A Novel Non-Invasive Metric of Pulmonary Arterial Pressure

Science.gov (United States)

Menon, Prahlad G; Adhypak, Srilakshmi M; Williams, Ronald B; Doyle, Mark; Biederman, Robert WW

2014-01-01

BACKGROUND We test the hypothesis that cardiac magnetic resonance (CMR) imaging-based indices of four-dimensional (4D) (three dimensions (3D) + time) right ventricle (RV) function have predictive values in ascertaining invasive pulmonary arterial systolic pressure (PASP) measurements from right heart catheterization (RHC) in patients with pulmonary arterial hypertension (PAH). METHODS We studied five patients with idiopathic PAH and two age and sex-matched controls for RV function using a novel contractility index (CI) for amplitude and phase to peak contraction established from analysis of regional shape variation in the RV endocardium over 20 cardiac phases, segmented from CMR images in multiple orientations. RESULTS The amplitude of RV contractility correlated inversely with RV ejection fraction (RVEF; R2 = 0.64, P = 0.03) and PASP (R2 = 0.71, P = 0.02). Phase of peak RV contractility also correlated inversely to RVEF (R2 = 0.499, P = 0.12) and PASP (R2 = 0.66, P = 0.04). CONCLUSIONS RV contractility analyzed from CMR offers promising non-invasive metrics for classification of PAH, which are congruent with invasive pressure measurements. PMID:25624777

[The state of carotid arteries in young men with arterial hypertension].

Science.gov (United States)

Safarova, A F; Iurtaeva, V R; Kotovskaia, Iu V; Kobalava, Zh D

2012-01-01

To study elastic properties of carotid arteries in young men with arterial hypertension (AH). We examined men aged 18-25 years (mean 21.1+/-0.14 years): 36 with normal blood pressure (BP), 123 with stable and 51 with unstable AH. Parameters studied comprised intima-media thickness (IMT) of carotid arteries, their M-mode measured maximal systolic and minimal diastolic diameters (Ds and Dd), stiffness of common carotid artery (CCA) wall determined on the basis of analysis of elasticity and distensibility coefficients (CC and DC), Peterson's and Young's modules of elasticity (Ep and E), and index of flow deformation (CS). Compared with young men with normal BP and unstable AH patients with stable AH had abnormal elastic properties of CCA and increased IMT. Stable AH in young men is associated with signs of remodeling of CCA walls and increase of their rigidity.

The usefulness of contrast during exercise echocardiography for the assessment of systolic pulmonary pressure

Directory of Open Access Journals (Sweden)

Cordeiro Ana

2008-10-01

Full Text Available Abstract Background The systolic pulmonary artery pressure (PAPs can be accurately estimated, non-invasively, using continuous-wave Doppler (CWD ultrasound measurement of the peak velocity of a tricuspid regurgitant (TR jet. However, it is often difficult to obtain adequate tricuspid regurgitation signals for measurement of PAPs, what could lead to its underestimation. Therefore, utilization of air-blood-saline contrast has been implemented for the improvement of Doppler signal in several clinical contexts. It is now recommended in the evaluation of patients with pulmonary hypertension. Physical activity is severely restricted in patients with PAH, being exertional dypnea the most typical symptom. Exercise stress echo-Doppler imaging allows assessment of the response to exercise. It is an excellent screening test for patients with suspected PAH. Our purpose was to evaluate the value and accuracy of agitated saline with blood contrast echocardiography, in the improvement of the Doppler signal, to quantify PAPs during treadmill exercise-echocardiography. Purpose To evaluate the value of contrast echocardiography, using agitated saline with blood, in the improvement of the Doppler signal used to quantify the pulmonary artery systolic pressure during exercise. Methods From a total of 41 patients (pts, we studied 38 pts (93%, 35 women, aged 54 ± 12 years-old. 27 with the diagnosis of systemic sclerosis, 10 with history of pulmonary embolism and one patient with a suspected idiopathic PAH, who were referred to the Unity of Heart Failure and Pulmonary Hypertension for screening of PAH. According to the Unity protocol, a transthoracic echocardiogram was made, in left decubitus (LD, with evaluation of right ventricle-right atria gradient (RV/RAg. A peripheral venous access was obtained, with a 3-way stopcock and the patients were placed in orthostatism (O, with a new evaluation of RV/RAg. Exercise echocardiography (EE was begun, with evaluation of RV

Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation.

Science.gov (United States)

Fu, H-C; Huang, K-H; Tseng, C-W; Liang, H-M; Lin, H; Chou, Y-J; Kung, F-T

2006-11-01

To compare clinical outcomes and hemodynamic alterations of uterine and ovarian stromal arteries between patients with symptomatic myomas undergoing myomectomy preceded by arterial ligation and those undergoing myomectomy alone. In this prospective, non-randomized comparative study, myomectomy was performed on 69 women with symptomatic myomas. Myomectomy alone was performed in 31 patients (Group I) and myomectomy with concomitant bilateral hypogastric arterial ligation was performed in 38 patients (Group II). In both groups, surgical results and clinical outcomes were evaluated by peripheral hemoglobin levels, a pictorial blood-loss assessment chart, and visual analog scales. Spectral Doppler indices of uterine and ovarian stromal arteries, including peak systolic velocity, end-diastolic velocity, pulsatility index and resistance index were performed preoperatively, and 1 day and 1 or more months postoperatively. Twenty-two patients in Group I and 31 patients in Group II received regular follow-up examinations for a mean follow-up period of 10.1 months. Menstrual flow, dysmenorrhea and hemoglobin levels improved significantly after surgery in both groups. Blood loss during surgery was less in Group II than it was in Group I (P=0.02). Doppler indices of uterine and ovarian stromal arteries from preoperation to mean follow-up point were not significantly different between the groups, except for a significantly lower uterine artery pulsatility index in Group II (P=0.01). Myomectomy with hypogastric arterial ligation for symptomatic myomas is as efficient as is myomectomy alone and reduces blood loss during surgery. Serial Doppler studies showed that hypogastric ligation does not block uterine and ovarian perfusion, and even reduces the impedance of the uterine arteries. The long-term recurrence rate after myomectomy with hypogastric arterial ligation remains to be determined. Copyright (c) 2006 ISUOG.

Effect of Zhen-wu decoction on chronic heart failure in rats | Liu ...

African Journals Online (AJOL)

Results: Compared with normal control group, ZWD group showed decreased arterial systolic pressure (SBP, 89.16 ± 17.27 mmHg), diastolic pressure (DBP, 72.54 ± 22.36 mmHg), mean arterial pressure (MAP, 72.64 ± 11.87 mmHg), heart rate (HR, 368.25 ± 39.12 beats/min), left ventricular systolic peak (LVSP, 105.27 ...

Cholecalciferol treatment to reduce blood pressure in older patients with isolated systolic hypertension: the VitDISH randomized controlled trial.

Science.gov (United States)

Witham, Miles D; Price, Rosemary J G; Struthers, Allan D; Donnan, Peter T; Messow, Claudia-Martina; Ford, Ian; McMurdo, Marion E T

2013-10-14

Observational data link low 25-hydroxyvitamin D levels to both prevalent blood pressure and incident hypertension. No clinical trial has yet examined the effect of vitamin D supplementation in isolated systolic hypertension, the most common pattern of hypertension in older people. To test whether high-dose, intermittent cholecalciferol supplementation lowers blood pressure in older patients with isolated systolic hypertension. Parallel group, double-blind, placebo-controlled randomized trial. Primary care clinics and hospital clinics. Patients 70 years and older with isolated systolic hypertension (supine systolic blood pressure >140 mm Hg and supine diastolic blood pressure blood pressure, 24-hour blood pressure, arterial stiffness, endothelial function, cholesterol level, insulin resistance, and b-type natriuretic peptide level during 12 months. A total of 159 participants were randomized (mean age, 77 years). Mean baseline office systolic blood pressure was 163/78 mm Hg. Mean baseline 25-hydroxyvitamin D level was 18 ng/mL. 25-Hydroxyvitamin D levels increased in the treatment group compared with the placebo group (+8 ng/mL at 1 year, P blood pressure (−1 [−6 to 4]/−2 [−4 to 1] mm Hg at 3 months and 1 [−2 to 4]/0 [−2 to 2] mm Hg overall treatment effect). No significant treatment effect was evident for any of the secondary outcomes (24-hour blood pressure, arterial stiffness, endothelial function, cholesterol level, glucose level, and walking distance). There was no excess of adverse events in the treatment group, and the total number of falls was nonsignificantly lower in the group receiving vitamin D (36 vs 46, P = .24). Vitamin D supplementation did not improve blood pressure or markers of vascular health in older patients with isolated systolic hypertension. isrctn.org Identifier: ISRCTN92186858.

Diabetes as an independent predictor of left ventricular longitudinal strain reduction at rest and during dobutamine stress test in patients with significant coronary artery disease.

Science.gov (United States)

Wierzbowska-Drabik, Karina; Trzos, Ewa; Kurpesa, Malgorzata; Rechcinski, Tomasz; Miskowiec, Dawid; Cieslik-Guerra, Urszula; Uznanska-Loch, Barbara; Sobczak, Maria; Kasprzak, Jaroslaw Damian

2017-12-09

Diabetes (DM) is a strong cardiovascular risk factor modifying also the left ventricular (LV) function that may be objectively assessed with echocardiographic strain analysis. Although the impact of isolated DM on myocardial deformation has been already studied, few data concern diabetics with coronary artery disease (CAD), especially in all stages of dobutamine stress echocardiography (DSE). We compared LV systolic function during DSE in CAD with and without DM using state-of-the art speckle-tracking quantification and assessed the impact of DM on LV systolic strain. DSE was performed in 250 patients with angina who afterwards had coronarography with ≥50% stenosis in the left main artery and ≥70% in other arteries considered as significant. In this analysis, we included 127 patients with confirmed CAD: 42 with DM [DM(+); mean age 64 ± 9 years] and 85 patients without DM [DM(-); mean age 63 ± 9 years]. The severity of CAD and LV ejection fraction (EF) were similar in both groups. Global and regional LV peak systolic longitudinal strain (PSLS) revealed in all DSE phases lower values in DM(+) group: 14.5 ± 3.6% vs. 17.4 ± 4.0% at rest; P = 0.0001, 13.8 ± 3.9% vs. 16.7 ± 4.0% at peak stress; P = 0.0002, and 14.2 ± 3.1% vs. 15.5 ± 3.5% at recovery; P = 0.0432 for global parameters, although dobutamine challenge did not enhance further resting differences. LV EF, body surface area, and diabetes were independent predictors for strain in 16-variable model (R2 = 0, 51, P coexisting CAD and DM on myocardial strain. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Arterial blood pressure measurement and pulse wave analysis—their role in enhancing cardiovascular assessment

International Nuclear Information System (INIS)

Avolio, Alberto P; Butlin, Mark; Walsh, Andrew

2010-01-01

The most common method of clinical measurement of arterial blood pressure is by means of the cuff sphygmomanometer. This instrument has provided fundamental quantitative information on arterial pressure in individual subjects and in populations and facilitated estimation of cardiovascular risk related to levels of blood pressure obtained from the brachial cuff. Although the measurement is taken in a peripheral limb, the values are generally assumed to reflect the pressure throughout the arterial tree in large conduit arteries. Since the arterial pressure pulse becomes modified as it travels away from the heart towards the periphery, this is generally true for mean and diastolic pressure, but not for systolic pressure, and so pulse pressure. The relationship between central and peripheral pulse pressure depends on propagation characteristics of arteries. Hence, while the sphygmomanometer gives values of two single points on the pressure wave (systolic and diastolic pressure), there is additional information that can be obtained from the time-varying pulse waveform that enables an improved quantification of the systolic load on the heart and other central organs. This topical review will assess techniques of pressure measurement that relate to the use of the cuff sphygmomanometer and to the non-invasive registration and analysis of the peripheral and central arterial pressure waveform. Improved assessment of cardiovascular function in relation to treatment and management of high blood pressure will result from future developments in the indirect measurement of arterial blood pressure that involve the conventional cuff sphygmomanometer with the addition of information derived from the peripheral arterial pulse. (topical review)

Hyperbolic isometries of systolic complexes

DEFF Research Database (Denmark)

Prytula, Tomasz Pawel

The main topics of this thesis are the geometric features of systolic complexesarising from the actions of hyperbolic isometries. The thesis consists ofan introduction followed by two articles.Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal displace......The main topics of this thesis are the geometric features of systolic complexesarising from the actions of hyperbolic isometries. The thesis consists ofan introduction followed by two articles.Given a hyperbolic isometry h of a systolic complex X, our central theme isto study the minimal...... algebraic-topological features of systolic groups. In addition, we provide newexamples of systolic groups.In the first article we show that the minimal displacement set of a hyperbolicisometry of a systolic complex is quasi-isometric to the product of a tree andthe real line. We use this theorem...

Reduced systolic performance by tissue Doppler in patients with preserved and abnormal ejection fraction: new insights in chronic heart failure.

Science.gov (United States)

García, Edgar H; Perna, Eduardo R; Farías, Eduardo F; Obregón, Ricardo O; Macin, Stella M; Parras, Jorge I; Agüero, Marcelo A; Moratorio, Diego A; Pitzus, Ariel E; Tassano, Eduardo A; Rodriguez, Leonardo

2006-04-04

Tissue Doppler imaging (TDI) is useful in the evaluation of systolic and diastolic function. It allows assessment of ventricular dynamics in its longitudinal axis. We sought to investigate the difference in systolic and diastolic longitudinal function in patients with chronic heart failure (CHF) with normal and reduced ejection fraction. One hundred ten outpatients with CHF and 68 controls were included. Ejection fraction (EF) was obtained and longitudinal systolic (S) and diastolic (E' and A') wall velocities were recorded from basal septum. Group A (controls) were normal and CHF patients were classified by EF in Group B1: > 45% and B2: < or = 45%. In A, B1 and B2 the mean S peak was 7.74; 5.45 and 4.89 cm/s (p<0.001); the mean E' peak was 8.56; 5.72 and 6.1 cm/s (p<0.001); and the mean A' peak was 10.2; 7.3 and 5.3 cm/s (p<0.001). Also, isovolumic contraction and relaxation time were different among control and CHF groups, (both p<0.001). The most useful parameters for identifying diastolic CHF were IVRT and S peak, with area under ROC curves of 0.93 and 0.89. The cut-off of 115 ms for IVRT and 5.8 cm/s for S peak showed a sensitivity of 94 and 97%, with a specificity of 82 and 73%, respectively. These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identifying the condition.

Endothelial function in postmenopausal women with nighttime systolic hypertension.

Science.gov (United States)

Routledge, Faye S; Hinderliter, Alan L; McFetridge-Durdle, Judith; Blumenthal, James A; Paine, Nicola J; Sherwood, Andrew

2015-08-01

Hypertension becomes more prevalent in women during their postmenopausal years. Nighttime systolic blood pressure (SBP) is especially predictive of adverse cardiac events, and the relationship between rising nighttime SBP and cardiovascular risk increases more rapidly in women compared with men. The reasons for the prognostic significance of nighttime SBP are not completely known but may involve vascular endothelial dysfunction. The purposes of this study were to examine the relationship between nighttime SBP and endothelial function, as assessed by brachial artery flow-mediated dilation (FMD), and to determine whether postmenopausal women with nighttime hypertension (SBP ≥120 mm Hg) evidenced greater endothelial dysfunction compared with women with normal nighttime SBP. One hundred postmenopausal women (mean [SD] age, 65.8 [7.5] y; mean [SD] body mass index, 28.3 [4.7] kg/m; hypertension, 47%; coronary artery disease, 51%; mean [SD] clinic SBP, 137 [17] mm Hg; mean [SD] clinic diastolic blood pressure, 67 [11] mm Hg; nighttime hypertension, 34 women) underwent 24-hour ambulatory blood pressure monitoring, actigraphy, and brachial artery FMD assessment. Multivariate regression models showed that higher nighttime SBP and larger baseline artery diameter were inversely related to FMD. Nighttime SBP and baseline artery diameter accounted for 23% of the variance in FMD. After adjustment for baseline artery diameter, women with nighttime hypertension had lower mean (SD) FMD than women with normal nighttime SBP (2.95% [0.65%] vs 5.52% [0.46%], P = 0.002). Nighttime hypertension is associated with reduced endothelial function in postmenopausal women. Research examining the therapeutic benefits of nighttime hypertension treatment on endothelial function and future cardiovascular risk in postmenopausal women is warranted.

Modifiable risk factors for increased arterial stiffness in outpatient nephrology.

Directory of Open Access Journals (Sweden)

Usama Elewa

Full Text Available Arterial stiffness, as measured by pulse wave velocity (PWV, is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5% patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV - (upper limit of the age-adjusted PWV values for the general population. Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

Effects of 6 months of aerobic and resistance exercise training on carotid artery intima media thickness in overweight and obese older women.

Science.gov (United States)

Park, Jinkee; Park, Hyuntea

2017-12-01

We studied the effects of exercise on carotid intima-media thickness, luminal diameter, and flow velocity in overweight and obese older women, and the associations between carotid parameters changes and other variables. A total of 41 overweight and obese older women (aged 65-77 years, fat mass percent ≥ 32%), who were divided into a control group (n = 20) and a supervised combined exercise group (n = 21). The 24-week combined exercise program (aerobic and resistance exercise) consisted of sessions 40-80 min in length 5 days per week under the supervision of an exercise specialist. Body composition, blood pressure, physical function and carotid variables were assessed. The differences in all variables, and the relative changes between baseline and 24 weeks' follow up were evaluated. Carotid intima-media thickness, systolic carotid luminal diameter, peak systolic flow velocity and end diastolic flow velocity showed a significant group × time interaction. No interaction was observed for diastolic luminal diameter. In the exercise group, the change of carotid intima-media thickness was significantly associated with systolic blood pressure, maximal walking speed, 1-mile walking time and maximal oxygen uptake. Also, the change of peak systolic flow velocity was significantly associated with skeletal muscle mass, diastolic blood pressure and maximum walking speed. Combined exercise can effectively improve carotid intima-media thickness in overweight and obese older women. In addition, exercise training increases the systolic carotid luminal diameter and flow velocity in older women. Therefore, regular combined exercise might help prevent atherosclerotic disease by improving the carotid artery. Geriatr Gerontol Int 2017; 17: 2304-2310. © 2017 Japan Geriatrics Society.

Reliability of palpation of the radial artery compared with auscultation of the brachial artery in measuring SBP

NARCIS (Netherlands)

van der Hoeven, Niels V.; van den Born, Bert-Jan H.; van Montfrans, Gert A.

2011-01-01

Background Systolic blood pressure contributes more to cardiovascular disease than DBP, especially in elderly persons. Palpation of the radial artery to assess SBP - Riva-Rocci's technique-may be an attractive alternative for auscultatory SBP in these patients. Therefore, we investigated the

Efficacy of Transcatheter Arterial Embolization in the Traumatic Injury

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Park, Dae Hong; Kim, Jeong Ho; Byun, Sung Su; Kim, Hyung Sik [Dept. of Radiology, Gachon University School of Medicine, Gil Hospital, Incheon (Korea, Republic of)

2012-09-15

This study evaluated technical and clinical outcomes and identified factors associated with clinical success in trauma patients that underwent transcatheter arterial embolization (TAE) in a single regional hospital. A retrospective study was performed of 106 patients with a variety of trauma who were suspected of active arterial bleeding and underwent angiography. Technical success was defined as non-visualization of extravasation and pseudoaneurysm in injured arteries. Clinical success was defined as the patient was not expired within 30 days from the date of TAE. Electronic medical records were reviewed. The risk factors between groups of clinical success and failure were analyzed statistically. Technical and clinical success rates of TAE were 96% (102/106) and 70% (74/106) respectively. Of the factors we assessed, age, older than 60 years, systolic blood pressure and heart rate at admission and after TAE, and combined brain injury were statistically significant (p < 0.05). Old age, low systolic blood pressure after TAE, and combined brain injury were significant predictors of poor prognosis in multivariate analysis. TAE is an effective treatment for active arterial bleeding of the traumatic injury patient.

Efficacy of Transcatheter Arterial Embolization in the Traumatic Injury

International Nuclear Information System (INIS)

Park, Dae Hong; Kim, Jeong Ho; Byun, Sung Su; Kim, Hyung Sik

2012-01-01

This study evaluated technical and clinical outcomes and identified factors associated with clinical success in trauma patients that underwent transcatheter arterial embolization (TAE) in a single regional hospital. A retrospective study was performed of 106 patients with a variety of trauma who were suspected of active arterial bleeding and underwent angiography. Technical success was defined as non-visualization of extravasation and pseudoaneurysm in injured arteries. Clinical success was defined as the patient was not expired within 30 days from the date of TAE. Electronic medical records were reviewed. The risk factors between groups of clinical success and failure were analyzed statistically. Technical and clinical success rates of TAE were 96% (102/106) and 70% (74/106) respectively. Of the factors we assessed, age, older than 60 years, systolic blood pressure and heart rate at admission and after TAE, and combined brain injury were statistically significant (p < 0.05). Old age, low systolic blood pressure after TAE, and combined brain injury were significant predictors of poor prognosis in multivariate analysis. TAE is an effective treatment for active arterial bleeding of the traumatic injury patient.

Interesting images: Multiple coronary artery aneurysms.

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Howard, Jonathon M; Viswanath, Omar; Armas, Alfredo; Santana, Orlando; Rosen, Gerald P

2017-01-01

We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure.

Science.gov (United States)

Zhang, Duan-Zhen; Zhu, Xian-Yang; Lv, Bei; Cui, Chun-Sheng; Han, Xiu-Min; Sheng, Xiao-Tang; Wang, Qi-Guang; Zhang, Po

2014-08-01

No method is available to predict whether patients with patent ductus arteriosus (PDA) and severe pulmonary arterial hypertension (PAH) will show persistent postprocedural PAH (PP-PAH) after PDA closure. This study evaluated the usefulness of trial occlusion for predicting PP-PAH after transcatheter PDA closure in patients with severe PAH. Trial occlusion was performed in 137 patients (age ≥12 years) with PDA and severe PAH. All patients undergoing trial occlusion had a mean pulmonary artery pressure ≥45 mm Hg, pulmonary:systemic flow (Qp/Qs) ratio >1.5, and pulmonary:systemic resistance (Rp/Rs) ratio closure. Linear correlation analysis revealed weak or moderate relationships between the baseline and post-trial pulmonary artery pressures and pulmonary:systemic pressure (Pp/Ps) ratios. Patients were followed up for 1 to 10 years (median: 5 years). PP-PAH (systolic pulmonary artery pressure >50 mm Hg by Doppler echocardiography) was detected in 17 patients (13%), who displayed no significant differences in sex and age compared with patients without PP-PAH. According to discriminant analysis, the strongest discriminators between patients with and without PP-PAH were the baseline left ventricular end-diastolic volume and the baseline and post-trial systolic Pp/Ps ratios. In particular, a post-trial systolic Pp/Ps ratio >0.5 correctly classified 100% of the PP-PAH and non-PAH patients. Trial occlusion is a feasible method to predict PP-PAH in patients with PDA and severe PAH. A post-trial systolic Pp/Ps ratio >0.5 indicates a high risk of PP-PAH occurrence after device closure. © 2014 American Heart Association, Inc.

Increased arterial compliance in decompensated cirrhosis

DEFF Research Database (Denmark)

Henriksen, Jens Henrik; Møller, Søren; Schifter, S

1999-01-01

BACKGROUND/AIMS: In patients with cirrhosis, the systemic circulation is hyperdynamic with low arterial blood pressure and reduced systemic vascular resistance. The present study was undertaken to estimate the compliance of the arterial tree in relation to severity of cirrhosis, circulating level...... of the vasodilator, calcitonin gene-related peptide (CGRP) and mean arterial blood pressure (MAP). METHODS: Arterial compliance (COMPart=deltaV/deltaP) was determined as the stroke volume relative to pulse pressure (i.e. systolic minus diastolic blood pressure) during a haemodynamic evaluation of portal hypertension...... of CGRP (r=0.34, pcompliance in cirrhosis is directly related to the severity of the disease and to the elevated level of circulating vasodilator peptide CGRP, and inversely related...

Increased arterial compliance in decompensated cirrhosis

DEFF Research Database (Denmark)

Henriksen, Jens Henrik Sahl; Møller, Søren; Schifter, S

1999-01-01

of the vasodilator, calcitonin gene-related peptide (CGRP) and mean arterial blood pressure (MAP). METHODS: Arterial compliance (COMPart=deltaV/deltaP) was determined as the stroke volume relative to pulse pressure (i.e. systolic minus diastolic blood pressure) during a haemodynamic evaluation of portal hypertension......BACKGROUND/AIMS: In patients with cirrhosis, the systemic circulation is hyperdynamic with low arterial blood pressure and reduced systemic vascular resistance. The present study was undertaken to estimate the compliance of the arterial tree in relation to severity of cirrhosis, circulating level...... of CGRP (r=0.34, parterial compliance in cirrhosis is directly related to the severity of the disease and to the elevated level of circulating vasodilator peptide CGRP, and inversely related...

Does Renal Artery Supply Indicate Treatment Success of Renal Denervation?

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Schmid, Axel, E-mail: axel.schmid@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Radiology (Germany); Ditting, Tilmann, E-mail: tilmann.ditting@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany); Sobotka, Paul A., E-mail: sobotka@alumni.stanford.edu [Ohio State University (United States); Veelken, Roland, E-mail: roland.veelken@uk-erlangen.de; Schmieder, Roland E., E-mail: roland.schmieder@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany); Uder, Michael, E-mail: michael.uder@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Radiology (Germany); Ott, Christian, E-mail: christian.ott@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany)

2013-08-01

PurposeRenal denervation (RDN) emerged as an innovative interventional antihypertensive therapy. With the exception of pretreatment blood pressure (BP) level, no other clear predictor for treatment efficacy is yet known. We analyzed whether the presence of multiple renal arteries has an impact on BP reduction after RDN.MethodsFifty-three patients with treatment-resistant hypertension (office BP {>=} 140/90 mmHg and 24-h ambulatory BP monitoring ({>=}130/80 mmHg) underwent bilateral catheter-based RDN. Patients were stratified into one-vessel (OV) (both sides) and at least multivessel (MV) supply at one side. Both groups were treated on one vessel at each side; in case of multiple arteries, only the dominant artery was treated on each side.ResultsBaseline clinical characteristics (including BP, age, and estimated glomerular filtration rate) did not differ between patients with OV (n = 32) and MV (n = 21). Office BP was significantly reduced in both groups at 3 months (systolic: OV -15 {+-} 23 vs. MV -16 {+-} 20 mmHg; diastolic: OV -10 {+-} 12 vs. MV -8 {+-} 11 mmHg, both p = NS) as well as 6 months (systolic: OV -18 {+-} 18 vs. MV -17 {+-} 22 mmHg; diastolic: OV -10 {+-} 10 vs. -10 {+-} 12 mmHg, both p = NS) after RDN. There was no difference in responder rate (rate of patients with office systolic BP reduction of at least 10 mmHg after 6 months) between the groups.ConclusionIn patients with multiple renal arteries, RDN of one renal artery-namely, the dominant one-is sufficient to induce BP reduction in treatment-resistant hypertension.

Tricuspid Annular Plane Systolic Excursion (TAPSE in a Patient with Pulmonary Emboli

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Nicole Zawada

2018-01-01

Full Text Available History of present illness: A 60-year-old male with a history of pulmonary emboli (PE presented to the emergency department with exertional shortness of breath following a ten-hour flight. The patient admitted to recently stopping his previously prescribed rivaroxaban. His electrocardiogram (ECG showed findings consistent with a S1Q3T3 pattern. Point-of-care ultrasound (POCUS was performed using the curvilinear probe, which revealed a thrombus in the inferior vena cava (IVC. POCUS using the phased array probe demonstrated an abnormal tricuspid annular plane systolic excursion (TAPSE and a significantly dilated right ventricle (RV. Computed tomography angiogram (CTA showed evidence of acute emboli within the right and left distal main pulmonary arteries, left lobar, and left proximal segmental artery. Additionally, a thrombus was visualized in the left distal subhepatic IVC. The patient was admitted to telemetry for anticoagulation and monitoring. Right heart catheterization revealed a significantly elevated pulmonary artery pressure of 95/27. Significant findings: Video 1 and Image 1 show a thrombus in the patient’s IVC. Video 2 and Images 2-3 demonstrate a positive TAPSE of less than 17mm (blue arrow length with a significantly dilated RV, indicating abnormal excursion of the tricuspid annulus and right ventricular dysfunction. Discussion: Pulmonary embolism is the third leading cause of death from cardiovascular disease following myocardial infarction and stroke.1 Approximately half of all PEs are diagnosed in the emergency department2 and early detection and treatment have been shown to improve outcomes and survival.3 Pulmonary emboli can present with a wide range of symptoms including dyspnea, chest pain, shock, or sustained hypotension, and can even be asymptomatic, making it a potentially challenging diagnosis.4 Studies show a high specificity of over 80% but low sensitivity of lower than 60%, for echocardiography in the diagnosis of PE

The correlation between psychological intervention and heart rate,systolic pressure in patients of cervical cancer treated with interventional chemoembolization

International Nuclear Information System (INIS)

Qiao Cuiyun; Lan Guiyun; Liu Shuang; Chen Bao'e; Liu Yali; Wang Zhujun

2010-01-01

Objective: To discuss the effect of psychological intervention on the heart rate, systolic pressure of the patients with cervical cancer who are treated with interventional chemoembolization. Methods: Eighty patients with cervical cancer were randomly and equally divided into two groups. Transcatheter arterial chemoembolization (TACE) was performed in all cases. Patients in study group (n=10) received systemic psychological intervention 30 minutes before TACE. The heart rate and systolic pressure of the patients were measured when TACE started. The results were compared with that obtained at the time of admission. Patients in control group (n=10) did not receive systemic psychological intervention before TACE and their heart rate and systolic pressure were measured in the same way as in study group. Results: At the time TACE started the heart rate and systolic pressure of the patients in study group were significantly lower than that in control group (P < 0.05). Conclusion: Preoperative psychological intervention is very helpful for reducing psychological stress and mental tension,in stabilizing heart rate and systolic pressure of the patients with cervical cancer who are treated with TACE. (authors)

Unusual Survival of Anomalous Left Coronary Artery From the Pulmonary Artery With Severe Rheumatic Mitral Stenosis in Septuagenarian Women: Foes Becoming Friends?

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Sinha, Santosh Kumar; Khanra, Dibbendhu; Jha, Mukesh Jitendra; Singh, Karandeep; Razi, Mahamdulla; Goel, Amit; Mishra, Vikas; Asif, Mohammad; Sachan, Mohit; Afdaali, Nasar; Kumar, Ashutosh; Thakur, Ramesh; Krishna, Vinay; Pandey, Umeshwar; Varma, Chandra Mohan

2016-10-01

ALCAPA syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease but lethal with clinical expression from myocardial infarction, congestive heart failure to death during early infancy and unusual survival to adulthood. We report a 73-year-old woman with ALCAPA who presented with exertional dyspnea (NYHA functional class II) over past 2 years. Physical examination revealed soft S, long mid diastolic rumbling murmur and apical pan-systolic murmur. Electrocardiography displayed biatrial enlargement and poor R progression and normal sinus rhythm. Echocardiography established calcified severe mitral stenosis (MS), presence of continuous flow entering the pulmonary trunk, turbulent continuous flow in inter-ventricular septum with left to right shunt in contrast echocardiography and normal systolic function. Coronary angiogram showed absence of left coronary artery (LCA) originating from aorta, dilated and tortuous right coronary artery (RCA) and abundant Rentrop grade 3 intercoronary collateral communicating with LCA originating from pulmonary trunk which was also confirmed on coronary CT angiogram thus establishing diagnosis of ALCAPA. It is exceedingly rare to be associated with severe MS. However, such a long survival in our patient can be explained by the severe pulmonary arterial hypertension which may be contributing to lesser coronary steal.

Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

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Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

2016-08-01

We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Penile artery shunt syndrome: a novel cause of erectile dysfunction after penile revascularization surgery.

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Pavlinec, Jonathan G; Hakky, Tariq S; Yang, Christopher; Massis, Kamal; Munarriz, Ricardo; Carrion, Rafael E

2014-09-01

Penile revascularization is a surgical treatment option for erectile dysfunction (ED) in healthy individuals due to a focal arterial occlusion in the absence of generalized vascular disease. Most described failures have been attributed to graft stenosis or disruption of the anastomosis. We report a novel phenomenon called Penile Artery Shunt Syndrome that contributed to persistent ED in a patient after penile microvascular arterial bypass surgery. A 26-year-old man presented for evaluation of long-standing ED, which was attributed to trauma sustained 12 years earlier. He had difficulty obtaining and maintaining erections despite oral pharmacotherapy. Clinical data related to the case were studied, analyzed, and reviewed with urologic and radiologic specialists at multiple centers that collaborated in the care of this patient. Penile duplex ultrasound peak systolic velocities and five-item International Index for Erectile Function questionnaire scores were the main outcome measures. Initial diagnostic workup of the patient confirmed severe insufficiency of the left cavernosal artery, with no evidence of venous leak. The patient underwent penile microvascular arterial bypass surgery with anastomosis of the left inferior epigastric artery to the left dorsal penile artery. The patient had persistence of severe ED despite patent anastomosis by penile duplex ultrasound. Subsequent arteriography revealed an arterial shunt due to an aberrant obturator artery arising from the donor inferior epigastric artery. The patient underwent embolization of the aberrant obturator artery, with resolution of the shunt and marked improvement in erectile function. The presence of an aberrant obturator artery arising from the inferior epigastric artery may predispose to persistent ED after revascularization due to the creation of a shunt phenomenon. Pelvic arteriography may be useful in identifying anomalous anatomic considerations prior to penile revascularization and to evaluate patients

COMPARISON OF HIGH-DEFINITION OSCILLOMETRIC AND DIRECT ARTERIAL BLOOD PRESSURE MEASUREMENT IN ANESTHETIZED CHEETAHS (ACINONYX JUBATUS).

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Sant Cassia, Emma V; Boswood, Adrian; Tordiffe, Adrian S W

2015-09-01

Blood pressure measurement reveals important insights into the health of conscious and anesthetized individuals. This is of particular interest in cheetahs (Acinonyx jubatus), which in captivity are known to suffer from chronic diseases that may be associated with hypertension and which often require immobilization for transport or veterinary treatment. Invasive testing methods are considered the gold standard but are not practical in many settings. Consequently, it is important to evaluate the use of noninvasive methods in this species. Measurements for systolic, diastolic, and mean arterial pressure obtained using high-definition oscillometry (HDO) at the coccygeal artery were compared to simultaneous direct measurements obtained via catheterization of the femoral or dorsal pedal artery in eight anesthetized captive cheetahs during nine anesthetic events. Overall, HDO and direct measurements agreed most closely for mean arterial pressure, and the poorest agreement was observed for systolic pressure. There was a tendency for low diastolic pressures to be underestimated and for high diastolic pressures to be overestimated. Across all three parameters, HDO measurements from the tail overestimated directly measured pressures in the femoral artery and underestimated those in the dorsal pedal artery. HDO agreed most closely with directly measured dorsal pedal pressures. Mean arterial pressure showed the greatest precision (standard deviation of 10.2 mm Hg) and lowest bias (-1.2 mm Hg), with 75.9% of readings within 10 mm Hg of the direct dorsal pedal pressure. Agreement with systolic pressure was hindered by a high bias (-10.4 mm Hg), but if a correction factor of +10 mm Hg was applied to all systolic measurements, agreement was improved and 65.7% of readings were within 10 mm Hg of the direct pressure. When compared to criteria defined by the American College of Veterinary Internal Medicine for validation of blood pressure devices, results were favorable, but a

Hemodynamics in Transplant Renal Artery Stenosis and its Alteration after Stent Implantation Based on a Patient-specific Computational Fluid Dynamics Model

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Wang, Hong-Yang; Liu, Long-Shan; Cao, Hai-Ming; Li, Jun; Deng, Rong-Hai; Fu, Qian; Zhang, Huan-Xi; Fei, Ji-Guang; Wang, Chang-Xi

2017-01-01

Background: Accumulating studies on computational fluid dynamics (CFD) support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis (TRAS) and its alteration after stent treatment. Methods: Computed tomography angiography (CTA) data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery (TRA) was reconstructed from the qualified CTA images and categorized into three groups: the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress (WSS), and mass flow rate (MFR) were extracted. The data of hemodynamic parameters were expressed as median (interquartile range), and Mann–Whitney U-test was used for analysis. Results: Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS (2.94 [2.14, 3.30] vs. 1.06 [0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P = 0.001; 3.25 [2.67, 3.56] vs. 1.65 [1.18, 1.72] m/s, 281.3 [184.3, 364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P = 0.001) and lower minimal WSS and MFRs (0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P = 0.001; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P = 0.001) as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS. Conclusions: Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or

Hemodynamics in Transplant Renal Artery Stenosis and its Alteration after Stent Implantation Based on a Patient-specific Computational Fluid Dynamics Model.

Science.gov (United States)

Wang, Hong-Yang; Liu, Long-Shan; Cao, Hai-Ming; Li, Jun; Deng, Rong-Hai; Fu, Qian; Zhang, Huan-Xi; Fei, Ji-Guang; Wang, Chang-Xi

Accumulating studies on computational fluid dynamics (CFD) support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis (TRAS) and its alteration after stent treatment. Computed tomography angiography (CTA) data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery (TRA) was reconstructed from the qualified CTA images and categorized into three groups: the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress (WSS), and mass flow rate (MFR) were extracted. The data of hemodynamic parameters were expressed as median (interquartile range), and Mann-Whitney U-test was used for analysis. Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS (2.94 [2.14, 3.30] vs. 1.06 [0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P= 0.001; 3.25 [2.67, 3.56] vs. 1.65 [1.18, 1.72] m/s, 281.3 [184.3, 364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P= 0.001) and lower minimal WSS and MFRs (0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P= 0.001; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P= 0.001) as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS. Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or ameliorate deleterious change of hemodynamic

Isolated Systolic Hypertension: A Health Concern?

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Isolated systolic hypertension: A health concern? Is having a high top number (systolic) blood pressure, but a normal bottom number (diastolic) ... mm Hg, you have a common type of high blood pressure called isolated systolic hypertension. Isolated systolic hypertension can ...

Systolic time intervals vs invasive predictors of fluid responsiveness after coronary artery bypass surgery(dagger)

NARCIS (Netherlands)

Smorenberg, A.; Lust, E.J.; Beishuizen, A.; Meijer, J.H.; Verdaasdonk, R.M.; Groeneveld, A.B.J.

2013-01-01

OBJECTIVES: Haemodynamic parameters for predicting fluid responsiveness in intensive care patients are invasive, technically challenging or not universally applicable. We compared the initial systolic time interval (ISTI), a non-invasive measure of the time interval between the electrical and

The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients

Science.gov (United States)

Iacoviello, Massimo; Monitillo, Francesco; Leone, Marta; Citarelli, Gaetano; Doronzo, Annalisa; Antoncecchi, Valeria; Puzzovivo, Agata; Rizzo, Caterina; Lattarulo, Maria Silvia; Massari, Francesco; Caldarola, Pasquale; Ciccone, Marco Matteo

2016-01-01

Background/Aim The renal arterial resistance index (RRI) is a Doppler measure, which reflects abnormalities in the renal blood flow. The aim of this study was to verify the value of RRI as a predictor of worsening renal function (WRF) in a group of chronic heart failure (CHF) outpatients. Methods We enrolled 266 patients in stable clinical conditions and on conventional therapy. Peak systolic velocity and end diastolic velocity of a segmental renal artery were obtained by pulsed Doppler flow, and RRI was calculated. Creatinine serum levels were evaluated at baseline and at 1 year, and the changes were used to assess WRF occurrence. Results During follow-up, 34 (13%) patients showed WRF. RRI was associated with WRF at univariate (OR: 1.13; 95% CI: 1.07–1.20) as well as at a forward stepwise multivariate logistic regression analysis (OR: 1.09; 95% CI: 1.03–1.16; p = 0.005) including the other univariate predictors. Conclusions Quantification of arterial renal perfusion provides a new parameter that independently predicts the WRF in CHF outpatients. Its possible role in current clinical practice to better define the risk of cardiorenal syndrome progression is strengthened. PMID:27994601

Endovascular treatment of renal artery stenoses

International Nuclear Information System (INIS)

Lashari, M.N.

2015-01-01

To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. Study Design: An experimental study. Place and Duration of Study: A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. Methodology: Hypertension (systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications) with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. Results: There were 25 patients, 14 (56%) male and 11 (44%) female, with mean age of 49 +- 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 (44%), 10 (40%) and 4 (16%) patients respectively. Renal insufficiency (serum creatinine > 1.5 mg/dl) was seen in one (04%) patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 (20%), 9 (36%) and 11(44%) patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 (80%) patients. A significant decrease in systolic (168.20 +- 9.987 vs. 140.60 +- 5.649 mmHg, p < 0.001) and diastolic blood pressure (88.60 +- 5.50 vs. 77.20 +- 5.017 mmHg, p < 0.001) and reduction of medication (2.72 +- 0.458 vs. 1.5 +- 0.510, p < 0.01) were noted without a change in renal function (p= 0.061) after renal artery stenting. Conclusion: Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment

Non-dipping blood pressure patterns and arterial stiffness parameters in patients with Behcet's disease.

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Celik, Gulperi; Yilmaz, Sema; Ergulu Esmen, Serpil

2015-12-01

Behcet's disease is a multisystemic vasculitis involving veins and arteries of various sizes. Non-dipping status, augmentation index and pulse wave velocity are important determinants of cardiovascular mortality and morbidity. We investigated the non-dipping status and arterial stiffness in patients with Behcet's disease. In this cross-sectional study, we examined the vascular parameters of 96 patients with Behcet's disease (53% female) and 60 age- and sex-matched control subjects. The non-dipping status and arterial distensibility were assessed using a Mobil-O-Graph Arteriograph, an automatic oscillometric device. In total, 65.6% of 96 patients were systolic non-dippers, and 34.4% exhibited high augmentation indices. Ten percent of the control subjects were systolic non-dippers, and 11.7% exhibited high augmentation indices. Nocturnal decreases in systolic blood pressure correlated with central systolic blood pressure and diastolic blood pressure, as well as nocturnal decreases in diastolic blood pressure. Furthermore, non-dipper patients with Behcet's disease exhibited higher nocturnal cardiac outputs than did dipper patients with Behcet's disease. Augmentation index correlated negatively with C-reactive protein and correlated positively with both 24 h and nocturnal peripheral resistance, as well as 24 h pulse wave velocity. The patients with high augmentation indices exhibited lower creatinine clearance, as well as lower nocturnal cardiac outputs, higher 24 h peripheral resistance and higher 24 h pulse wave velocities. Non-dipping status and arterial stiffness may exacerbate the harmful cardiovascular effects of the other. In addition to conventional risk factors, non-dipping status and arterial stiffness should be examined during the follow-up evaluations of patients with Behcet's disease.

Left ventricular systolic dysfunction after transcatheter closure of a large patent ductus arteriosus.

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Galal, Mohammed Omar; Arfi, Muhammed Amin; Nicole, Sekarski; Payot, Maurice; Hussain, Arif; Qureshi, Shakeel

2005-11-01

A 12-year-old boy reported in outpatient department with history of shortness of breath and dyspnoea on moderate exertion. Physical examination was significant for bounding pulses and for a continuous murmur III/VI, best heard at the left upper sternal border. Echocardiography confirmed a large patent arterial duct with shortening fraction of 33%. He underwent successful transcatheter closure of the patent arterial, using Amplatzer duct occluder 12/10. Few hours later echocardiography revealed an unexpected, yet important depression of left ventricular systolic function with shortening fraction decreasing to 24% and then two weeks later decreasing further to 20%. At a follow-up after four months, he had improved clinically but left ventricular dysfunction still persisted with shortening fraction of 24%.

Ankle-brachial index as indicator of chronic arterial insufficiency of the lower extremities and renal artery stenosis CT/DS angiography

International Nuclear Information System (INIS)

Georgiev, A.; Chervenkov, L.; Karadon, S.

2015-01-01

Full text: The aim is to validate the measurements of ankle -brachial index (ABI), as part of routine examination algorithm in conducting CTA/DSA of the extremities in patients suffering from PAD. Correlations between ABI values and renal artery stenosis. The present study includes 200 patients (138 men and 62 women, aged between 60 and 75 years). 130 of them were examined by a computer- tomography angiography - 95 men and 32 women. 70 patients were examined by digital subtraction angiography - 50 men and 20 women. Measurements of ankle-brachial index (ABI) were performed on all patients by measuring the systolic blood pressure on both brachial arteries and determine the peak pressure in both aa. dorsalis pedis. Statistical data processing. There are no patients in the study with ABI values above 0.7 that have established renal artery stenosis. All patients with severe atherosclerotic changes have values of the ABI below 0.7, and those with the most severe changes below 0.5. This fully corresponds to global data showing that values below 0.9 ABI show mild engagement, below 0.7 average, and below 0.5 severe involvement. According to the results of this survey sensitivity of ABI for renal arteries below 0.7 equals 100% and its specificity = 67.5%. For values of ABI below 0.5: Sensitivity =100%; Specificity = 83.85%. By determining ABI values both symptomatic and asymptomatic form of a PAD can be diagnosed. the method is fast, non-invasive, inexpensive and applicable everywhere. No special preparation of the patient is needed. The method can be used not only to assess the degree of commitment of the vessels of the lower limbs, but also as an indicator for the state of renal arteries in those patients

Systolic trees and systolic language recognition by tree automata

Energy Technology Data Exchange (ETDEWEB)

Steinby, M

1983-01-01

K. Culik II, J. Gruska, A. Salomaa and D. Wood have studied the language recognition capabilities of certain types of systolically operating networks of processors (see research reports Cs-81-32, Cs-81-36 and Cs-82-01, Univ. of Waterloo, Ontario, Canada). In this paper, their model for systolic VLSI trees is formalised in terms of standard tree automaton theory, and the way in which some known facts about recognisable forests and tree transductions can be applied in VLSI tree theory is demonstrated. 13 references.

Investigation Of Arterial Blood Pressure Level And Metabolic Indices In Patients With Arterial Hypertension At Pharmacotherapy With Antihypertensive Medicines Of Various Chemical Structure

Directory of Open Access Journals (Sweden)

G.Kh. Glybochko

2009-12-01

Full Text Available The research goal is to carry on the comparative analysis of medicines of various chemical structure, Telmisar-tan and Bisoprolol, and to reveal their effect on the arterial blood pressure level and the indices of various metabolic processes in patients with arterial hypertension. 60 out-patients with arterial hypertension (stage II risk III both males and females aged 33-55 have been under study taking Telmisartan and Bisoprolol for 3 months. While treating the patients the arterial blood pressure level control and biochemical investigations for determination the indices of metabolic processes have been carried out. The investigated medications have provided the decrease of systolic and diastolic arterial pressure parameters, the increase of concentration of total and ionized calcium, chlorine ions, urea and total bilirubin in blood plasma. Therapy with Telmisartan has shown more significant increase of potassium level in erythro-cytes, decrease of levels of natrium, glucose, glycolized hemoglobin and triglycerides and increased contents of alani-naminotransferase and aspartataminotransferase. The course of therapy with Bisoprolol has restored the normal level of magnesium in blood plasma, has not have any influence on carbohydrate and lipid metabolism, increased the level of alaninaminotransferase and significantly increased the contents of total and ionized calcium, urea and creatinine. 3-months therapy with Telmisartan and Bisoprolol has proved the decrease of systolic and diastolic arterial pressure in patients with arterial hypertension. The medications under study have had active and variable effects on metabolic indices

Ocular Image and Haemodynamic Features Associated with Different Gradings of Ipsilateral Internal Carotid Artery Stenosis

Directory of Open Access Journals (Sweden)

Hui Wang

2017-01-01

Full Text Available Objectives. To analyse the changes of ocular haemodynamics and morphology in Chinese patients with internal carotid artery (ICA stenosis in the current study. Methods. A retrospective case-control study was conducted with 219 patients. The haemodynamic characteristics, the calibre of retinal vessels, and the subfoveal choroidal thickness (SFChT were compared. We analysed the correlations with the degree of ipsilateral ICA stenosis. Results. There were no significant differences among the groups in the central retinal artery equivalent (CRAE, central retinal vein equivalent (CRVE, and AVR (p=0.073, p=0.188, and p=0.738, resp.. The peak systolic velocity (PSV and end diastolic velocity (EDV in the central retinal artery (CRA and the posterior ciliary artery (PCA were significantly lower than normal eyes (p<0.001. The outer retinal layer thickness and SFChT values of the ICA stenosis groups were significantly lower than normal eyes (p=0.030 and p<0.001, resp.. Conclusion. The PSV and EDV in CRA and PCA and the SFChT and outer retinal layer thickness of ICA eyes were significantly lower than normal eyes. ICA stenosis may impact choroidal haemodynamics, and decreased choroidal circulation might affect the discordance of the SFChT and the outer retinal layer thickness.

Analysis of the flow in stenosed carotid artery bifurcation models--hydrogen-bubble visualisation.

Science.gov (United States)

Palmen, D E; van de Vosse, F N; Janssen, J D; van Dongen, M E

1994-05-01

This paper deals with the effect of geometric changes of mild stenoses on large-scale flow disturbances in the carotid artery bifurcation. Hydrogen-bubble visualisation experiments have been performed in Plexiglas models of a non-stenosed and a 25% stenosed carotid artery bifurcation. The flow conditions approximate physiological flow. The experiments show that shortly after the onset of the diastolic phase vortex formation occurs in the plane of symmetry. This vortex formation is found in a shear layer, which is formed in the carotid sinus. The shear layer is located between a region with low shear rates at the non-divider wall and a region with high shear rates at the divider wall. In order to gain insight into the parameters that are important with respect to the stability of the shear layer, experiments have been performed in which the influence of the shape of the flow pulse, the Reynolds number (Re), the Womersley parameter (alpha) and the flow division ratio (gamma) on the flow phenomena is studied. From these experiments it appears that the flow phenomena in the carotid artery bifurcation are significantly influenced by Re, alpha the systolic acceleration (sa) and deceleration (sd) and the duration of the peak-systolic flow (Tmax). With these results a simplified flow pulse is chosen, with which the experiments in the non-stenosed and the 25% stenosed bifurcation are performed. Comparison of the hydrogen-bubble profiles in the 0 and 25% stenosed models with similar flow conditions shows that the geometric change of the 25% stenosis only slightly influences the flow phenomena. The most striking influences are found in the stability of the shear layer. Quantitative experiments by means of laser Doppler anemometry measurements and numerical computations are needed to analyse the influence of the stenosis of the flow field more accurately.

Aerobic Exercise Training and Arterial Changes in African-Americans versus Caucasians

Science.gov (United States)

Ranadive, Sushant M.; Yan, Huimin; Lane, Abbi D.; Kappus, Rebecca M.; Cook, Marc D.; Sun, Peng; Harvey, Idethia; Ploutz-Synder, Robert; Woods, Jeffrey A.; Wilund, Kenneth R.; Fernhall, Bo

2015-01-01

African-Americans (AA) have increased carotid artery intima-media thickness and decreased vascular function compared to their Caucasian (CA) peers. Aerobic exercise prevents and potentially reverses arterial dysfunction. Purpose The purpose of this study was to examine the effect of 8 weeks of moderate-high intensity aerobic training in young healthy sedentary AA and CA men and women. Methods Sixty-four healthy volunteers (men = 28, women = 36) with mean age = 24 underwent measures of arterial structure, function and blood pressure variables at baseline, post-4 week control period and 8 weeks post-training. Results There was a significant increase in VO2peak amongst both groups post exercise training. Brachial systolic blood pressure decreased significantly following control period in both groups but not following exercise training. Carotid pulse pressure decreased significantly in both groups post exercise training as compared to baseline. There was no change in any of the other blood pressure variables. AAs had a higher intima-media thickness at baseline and post-control period, but significantly decreased following exercise training compared to CAs. AAs had significantly lower baseline forearm blood flow and RH compared to CAs, but exercise training had no effect on these variables. There was no significant difference in arterial stiffness (cPWV) and wave-reflection (AIx) between the two groups at any time point. Conclusions This is the first study to show that, 8 weeks of aerobic exercise training causes significant improvement in the arterial structure in young, healthy AAs, making it comparable to the CAs and with minimal effects on blood pressure variables. PMID:26225767

Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction.

Science.gov (United States)

Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Arruda, Ana Lúcia Martins; Hotta, Viviane Tiemi; Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador

2014-03-01

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.

Ankle Brachial Index: simple non-invasive estimation of peripheral artery disease

Science.gov (United States)

Pieniak, Marcin; Cieślicki, Krzysztof; Żyliński, Marek; Górski, Piotr; Murgrabia, Agnieszka; Cybulski, Gerard

2014-11-01

According to international guidelines, patients with Peripheral Artery Disease (PAD) are burdened with high cardiovascular risk. One of the simplest, non-invasive methods for PAD detection is the ankle-brachial index (ABI) measurement. The ABI is calculated as the ratio of systolic blood pressure at the ankle (pressure in the posterior tibial artery or the dorsal artery) to the systolic pressure in the arm (in the brachial artery) when the body is in a horizontal position. The physiological value of the ABI is assumed to be between 1 and 1.3; however, these limits vary from study to study. A value less than 0.9 indicates PAD. Some authors propose also measuring the ABI on both sides of the body to highlight possible differences in blood pressure between the opposite arterial segments. The aim of this study was to perform a meta-analysis of the ABI diagnostic criteria used in different publications. Additionally, ABI measurements were performed on 19 healthy patients in age ranged from 20 to 63 years. The results showed a slight dependence between age and the differences between the values obtained from left and right sides of the body.

Accuracy and Precision of a Plane Wave Vector Flow Imaging Method in the Healthy Carotid Artery

DEFF Research Database (Denmark)

Jensen, Jonas; Villagómez Hoyos, Carlos Armando; Traberg, Marie Sand

2018-01-01

The objective of the study described here was to investigate the accuracy and precision of a plane wave 2-D vector flow imaging (VFI) method in laminar and complex blood flow conditions in the healthy carotid artery. The approach was to study (i) the accuracy for complex flow by comparing...... of laminar flow in vivo. The precision in vivo was calculated as the mean standard deviation (SD) of estimates aligned to the heart cycle and was highest in the center of the common carotid artery (SD = 3.6% for velocity magnitudes and 4.5° for angles) and lowest in the external branch and for vortices (SD...... the velocity field from a computational fluid dynamics (CFD) simulation to VFI estimates obtained from the scan of an anthropomorphic flow phantom and from an in vivo scan; (ii) the accuracy for laminar unidirectional flow in vivo by comparing peak systolic velocities from VFI with magnetic resonance...

Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia.

Science.gov (United States)

Chalmers, J D; Singanayagam, A; Hill, A T

2008-08-01

Admission blood pressure (BP) assessment is a central component of severity assessment for community acquired pneumonia. The aim of this study was to establish which readily available haemodynamic measure on admission is most useful for predicting severity in patients admitted with community acquired pneumonia. A prospective observational study of patients admitted with community acquired pneumonia was conducted in Edinburgh, UK. The measurements compared were systolic and diastolic BP, mean arterial pressure and pulse pressure. The outcomes of interest were 30 day mortality and the requirement for mechanical ventilation and/or inotropic support. Admission systolic BP pressure pressure AUC values for each predictor of 30 day mortality were as follows: systolic BP pressure pressure AUC values for each predictor of need for mechanical ventilation and/or inotropic support were as follows: systolic BP pressure pressure blood pressure AUC 0.76 vs 0.74) and to the standard CURB65 score (0.76 vs 0.76) for the prediction of 30 day mortality. The simplified CRB65 score was equivalent for prediction of mechanical ventilation and/or inotropic support to standard CRB65 (0.77 vs 0.77) and to CURB65 (0.77 vs 0.78). Systolic BP is superior to other haemodynamic predictors of 30 day mortality and need for mechanical ventilation and/or inotropic support in community acquired pneumonia. The CURB65 score can be simplified to a modified CRB65 score by omission of the diastolic BP criterion without compromising its accuracy.

The effect of chronic digitalization on pump function in systolic heart failure.

Science.gov (United States)

Hassapoyannes, C A; Easterling, B M; Chavda, K; Chavda, K K; Movahed, M R; Welch, G W

2001-10-01

Short- and intermediate-term use of cardiac glycosides promotes inotropy and improves the ejection fraction in systolic heart failure. To determine whether chronic digitalization alters left ventricular function and performance. Eighty patients with mild-to-moderate systolic heart failure (baseline ejection fraction < or =45%) participated from our institution in a multi-center, chronic, randomized, double-blind study of digitalis vs. placebo. Of the 40 survivors, 38 (20 allocated to the digitalis arm and 18 to the placebo arm) were evaluated at the end of follow-up (mean, 48.4 months). Left ventricular systolic function was assessed by both nuclear ventriculography and echocardiography. The ejection fraction was measured scintigraphically, while the ventricular volumes were computed echocardiographically. The groups did not differ, at baseline or end-of-study, with respect to the ejection fraction and the loading conditions (arterial pressure, ventricular volumes and heart rate) by either intention-to-treat or actual-treatment-received analysis. Over the course of the trial, the digitalis arm exhibited no significant increase in the use of diuretics (18%, P=0.33), in distinction from the placebo group (78%, P=0.004), and a longer stay on study drug among those patients who withdrew from double-blind treatment (28.6 vs. 11.4 months, P=0.01). Following chronic use of digitalis for mild-to-moderate heart failure, cross-sectional comparison with a control group from the same inception cohort showed no appreciable difference in systolic function or performance. Thus, the suggested clinical benefit cannot be explained by an inotropic effect.

Development of optoelectronic monitoring system for ear arterial pressure waveforms

Science.gov (United States)

Sasayama, Satoshi; Imachi, Yu; Yagi, Tamotsu; Imachi, Kou; Ono, Toshirou; Man-i, Masando

1994-02-01

Invasive intra-arterial blood pressure measurement is the most accurate method but not practical if the subject is in motion. The apparatus developed by Wesseling et al., based on a volume-clamp method of Penaz (Finapres), is able to monitor continuous finger arterial pressure waveforms noninvasively. The limitation of Finapres is the difficulty in measuring the pressure of a subject during work that involves finger or arm action. Because the Finapres detector is attached to subject's finger, the measurements are affected by inertia of blood and hydrostatic effect cause by arm or finger motion. To overcome this problem, the authors made a detector that is attached to subject's ear and developed and optoelectronic monitoring systems for ear arterial pressure waveform (Earpres). An IR LEDs, photodiode, and air cuff comprised the detector. The detector was attached to a subject's ear, and the space adjusted between the air cuff and the rubber plate on which the LED and photodiode were positioned. To evaluate the accuracy of Earpres, the following tests were conducted with participation of 10 healthy male volunteers. The subjects rested for about five minutes, then performed standing and squatting exercises to provide wide ranges of systolic and diastolic arterial pressure. Intra- and inter-individual standard errors were calculated according to the method of van Egmond et al. As a result, average, the averages of intra-individual standard errors for earpres appeared small (3.7 and 2.7 mmHg for systolic and diastolic pressure respectively). The inter-individual standard errors for Earpres were about the same was Finapres for both systolic and diastolic pressure. The results showed the ear monitor was reliable in measuring arterial blood pressure waveforms and might be applicable to various fields such as sports medicine and ergonomics.

Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments.

Science.gov (United States)

Corrà, Ugo; Giordano, Andrea; Mezzani, Alessandro; Gnemmi, Marco; Pistono, Massimo; Caruso, Roberto; Giannuzzi, Pantaleo

2012-02-01

The study aims were to validate the cardiopulmonary exercise testing (CPET) parameters recommended by the European Society of Cardiology 2008 Guidelines for risk assessment in heart failure (HF) (ESC-predictors) and to verify the predictive role of 11 supplementary CPET (S-predictors) parameters. We followed 749 HF patients for cardiovascular death and urgent heart transplantation for 3 years: 139 (19%) patients had cardiac events. ESC-predictors - peak oxygen consumption (VO(2)), slope of minute ventilation vs carbon dioxide production (VE/VCO(2)) and exertional oscillatory ventilation - were all related to outcome at univariate and multivariable analysis. The ESC/2008 prototype based on ESC-predictors presented a Harrell's C concordance index of 0.725, with a likely χ2 of 98.31. S-predictors - predicted peak VO(2), peak oxygen pulse, peak respiratory exchange ratio, peak circulatory power, peak VE/VCO(2), VE/VCO(2) slope normalized by peak VO(2), VO(2) efficiency slope, ventilatory anaerobic threshold detection, peak end-tidal CO(2) partial pressure, peak heart rate, and peak systolic arterial blood pressure (SBP) - were all linked to outcome at univariate analysis. When individually added to the ESC/2008 prototype, only peak SBP and peak O(2) pulse significantly improved the model discrimination ability: the ESC + peak SBP prototype had a Harrell's C index 0.750 and reached the highest likely χ2 (127.16, p < 0.0001). We evaluated the longest list of CPET prognostic parameters yet studied in HF: ESC-predictors were independent predictors of cardiovascular events, and the ESC prototype showed a convincing predictive capacity, whereas none of 11 S-predictors enhanced the prognostic performance, except peak SBP.

Hemodynamic patterns of anterior communicating artery aneurysms: a possible association with rupture

Science.gov (United States)

Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

2007-03-01

The aim of this study is to characterize the different flows present at anterior communicating artery (AcoA) aneurysms and investigate possible associations with rupture. For that purpose, patient-specific computational models of 26 AcoA aneurysms were constructed from 3D rotational angiography images. Bilateral images were acquired in 15 patients who had both A1 segments of the anterior cerebral arteries and models were created by fusing the reconstructed left and right arterial trees. Computational fluid dynamics simulations were performed under pulsatile flow conditions. Visualizations of the flow velocity pattern were created to classify the aneurysms into the following flow types: A) inflow from both A1 segments, B) flow jet in the parent artery splits into three secondary jets, one enters the aneurysm and the other two are directed to the A2 segments, C) the parent artery jet splits into two secondary jets, one is directed to one of the A2 segments and the other enters the aneurysm before being directed to the other A2 segment, and D) the parent artery jet enters the aneurysm before being directed towards the A2 segments. The maximum wall shear stress in the aneurysm at the systolic peak (MWSS) was calculated. Most aneurysms in group A were unruptured and had the lowest MWSS. Group B had the same number of unruptured and ruptured aneurysms, and a low MWSS. Groups C and D had high rupture ratios, being the average MWSS significantly higher in group C. Finally, it was found that the MWSS was higher for ruptured aneurysms of all flow types.

Healing of ulcers on the feet correlated with distal blood pressure measurements in occlusive arterial disease

DEFF Research Database (Denmark)

Holstein, P; Lassen, N A

1980-01-01

The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel...

Aerobic Exercise Training and Arterial Changes in African Americans versus Caucasians.

Science.gov (United States)

Ranadive, Sushant M; Yan, Huimin; Lane, Abbi D; Kappus, Rebecca M; Cook, Marc D; Sun, Peng; Harvey, Idethia; Ploutz-Synder, Robert; Woods, Jeffrey A; Wilund, Kenneth R; Fernhall, B O

2016-01-01

African Americans (AA) have increased carotid artery intima-media thickness and decreased vascular function compared with their Caucasian (CA) peers. Aerobic exercise prevents and potentially reverses arterial dysfunction. The purpose of this study was to examine the effect of 8 wk of moderate- to high-intensity aerobic training in young healthy sedentary AA and CA men and women. Sixty-four healthy volunteers (men, 28; women, 36) with mean age 24 yr underwent measures of arterial structure, function, and blood pressure (BP) variables at baseline, after the 4-wk control period, and 8 wk after training. There was a significant increase in VO2peak among both groups after exercise training. Brachial systolic BP decreased significantly after the control period in both groups but not after exercise training. Carotid pulse pressure decreased significantly in both groups after exercise training as compared with that in baseline. There was no change in any of the other BP variables. AA had higher intima-media thickness at baseline and after the control period but it significantly decreased after exercise training compared with that of CA. AA had significantly lower baseline forearm blood flow and reactive hyperemia compared with those of CA, but exercise training had no effect on these variables. There was no significant difference in arterial stiffness (central pulse wave velocity) and wave-reflection (augmentation index) between the two groups at any time point. This is the first study to show that 8 wk of aerobic exercise training causes significant improvement in the arterial structure in young, healthy AA, making it comparable with the CA and with minimal effects on BP variables.

Cardiac structure and function, and ventricular-arterial interaction 11 years following a pregnancy with preeclampsia.

Science.gov (United States)

Al-Nashi, Maha; Eriksson, Maria J; Östlund, Eva; Bremme, Katarina; Kahan, Thomas

2016-04-01

Preeclampsia (PE) is associated with acute left ventricular dysfunction. Whether these changes eventually resolve remains unclear. This study assessed left and right ventricular structure and function, and ventricular-arterial interaction in 15 women 11 years after a pregnancy with PE and 16 matched control subjects with a normal pregnancy. We found normal left and right ventricular dimensions, systolic function, and global left ventricular strain, with no differences between the groups. In addition, indices of diastolic function, left and right atrial size, and amino-terminal pro-brain natriuretic peptide were normal and did not differ between the groups. Women with a previous PE had impaired night/day ratios for systolic and diastolic ambulatory blood pressure. However, indices of aortic stiffness or ventricular-arterial coupling did not differ between the groups. In conclusion, we could not demonstrate remaining alterations in systolic or diastolic left or right ventricular function, or in ventricular-arterial interaction in women 11 years after PE. Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated Tc-99m-MIBI myocardial SPECT

International Nuclear Information System (INIS)

Paeng, Jin Chul; Lee, Dong Soo; Cheon, Gi Jeong; Kim, Yu Kyeong; Chung, June Key; Lee, Myung Chul

2000-01-01

The aim of this study is to investigate the reproducibility of the quantitative assessment of segmental wall motion and systolic thickening provided by an automatic quantitation algorithm. Tc-99m-MIBI gated myocardial SPECT with dipyridamole stress was performed in 31 patients with known or suspected coronary artery disease (4 with single, 6 with two, 11 with triple vessel disease; ejection fraction 51±14%) twice consecutively in the same position. Myocardium was divided into 20 segments. Segmental wall motion and systolic thickening were calculated and expressed in mm and % increase respectively, using AutoQUANT TM software. The reproducibility of this quantitative measurement of wall motion and thickening was tested. Correlations between repeated measurements on consecutive gated SPECT were excellent for wall motion (r=0.95) and systolic thickening (r=0.88). On Bland-Altman analysis, two standard deviation was 2 mm for repeated measurement of segmental wall motion, and 20% for that of systolic thickening. The weighted kappa values of repeated measurements were 0.807 for wall motion and 0.708 for systolic thickening. Sex, perfusion, or segmental location had no influence on reproducibility. Segmental wall motion and systolic thickening quantified using AutoQUANT TM software on gated myocardial SPECT offers good reproducibility and is significantly different when the change is more than 2 mm for wall motion and more than 20% for systolic thickening

A new noninvasive device for continuous arterial blood pressure monitoring in the superficial temporal artery

International Nuclear Information System (INIS)

Chin, K Y; Panerai, R B

2013-01-01

Continuous recording of arterial blood pressure (ABP) has many applications in cardiovascular physiology, but existing alternatives rely on measurements performed in the fingers or radial artery. Peripheral recordings have significant differences from central ABP regarding the pattern of the waveform and corresponding systolic and diastolic values. To address the need for noninvasive measurements closer to the ascending aorta, a new device was constructed to measure ABP in the superficial temporal artery (STA) using photoplethysmography and the arterial volume clamping technique. The optoelectronic circuitry to generate the photoplethysmogram is contained in a specially designed probe placed over the STA and kept in place with a head frame. The prototype (STAbp) also includes original designs for the pneumatic, electronic, signal processing, control and display sub-systems. A self-calibration feature regularly updates the photoplethysmogram operating point to improve accuracy. The performance of the STAbp was compared against the Finapres in 19 healthy subjects. At rest, the bias (SD d ) was −23.1 (15.05), −10.8 (13.83) and −12.4 (12.93) mmHg for systolic, mean and diastolic pressures respectively, without significant differences in drift between the two devices. The 99% bandwidth (SD) for the spectral distribution of ABP waveforms was 5.3 (1.46) Hz for STAbp and 6.8 (0.73) Hz for the Finapres (p < 0.01). Handgrip manoeuvre showed a very similar response to the Finapres, including the rapid return to baseline on release. The new STAbp device has considerable potential as a new tool for clinical and research applications where continuous recording of more central ABP is advantageous compared to peripheral alternatives. (paper)

Does Renal Artery Supply Indicate Treatment Success of Renal Denervation?

International Nuclear Information System (INIS)

Schmid, Axel; Ditting, Tilmann; Sobotka, Paul A.; Veelken, Roland; Schmieder, Roland E.; Uder, Michael; Ott, Christian

2013-01-01

PurposeRenal denervation (RDN) emerged as an innovative interventional antihypertensive therapy. With the exception of pretreatment blood pressure (BP) level, no other clear predictor for treatment efficacy is yet known. We analyzed whether the presence of multiple renal arteries has an impact on BP reduction after RDN.MethodsFifty-three patients with treatment-resistant hypertension (office BP ≥ 140/90 mmHg and 24-h ambulatory BP monitoring (≥130/80 mmHg) underwent bilateral catheter-based RDN. Patients were stratified into one-vessel (OV) (both sides) and at least multivessel (MV) supply at one side. Both groups were treated on one vessel at each side; in case of multiple arteries, only the dominant artery was treated on each side.ResultsBaseline clinical characteristics (including BP, age, and estimated glomerular filtration rate) did not differ between patients with OV (n = 32) and MV (n = 21). Office BP was significantly reduced in both groups at 3 months (systolic: OV −15 ± 23 vs. MV −16 ± 20 mmHg; diastolic: OV −10 ± 12 vs. MV −8 ± 11 mmHg, both p = NS) as well as 6 months (systolic: OV −18 ± 18 vs. MV −17 ± 22 mmHg; diastolic: OV −10 ± 10 vs. −10 ± 12 mmHg, both p = NS) after RDN. There was no difference in responder rate (rate of patients with office systolic BP reduction of at least 10 mmHg after 6 months) between the groups.ConclusionIn patients with multiple renal arteries, RDN of one renal artery—namely, the dominant one—is sufficient to induce BP reduction in treatment-resistant hypertension

Cardiac MRI in pulmonary artery hypertension: correlations between morphological and functional parameters and invasive measurements

Energy Technology Data Exchange (ETDEWEB)

Alunni, Jean-Philippe; Otal, Philippe; Rousseau, Herve; Chabbert, Valerie [CHU Rangueil, Department of Radiology, Toulouse (France); Degano, Bruno; Tetu, Laurent; Didier, Alain [CHU Larrey, Department of Pneumology, Toulouse (France); Arnaud, Catherine [CHU Rangueil, Department of Methods in Clinical Research, Toulouse (France); Blot-Souletie, Nathalie [CHU Rangueil, Department of Cardiology, Toulouse (France)

2010-05-15

To compare cardiac MRI with right heart catheterisation in patients with pulmonary hypertension (PH) and to evaluate its ability to assess PH severity. Forty patients were included. MRI included cine and phase-contrast sequences, study of ventricular function, cardiac cavity areas and ratios, position of the interventricular septum (IVS) in systole and diastole, and flow measurements. We defined four groups according to the severity of PH and three groups according to IVS position: A, normal position; B, abnormal in diastole; C, abnormal in diastole and systole. IVS position was correlated with pulmonary artery pressures and PVR (pulmonary vascular resistance). Median pulmonary artery pressures and resistance were significantly higher in patients with an abnormal septal position compared with those with a normal position. Correlations were good between the right ventricular ejection fraction and PVR, right ventricular end-systolic volume and PAP, percentage of right ventricular area change and PVR, and diastolic and systolic ventricular area ratio and PVR. These parameters were significantly associated with PH severity. Cardiac MRI can help to assess the severity of PH. (orig.)

Pulmonary thallium uptake: Correlation with systolic and diastolic left ventricular function at rest and during exercise

International Nuclear Information System (INIS)

Mannting, F.

1990-01-01

Quantified pulmonary 201-thallium uptake, assessed as pulmonary/myocardial ratios (PM) and body surface area-corrected absolute pulmonary uptake (Pc), was determined from single photon emission computed tomography studies in 22 normal subjects and 46 consecutive patients with coronary artery disease (CAD). By means of equilibrium radionuclide angiography (ERNA), ejection fraction (EF), peak ejection rate (PER) in end-diastolic volume (EDV/sec) and peak filling rate (PFR) in EDV/sec and stroke volume (SV/sec) units, PFR/PER ratio, and time to peak filling rate (TPFR) in milliseconds were computed at rest and during exercise (n = 35). Left ventricular response to exercise was assessed as delta EF, relative delta EF, delta EDV, and delta ESV. In normal subjects the PM ratios showed significant inverse correlation with PER at rest and with EF, PER, and PFRedv during exercise. For the left ventricular response to exercise, delta ESV showed significant correlation with the PM ratios. The body surface area-corrected pulmonary uptake values showed no correlation with any of the variables. In patients with CAD the PM ratios and Pc uptake showed significant inverse correlation with EF, PER, PFRedv and to exercise EF, exercise PER, and exercise PFRedv. For the left ventricular response to exercise, delta EF showed significant inverse correlation with the PM ratios but not with the Pc uptake. Neither in normal subjects nor in patients with CAD did any of the independent diastolic variables show significant correlation with the PM ratios or Pc values. Thus pulmonary thallium uptake is correlated with systolic left ventricular function at rest and during exercise in normal subjects and in patients with CAD but not with diastolic function. In normal subjects delta ESV and in patients with CAD, delta EF showed correlation with pulmonary thallium uptake

Contribution of the Arterial System and the Heart to Blood Pressure during Normal Aging - A Simulation Study

NARCIS (Netherlands)

Maksuti, Elira; Westerhof, Nico; Westerhof, Berend E.; Broomé, Michael; Stergiopulos, Nikos

2016-01-01

During aging, systolic blood pressure continuously increases over time, whereas diastolic pressure first increases and then slightly decreases after middle age. These pressure changes are usually explained by changes of the arterial system alone (increase in arterial stiffness and vascular

Machine Learning Techniques for Arterial Pressure Waveform Analysis

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João Cardoso

2013-05-01

Full Text Available The Arterial Pressure Waveform (APW can provide essential information about arterial wall integrity and arterial stiffness. Most of APW analysis frameworks individually process each hemodynamic parameter and do not evaluate inter-dependencies in the overall pulse morphology. The key contribution of this work is the use of machine learning algorithms to deal with vectorized features extracted from APW. With this purpose, we follow a five-step evaluation methodology: (1 a custom-designed, non-invasive, electromechanical device was used in the data collection from 50 subjects; (2 the acquired position and amplitude of onset, Systolic Peak (SP, Point of Inflection (Pi and Dicrotic Wave (DW were used for the computation of some morphological attributes; (3 pre-processing work on the datasets was performed in order to reduce the number of input features and increase the model accuracy by selecting the most relevant ones; (4 classification of the dataset was carried out using four different machine learning algorithms: Random Forest, BayesNet (probabilistic, J48 (decision tree and RIPPER (rule-based induction; and (5 we evaluate the trained models, using the majority-voting system, comparatively to the respective calculated Augmentation Index (AIx. Classification algorithms have been proved to be efficient, in particular Random Forest has shown good accuracy (96.95% and high area under the curve (AUC of a Receiver Operating Characteristic (ROC curve (0.961. Finally, during validation tests, a correlation between high risk labels, retrieved from the multi-parametric approach, and positive AIx values was verified. This approach gives allowance for designing new hemodynamic morphology vectors and techniques for multiple APW analysis, thus improving the arterial pulse understanding, especially when compared to traditional single-parameter analysis, where the failure in one parameter measurement component, such as Pi, can jeopardize the whole evaluation.

Pacing stress echocardiography

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Agrusta Marco

2005-12-01

Full Text Available Abstract Background High-rate pacing is a valid stress test to be used in conjunction with echocardiography; it is independent of physical exercise and does not require drug administration. There are two main applications of pacing stress in the echo lab: the noninvasive detection of coronary artery disease through induction of a regional transient dysfunction; and the assessment of contractile reserve through peak systolic pressure/ end-systolic volume relationship at increasing heart rates to assess global left ventricular contractility. Methods The pathophysiologic rationale of pacing stress for noninvasive detection of coronary artery disease is obvious, with the stress determined by a controlled increase in heart rate, which is a major determinant of myocardial oxygen demand, and thereby tachycardia may exceed a fixed coronary flow reserve in the presence of hemodynamically significant coronary artery disease. The use of pacing stress echo to assess left ventricular contractile reserve is less established, but promising. Positive inotropic interventions are mirrored by smaller end-systolic volumes and higher end-systolic pressures. An increased heart rate progressively increases the force of ventricular contraction (Bowditch treppe or staircase phenomenon. To build the force-frequency relationship, the force is determined at different heart rate steps as the ratio of the systolic pressure (cuff sphygmomanometer/end-systolic volume index (biplane Simpson rule. The heart rate is determined from ECG. Conclusion Two-dimensional echocardiography during pacing is a useful tool in the detection of coronary artery disease. Because of its safety and ease of repeatability noninvasive pacing stress echo can be the first-line stress test in patients with permanent pacemaker. The force-frequency can be defined as up- sloping (normal when the peak stress pacing systolic pressure/end-systolic volume index is higher than baseline and intermediate stress

[Peculiarities of the course of arterial hypertension in patients with atherosclerotic stenoses of brachiocephalic arteries before and after surgery on carotid arteries].

Science.gov (United States)

Kosacheva, N B; Tuev, A V

2013-01-01

Study aim was to investigate relationship between atherosclerosis of carotid arteries (CA) and the presence of arterial hypertension (AH) and possibilities of correction of AH after surgery. We examined 70 patients with episodes of elevation of arterial pressure (AP) scheduled for surgical interventions on brachiocephalic arteries (BCA) because of CA stenoses (n=50, group 1) or anomalies of BCA development (n=20, group 2). Before operation patients of group 1 had higher mean AP than patients of group 2 (103.6+/-11.3 and 91.7+/-6.6 mm Hg, respectively, p=0.00007). This difference disappeared after surgery. In postoperative period in patients with CA stenoses levels of both systolic and diastolic AP decreased (from 145.1+/-14.7 to 135.6+/-12.3, p=0.02; and from 83.3+/-10.2 78.1+/-9.7 mm Hg, =0.02, respectively). In group 2 no significant AP reduction was observed. Thus AP elevation in patients with involvement of BCA to a considerable degree is caused by CA stenosis. Surgical treatment of these patients facilitates lowering of AP.

Assessment of myocardial bridge by cardiac CT: Intracoronary transluminal attenuation gradient derived from diastolic phase predicts systolic compression

Energy Technology Data Exchange (ETDEWEB)

Yu, Meng Meng; Zhang, Yang; Li, Yue Hua; Li, Wen Bin; Li, Ming Hua; Zhang, Jiayin [Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shangha (China)

2017-08-01

To study the predictive value of transluminal attenuation gradient (TAG) derived from diastolic phase of coronary computed tomography angiography (CCTA) for identifying systolic compression of myocardial bridge (MB). Consecutive patients diagnosed with MB based on CCTA findings and without obstructive coronary artery disease were retrospectively enrolled. In total, 143 patients with 144 MBs were included in the study. Patients were classified into three groups: without systolic compression, with systolic compression < 50%, and with systolic compression ≥ 50%. TAG was defined as the linear regression coefficient between intraluminal attenuation in Hounsfield units (HU) and length from the vessel ostium. Other indices such as the length and depth of the MB were also recorded. TAG was the lowest in MB patients with systolic compression ≥ 50% (-19.9 ± 8.7 HU/10 mm). Receiver operating characteristic curve analysis was performed to determine the optimal cutoff values for identifying systolic compression ≥ 50%. The result indicated an optimal cutoff value of TAG as -18.8 HU/10 mm (area under curve = 0.778, p < 0.001), which yielded higher sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy (54.1, 80.5, 72.8, and 75.0%, respectively). In addition, the TAG of MB with diastolic compression was significantly lower than the TAG of MB without diastolic compression (-21.4 ± 4.8 HU/10 mm vs. -12.7 ± 8 HU/10 mm, p < 0.001). TAG was a better predictor of MB with systolic compression ≥ 50%, compared to the length or depth of the MB. The TAG of MB with persistent diastolic compression was significantly lower than the TAG without diastolic compression.

Allergic rhinitis and arterial blood pressure: a population-based study.

Science.gov (United States)

Sakallioglu, O; Polat, C; Akyigit, A; Cetiner, H; Duzer, S

2018-05-01

To investigate the likelihood of allergic rhinitis and potential co-morbidities, and to assess whether allergic rhinitis is associated with arterial blood pressure and hypertension. In this population-based study, 369 adults with allergic rhinitis and asthma were assessed via a questionnaire and immunoglobulin E levels. There were four groups: control (n = 90), allergic rhinitis (n = 99), asthma (n = 87) and hypertension (n = 93). Arterial blood pressure was measured in all groups. There were no significant differences in systolic or diastolic blood pressure between males and females in any group. Pairwise comparisons revealed no significant differences between: the control and allergic rhinitis groups, the control and asthma groups, or the allergic rhinitis and asthma groups. The systolic and diastolic blood pressure values of males and females were significantly higher in the hypertension group than the allergic rhinitis group. There were no significant differences in systolic blood pressure or diastolic blood pressure for seasonal and perennial allergic rhinitis patients. Rhinitis was not associated with increased blood pressure. Allergic rhinitis can coincide with asthma and hypertension. The findings do not support the need for blood pressure follow up in allergic rhinitis patients.

Wall morphology, blood flow and wall shear stress: MR findings in patients with peripheral artery disease

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Galizia, Mauricio S.; Barker, Alex; Collins, Jeremy; Carr, James [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Liao, Yihua [Northwestern University' s Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL (United States); McDermott, Mary M. [Northwestern University' s Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL (United States); Northwestern University' s Feinberg School of Medicine, Department of Medicine, Chicago, IL (United States); Markl, Michael [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Northwestern University, Department Biomedical Engineering, McCormick School of Engineering, Chicago, IL (United States)

2014-04-15

To investigate the influence of atherosclerotic plaques on femoral haemodynamics assessed by two-dimensional (2D) phase-contrast (PC) magnetic resonance imaging (MRI) with three-directional velocity encoding. During 1 year, patients with peripheral artery disease and an ankle brachial index <1.00 were enrolled. After institutional review board approval and written informed consent, 44 patients (age, 70 ± 12 years) underwent common femoral artery MRI. Patients with contra-indications for MRI were excluded. Sequences included 2D time-of-flight, proton-density, T1-weighted and T2-weighted MRI. Electrocardiogram (ECG)-gated 2D PC-MRI with 3D velocity encoding was acquired. A radiologist classified images in five categories. Blood flow, velocity and wall shear stress (WSS) along the vessel circumference were quantified from the PC-MRI data. The acquired images were of good quality for interpretation. There were no image quality problems related to poor ECG-gating or slice positioning. Velocities, oscillatory shear stress and total flow were similar between patients with normal arteries and wall thickening/plaque. Patients with plaques demonstrated regionally increased peak systolic WSS and enhanced WSS eccentricity. Combined multi-contrast morphological imaging of the peripheral arterial wall with PC-MRI with three-directional velocity encoding is a feasible technique. Further study is needed to determine whether flow is an appropriate marker for altered endothelial cell function, vascular remodelling and plaque progression. (orig.)

Interaction between the Haptoglobin 2 Phenotype and Diabetes Mellitus on Systolic Pulmonary Arterial Pressure and Nitric Oxide Bioavailability in Hemodialysis Patients

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Inbal Dahan

2015-01-01

Full Text Available Elevated systolic pulmonary artery pressure (s-PAP, ≥35 mmHg serves as an independent predictor of mortality in hemodialysis (HD and diabetic (DM patients. A polymorphism in the antioxidant Haptoglobin (Hp gene has been shown to regulate the bioavailability of nitric oxide (NO, a major mediator of pulmonary vascular tone. We therefore set out to test the hypothesis that the Hp polymorphism may be a determinant of developing elevated s-PAP specifically in the DM state due to a decreased bioavailability of NO. To test our hypothesis we Hp typed and performed transthoracic echocardiography on a series of HD patients and stratified them into elevated and normal s-PAP groups and then evaluated whether there was a significant association between the Hp type, elevated s-PAP, and decreased NO bioavailability as defined by low plasma nitrite. We found a statistically significant interaction between the Hp type and DM on the prevalence of elevated s-PAP and lower mean nitrite levels with the combination of elevated s-PAP and low nitrite levels being significantly more prevalent in Hp 2-2 DM individuals. We conclude that the Hp 2 type is associated with elevated s-PAP levels and low plasma nitrite levels in HD patients specifically in the DM state.

Physiological Mechanisms Mediating the Coupling between Heart Period and Arterial Pressure in Response to Postural Changes in Humans

NARCIS (Netherlands)

Silvani, A.; Calandra-Buonaura, G.; Johnson, B.D.; Helmond, N. van; Barletta, G.; Cecere, A.G.; Joyner, M.J.; Cortelli, P.

2017-01-01

The upright posture strengthens the coupling between heart period (HP) and systolic arterial pressure (SAP) consistently with a greater contribution of the arterial baroreflex to cardiac control, while paradoxically decreasing cardiac baroreflex sensitivity (cBRS). To investigate the physiological

Noninvasive detection of coronary artery bypass graft patency by intravenous electron beam computed tomographic angiography.

Science.gov (United States)

Yamakami, Shoji; Toyama, Junji; Okamoto, Mitsuhiro; Matsushita, Toyoaki; Murakami, Yoshimasa; Ogata, Masaki; Ito, Shigenori; Fukutomi, Tatsuya; Okayama, Naotsuka; Itoh, Makoto

2003-11-01

This study evaluates the usefullness of intravenous electron beam computed tomographic angiography (EBA) for the detection of coronary artery bypass graft patency in 43 patients (33 men and 10 women, mean age, 65 years) who had coronary artery bypass graft surgery. EBA was performed a few days before selective bypass graft angiography (SGA). Forty axial cross-sections of angiographic images of the heart were acquired consecutively by an electrocardiographic trigger signal at 40% of the RR interval, which corresponds to the end-systolic phase. EBA data were reconstructed as a three-dimensional shaded surface display of the heart and bypass grafts. Detectability of the patency of bypass gratis was evaluated, taking selective angiographic images of the bypass grafts as a gold standard. One hundred and nine grafts (96%) out of 114 grafts were subjected to evaluation: 37 grafts were left internal mammary artery grafts (LIMA), 7 were right internal mammary artery grafts (RIMA), 6 were gastroepiploic artery grafts (GEA), 7 were free gastroepiploic artery grafts with venous drainage (free-GEA), 7 were radial artery grafts (RAG), and 45 were saphenous vein gratis (SVG). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBA were 98%, 100%, 100%, 91%, and 98%, respectively. EBA sampled at the end-systolic period was determined to be useful for the detection of coronary artery bypass graft patency and occlusion.

Influence of inhaled nicotine source on arterial stiffness.

Science.gov (United States)

Szołtysek-Bołdys, Izabela; Sobczak, Andrzej; Zielińska-Danch, Wioleta; Bartoń, Aleksandra; Koszowski, Bartosz; Kośmider, Leon

2014-01-01

Tobacco smoking leads to changes in hemodynamic parameters such as heart rate and systolic or diastolic blood pressure. It has a direct influence on the elasticity of blood vessels and increases arterial stiffness, which can result in development of atherosclerosis. Data show that the nicotine in tobacco smoke probably is responsible for these changes. Electronic cigarettes (e-cigarettes) were supposedly a healthier alternative to combustible cigarettes because they imitate a process of cigarettes smoking but generate nicotine aerosol without the toxic substances from tobacco combustion. However, the use of e-cigarettes is still controversial because their toxicity, safety and long term use health impact have not been sufficiently studied. The aim of this study was to evaluate changes in arterial stiffness parameters after smoking a cigarette or e-cigarette use. Fifteen healthy women, aged 19-25 years old, smoking ≥5 cigarettes per day for at least two years participated in the study. A non-invasive measurement of arterial stiffness parameters - Stiffness Index (SI) and Reflection Index (RI) - was conducted and systolic and diastolic blood pressure and heart rate were measured before and after smoking a conventional cigarette as well as use of an e-cigarette. Statistically significant changes in the SI and RI were observed before and after smoking of a conventional cigarette [SI: 6.75m/s (6.66 - 6.85, 95% CI) vs 6.56m/s (6.46 - 6.65. 95% CI), p=0.0056; RI: 54.0% (51.5 - 56.7, 95% CI) vs 49.6% (47.5 - 51.8, 95% CI), p=0.010]. The use of e-cigarettes resulted in no statistically significant changes in the SI and RI. After both product use systolic and diastolic blood pressure and heart rate increased but the changes were not statistically significant. In contrast to conventional cigarette use, the use of electronic cigarettes causes no changes in arterial stiffness. This may indicate lower bioavailability of nicotine from the e-cigarette or an additional effect of

Long-term prognosis after acute myocardial infarction in patients with a history of arterial hypertension. TRACE study group

DEFF Research Database (Denmark)

Gustafsson, F; Køber, L; Torp-Pedersen, C

1998-01-01

AIMS: The objective of the study was to investigate the influence of a history of arterial hypertension on long-term prognosis after an acute myocardial infarction in a representative population, and secondly to assess the impact on prognosis of left ventricular systolic function in hypertensives......%) of the patients had a history of arterial hypertension. During the time of observation 763 (50.6%) hypertensives and 2253 (43.7%) normotensives died, corresponding to a risk ratio for death in hypertensives of 1.23 (1.13-1.33, P .... CONCLUSION: A history of arterial hypertension is a moderate risk factor for mortality after an acute myocardial infarction in patients aged 65 years or less. This excess risk is present at all levels of left ventricular systolic function....

The phosphodiesterase 3 inhibitor cilostazol dilates large cerebral arteries in humans without affecting regional cerebral blood flow

DEFF Research Database (Denmark)

Birk, Steffen; Kruuse, Christina Rostrup; Petersen, Kenneth A

2004-01-01

in the middle cerebral arteries (VMCA) was measured with transcranial Doppler, and the superficial temporal and radial arteries diameters were measured with ultrasonography. During the 4-hour observation period, there was no effect on systolic blood pressure (P = 0.28), but diastolic blood pressure decreased...

Imaging of Post-Traumatic Cardiac Rhabdomyolysis with Normal Coronary Arteries

International Nuclear Information System (INIS)

Filippo, M. de; Blasi, M. de; Paoli, G.; Sverzellati, N.; Beghi, C.; Ardissino, D.; Zompatori, M.

2006-01-01

Numerous cases of acute myocardial infarction (AMI) have been reported in the literature following closed chest injuries, due to post-traumatic dissection or thrombosis of a coronary artery. In the follow-up of AMI, wall thickness during diastole and systole provides important information on heart viability. Multidetector computed tomography (MDCT) is currently the only noninvasive instrumental investigation which provides an appreciable assessment of the coronary arteries, as well as heart wall thickness measurements. We describe and discuss the clinical and imaging findings, especially of MDCT, in a case of post-traumatic regional myocardial necrosis with normal coronary arteries

Imaging of Post-Traumatic Cardiac Rhabdomyolysis with Normal Coronary Arteries

Energy Technology Data Exchange (ETDEWEB)

Filippo, M. de; Blasi, M. de; Paoli, G.; Sverzellati, N.; Beghi, C.; Ardissino, D.; Zompatori, M. [Univ. of Parma, Parma Hospital, Parma (Italy). Dept. of Clinical Sciences, Section of Radiological Sciences

2006-11-15

Numerous cases of acute myocardial infarction (AMI) have been reported in the literature following closed chest injuries, due to post-traumatic dissection or thrombosis of a coronary artery. In the follow-up of AMI, wall thickness during diastole and systole provides important information on heart viability. Multidetector computed tomography (MDCT) is currently the only noninvasive instrumental investigation which provides an appreciable assessment of the coronary arteries, as well as heart wall thickness measurements. We describe and discuss the clinical and imaging findings, especially of MDCT, in a case of post-traumatic regional myocardial necrosis with normal coronary arteries.

Abnormal shortened diastolic time length at increasing heart rates in patients with abnormal exercise-induced increase in pulmonary artery pressure

Directory of Open Access Journals (Sweden)

Bombardini Tonino

2011-11-01

Full Text Available Abstract Background The degree of pulmonary hypertension is not independently related to the severity of left ventricular systolic dysfunction but is frequently associated with diastolic filling abnormalities. The aim of this study was to assess diastolic times at increasing heart rates in normal and in patients with and without abnormal exercise-induced increase in pulmonary artery pressure (PASP. Methods. We enrolled 109 patients (78 males, age 62 ± 13 years referred for exercise stress echocardiography and 16 controls. The PASP was derived from the tricuspid Doppler tracing. A cut-off value of PASP ≥ 50 mmHg at peak stress was considered as indicative of abnormal increase in PASP. Diastolic times and the diastolic/systolic time ratio were recorded by a precordial cutaneous force sensor based on a linear accelerometer. Results At baseline, PASP was 30 ± 5 mmHg in patients and 25 ± 4 in controls. At peak stress the PASP was normal in 95 patients (Group 1; 14 patients (Group 2 showed an abnormal increase in PASP (from 35 ± 4 to 62 ± 12 mmHg; P Conclusion The first and second heart sound vibrations non-invasively monitored by a force sensor are useful for continuously assessing diastolic time during exercise. Exercise-induced abnormal PASP was associated with reduced diastolic time at heart rates beyond 100 beats per minute.

Analysis of end-systolic pressure-volume relation by gated radionuclide angiocardiography

International Nuclear Information System (INIS)

Adachi, Haruhiko; Sugihara, Horoki; Katsume, Hiroshi; Ijichi, Hamao; Miyanaga, Hajime

1982-01-01

Left ventricular end-systolic pressure-volume relation has been proved experimentally to b e an useful index of left ventricular contractility relatively independent of preload or afterload. But less clinical application has been reported because of its invasive nature, and we evaluated this relationship non-invasively using gated radionuclide angiocardiography as volume determination and cuff sphyngomanometer in the arm as pressure measurement. Gated equilibrium blood pool scintigrams were obtained at rest and during intravenous infusion of angiotensin or nitrate. Ventricular volumes were derived from ventricular activity and peripheral blood volume and activity. The peak systolic pressure (PSP) by cuff method to end-systolic volume index (ESVI) relations showed good linearity (r gt .930 in 84% of consecutive 50 cases) and were gentler in the groups with more impaired left ventricular function. Emax was related exponentially to ejection fraction (EF) and hyperbolically to end-diastolic volume index. The dead volume (VoI) was unfixed and fell into positive or negative value, and was not related to EF under control condition. PSP/ESVI in each loading condition was less variable with the alteration of blood pressure than EF. The linear relation was found between PSP/ESVI under control condition and Emax (PSP/ESVI = 0.651.Emax + 0.958, r = 0.841, p lt .001). Thus in measuring ventricular volume, gated radionuclide angiocardiography is a non-invasive method less affected by the geometry of the left ventricle. Non-invasive determination of end-systolic pressure-volume relation using the volume by radionuclide and the blood pressure by cuff method is clinically useful in the assessment of left ventricular contractility. (author)

Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis.

Science.gov (United States)

Grint, K A; Kellihan, H B

2017-04-01

A 3-month-old, 9.9 kg, male pit bull cross was referred for evaluation of collapse. A left basilar systolic heart murmur graded V/VI and a grade IV/VI right basilar systolic heart murmur were ausculted. Echocardiography showed severe pulmonic stenosis characterized by annular hypoplasia, leaflet thickening, and leaflet fusion. After 1 month of atenolol therapy, a pulmonic valve balloon valvuloplasty procedure was performed, and the intra-operative right ventricular pressure was reduced by 43%. Echocardiography, performed the following day, showed apparent rupture of a pulmonary valve leaflet and a membranous structure within the pulmonary artery consistent with a dissecting membrane. Short-term follow-up has shown no apparent progression of the pulmonary artery dissection and the patient remains free of clinical signs. Copyright © 2016 Elsevier B.V. All rights reserved.

Pulmonary branch arterial flow can be measured with cine MR velocity mapping

International Nuclear Information System (INIS)

Caputo, G.R.; Kondo, C.; Masui, T.; Foster, E.; Geraci, S.J.; O'Sullivan, M.; Higgins, C.B.

1990-01-01

This paper assesses the capability of cine MR phase velocity mapping (CVM) to measure main, right-sided, and left-sided pulmonary arterial (PA) blood flow. The authors examined a constant-flow phantom and nine healthy volunteers with use of 1.5-T MR imaging system (GE Signa) with phase velocity cine sequences. CVM correctly measured constant-flow phantom velocities (range, 20-190 cm/sec; r = .998, SEE = 4.2 cm/sec), and velocity with use of angulated planes to section the phantom tube perpendicularly. CVM peak systolic main PA velocity (79 cm/sec ± 10) correlated well with Doppler US measurements (80 cm/sec ± 7). CVM main PA flow correlated well with conventional cine MR LV stroke volume measurements (r = .98, SEE = 4.8 mL). Left and right PA flow on the angulated planes were 29 mL ± 7 and 34 mL ± 10, respectively

Patent ductus arteriosus associated with congenital anomaly of coronary artery.

Science.gov (United States)

Maleki, Majid; Azizian, Nassrin; Esmaeilzadeh, Maryam; Moradi, Bahieh

2013-11-01

We reported a case of patent ductus arteriosus (PDA) with congenital anomaly of coronary arteries as abnormal origin of right coronary artery (RCA) and left coronary artery (LCA) from a single ostium of the right coronary sinus. A 21-year-old man referred to our institution for evaluation of cardiac murmur. He has suffered from palpitation and atypical chest pain for three months. On physical examination, a continuous murmur was heard in the second left parasternal space. Transthoracic echocardiography showed normal left and right ventricular size and systolic function (LVEF = 55%). Main pulmonary artery (PA) and left pulmonary artery (LPA) branch were considerably dilated. Considering normal coronary flow, lack of clinical evidence of myocardial ischemia and echocardiography findings, patient underwent surgical closure of PDA via left thoracotomy and after five days discharged uneventfully.

Pulmonary arterial hypertension

Science.gov (United States)

2013-01-01

, essentially in the screening proposing criteria for estimating the presence of PH mainly based on tricuspid regurgitation peak velocity and systolic artery pressure (sPAP). The therapy of PAH consists of non-specific drugs including oral anticoagulation and diuretics as well as PAH specific therapy. Diuretics are one of the most important treatment in the setting of PH because right heart failure leads to fluid retention, hepatic congestion, ascites and peripheral edema. Current recommendations propose oral anticoagulation aiming for targeting an International Normalized Ratio (INR) between 1.5-2.5. Target INR for patients displaying chronic thromboembolic PH is between 2–3. Better understanding in pathophysiological mechanisms of PH over the past quarter of a century has led to the development of medical therapeutics, even though no cure for PAH exists. Several specific therapeutic agents were developed for the medical management of PAH including prostanoids (epoprostenol, trepoprostenil, iloprost), endothelin receptor antagonists (bosentan, ambrisentan) and phosphodiesterase type 5 inhibitors (sildenafil, tadalafil). This review discusses the current state of art regarding to epidemiologic aspects of PH, diagnostic approaches and the current classification of PH. In addition, currently available specific PAH therapy is discussed as well as future treatments. PMID:23829793

Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: A randomised porcine study.

Science.gov (United States)

Hardig, Bjarne Madsen; Götberg, Michael; Rundgren, Malin; Götberg, Matthias; Zughaft, David; Kopotic, Robert; Wagner, Henrik

2016-04-01

This porcine study was designed to explore the effects of repetitive intravenous adrenaline doses on physiologic parameters during CPR. Thirty-six adult pigs were randomised to four injections of: adrenaline 0.02 mg(kgdose)(-1), adrenaline 0.03 mg(kgdose)(-1) or saline control. The effect on systolic, diastolic and mean arterial blood pressure, cerebral perfusion pressure (CePP), end tidal carbon dioxide (ETCO2), arterial oxygen saturation via pulse oximetry (SpO2), cerebral tissue oximetry (SctO2), were analysed immediately prior to each injection and at peak arterial systolic pressure and arterial blood gases were analysed at baseline and after 15 min. In the group given 0.02 mg(kgdose)(-1), there were increases in all arterial blood pressures at all 4 pressure peaks but CePP only increased significantly after peak 1. A decrease in ETCO2 following peak 1 and 2 was observed. SctO2 and SpO2 were lowered following injection 2 and beyond. In the group given a 0.03 mg(kgdose)(-1), all ABP's increased at the first 4 pressure peaks but CePP only following 3 pressure peaks. Lower ETCO2, SctO2 and SpO2 were seen at peak 1 and beyond. In the two adrenaline groups, pH and Base Excess were lower and lactate levels higher compared to baseline as well as compared to the control. Repetitive intravenous adrenaline doses increased ABP's and to some extent also CePP, but significantly decreased organ and brain perfusion. The institutional protocol number: Malmö/Lund Committee for Animal Experiment Ethics, approval reference number: M 192-10. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cryoplasty for Occlusive Disease of the Femoropopliteal Arteries: 1-Year Follow-Up

International Nuclear Information System (INIS)

Korteweg, Mies A.; Gils, Marjon van; Hoedt, Marco T.; Valk, Pieter H. M. van der; Tutein Noltenius, Rudolf P.; Avontuur, Jurgen A.; Bronswijk-Monster, Krien F.; Elgersma, Otto E. H.

2009-01-01

Atherosclerosis of femoropopliteal arteries is an important cause of morbidity and mortality. Percutaneous transluminal angioplasty (PTA) has only limited success in treating these arteries, mainly because of the high rate of recurrent stenosis. Cryoplasty has been proposed as a technique which might improve treatment outcome. This study reports our single-center experience with cryoplasty. Thirty-two claudicants, 33 arteries, in whom conservative therapy failed, were consecutively included. Duplex ultrasound (US), angiography, and ankle-brachial index (ABI) measurement were performed before the procedure; ABI and duplex US, 2 weeks and 3, 6, and 12 months after the procedure. Patients' symptoms were categorized according to the Rutherford classification. Lesions were classified as TASC A, B, or C according to angiographic appearance. Differences in ABI before and after the procedure were defined as significant at p < 0.05 by paired t-test. Patency was evaluated using duplex US by determining the peak systolic velocity ratio. Sixteen TASC A lesions, 13 TASC B lesions, and 4 TASC C lesions were included. ABI improved significantly for TASC A lesions 2 weeks and 3 months postprocedure. Patency after 2 weeks, 6 months, and 12 months was 93%, 67%, and 64% for TASC A lesions, 83%, 31%, and 31% for TASC B lesions, and 100%, 50%, and 33% for TASC C lesions, respectively. In conclusion, cryoplasty has good immediate success rates and patency rates similar to the results of conventional PTA in the literature.

Increased arterial smooth muscle Ca2+ signaling, vasoconstriction, and myogenic reactivity in Milan hypertensive rats

Science.gov (United States)

Linde, Cristina I.; Karashima, Eiji; Raina, Hema; Zulian, Alessandra; Wier, Withrow G.; Hamlyn, John M.; Ferrari, Patrizia; Blaustein, Mordecai P.

2012-01-01

The Milan hypertensive strain (MHS) rats are a genetic model of hypertension with adducin gene polymorphisms linked to enhanced renal tubular Na+ reabsorption. Recently we demonstrated that Ca2+ signaling is augmented in freshly isolated mesenteric artery myocytes from MHS rats. This is associated with greatly enhanced expression of Na+/Ca2+ exchanger-1 (NCX1), C-type transient receptor potential (TRPC6) protein, and sarco(endo)plasmic reticulum Ca2+-ATPase (SERCA2) compared with arteries from Milan normotensive strain (MNS) rats. Here, we test the hypothesis that the enhanced Ca2+ signaling in MHS arterial smooth muscle is directly reflected in augmented vasoconstriction [myogenic and phenylephrine (PE)-evoked responses] in isolated mesenteric small arteries. Systolic blood pressure was higher in MHS (145 ± 1 mmHg) than in MNS (112 ± 1 mmHg; P arteries from MHS rats had significantly augmented myogenic tone and reactivity and enhanced constriction to low-dose (1–100 nM) PE. Isolated MHS arterial myocytes exhibited approximately twofold increased peak Ca2+ signals in response to 5 μM PE or ATP in the absence and presence of extracellular Ca2+. These augmented responses are consistent with increased vasoconstrictor-evoked sarcoplasmic reticulum (SR) Ca2+ release and increased Ca2+ entry, respectively. The increased SR Ca2+ release correlates with a doubling of inositol 1,4,5-trisphosphate receptor type 1 and tripling of SERCA2 expression. Pressurized MHS arteries also exhibited a ∼70% increase in 100 nM ouabain-induced vasoconstriction compared with MNS arteries. These functional alterations reveal that, in a genetic model of hypertension linked to renal dysfunction, multiple mechanisms within the arterial myocytes contribute to enhanced Ca2+ signaling and myogenic and vasoconstrictor-induced arterial constriction. MHS rats have elevated plasma levels of endogenous ouabain, which may initiate the protein upregulation and enhanced Ca2+ signaling. These

Systolic Strain Abnormalities to Predict Hospital Readmission in Patients With Heart Failure and Normal Ejection Fraction

Science.gov (United States)

Borer, Steven M.; Kokkirala, Aravind; O'Sullivan, David M.; Silverman, David I.

2011-01-01

Background Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction (HFNEF) remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes. Methods Patients of new CHF and left ventricular ejection fraction > 50% were included. Exclusion criteria were recent myocardial infarction, severe valvular heart disease, severe left ventricular hypertrophy (septum >1.8 cm), or a technically insufficient echocardiogram. Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. Results One hundred consecutive patients with a 1st admission for HFNEF from January 1, 2004 through December 31, 2007, inclusive, were analyzed. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls. However, systolic strain did not differ significantly between the two groups (-11.7% for those readmitted compared with -12.9% for those free from readmission, P = 0.198) and systolic strain rates also were similar (-1.05 s-1 versus -1.09 s-1, P = 0.545). E/e’ was significantly higher in readmitted patients compared with those who remained free from readmission (14.5 versus 11.0, P = 0.013). E/e’ (OR 1.189, 95% CI 1.026-1.378; P = 0.021) was found to be an independent predictor for HFNEF readmission. Conclusions Among patients with new onset HFNEF, SS and SR rates are reduced compared with patients free of HFNEF, but do not predict hospital readmission. Elevated E/e’ is a predictor of readmission in these patients. PMID:28352395

The evaluation of the predictors of left ventricular systolic function improvement in patients with severe aortic stenosis after aortic valve replacement

Directory of Open Access Journals (Sweden)

N.V. Ponych

2017-03-01

Full Text Available The aim – to evaluate clinical and echocardiographic predictors of the systolic function improvement in patients with aortic stenosis (AS and low left ventricular ejection fraction (LVEF after aortic valve replacement (AVR. Material and methods. One-center study analyzed data received at clinical and instrumental examination of 72 consecutively examined patients with severe aortic stenosis and systolic dysfunction (LVEF less than 45 % selected for AVR with or without coronary artery bypass grafting (CABG. The average age of patients was 62 (lower-upper quartiles 34–79 years. All patients underwent clinical and instrumental investigations, including transthoracic echocardiography and coronary angiography. Patients were retrospectively divided into two groups: 48 (66.76 % patients with left ventricular ejection fraction increased more than 30 % in the early post-surgery period, and 24 (33.3 % – less than 30 %. In 21 (29.2 % patients AVR was combined with CABG. Results. Group of patients with greater growth of LVEF was characterized by lower body mass index (p = 0.016, greater initial signs of heart failure (p = 0.019, less frequent arterial hypertension. In addition, patients with LVEF growth over 30 % had more pronounced decrease of initial EF, greater end-systolic volume (ESV index and changes of some indices of diastolic LV function. The smaller increase in LVEF was associated with greater rate of atrial fibrillation (p = 0.028 and aortic regurgitation I degree (p = 0.012. Conclusions. The median LVEF in patients with AS and systolic dysfunction after AVR increased from 29 to 43 %. Under proper selection of patients with AS and reduced LVEF for surgery more than 30 % improvement of LVEF may be expected at early postoperative period. Critical AS with reduced LVEF, including low-flow, low gradient AS should not be regarded as an independent restriction to AVR.

Statistical analysis of simulation-generated time series : Systolic vs. semi-systolic correlation on the Connection Machine

NARCIS (Netherlands)

Dontje, T.; Lippert, Th.; Petkov, N.; Schilling, K.

1992-01-01

Autocorrelation becomes an increasingly important tool to verify improvements in the state of the simulational art in Latice Gauge Theory. Semi-systolic and full-systolic algorithms are presented which are intensively used for correlation computations on the Connection Machine CM-2. The

Preliminary comparison between real-time in-vivo spectral and transverse oscillation velocity estimates

DEFF Research Database (Denmark)

Pedersen, Mads Møller; Pihl, Michael Johannes; Haugaard, Per

2011-01-01

Spectral velocity estimation is considered the gold standard in medical ultrasound. Peak systole (PS), end diastole (ED), and resistive index (RI) are used clinically. Angle correction is performed using a flow angle set manually. With Transverse Oscillation (TO) velocity estimates the flow angle......, peak systole (PSTO), end diastole (EDTO), and resistive index (RITO) are estimated. This study investigates if these clinical parameters are estimated equally good using spectral and TO data. The right common carotid arteries of three healthy volunteers were scanned longitudinally. Average TO flow...

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment: A Prospective Cohort Study

DEFF Research Database (Denmark)

Laugesen, Esben; Knudsen, Søren T; Hansen, Klavs W

2016-01-01

Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated. In this study, office systolic BP and invasively......) and with myocardial infarction in patients without diabetes mellitus (hazard ratio, 1.07 [95% confidence interval, 1.02-1.12] and 1.05 [95% confidence interval, 1.01-1.10], respectively). In models including both BP measurements, aortic BP lost statistical significance and aortic BP did not confer improvement...

[Arterial hypertension due to altitude].

Science.gov (United States)

Domej, Wolfgang; Trapp, Michael; Miggitsch, Eva Maria; Krakher, Tiziana; Riedlbauer, Rita; Roher, Peter; Schwaberger, Günther

2008-01-01

The behavior of blood pressure under hypoxic conditions depends on individual factors, altitude and duration of stay at altitude. While most humans are normotensive at higher altitudes, a few will react with moderate hypertension or hypotension. Excessive elevation of arterial blood pressure is not even to be expected below 4,000 m. Rather, several weeks' stay at higher altitude will decrease systolic and diastolic blood pressure at rest as well as during physical exertion. A high-altitude treatment for rehabilitation purposes at moderate altitude may be recommended for patients with cardio-circulatory disorders. Improvements can last several months even after returning to accustomed altitudes. Furthermore, endurance-trained hypertensive patients with pharmacologically controlled arterial blood pressure might be able to participate in mountain treks without additional health risk.

Color Doppler evaluation of the ocular arterial flow changes in chronic obstructive pulmonary disease

International Nuclear Information System (INIS)

Ozer, Tulay; Altin, Remzi; Ugurbas, Suat Hayri; Ozer, Yetkin; Mahmutyazicioglu, Kamran; Kart, Levent

2006-01-01

Purpose: To evaluate the hemodynamic changes in the extraocular orbital vessels of the patients with chronic obstructive pulmonary disease (COPD), using color Doppler ultrasonography (CDU) technique, and to compare the results with those of healthy control subjects. Methods: Forty-five patients with COPD and 17 healthy control subjects were included in this study. Patients with COPD were classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Fifteen patients of stage I COPD (mild airflow limitation), stage II COPD (worsening airflow limitation) or stage III COPD (severe airflow limitation) were enrolled into Group I, II and III, respectively. End tidal carbon dioxide (EtCO 2 ), peripheral oxygen saturation (SpO 2 ), pulse rate (PR) and respiratory rate (RR) were measured by using capnograph/pulse oximeter in all patients. Measurements were performed in only one randomly chosen eye of each participant. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), lateral short posterior ciliary artery (LPCA) and medial short posterior ciliary artery (MPCA), using CDU technique. Results: The PSV measurements of the OA were significantly higher in Groups II and III compared to control group (p 2 with PSV (r = 0.53, p < 0.01) and EDV (r = 0.51, p < 0.01) of the OA. Statistically significant correlations were also found for the SpO2 with RI (r = -0.34, p < 0.05) in the OA. Conclusion: We concluded that COPD is associated with impaired retrobulbar hemodynamics, especially in the ophthalmic artery. Moreover, central retinal and posterior ciliary arteries with increased resistance are also found to be affected when compared with healthy control eyes

Numerical modeling of dynamics of heart rate and arterial pressure during passive orthostatic test

Science.gov (United States)

Ishbulatov, Yu. M.; Kiselev, A. R.; Karavaev, A. S.

2018-04-01

A model of human cardiovascular system is proposed to describe the main heart rhythm, influence of autonomous regulation on frequency and strength of heart contractions and resistance of arterial vessels; process of formation of arterial pressure during systolic and diastolic phases; influence of respiration; synchronization between loops of autonomous regulation. The proposed model is used to simulate the dynamics of heart rate and arterial pressure during passive transition from supine to upright position. Results of mathematical modeling are compared to original experimental data.

Pseudonormalization of transmitral flow pattern during exercise thallium-201 imaging in patients with coronary artery disease

International Nuclear Information System (INIS)

Shiota, Takahiro; Sakamoto, Tsuguya; Takenaka, Katsu; Amano, Keiko; Amano, Wataru; Igarashi, Tsutomu; Otake, Takeshi; Sugimoto, Tsuneaki

1993-01-01

This study was undertaken to assess the usefulness of Doppler parameters and transmitral blood velocity for detecting abnormalities of left ventricular diastolic function during low-level exercise thallium-201 imaging. The study population consisted of 16 thallium perfusion defect patients with coronary artery disease (mean 61±8 years) and 21 age-matched control subjects (mean 55±5 years) without any thallium perfusion defect. Of the 16 thallium perfusion defect patients, 12 were examined by coronary arteriography, of whom single vessel coronary artery disease was seen in 2 and multivessel coronary artery disease in 10. Patients with mitral regurgitant murmurs were excluded from the study. Peak mitral blood flow velocity was measured in early diastole (E) and during atrial systole (A) and the A/E ratio was calculated. The changes in blood pressure and heart rate after low-level exercise were not significantly different between control and thallium perfusion defect groups. The A/E ratio increased slightly in control subjects from 93±14% at baseline to 100±15% during low-level exercise (p<0.05), whereas in patients with thallium perfusion defect, it decreased significantly from 119±33% at baseline to 92±23% during low-level exercise (p<0.01). Thus pseudonormalization of the A/E ratio during low-level exercise may be valuable in the evaluation of patients with severe or multivessel coronary artery disease. (author)

Evaluation of the Effects of Sildenafil Citrate (Viagra) on Vertebral Artery Blood Flow in Patients with Vertebro-Basilar Insufficiency

International Nuclear Information System (INIS)

Bozgeyik, Zulkif; Berilgen, Sait; Ozdemir, Huseyin; Ogur, Erkin; Tekatas, Aslan

2008-01-01

To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). The study included 21 patients with VBI (aged 31-76; mean 61.0 ± 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm 2 to 10.80 cm 2 at 45 minutes and 10.81 cm 2 at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs

Evaluation of the effects of sildenafil citrate (viagra) on vertebral artery blood flow in patients with vertebro-basilar insufficiency.

Science.gov (United States)

Bozgeyik, Zulkif; Berilgen, Sait; Ozdemir, Huseyin; Tekatas, Aslan; Ogur, Erkin

2008-01-01

To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). The study included 21 patients with VBI (aged 31-76; mean 61.0 +/- 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm(2) to 10.80 cm(2) at 45 minutes and 10.81 cm(2) at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs.

Evaluation of the Effects of Sildenafil Citrate (Viagra) on Vertebral Artery Blood Flow in Patients with Vertebro-Basilar Insufficiency

Energy Technology Data Exchange (ETDEWEB)

Bozgeyik, Zulkif; Berilgen, Sait; Ozdemir, Huseyin; Ogur, Erkin [Firat University School of Medicine, Elazig(Turkmenistan); Tekatas, Aslan [Elazig Government Hospital, Elazig (Turkmenistan)

2008-12-15

To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). The study included 21 patients with VBI (aged 31-76; mean 61.0 +- 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm{sup 2} to 10.80 cm{sup 2} at 45 minutes and 10.81 cm{sup 2} at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure.

Science.gov (United States)

Oner, Ender; Erturk, Mehmet; Birant, Ali; Kurtar Mansıroglu, Aslı; Akturk, Ibrahim Faruk; Karakurt, Huseyin; Yalcin, Ahmet Arif; Uzun, Fatih; Somuncu, Mustafa Umut; Yildirim, Aydin

2015-01-01

Previous studies comparing levosimendan vs. dobutamine have revealed that levosimendan is better in relieving symptoms. Echocardiographic studies have been done using second measurements immediately following a dobutamine infusion or while it was still being administered. The aim of our study was assessment of sustained effects of 24 h levosimendan and dobutamine infusions on left ventricular systolic functions. A total of 61 patients with acutely decompensated heart failure with New York Heart Association (NYHA) class III or IV symptoms were randomized to receive either levosimendan or dobutamine 2:1 in an open label fashion. Before and 5 days after the initiation of infusions, functional class was assessed, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels and left ventricular ejection fraction (LVEF), mitral inflow peak E and A wave velocity, and E/A ratios were measured; using tissue Doppler imaging, isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), early (E') and late (A') diastolic velocities, and E'/A' and E/E' ratios were measured. The NYHA class improved in both groups, but improvements were prominent in the levosimendan group. NT-proBNP levels were significantly reduced in the levosimendan group. Improvements in LVEF and diastolic indices were significant in the levosimendan group. Tissue Doppler-derived systolic indices of IVV and IVA increased significantly in the levosimendan group. Improvements in left ventricular systolic and diastolic functions continue after a levosimendan infusion.

Distribution and Determinants of Myocardial Perfusion Grade Following Late Mechanical Recanalization of Occluded Infarct-Related Arteries Postmyocardial Infarction: A Report From the Occluded Artery Trial

Science.gov (United States)

Jorapur, Vinod; Steigen, Terje K.; Buller, Christopher E.; Dẑavík, Vladimír; Webb, John G.; Strauss, Bradley H.; Yeoh, Eunice E.S.; Kurray, Peter; Sokalski, Leszek; Machado, Mauricio C.; Kronsberg, Shari S.; Lamas, Gervasio A.; Hochman, Judith S.; John Mancini, G.B.

2010-01-01

Objective To evaluate the distribution and determinants of myocardial perfusion grade (MPG) following late recanalization of persistently occluded infarct-related arteries (IRA). Background MPG reflects microvascular integrity. It is an independent prognostic factor following myocardial infarction, but has been studied mainly in the setting of early reperfusion. The occluded artery trial (OAT) enrolled stable patients with persistently occluded IRAs beyond 24 hr and up to 28 days post-MI. Methods Myocardial blush was assessed using TIMI MPG grading in 261 patients with TIMI 3 epicardial flow following IRA PCI. Patients demonstrating impaired (0–1) versus preserved (2–3) MPG were compared with regard to baseline clinical and pre-PCI angiographic characteristics. Results Impaired MPG was observed in 60 of 261 patients (23%). By univariate analysis, impaired MPG was associated with failed fibrinolytic therapy, higher heart rate, lower systolic blood pressure, lower ejection fraction, LAD occlusion, absence of collaterals (P < 0.01) and ST elevation MI, lower diastolic blood pressure, and higher systolic sphericity index (P < 0.05). By multivariable analysis, higher heart rate, LAD occlusion, absence of collaterals and higher systolic sphericity index (P < 0.01), and lower systolic blood pressure (P < 0.05) were independently associated with impaired MPG. Conclusion Preserved microvascular integrity was present in a high proportion of patients following late recanalization of occluded IRAs post-MI. Presence of collaterals was independently associated with preserved MPG and likely accounted for the high frequency of preserved myocardial perfusion in this clinical setting. Impaired MPG was associated with baseline clinical and angiographic features consistent with larger infarct size. PMID:18798327

Cone pathway function in relation to asymmetric carotid artery stenosis

DEFF Research Database (Denmark)

Kofoed, Peter Kristian; Munch, Inger Christine; Holfort, Stig K

2013-01-01

Purpose:  To examine retinal function in relation to retinal perfusion pressure in patients with carotid artery stenosis. Methods:  Thirteen patients with carotid artery stenosis without clinical eye disease underwent assessment of ophthalmic artery systolic blood pressure (OSP) by ocular...... pneumoplethysmography, carotid artery obstructive disease by ultrasonography, intraocular pressure by applanation tonometry, retinal perfusion by fluorescein angiography and retinal function by multifocal electroretinography (mfERG). Data analysis compared the eye on the most stenotic side with the fellow eye...... pressure (p = 0.0028, 0.011, 0.041 for N1, P1, N2 implicit times, respectively, and p = 0.0086, 0.016, 0.040 for N1, P1, N2 for amplitudes, respectively, corrected for OSP). Conclusion:  Cone function deviation was observed in clinically healthy eyes on the side with highest degree of carotid artery...

Noninvasive Doppler tissue measurement of pulmonary artery compliance in children with pulmonary hypertension.

Science.gov (United States)

Dyer, Karrie; Lanning, Craig; Das, Bibhuti; Lee, Po-Feng; Ivy, D Dunbar; Valdes-Cruz, Lilliam; Shandas, Robin

2006-04-01

We have shown previously that input impedance of the pulmonary vasculature provides a comprehensive characterization of right ventricular afterload by including compliance. However, impedance-based compliance assessment requires invasive measurements. Here, we develop and validate a noninvasive method to measure pulmonary artery (PA) compliance using ultrasound color M-mode (CMM) Doppler tissue imaging (DTI). Dynamic compliance (C(dyn)) of the PA was obtained from CMM DTI and continuous wave Doppler measurement of the tricuspid regurgitant velocity. C(dyn) was calculated as: [(D(s) - D(d))/(D(d) x P(s))] x 10(4); where D(s) = systolic diameter, D(d) = diastolic diameter, and P(s) = systolic pressure. The method was validated both in vitro and in 13 patients in the catheterization laboratory, and then tested on 27 pediatric patients with pulmonary hypertension, with comparison with 10 age-matched control subjects. C(dyn) was also measured in an additional 13 patients undergoing reactivity studies. Instantaneous diameter measured using CMM DTI agreed well with intravascular ultrasound measurements in the in vitro models. Clinically, C(dyn) calculated by CMM DTI agreed with C(dyn) calculated using invasive techniques (23.4 +/- 16.8 vs 29.1 +/- 20.6%/100 mm Hg; P = not significant). Patients with pulmonary hypertension had significantly lower peak wall velocity values and lower C(dyn) values than control subjects (P < .01). C(dyn) values followed an exponentially decaying relationship with PA pressure, indicating the nonlinear stress-strain behavior of these arteries. Reactivity in C(dyn) agreed with reactivity measured using impedance techniques. The C(dyn) method provides a noninvasive means of assessing PA compliance and should be useful as an additional measure of vascular reactivity subsequent to pulmonary vascular resistance in patients with pulmonary hypertension.

Quantification of left ventricular regional functions using ECG-gated myocardial perfusion SPECT. Validation of left ventricular systolic functions

International Nuclear Information System (INIS)

Yamamoto, Akira; Takahashi, Naoto; Iwahara, Shin-ichiro; Munakata, Kazuo; Hosoya, Tetsuo

2006-01-01

We have developed a program to quantify regional left ventricular (LV) function and wall motion synchrony using electrocardiogram (ECG)-gated myocardial perfusion SPECT (MPS). This preliminary study was undertaken to validate the use of this program for estimating regional LV systolic function. Patients were subjected to MPS by 99m Tc-sestamibi at rest. The study included 20 patients who were confirmed to have a low probability of coronary artery disease (LPG; low probability group), 19 heart disease patients who were examined by MPS and equilibrium radionuclide angiography (ERNA) (ERG; ERNA group), and 24 patients who were examined by MPS and 2-dimensional echocardiography (2DE) (2DEG; 2DE group). The values of the ejection fraction (EF) and peak ejection rate (PER) were estimated. The global functions evaluated by this program were compared with those obtained by ERNA in the ERG. For regional assessment, the reference values of the functional indices were obtained for 17 LV segments in LPG. The Z score, (reference average value of the segment-patient's value of the segment)/reference standard deviation of the segment, was used for the evaluation of regional functions; a score equal to or greater than 2 was defined as abnormal. Semiquantitative visual interpretation of 2DE was used as the standard to assess wall motion. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these criteria and the relationship between 2DE grading and Z scoring were validated in 2DEG. The values of the global EF and PER evaluated by this program correlated with those determined by ERNA (r=0.76 and 0.58, respectively; p -10 ). The potential of this program to quantify the regional systolic function was validated. (author)

Iron Deficiency in COPD Associates with Increased Pulmonary Artery Pressure Estimated by Echocardiography

DEFF Research Database (Denmark)

Plesner, Louis L; Schoos, Mikkel M; Dalsgaard, Morten

2017-01-01

OBJECTIVES: Iron deficiency (ID) might augment chronic pulmonary hypertension in chronic obstructive pulmonary disease (COPD). This observational study investigates the association between ID and systolic pulmonary artery pressure estimated by echocardiography in non-anaemic COPD outpatients...

Load Adaptability in Patients With Pulmonary Arterial Hypertension.

Science.gov (United States)

Amsallem, Myriam; Boulate, David; Aymami, Marie; Guihaire, Julien; Selej, Mona; Huo, Jennie; Denault, Andre Y; McConnell, Michael V; Schnittger, Ingela; Fadel, Elie; Mercier, Olaf; Zamanian, Roham T; Haddad, Francois

2017-09-01

Right ventricular (RV) adaptation to pressure overload is a major prognostic factor in patients with pulmonary arterial hypertension (PAH). The objectives were first to define the relation between RV adaptation and load using allometric modeling, then to compare the prognostic value of different indices of load adaptability in PAH. Both a derivation (n = 85) and a validation cohort (n = 200) were included. Load adaptability was assessed using 3 approaches: (1) surrogates of ventriculo-arterial coupling (e.g., RV area change/end-systolic area), (2) simple ratio of function and load (e.g., tricuspid annular plane systolic excursion/right ventricular systolic pressure), and (3) indices assessing the proportionality of adaptation using allometric pressure-function or size modeling. Proportional hazard modeling was used to compare the hazard ratio for the outcome of death or lung transplantation. The mean age of the derivation cohort was 44 ± 11 years, with 80% female and 74% in New York Heart Association class III or IV. Mean pulmonary vascular resistance index (PVRI) was 24 ± 11 with a wide distribution (1.6 to 57.5 WU/m 2 ). Allometric relations were observed between PVRI and RV fractional area change (R 2  = 0.53, p adaptation. In right heart parameters, RVESAI was the strongest predictor of outcomes (hazard ratio per SD = 1.93, 95% confidence interval 1.37 to 2.75, p adaptability indices provided stronger discrimination of outcome than simple RV adaptation metrics in either the derivation or the validation cohort. In conclusion, allometric modeling enables quantification of the proportionality of RV load adaptation but offers small incremental prognostic value to RV end-systolic dimension in PAH. Copyright © 2017 Elsevier Inc. All rights reserved.

Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults

International Nuclear Information System (INIS)

Zhao Shihua; Yan Chaowu; Jiang Shiliang; Xu Zhongying; Huang Lianjun; Ling Jian; Zheng Hong; Wang Cheng; Hu Haibo; Wu Wenhui; Li Shiguo; Dai Ruping

2006-01-01

Objective: To evaluate the effect of self-expandable occluder on closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PH) in adults. Methods: Twenty-eight adult patients underwent transcatheter closure of PDA at a mean age of (31.3±11.6) years [(18-58) years]. Either Amplatzer duct occluder or domestic device was used in the present study. X-ray, EKG and UCG were repeated in one day, one month, three months, and six months. Results: Twenty of the 28 patients had successful occlusion, and the other 8 patients were given up. In the successful group, the narrowest diameter of PDA was (10.4±2.7) mm [(6-16) mm], the diameter of selected occluder was (15.6±3.2)mm [(10-20) mm] at the end of pulmonary artery. Systemic artery oxygen saturation (SAsat) before and after oxygen inhalation was (93.5±1.8)%, (98.2±1.8)%, respectively (P<0.01). Systolic pulmonary arterial pressure decreased significantly after trial occlusion from (95.5± 24.l) mm Hg to (56.3±18.3) mm Hg (P<0.01); Mean pulmonary arterial pressures decreased significantly from (70.8±18.2) mm Hg to (41.0±13.8 )mm Hg (P<0. 01), too. Six months later UCG showed that the dimensions of left atrium, left ventricle and pulmonary artery attenuated significantly with one exception; X rays showed decreased pulmonary vascularity or cardiac size as well [cardio-thoracic ratio: (59.2±6.6)% vs (54.2±3.3)%, P<0.01]. In given up group, four patients were defined as Eisenmenger syndromes with differential cyanosis. They presented with elevated systolic pulmonary arterial pressure [(110.3±13.9) mm Hg vs (139.5±20.0)mm Hg, P<0.01], or decreased systolic aortic pressure[(116.0±20.2)mm Hg vs (106.3±16.9) mm Hg, P<0.05]after occlusion. The others included two cases with large residual shunt, and two cases with worsening of symptoms. Conclusions: Transcatheter closure of PDA with reversible severe PH is feasible, effective and safe in adults. (authors)

Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults

Energy Technology Data Exchange (ETDEWEB)

Shihua, Zhao; Chaowu, Yan; Shiliang, Jiang; Zhongying, Xu; Lianjun, Huang; Jian, Ling; Hong, Zheng; Cheng, Wang; Haibo, Hu; Wenhui, Wu; Shiguo, Li; Ruping, Dai [Department of Radiology, Cardiovascular Inst. and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing Union Medical College, Beijing (China)

2006-11-15

Objective: To evaluate the effect of self-expandable occluder on closure of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PH) in adults. Methods: Twenty-eight adult patients underwent transcatheter closure of PDA at a mean age of (31.3{+-}11.6) years [(18-58) years]. Either Amplatzer duct occluder or domestic device was used in the present study. X-ray, EKG and UCG were repeated in one day, one month, three months, and six months. Results: Twenty of the 28 patients had successful occlusion, and the other 8 patients were given up. In the successful group, the narrowest diameter of PDA was (10.4{+-}2.7) mm [(6-16) mm], the diameter of selected occluder was (15.6{+-}3.2)mm [(10-20) mm] at the end of pulmonary artery. Systemic artery oxygen saturation (SAsat) before and after oxygen inhalation was (93.5{+-}1.8)%, (98.2{+-}1.8)%, respectively (P<0.01). Systolic pulmonary arterial pressure decreased significantly after trial occlusion from (95.5{+-} 24.l) mm Hg to (56.3{+-}18.3) mm Hg (P<0.01); Mean pulmonary arterial pressures decreased significantly from (70.8{+-}18.2) mm Hg to (41.0{+-}13.8 )mm Hg (P<0. 01), too. Six months later UCG showed that the dimensions of left atrium, left ventricle and pulmonary artery attenuated significantly with one exception; X rays showed decreased pulmonary vascularity or cardiac size as well [cardio-thoracic ratio: (59.2{+-}6.6)% vs (54.2{+-}3.3)%, P<0.01]. In given up group, four patients were defined as Eisenmenger syndromes with differential cyanosis. They presented with elevated systolic pulmonary arterial pressure [(110.3{+-}13.9) mm Hg vs (139.5{+-}20.0)mm Hg, P<0.01], or decreased systolic aortic pressure[(116.0{+-}20.2)mm Hg vs (106.3{+-}16.9) mm Hg, P<0.05]after occlusion. The others included two cases with large residual shunt, and two cases with worsening of symptoms. Conclusions: Transcatheter closure of PDA with reversible severe PH is feasible, effective and safe in adults. (authors)

A noninvasive method for the prediction of fetal hemolytic disease

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E. N. Kravchenko

2017-01-01

Full Text Available Objective: to improve the diagnosis of fetal hemolytic disease.Subjects and methods. A study group consisted of 42 pregnant women whose newborn infants had varying degrees of hemolytic disease. The women were divided into 3 subgroups according to the severity of neonatal hemolytic disease: 1 pregnant women whose neonates were born with severe hemolytic disease (n = 14; 2 those who gave birth to babies with moderate hemolytic disease (n = 11; 3 those who delivered infants with mild hemolytic disease (n = 17. A comparison group included 42 pregnant women whose babies were born without signs of hemolytic disease. Curvesfor blood flow velocity in the middle cerebral artery were analyzed in a fetus of 25 to 39 weeks’ gestation.Results. The peak systolic blood flow velocity was observed in Subgroup 1; however, the indicator did not exceed 1.5 MoM even in severe fetal anemic syndrome. The fetal middle artery blood flow velocity rating scale was divided into 2 zones: 1 the boundary values of peak systolic blood flow velocity from the median to the obtained midscore; 2 the boundary values of peak systolic blood flow velocity of the obtained values of as high as 1.5 MoM.Conclusion. The value of peak systolic blood flow velocity being in Zone 2, or its dynamic changes by transiting to this zone can serve as a prognostic factor in the development of severe fetal hemolytic disease. 

4D cardiovascular magnetic resonance velocity mapping of alterations of right heart flow patterns and main pulmonary artery hemodynamics in tetralogy of Fallot

Science.gov (United States)

2012-01-01

Background To assess changes in right heart flow and pulmonary artery hemodynamics in patients with repaired Tetralogy of Fallot (rTOF) we used whole heart, four dimensional (4D) velocity mapping (VM) cardiovascular magnetic resonance (CMR). Methods CMR studies were performed in 11 subjects with rTOF (5M/6F; 20.1 ± 12.4 years) and 10 normal volunteers (6M/4F; 34.2 ± 13.4 years) on clinical 1.5T and 3.0T MR scanners. 4D VM-CMR was performed using PC VIPR (Phase Contrast Vastly undersampled Isotropic Projection Reconstruction). Interactive streamline and particle trace visualizations of the superior and inferior vena cava (IVC and SVC, respectively), right atrium (RA), right ventricle (RV), and pulmonary artery (PA) were generated and reviewed by three experienced readers. Main PA net flow, retrograde flow, peak flow, time-to-peak flow, peak acceleration, resistance index and mean wall shear stress were quantified. Differences in flow patterns between the two groups were tested using Fisher's exact test. Differences in quantitative parameters were analyzed with the Kruskal-Wallis rank sum test. Results 4D VM-CMR was successfully performed in all volunteers and subjects with TOF. Right heart flow patterns in rTOF subjects were characterized by (a) greater SVC/IVC flow during diastole than systole, (b) increased vortical flow patterns in the RA and in the RV during diastole, and (c) increased helical or vortical flow features in the PA's. Differences in main PA retrograde flow, resistance index, peak flow, time-to-peak flow, peak acceleration and mean wall shear stress were statistically significant. Conclusions Whole heart 4D VM-CMR with PC VIPR enables detection of both normal and abnormal right heart flow patterns, which may allow for comprehensive studies to evaluate interdependencies of post-surgically altered geometries and hemodynamics. PMID:22313680

Elevated pulmonary arterial and systemic plasma aldosterone levels associate with impaired cardiac reserve capacity during exercise in left ventricular systolic heart failure patients: A pilot study.

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Maron, Bradley A; Stephens, Thomas E; Farrell, Laurie A; Oldham, William M; Loscalzo, Joseph; Leopold, Jane A; Lewis, Gregory D

2016-03-01

Elevated levels of aldosterone are a modifiable contributor to clinical worsening in heart failure with reduced ejection fraction (HFrEF). Endothelin-1 (ET-1), which is increased in HFrEF, induces pulmonary endothelial aldosterone synthesis in vitro. However, whether transpulmonary aldosterone release occurs in humans or aldosterone relates to functional capacity in HFrEF is not known. Therefore, we aimed to characterize ET-1 and transpulmonary aldosterone levels in HFrEF and determine if aldosterone levels relate to peak volume of oxygen uptake (pVO2). Data from 42 consecutive HFrEF patients and 18 controls referred for invasive cardiopulmonary exercise testing were analyzed retrospectively. Radial ET-1 levels (median [interquartile range]) were higher in HFrEF patients compared with controls (17.5 [11.5-31.4] vs 11.5 [4.4-19.0] pg/ml, p = 0.04). A significant ET-1 transpulmonary gradient (pulmonary arterial [PA] - radial arterial levels) was present in HFrEF (p reserve capacity in HFrEF. Published by Elsevier Inc.

Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study).

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Kądziela, Jacek; Januszewicz, Andrzej; Prejbisz, Aleksander; Michałowska, Ilona; Januszewicz, Magdalena; Florczak, Elżbieta; Kalińczuk, Łukasz; Norwa-Otto, Bożena; Warchoł, Ewa; Witkowski, Adam

2013-01-01

The aim of our study was to determine a potential relationship between resting translesional pressures ratio (Pd/Pa ratio), renal fractional flow reserve (rFFR) and blood pressure response after renal artery stenting. Thirty five hypertensive patients (49% males, mean age 64 years) with at least 60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were measured before stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before the procedure and after 6 months. The ABPM results were presented as blood pressure changes in subgroups of patients with normal (≥ 0.9) vs. abnormal (renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were comparable in patients with abnormal vs. normal Pd/Pa ratio (-4/-3 vs. 0/2 mm Hg; p = NS) and with abnormal vs. normal rFFR (-2/-1 vs. -2/-0.5 mm Hg, respectively). Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine- induced renal fractional fl ow reserve did not predict hypertension response after renal artery stenting.

Normal left ventricular emptying in coronary artery disease at rest: analysis by radiographic and equilibrium radionuclide ventriculography

International Nuclear Information System (INIS)

Denenberg, B.S.; Makler, P.T.; Bove, A.A.; Spann, J.F.

1981-01-01

The volume ejected early in systole has been proposed as an indicator of abnormal left ventricular function that is present at rest in patients with coronary artery disease with a normal ejection fraction and normal wall motion. The volume ejected in systole was examined by calculating the percent change in ventricular volume using both computer-assisted analysis of biplane radiographic ventriculograms at 60 frames/s and equilibrium gated radionuclide ventriculograms. Ventricular emptying was examined with radiographic ventriculography in 33 normal patients and 23 patients with coronary artery disease and normal ejection fraction. Eight normal subjects and six patients with coronary artery disease had both radiographic ventriculography and equilibrium gated radionuclide ventriculography. In all patients, there was excellent correlation between the radiographic and radionuclide ventricular emptying curves (r . 0.971). There were no difference in the ventricular emptying curves of normal subjects and patients with coronary artery disease whether volumes were measured by radiographic or equilibrium gated radionuclide ventriculography. It is concluded that the resting ventricular emptying curves are identical in normal subjects and patients with coronary artery disease who have a normal ejection fraction and normal wall motion

[Clinical characteristics and medium-term prognosis of patients with heart failure and preserved systolic function. Do they differ in systolic dysfunction?].

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Ojeda, Soledad; Anguita, Manuel; Muñoz, Juan F; Rodríguez, Marcos T; Mesa, Dolores; Franco, Manuel; Ureña, Isabel; Vallés, Federico

2003-11-01

To assess the prevalence, clinical profile and medium-term prognosis in patients with heart failure and preserved systolic ventricular function compared to those with systolic dysfunction. 153 patients were included, 62 with preserved systolic ventricular function (left ventricular ejection fraction > or = 45%) and 91 with impaired systolic ventricular function (left ventricular ejection fraction < 45%). The mean follow-up period was 25 10 months. Mean age was similar (66 10 vs. 65 10; p = 0.54). There was a higher proportion of women among patients with preserved systolic function (53% vs. 28%; p < 0.01). Ischemic and idiopathic cardiomyopathy were the most common causes of heart failure in patients with systolic dysfunction, whereas valvular disease and hypertensive cardiopathy were the most common in patients with preserved systolic function. Angiotensin-converting enzyme inhibitors and beta-blockers were more often prescribed in patients with impaired systolic ventricular function (86% vs. 52%; p < 0.01 and 33% vs. 11%; p < 0.01, respectively). There were no differences between the groups in terms of mortality rate (37% vs. 29%), readmission rate for other causes (29% vs. 23%), readmission rate for heart failure (45% vs. 45%), cumulative survival (51% vs. 62%) and the likelihood of not being readmitted for heart failure (50% vs. 52%). In the multivariate analysis, left ventricular ejection fraction was not a predictor of death or readmission because of heart failure. In a large proportion of patients with heart failure, systolic ventricular function is preserved. Despite the clinical differences between patients with preserved and impaired systolic ventricular function, the medium-term prognosis was similar in both groups.

Prognostic value and limitations of exercise radionuclide angiography in medically treated coronary artery disease

International Nuclear Information System (INIS)

Taliercio, C.P.; Clements, I.P.; Zinsmeister, A.R.; Gibbons, R.J.

1988-01-01

We investigated whether exercise radionuclide angiography provides prognostic information in addition to that identified by resting left ventricular function and coronary anatomy in patients with medically treated coronary artery disease. Clinical follow-up (median, 21.7 months) was obtained in 424 medically treated patients who underwent exercise radionuclide angiography and coronary angiography. The mean age of the study population was 58 years, and 67% were men. Cardiac death occurred in 16 patients, nonfatal myocardial infarction in 16, and nonfatal out-of-hospital cardiac arrest in 1. Univariate analysis showed that multiple variables were associated with future cardiac events, including number of diseased vessels, exercise and rest radionuclide ejection fraction, history of myocardial infarction, exercise and rest left ventricular end-systolic and end-diastolic volume indices, peak exercise workload, age, abnormal resting electrocardiogram, and peak exercise ST-segment depression. Only three variables were independently associated with cardiac events on follow-up: number of diseased vessels, radionuclide ejection fraction at rest, and age. In patients with three-vessel disease and a resting radionuclide ejection fraction of more than 40%, a subgroup with higher risk could not be identified on the basis of exercise radionuclide response

Evaluation of three-dimensional navigator-gated whole heart MR coronary angiography: The importance of systolic imaging in subjects with high heart rates

International Nuclear Information System (INIS)

Wu Yenwen; Tadamura, Eiji; Yamamuro, Masaki; Kanao, Shotaro; Nakayama, Kazuki; Togashi, Kaori

2007-01-01

Purpose: To evaluate the influence of heart rate (HR) on magnetic resonance coronary angiography (MRCA) image quality in diastolic and systolic phases. Materials and methods: Twenty-seven healthy volunteers (9 men; 33 ± 9 years, HR 53-110 bpm), were evaluated with the electrocardiography and three-dimensional navigator-gating MRCA in a 1.5-T MR scanner (Avanto, Siemens) in diastolic and systolic phases (steady-state free precession; TR/TE/flip angle = 3.2 ms/1.6 ms/90 o ). The timing of scanning was individually adapted to the cardiac rest periods obtained in the prescanning, by visually identifying when the movement of right coronary artery was minimized during diastole and systole. Images of two phases were side-by-side compared on a four-point scale (from 1 = poor to 4 = excellent visibility; score of 3 or 4 as diagnostic). Results: Of 13 subjects with HR ≤65 bpm (low HR group, mean 59.8 ± 4.9 bpm, range 53-65), the image quality scores were significantly better than that with higher heart rates (73.9 ± 9.0 bpm, range 68-110) in diastolic MRCA. The image quality was significantly improved during systole in high HR group. Overall, 91.3% of low HR group had MRCA image of diagnostic quality acquired at diastole, while 88.3% of high HR group had diagnostic images at systole by segmental analysis (p = NS). Conclusions: MRCA at systole offered superior quality in patients with high heart rates

Impaired left ventricular systolic function reserve limits cardiac output and exercise capacity in HFpEF patients due to systemic hypertension.

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Henein, Michael; Mörner, Stellan; Lindmark, Krister; Lindqvist, Per

2013-09-30

Heart failure (HF) patients with preserved left ventricular (LV) ejection fraction (EF) (HFpEF) due to systemic hypertension (SHT) are known to have limited exercise tolerance. Despite having normal EF at rest, we hypothesize that these patients have abnormal systolic function reserve limiting their exercise capacity. Seventeen patients with SHT (mean age 68 ± 9 years) but no valve disease and 14 healthy individuals (mean age of 65 ± 10 years) underwent resting and peak exercise echocardiography using conventional, tissue Doppler and speckle tracking techniques. The differences between resting and peak exercise values were also analyzed (Δ). Exercise capacity was determined as the workload divided by body surface area. Resting values for left atrial (LA) volume/BSA (r=-0.66, pexercise capacity. LVEF increased during exercise in normals (mean Δ EF=10 ± 8%) but failed to do so in patients (mean Δ EF=0.6 ± 9%, pexercise in patients, to the same extent as it did in normals (0.2 ± 0.2 vs. 0.6 ± 0.3 1/s, pexercise (Δ) in LV lateral wall systolic velocity from tissue Doppler (s') (0.71, pexercise capacity independent of changes in heart rate. HFpEF patients with hypertensive LV disease have significantly limited exercise capacity which is related to left atrial enlargement as well as compromised LV systolic function at the time of the symptoms. The limited myocardial systolic function reserve seems to be underlying important explanation for their limited exercise capacity. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Right ventricular systolic function in hypertensive heart failure

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Oketona OA

2017-09-01

Full Text Available OA Oketona,1 MO Balogun,2 AO Akintomide,2 OE Ajayi,2 RA Adebayo,2 TO Mene-Afejuku,3 OT Oketona,1 OJ Bamikole2 1Fort Nelson General Hospital, Fort Nelson, BC, Canada; 2Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria; 3Department of Medicine, Metropolitan Hospital Center, New York, NY, USA Background: Heart failure (HF is a major cause of cardiovascular admissions and hypertensive heart failure (HHF is the most common cause of HF admissions in sub-Saharan Africa, Nigeria inclusive. Right ventricular (RV dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters.Methodology: One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, 12-lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults. This included tricuspid annular plane systolic excursion (TAPSE, RV myocardial performance index (MPI, and RV systolic excursion velocity by tissue Doppler (S′.Results: RV systolic dysfunction was found in 53% of subjects with HHF by TAPSE, 56% by RV MPI, and 48% by tissue Doppler systolic excursion S′. RV systolic dysfunction increased with reducing left ventricular ejection fraction (LVEF in subjects with HHF.Conclusion: A high proportion of subjects with HHF were found to have RV systolic functional abnormalities using TAPSE, RV MPI, and RV S′. Prevalence of RV systolic dysfunction increased with reducing LVEF. Keywords: right ventricle

Left ventricular diastolic function in patients with coronary artery disease

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Brugger, P.T.

1986-08-01

In 302 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 201 patients had already suffered a myocardial infarction, of these 99 an anterior wall and 102 an inferior wall infarction. The remaining 101 patients had a CAD without a history of myocardial infarction. The PFR was 2.19 +- 0.65 EDV/sec in the 99 patients after anterior wall infarction and 2.62 +- 0.85 EDV/sec in the 102 patients after inferior wall infarction and 2.79 +- 0.85 EDV/sec in 101 patients with coronary artery disease without a history of myocardial infarction. For the PFR there could be found a statistically significant difference between normal patients and patients after anterior wall infarction (p < 0.0001), normal patients and patients after inferior wall infarction (p < 0.0001) and normal patients and patients with coronary artery disease (p < 0.0001). The TPFR was 180 +- 37.5 msec after anterior - and 158 +- 50.7 msec after inferior wall infarction and 156 +- 45.2 msec in the patients with CAD without previous infarction. The left ventricular diastolic function (PFR and/or TPFR) was abnormal in 88% after anterior- and in 82% after inferior wall infarction and in 69% in coronary patients without previous myocardial infarction. In comparison with this the ejection fraction was reduced in 66% in anterior- and in 61% inferior wall infarction at rest. These results indicate that the diastolic function at rest appears to be more informative for evaluation of a left ventricular dysfunction than the systolic function at rest.

MRI-based flow measurements in the main pulmonary artery to detect pulmonary arterial hypertension in patients with cystic fibrosis

International Nuclear Information System (INIS)

Wolf, T.; Anjorin, A.; Abolmaali, N.; Posselt, H.; Smaczny, C.; Vogl, T.J.

2009-01-01

Development of pulmonary arterial hypertension (PH) is a common problem in the course of patients suffering from cystic fibrosis (CF). This study was performed to evaluate MRI based flow measurements (MR venc ; Velocity ENCoding) to detect signs of an evolving PH in patients suffering from CF. 48 patients (median age: 16 years, range: 10 - 40 years, 25 female) suffering from CF of different severity (mean FEV1: 74 % ± 23, mean Shwachman-score: 63 ± 10) were examined using MRI based flow measurements of the main pulmonary artery (MPA). Phase-contrast flash sequences (TR: 9.6 ms, TE: 2.5 ms, bandwidth: 1395 Hertz/Pixel) were utilized. Results were compared to an age- and sex-matched group of 48 healthy subjects. Analyzed flow data where: heart frequency (HF), cardiac output (HZV), acceleration time (AT), proportional acceleration time related to heart rate (ATr), mean systolic blood velocity (MFG), peak velocity (Peak), maximum flow (Fluss max ), mean flow (Fluss mitt ) and distensibility (Dist). The comparison of means revealed significant differences only for MFG, Fluss max and Dist, but overlap was marked. However, using a scatter-plot of AT versus MFG, it was possible to identify five CF-patients demonstrating definite signs of PH: AT = 81 ms ± 14, MFG = 46 ± 11 cm/s, Dist = 41 % ± 7. These CF-patients where the most severely affected in the investigated group, two of them were listed for complete heart and lung transplantation. The comparison of this subgroup and the remaining CF-patients revealed a highly significant difference for the AT (p = 0.000001) without overlap. Screening of CF-patients for the development of PH using MR venc of the MPA is not possible. In later stages of disease, the quantification of AT, MFG and Dist in the MPA may be useful for the detection, follow-up and control of therapy of PH. MR venc of the MPA completes the MRI-based follow-up of lung parenchyma damage in patients suffering from CF. (orig.)

Relación entre el envejecimiento y la morfología de los registros de variación de diámetro arterial: clasificación con redes neuronales artificiales

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Fernando M. Clara

2005-01-01

Full Text Available Relation between Aging and the Morphology of Radial Artery Diameter Variation Registers: Classification Using Artificial Neural Networks Aníbal R. Introzzi, Lucía I. Passoni, Adriana G. Scandurra, Gustavo J. Meschino, Fernando M. Clara The aim of this study was to assess the modification of the radial artery diameter variation signal in accordance with aging. The signal was registered via an acquisition system using a capacitive transducer leaning on the skin at the level of the radial artery. In order to assess the relation between loss of distensibility and signal modifications due to aging, the experiment was carried out on a group of 64 normotensive subjects: 20 youths, 24 adults and 20 elderly men. Morphological descriptive parameters were obtained and the potentiality to classify the arterial diameter variation waves according to aging was evaluated with a Kohonen artificial neural network. Signal analysis processing revealed the presence of three constituent waves: two systolic waves, first and second, and a diastolic wave. Aging produces important changes in signal conformation, such as expansion of the first systolic wave, decrease of the diastolic wave amplitude and rise of the second systolic wave approaching and overlapping the vertex of the first systolic wave. The artificial neural network correctly classified the 64 registrations, locating them in their corresponding age cluster. Considering the absence of illness in the sample subjects, the existence of a healthy arterial aging pattern is revealed. This system could be able to detect early evidence of arterial pathology development involving an increment of arterial stiffness with a loss of compliance (sclerosis, hypertension.

Statistical dependence of clinical data on the chosen treatment of patients with a multivessel coronary artery disease.

Science.gov (United States)

Walichiewicz, P; Wodniecki, J; Szczurek-Katański, K; Jacheć, W; Nowalany-Kozielska, E; Trzeciak, P; Janik, J

2001-01-01

In this study we tried to check which clinical data are connected with the choice of treatment in patients with a multivessel coronary artery disease. The data of 137 patients with a multivessel coronary artery disease, were analysed retrospectively. The patients were divided into three groups: treated conservatively, CABG and PTCA. Multivessel coronary artery disease was recognised when there were atherosclerotic changes in more a 2 vessels with a not less a 2 mm in diameter. Patients with previous CABG or a left main coronary artery disease were excluded. The data were analysed by means of several methods, variance analysis, correlation analysis, discriminant functions, chi-square test and T-Student test. For treatment decision making in multivessel coronary artery disease of statistical significance were: the state of the left anterior descendent artery below the first diagonal branch, the state of the first diagonal branch and peripheral parts of the left anterior descendent artery and right coronary artery, the systolic function of the antero-lateral, apical and phrenic segments of the left ventricle, the global left ventricular ejection fraction in angiography and echocardiography, local systolic disturbances of the left ventricular observed in echocardiography, the coexistence of symptoms of heart failure as well as unstable angina. Treatment decision making will always depend not only on diagnostic procedures but also on all the clinical data about the patient and the experience of coworking cardiology and surgery centres.

Newly diagnosed hyperthyroidism in the 25th gestational week of pregnancy presenting with systolic arterial hypertension only.

Science.gov (United States)

Zaveljcina, Janez; Legan, Mateja; Gaberšček, Simona

2016-05-01

We present a case of a 30-year-old woman diagnosed with arterial hypertension in the 25th week of pregnancy. Our search for secondary causes of arterial hypertension revealed hyperthyroid Hashimoto's thyroiditis (HT), which was treated with propilthiouracil. Three weeks after delivery, she was normotensive without medication. In the next four months, she developed hypothyroidism and treatment with L-thyroxine was started. In conclusion, in the second half of pregnancy, a hyperthyroid HT can occur - in spite of the well-known amelioration of autoimmune thyroid disorders in that period, and can be the only cause of arterial hypertension.

Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

International Nuclear Information System (INIS)

Rassi, Daniela do Carmo; Vieira, Marcelo Luiz Campos; Arruda, Ana Lúcia Martins; Hotta, Viviane Tiemi; Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador

2014-01-01

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m 2 were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction

Echocardiographic Parameters and Survival in Chagas Heart Disease with Severe Systolic Dysfunction

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Rassi, Daniela do Carmo, E-mail: dani.rassi@hotmail.com [Faculdade de Medicina e Hospital das Clínicas da Universidade Federal de Goiás (UFG), Goiânia, GO (Brazil); Vieira, Marcelo Luiz Campos [Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Arruda, Ana Lúcia Martins [Instituto de Radiologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Hotta, Viviane Tiemi [Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP (Brazil); Furtado, Rogério Gomes; Rassi, Danilo Teixeira; Rassi, Salvador [Faculdade de Medicina e Hospital das Clínicas da Universidade Federal de Goiás (UFG), Goiânia, GO (Brazil)

2014-03-15

Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m{sup 2} were associated with a significant increase in mortality (log rank p < 0.0001). The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.

The clinical use of objective quantification of flow disturbance in carotid artery disease

DEFF Research Database (Denmark)

Sillesen, H; Bitsch, K; Steenberg, H J

1987-01-01

In order to assess the accuracy of objective quantification of carotid flow disturbance, 147 carotid arteries were examined with continuous wave (CW) Doppler technique. The systolic spectral broadening index (SBI), determined as (maximum-mean)/maximum frequency, was calculated from the power...

Role of 2D speckle tracking echocardiography in predicting acute coronary occlusion in patients with non ST-segment elevation myocardial infarction

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Viola William Keddeas

2017-06-01

Conclusion: Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.

Oscillometric blood pressure measurements: differences between measured and calculated mean arterial pressure.

NARCIS (Netherlands)

Kiers, H.D.; Hofstra, J.M.; Wetzels, J.F.M.

2008-01-01

Mean arterial pressure (MAP) is often used as an index of overall blood pressure. In recent years, the use of automated oscillometric blood pressure measurement devices is increasing. These devices directly measure and display MAP; however, MAP is often calculated from systolic blood pressure (SBP)

Validation of noninvasive indices of global systolic function in patients with normal and abnormal loading conditions: a simultaneous echocardiography pressure-volume catheterization study.

Science.gov (United States)

Yotti, Raquel; Bermejo, Javier; Benito, Yolanda; Sanz-Ruiz, Ricardo; Ripoll, Cristina; Martínez-Legazpi, Pablo; del Villar, Candelas Pérez; Elízaga, Jaime; González-Mansilla, Ana; Barrio, Alicia; Bañares, Rafael; Fernández-Avilés, Francisco

2014-01-01

Noninvasive indices based on Doppler echocardiography are increasingly used in clinical cardiovascular research to evaluate left ventricular global systolic chamber function. Our objectives were to clinically validate ultrasound-based methods of global systolic chamber function to account for differences between patients in conditions of abnormal load, and to assess their sensitivity to load confounders. Twenty-seven patients (8 dilated cardiomyopathy, 10 normal ejection fraction, and 9 end-stage liver disease) underwent simultaneous echocardiography and left heart catheterization with pressure-conductance instrumentation. The reference index, maximal elastance (Emax), was calculated from pressure-volume loop data obtained during acute inferior vena cava occlusion. A wide range of values were observed for left ventricular systolic chamber function (Emax: 2.8±1.0 mm Hg/mL), preload, and afterload. Among the noninvasive indices tested, the peak ejection intraventricular pressure difference showed the best correlation with Emax (R=0.75). A significant but weaker correlation with Emax was observed for ejection fraction (R=0.41), midwall fractional shortening (R=0.51), global circumferential strain (R=-0.53), and strain rate (R=-0.46). Longitudinal strain and strain rate failed to correlate with Emax, as did noninvasive single-beat estimations of this index. Principal component and multiple regression analyses demonstrated that peak ejection intraventricular pressure difference was less sensitive to load, whereas ejection fraction and longitudinal strain and strain rate were heavily influenced by afterload. Current ultrasound methods have limited accuracy to characterize global left ventricular systolic chamber function in a given patient. The Doppler-derived peak ejection intraventricular pressure difference should be preferred for this purpose because it best correlates with the reference index and is more robust in conditions of abnormal load.

Mycophenolate mofetil attenuates pulmonary arterial hypertension in rats

International Nuclear Information System (INIS)

Suzuki, Chihiro; Takahashi, Masafumi; Morimoto, Hajime; Izawa, Atsushi; Ise, Hirohiko; Hongo, Minoru; Hoshikawa, Yasushi; Ito, Takayuki; Miyashita, Hiroshi; Kobayashi, Eiji; Shimada, Kazuyuki; Ikeda, Uichi

2006-01-01

Pulmonary arterial hypertension (PAH) is characterized by abnormal proliferation of smooth muscle cells (SMCs), leading to occlusion of pulmonary arterioles, right ventricular (RV) hypertrophy, and death. We investigated whether mycophenolate mofetil (MMF), a potent immunosuppresssant, prevents the development of monocrotaline (MCT)-induced PAH in rats. MMF effectively decreased RV systolic pressure and RV hypertrophy, and reduced the medial thickness of pulmonary arteries. MMF significantly inhibited the number of proliferating cell nuclear antigen (PCNA)-positive cells, infiltration of macrophages, and expression of P-selectin and interleukin-6 on the endothelium of pulmonary arteries. The infiltration of T cells and mast cells was not affected by MMF. In vitro experiments revealed that mycophenolic acid (MPA), an active metabolite of MMF, dose-dependently inhibited proliferation of human pulmonary arterial SMCs. MMF attenuated the development of PAH through its anti-inflammatory and anti-proliferative properties. These findings provide new insight into the potential role of immunosuppressants in the treatment of PAH

Evaluation of changes in left ventricular structure and function in hypertensive patients with coronary artery disease after PCI using real-time three-dimensional echocardiography.

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Meng, Yanhong; Zong, Ling; Zhang, Ziteng; Han, Youdong; Wang, Yanhui

2018-02-01

We aimed to evaluate the changes in left ventricular structure and function in hypertensive patients with coronary artery disease before and after percutaneous coronary intervention (PCI) using real-time three-dimensional echocardiography. Two hundred and eighty hypertensive patients with coronary artery disease undergoing PCI and 120 cases who did not receive PCI in our hospital were selected as the subjects of our study. All patients were administered with routine antiplatelet, anticoagulant, lipid-lowering, antihypertensive, dilating coronary artery and other medications. The left ventricular systolic function and systolic synchrony index changes before and after subjects were treated by PCI were analyzed using three-dimensional echocardiography. At 2 days before surgery, there were no significant differences in the left ventricular end-diastolic volume, left ventricular end-systolic volume (LVESV) and ejection fraction (EF) between the two patient groups (P>0.05). At 3 months and 9 months, the two key time points after PCI, the LVESV level in the PCI group was distinctly decreased, while EF was significantly increased (P0.05); however, the parameters of time from the corresponding segment of the myocardium to the minimal systolic volume in patients in the PCI group were significantly reduced at 3 and 9 months after surgery (PPCI accurately and in real-time, which may play a significant role.

Contribution of reactive oxygen species to the pathogenesis of pulmonary arterial hypertension

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Naik, Jay S.; Weise-Cross, Laura; Detweiler, Neil D.; Herbert, Lindsay M.; Yellowhair, Tracylyn R.; Resta, Thomas C.

2017-01-01

Pulmonary arterial hypertension is associated with a decreased antioxidant capacity. However, neither the contribution of reactive oxygen species to pulmonary vasoconstrictor sensitivity, nor the therapeutic efficacy of antioxidant strategies in this setting are known. We hypothesized that reactive oxygen species play a central role in mediating both vasoconstrictor and arterial remodeling components of severe pulmonary arterial hypertension. We examined the effect of the chemical antioxidant, TEMPOL, on right ventricular systolic pressure, vascular remodeling, and enhanced vasoconstrictor reactivity in both chronic hypoxia and hypoxia/SU5416 rat models of pulmonary hypertension. SU5416 is a vascular endothelial growth factor receptor antagonist and the combination of chronic hypoxia/SU5416 produces a model of severe pulmonary arterial hypertension with vascular plexiform lesions/fibrosis that is not present with chronic hypoxia alone. The major findings from this study are: 1) compared to hypoxia alone, hypoxia/SU5416 exposure caused more severe pulmonary hypertension, right ventricular hypertrophy, adventitial lesion formation, and greater vasoconstrictor sensitivity through a superoxide and Rho kinase-dependent Ca2+ sensitization mechanism. 2) Chronic hypoxia increased medial muscularization and superoxide levels, however there was no effect of SU5416 to augment these responses. 3) Treatment with TEMPOL decreased right ventricular systolic pressure in both hypoxia and hypoxia/SU5416 groups. 4) This effect of TEMPOL was associated with normalization of vasoconstrictor responses, but not arterial remodeling. Rather, medial hypertrophy and adventitial fibrotic lesion formation were more pronounced following chronic TEMPOL treatment in hypoxia/SU5416 rats. Our findings support a major role for reactive oxygen species in mediating enhanced vasoconstrictor reactivity and pulmonary hypertension in both chronic hypoxia and hypoxia/SU5416 rat models, despite a

Systolic array processing of the sequential decoding algorithm

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Chang, C. Y.; Yao, K.

1989-01-01

A systolic array processing technique is applied to implementing the stack algorithm form of the sequential decoding algorithm. It is shown that sorting, a key function in the stack algorithm, can be efficiently realized by a special type of systolic arrays known as systolic priority queues. Compared to the stack-bucket algorithm, this approach is shown to have the advantages that the decoding always moves along the optimal path, that it has a fast and constant decoding speed and that its simple and regular hardware architecture is suitable for VLSI implementation. Three types of systolic priority queues are discussed: random access scheme, shift register scheme and ripple register scheme. The property of the entries stored in the systolic priority queue is also investigated. The results are applicable to many other basic sorting type problems.

Feasibility of UltraFast Doppler in Post-operative Evaluation of Hepatic Artery in Recipients following Liver Transplantation.

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Kim, Se-Young; Kim, Kyoung Won; Choi, Sang Hyun; Kwon, Jae Hyun; Song, Gi-Won; Kwon, Heon-Ju; Yun, Young Ju; Lee, Jeongjin; Lee, Sung-Gyu

2017-11-01

To determine the feasibility of using UltraFast Doppler in post-operative evaluation of the hepatic artery (HA) after liver transplantation (LT), we evaluated 283 simultaneous conventional and UltraFast Doppler sessions in 126 recipients over a 2-mo period after LT, using an Aixplorer scanner The Doppler indexes of the HA (peak systolic velocity [PSV], end-diastolic velocity [EDV], resistive index [RI] and systolic acceleration time [SAT]) by retrospective analysis of retrieved waves from UltraFast Doppler clips were compared with those obtained by conventional spectral Doppler. Correlation, performance in diagnosing the pathologic wave, examination time and reproducibility were evaluated. The PSV, EDV, RI and SAT of spectral and UltraFast Doppler measurements exhibited excellent correlation with favorable diagnostic performance. During the bedside examination, the mean time spent for UltraFast clip storing was significantly shorter than that for conventional Doppler US measurements. Both conventional and UltraFast Doppler exhibited good to excellent inter-analysis consistency. In conclusion, compared with conventional spectral Doppler, UltraFast Doppler values correlated excellently and yielded acceptable pathologic wave diagnostic performance with reduced examination time at the bedside and excellent reproducibility. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Quantitative assessment of left ventricular systolic wall thickening using multidetector computed tomography

DEFF Research Database (Denmark)

Kristensen, Thomas S; Kofoed, Klaus F; Møller, Daniel V

2009-01-01

BACKGROUND: Multidetector computed tomography (MDCT) of the heart provides both anatomical and functional information. The objective of this study was to evaluate the accuracy of quantitative assessment of left ventricular contractile function in relation to two-dimensional transthoracic echocard......BACKGROUND: Multidetector computed tomography (MDCT) of the heart provides both anatomical and functional information. The objective of this study was to evaluate the accuracy of quantitative assessment of left ventricular contractile function in relation to two-dimensional transthoracic...... echocardiography (TTE). MATERIALS AND METHODS: Sixty-four patients with known or suspected coronary artery disease underwent ECG-gated 64-slice MDCT and TTE. Regional left ventricular contractile function was measured by percent systolic wall thickening (SWT) in 16 myocardial segments using MDCT, and compared...

Gerbode defect following endocarditis and misinterpreted as severe pulmonary arterial hypertension

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Allajbeu Iris

2010-09-01

Full Text Available Abstract A Gerbode -type defect is a ventricular septal defect communicating directly between the left ventricle and right atrium. It is usually congenital, but rarely is acquired, as a complication of endocarditis. This can be anatomically possible because the normal tricuspid valve is more apically displaced than the mitral valve. However, identification of an actual communication is often extremely difficult, so a careful and meticulous echocardiogram should be done in order to prevent echocardiographic misinterpretation of this defect as pulmonary arterial hypertension. The large systolic pressure gradient between the left ventricle and the right atrium would expectedly result in a high velocity systolic Doppler flow signal in right atrium and it can be sometimes mistakably diagnosed as tricuspid regurgitant jet simulating pulmonary arterial hypertension. We present a rare case of young woman, with endocarditis who presented with severe pulmonary arterial hypertension. The preoperative diagnosis of left ventricle to right atrial communication (acquired Gerbode defect was suspected initially by echocardiogram and confirmed at the time of the surgery. A point of interest, apart from the diagnostic problem, was the explanation for its mechanism and presentation. The probability of a bacterial etiology of the defect is high in this case.

Feasibility Study of Ex Ovo Chick Chorioallantoic Artery Model for Investigating Pulsatile Variation of Arterial Geometry.

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Kweon-Ho Nam

Full Text Available Despite considerable research efforts on the relationship between arterial geometry and cardiovascular pathology, information is lacking on the pulsatile geometrical variation caused by arterial distensibility and cardiomotility because of the lack of suitable in vivo experimental models and the methodological difficulties in examining the arterial dynamics. We aimed to investigate the feasibility of using a chick embryo system as an experimental model for basic research on the pulsatile variation of arterial geometry. Optical microscope video images of various arterial shapes in chick chorioallantoic circulation were recorded from different locations and different embryo samples. The high optical transparency of the chorioallantoic membrane (CAM allowed clear observation of tiny vessels and their movements. Systolic and diastolic changes in arterial geometry were visualized by detecting the wall boundaries from binary images. Several to hundreds of microns of wall displacement variations were recognized during a pulsatile cycle. The spatial maps of the wall motion harmonics and magnitude ratio of harmonic components were obtained by analyzing the temporal brightness variation at each pixel in sequential grayscale images using spectral analysis techniques. The local variations in the spectral characteristics of the arterial wall motion were reflected well in the analysis results. In addition, mapping the phase angle of the fundamental frequency identified the regional variations in the wall motion directivity and phase shift. Regional variations in wall motion phase angle and fundamental-to-second harmonic ratio were remarkable near the bifurcation area. In summary, wall motion in various arterial geometry including straight, curved and bifurcated shapes was well observed in the CAM artery model, and their local and cyclic variations could be characterized by Fourier and wavelet transforms of the acquired video images. The CAM artery model with

Reproducibility of the ambulatory arterial stiffness index in hypertensive patients

DEFF Research Database (Denmark)

Dechering, D.G.; Steen, M.S. van der; Adiyaman, A.

2008-01-01

BACKGROUND: We studied the repeatability of the ambulatory arterial stiffness index (AASI), which can be computed from 24-h blood pressure (BP) recordings as unity minus the regression slope of diastolic on systolic BP. METHODS: One hundred and fifty-two hypertensive outpatients recruited...... in Nijmegen (mean age = 46.2 years; 76.3% with systolic and diastolic hypertension) and 145 patients enrolled in the Systolic Hypertension in Europe (Syst-Eur) trial (71.0 years) underwent 24-h BP monitoring at a median interval of 8 and 31 days, respectively. We used the repeatability coefficient, which...... were approximately 30%. Differences in AASI between paired recordings were correlated with differences in the goodness of fit (r2) of the AASI regression line as well as with differences in the night-to-day BP ratio. However, in sensitivity analyses stratified for type of hypertension, r2, or dipping...

Assessment of regional systolic and diastolic myocardial function using tissue Doppler and strain imaging in dogs with dilated cardiomyopathy.

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Chetboul, Valérie; Gouni, Vassiliki; Sampedrano, Carolina Carlos; Tissier, Renaud; Serres, François; Pouchelon, Jean-Louis

2007-01-01

Tissue Doppler Imaging (TDI) or strain (St) imaging could provide sensitive indices for early detection and treatment follow-up of canine dilated cardiomyopathy (DCM). Analysis of TDI and St features in dogs with overt DCM is a prerequisite before using these new criteria in prospective screenings of predisposed families or in clinical trials. Radial and longitudinal right and left myocardial motion, assessed by TDI and St variables, is altered in dogs with DCM. Case records for 26 dogs; 14 with DCM and 12 healthy controls of comparable age and weight were reviewed. A retrospective analysis was conducted of conventional echocardiography, 2-dimensional color TDI, and St imaging data. The DCM group was characterized by decreases in radial and longitudinal systolic velocity gradients of the left ventricular free wall (LVFW), radial and longitudinal absolute values of peak systolic St of the LVFW, and longitudinal systolic right ventricular (RV) velocities (all P canine DCM.

Hyperuricemia in Destabilization of Endothelial Function in Adolescents with Arterial Hypertension

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N.M. Korenev

2013-08-01

Full Text Available The objective of this work was to study the correlation of uric acid level in blood serum and parameters of endothelial function and non-specific inflammation in adolescents with arterial hypertension considering their body weight. In the most of patients with arterial hypertension endothelial dysfunction was detected; endothelium-dependent vasodilation was more altered in the patients with obesity and especially in those with hyperuricemia. An increase in C-reactive protein serum level was mainly associated with obesity; a decrease in systolic-diastolic ratio — with hyperuricemia.

Nonmassive acute pulmonary embolism: evaluation of the impact of pulmonary arterial wall distensibility on the assessment of the CT obstruction score.

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Bigot, Julien; Rémy-Jardin, Martine; Duhamel, Alain; Gorgos, Andréi-Bogdan; Faivre, Jean-Baptiste; Rémy, Jacques

2010-02-01

To evaluate the impact of pulmonary arterial wall distensibility on the assessment of a computed tomography (CT) score in patients with nonmassive pulmonary embolism (PE) (ie, Mastora score). The arterial wall distensibility of five central pulmonary arteries (pulmonary artery trunk, right and left main pulmonary arteries, right and left interlobar pulmonary arteries) was studied on ECG-gated CT angiographic studies of the chest in 15 patients with no pulmonary arterial hypertension (group 1; mean pulmonary artery pressure: 17.2 mm Hg) and 9 patients with nonmassive PE (group 2), using 2D reconstructions at every 10% of the R-R interval. The systolic and diastolic reconstruction time windows of the examined arteries were identical in the 2 groups, obtained at 20% and 80% of the R-R interval, respectively. No statistically significant difference was observed between the mean values of the pulmonary arterial wall distensibility between the 2 groups, varying between 20.5% and 24% in group 1 and between 23.3% and 25.9% in group 2. The coefficients of variation of the average arterial surfaces were found to vary between 4.30% and 6.50% in group 1 and 4.2% and 8.4% in group 2. Except the pulmonary artery trunk in group 2, all the intraclass correlation coefficients were around 0.8 or greater than 0.8, that is the cutoff for good homogeneity of measurements. The pulmonary arterial wall systolic-diastolic distensibility does not interfere with the assessment of a CT obstruction score in the setting of nonmassive PE.

Noninvasive calculation of the aortic blood pressure waveform from the flow velocity waveform: a proof of concept.

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Vennin, Samuel; Mayer, Alexia; Li, Ye; Fok, Henry; Clapp, Brian; Alastruey, Jordi; Chowienczyk, Phil

2015-09-01

Estimation of aortic and left ventricular (LV) pressure usually requires measurements that are difficult to acquire during the imaging required to obtain concurrent LV dimensions essential for determination of LV mechanical properties. We describe a novel method for deriving aortic pressure from the aortic flow velocity. The target pressure waveform is divided into an early systolic upstroke, determined by the water hammer equation, and a diastolic decay equal to that in the peripheral arterial tree, interposed by a late systolic portion described by a second-order polynomial constrained by conditions of continuity and conservation of mean arterial pressure. Pulse wave velocity (PWV, which can be obtained through imaging), mean arterial pressure, diastolic pressure, and diastolic decay are required inputs for the algorithm. The algorithm was tested using 1) pressure data derived theoretically from prespecified flow waveforms and properties of the arterial tree using a single-tube 1-D model of the arterial tree, and 2) experimental data acquired from a pressure/Doppler flow velocity transducer placed in the ascending aorta in 18 patients (mean ± SD: age 63 ± 11 yr, aortic BP 136 ± 23/73 ± 13 mmHg) at the time of cardiac catheterization. For experimental data, PWV was calculated from measured pressures/flows, and mean and diastolic pressures and diastolic decay were taken from measured pressure (i.e., were assumed to be known). Pressure reconstructed from measured flow agreed well with theoretical pressure: mean ± SD root mean square (RMS) error 0.7 ± 0.1 mmHg. Similarly, for experimental data, pressure reconstructed from measured flow agreed well with measured pressure (mean RMS error 2.4 ± 1.0 mmHg). First systolic shoulder and systolic peak pressures were also accurately rendered (mean ± SD difference 1.4 ± 2.0 mmHg for peak systolic pressure). This is the first noninvasive derivation of aortic pressure based on fluid dynamics (flow and wave speed) in the

Diastolic effects of chronic digitalization in systolic heart failure.

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Hassapoyannes, C A; Bergh, M E; Movahed, M R; Easterling, B M; Omoigui, N A

1998-10-01

The efficacy of short-term digitalization on exercise tolerance may, in part, reflect enhanced diastolic performance. However, cardiac glycosides can impair ventricular relaxation from cytosolic Ca++ overload. To detect any time-dependent adverse effect, we assessed the diastolic function after long-term use of digitalis in patients with mild to moderate systolic left ventricular failure. From a cohort of 80 patients who received long-term, randomized, double-blind treatment with digitalis versus placebo at the WJB Dorn Veterans Affairs Medical Center, 38 survivors were evaluated at the end of follow-up (mean 48.4 months) with evaluators blinded to treatment used. Each survivor underwent equilibrium scintigraphic and echocardiographic assessment of diastolic function. Peak and mean filling rates normalized with filling volume (FV), diastolic phase durations normalized with duration of diastole, and filling fractions were measured from the time-activity curve. The isovolumic relaxation period and ventricular dimensions were computed echocardiographically. By actual-treatment-received analysis, treated versus untreated patients manifested a trend toward longer isovolumic relaxation (80.76 ms vs 61.54 ms, P = .06) but a markedly lower peak rapid filling rate (6.39 FV/sec vs 10.56 FV/sec, P = .02) despite comparable loading conditions. In addition, treated patients exhibited a lower mean rate of rapid filling (2.75 FV/sec vs 3.78 FV/sec, P = .05) in the absence of a longer rapid filling duration. However, the end-diastolic ventricular dimension did not differ between the 2 groups. Similar results were obtained by intention-to-treat analysis. Importantly, the mortality rate from worsening heart failure in the inception cohort was lower in the digitalis group versus the placebo group (P = .05) with no difference in total cardiac or all-cause mortality. After long-term digitalization for systolic left ventricular failure, cross-sectional comparison with a control group

Relationship between neck circumference, insulin resistance and arterial stiffness in overweight and obese subjects.

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Fantin, Francesco; Comellato, Gabriele; Rossi, Andrea P; Grison, Elisa; Zoico, Elena; Mazzali, Gloria; Zamboni, Mauro

2017-09-01

Background Only a few studies have investigated the relationship between neck circumference and cardiometabolic risk. The aim of this study was to assess the relationships between neck circumference, waist circumference, metabolic variables and arterial stiffness in a group of overweight and obese subjects evaluating a possible independent role of neck circumference in determining arterial stiffness. Methods and results We studied 95 subjects (53 women) with an age range of 20-77 years and body mass index range from 25.69 to 47.04 kg/m 2 . In each subject we evaluated body mass index, waist, hip and neck circumference, systolic and diastolic blood pressure, insulin, fasting glucose, cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWVcf) and carotid-radial pulse wave velocity (PWVcr). Both PWVcf and PWVcr were higher in subjects with high values of neck circumference compared with subjects with normal values of neck circumference. Subjects with high values of neck circumference and abdominal obesity presented higher values of mean arterial pressure, PWVcr and homeostasis model assessment (HOMA) index and lower values of high-density lipoprotein than subjects with only abdominal obesity. Two models of stepwise multiple regression were performed in order to evaluate the combined effect of independent variables on arterial stiffness. In the first model PWVcf was considered a dependent variable, and age, gender, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, waist circumference, neck circumference, HOMA index and the use of anti-hypertensive medications were considered independent variables. Age, systolic blood pressure, triglycerides and waist circumference were significant predictors of PWVcf, explaining 65% of its variance. In the second model, in which PWVcr was considered a dependent variable, neck circumference

Noninvasive arterial blood pressure waveforms in patients with continuous-flow left ventricular assist devices.

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Martina, Jerson R; Westerhof, Berend E; de Jonge, Nicolaas; van Goudoever, Jeroen; Westers, Paul; Chamuleau, Steven; van Dijk, Diederik; Rodermans, Ben F M; de Mol, Bas A J M; Lahpor, Jaap R

2014-01-01

Arterial blood pressure and echocardiography may provide useful physiological information regarding cardiac support in patients with continuous-flow left ventricular assist devices (cf-LVADs). We investigated the accuracy and characteristics of noninvasive blood pressure during cf-LVAD support. Noninvasive arterial pressure waveforms were recorded with Nexfin (BMEYE, Amsterdam, The Netherlands). First, these measurements were validated simultaneously with invasive arterial pressures in 29 intensive care unit patients. Next, the association between blood pressure responses and measures derived by echocardiography, including left ventricular end-diastolic dimensions (LVEDDs), left ventricular end-systolic dimensions (LVESDs), and left ventricular shortening fraction (LVSF) were determined during pump speed change procedures in 30 outpatients. Noninvasive arterial blood pressure waveforms by the Nexfin monitor slightly underestimated invasive measures during cf-LVAD support. Differences between noninvasive and invasive measures (mean ± SD) of systolic, diastolic, mean, and pulse pressures were -7.6 ± 5.8, -7.0 ± 5.2, -6.9 ± 5.1, and -0.6 ± 4.5 mm Hg, respectively (all blood pressure responses did not correlate with LVEDD, LVESD, or LVSF, while LVSF correlated weakly with both pulse pressure (r = 0.24; p = 0.005) and (dP(art)/dt)max (r = 0.25; p = 0.004). The dicrotic notch in the pressure waveform was a better predictor of aortic valve opening (area under the curve [AUC] = 0.87) than pulse pressure (AUC = 0.64) and (dP(art)/dt)max (AUC = 0.61). Patients with partial support rather than full support at 9,000 rpm had a significant change in systolic pressure, pulse pressure, and (dP(art)/dt)max during ramp studies, while echocardiographic measures did not change. Blood pressure measurements by Nexfin were reliable and may thereby act as a compliment to the assessment of the cf-LVAD patient.

Galectin-3: A Link between Myocardial and Arterial Stiffening in Patients with Acute Decompensated Heart Failure?

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Lala, Radu Ioan; Darabantiu, Dan; Pilat, Luminita; Puschita, Maria

2016-02-01

Heart failure is accompanied by abnormalities in ventricular-vascular interaction due to increased myocardial and arterial stiffness. Galectin-3 is a recently discovered biomarker that plays an important role in myocardial and vascular fibrosis and heart failure progression. The aim of this study was to determine whether galectin-3 is correlated with arterial stiffening markers and impaired ventricular-arterial coupling in decompensated heart failure patients. A total of 79 inpatients with acute decompensated heart failure were evaluated. Serum galectin-3 was determined at baseline, and during admission, transthoracic echocardiography and measurements of vascular indices by Doppler ultrasonography were performed. Elevated pulse wave velocity and low arterial carotid distensibility are associated with heart failure in patients with preserved ejection fraction (p = 0.04, p = 0.009). Pulse wave velocity, carotid distensibility and Young's modulus did not correlate with serum galectin-3 levels. Conversely, raised galectin-3 levels correlated with an increased ventricular-arterial coupling ratio (Ea/Elv) p = 0.047, OR = 1.9, 95% CI (1.0‑3.6). Increased galectin-3 levels were associated with lower rates of left ventricular pressure rise in early systole (dp/dt) (p=0.018) and raised pulmonary artery pressure (p = 0.046). High galectin-3 levels (p = 0.038, HR = 3.07) and arterial pulmonary pressure (p = 0.007, HR = 1.06) were found to be independent risk factors for all-cause mortality and readmissions. This study showed no significant correlation between serum galectin-3 levels and arterial stiffening markers. Instead, high galectin-3 levels predicted impaired ventricular-arterial coupling. Galectin-3 may be predictive of raised pulmonary artery pressures. Elevated galectin-3 levels correlate with severe systolic dysfunction and together with pulmonary hypertension are independent markers of outcome.

Systolic blood pressure target in systemic arterial hypertension: Is lower ever better? Results from a community-based Caucasian cohort.

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Di Nora, Concetta; Cioffi, Giovanni; Iorio, Annamaria; Rivetti, Luigi; Poli, Stefano; Zambon, Elena; Barbati, Giulia; Sinagra, Gianfranco; Di Lenarda, Andrea

2018-02-01

Extensive evidence exists about the prognostic role of systolic blood pressure (SBP) reduction ≤140mmHg. Recently, the SPRINT trial successfully tested the strategy of lowering SBP<120mmHg in patients with arterial hypertension (AH). To assess whether the SPRINT results are reproducible in a real world community population. Cross-sectional, population-based study analyzing data of 24,537 Caucasian people with AH from the Trieste Observatory of CV disease, 2010 to 2015. We selected and divided 2306 subjects with AH according to the SPRINT trial criteria; similarly, SPRINT clinical outcomes were considered. Study patients median age was 75±8years, two third male, one third had ischemic heart disease. They were older, with lower body mass index, higher SBP and Framingham CV risk score than the SPRINT patients. Three-hundred-sixty-eight patients (16%) had SBP<120mmHg. During 48 [36-60] months of follow-up, 751 patients (32%) experienced a major adverse cardiac event (MACE). The SBP <120mmHg group had higher incidence of MACE, CV deaths and all-cause death than SBP≥120mmHg group (37% vs 31%; 10% vs 4%; 19% vs 10%, all p<0.05). The condition of SBP<120mmHg was an independent predictor of MACE in multivariate Cox analysis together with older age, male gender, higher Charlson score. In our experience, the SBP<120mmHg condition is associated with worse clinical outcomes, suggesting the SPRINT results are not reproducible tout court in Caucasian community populations. These differences should be taken as a warning against aggressive reducing of SBP<120mmHg. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Combined resistance and endurance exercise training improves arterial stiffness, blood pressure, and muscle strength in postmenopausal women.

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Figueroa, Arturo; Park, Song Y; Seo, Dae Y; Sanchez-Gonzalez, Marcos A; Baek, Yeong H

2011-09-01

Menopause is associated with increased arterial stiffness and reduced muscle strength. Combined resistance (RE) and endurance (EE) exercise training can decrease brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness, in young men. We tested the hypothesis that combined circuit RE and EE training would improve baPWV, blood pressure (BP), and muscle strength in postmenopausal women. Twenty-four postmenopausal women (age 47-68 y) were randomly assigned to a "no exercise" control (n = 12) or to combined exercise training (EX; n = 12) group. The EX group performed concurrent circuit RE training followed by EE training at 60% of the predicted maximal heart rate (HR) 3 days per week. Brachial systolic BP, diastolic BP, mean arterial pressure, baPWV, HR, and dynamic and isometric muscle strength were measured before and after the 12-week study. Mean ± SE baPWV (-0.8 ± 0.2 meters/s), systolic BP (-6.0 ± 1.9 mm Hg), diastolic BP (-4.8 ± 1.7 mm Hg), HR (-4.0 ± 1.0 beats/min), and mean arterial pressure (-5.1 ± 1.6 mm Hg) decreased (P hypertension and frailty in postmenopausal women.

Relationship of carotid arterial functional and structural changes to left atrial volume in untreated hypertension.

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Jaroch, Joanna; Rzyczkowska, Barbara; Bociąga, Zbigniew; Vriz, Olga; Driussi, Caterina; Loboz-Rudnicka, Maria; Dudek, Krzysztof; Łoboz-Grudzień, Krystyna

2016-04-01

The contribution of arterial functional and structural changes to left ventricular (LV) diastolic dysfunction has been the area of recent research. There are some studies on the relationship between arterial stiffness (a.s.) and left atrial (LA) remodelling as a marker of diastolic burden. Little is known about the association of arterial structural changes and LA remodelling in hypertension (H). The aim of this study was to examine the relationship between carotid a.s. and intima-media thickness (IMT) and LA volume in subjects with H. The study included 245 previously untreated hypertensives (166 women and 79 men, mean age 53.7 ± 11.8 years). Each patient was subjected to echocardiography with measurement of LA volume, evaluation of left ventricular hypertrophy (LVH) and LV systolic/diastolic function indices, integrated assessment of carotid IMT and echo-tracking of a.s. and wave reflection parameters. Univariate regression analysis revealed significant correlations between indexed LA volume and selected clinical characteristics, echocardiographic indices of LVH and LV diastolic/systolic function and a.s./wave reflection parameters. The following parameters were identified as independent determinants of indexed LA volume on multivariate regression analysis: diastolic blood pressure (beta = -0.229, P arterial stiffness but not intima-media thickness and LA volume in patients with untreated hypertension.

Additive prognostic value of interleukin-6 at peak phase of dobutamine stress echocardiography in patients with coronary artery disease. A 6-year follow-up study.

Science.gov (United States)

Ikonomidis, Ignatios; Athanassopoulos, George; Stamatelopoulos, Kimon; Lekakis, John; Revela, Ioanna; Venetsanou, Kiriaki; Marinou, Margarita; Monaco, Claudia; Cokkinos, Dennis V; Nihoyannopoulos, Petros

2008-08-01

Interleukin-6 (IL-6) and tissue factor (TF) are elevated after myocardial ischemia during dobutamine stress echo (DSE). We examined the incremental prognostic value of IL-6 or TF measured during DSE over echocardiographic and clinical factors in patients with chronic coronary artery disease (CAD). We studied 106 patients with angiographically documented CAD. IL-6 and TF were measured at rest, peak, and during recovery. A wall motion score index was calculated. Fifty-seven (54%) patients had ischemia at DSE. During follow-up (63.7 +/- 20 months), 36 patients (33%) had an adverse event (12 cardiac deaths, 24 acute coronary events). Patients with events had a higher peak IL-6 (P = .02) but similar rest and recovery IL-6 than those without. Patients with peak IL-6 > or =3.14 pg/mL (upper tertile) had a hazard ratio of 2.7 (95% CI 1.44-5.37) (P statistic from 0.66 to 0.70 (P = .04). The addition of peak IL-6 further increased the model's c statistic to 0.75 (P = .04). Tissue factor was not related with cardiac events. Interleuikin-6 levels measured during the peak phase of DSE incrementally contribute to risk stratification in patients with chronic CAD.

Dietary sodium restriction reverses vascular endothelial dysfunction in middle-aged/older adults with moderately elevated systolic blood pressure

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Jablonski, Kristen L.; Racine, Matthew L.; Geolfos, Candace J.; Gates, Phillip E.; Chonchol, Michel; McQueen, Matthew B.; Seals, Douglas R.

2013-01-01

Objectives We determined the efficacy of dietary sodium restriction (DSR) for improving vascular endothelial dysfunction in middle-aged/older adults with moderately elevated systolic blood pressure (SBP; 130–159 mmHg) and the associated physiological mechanisms. Background Vascular endothelial dysfunction develops with advancing age and elevated SBP, contributing to increased cardiovascular risk. DSR lowers BP, but its effect on vascular endothelial function and mechanisms involved are unknown. Methods Seventeen subjects (11M/6F; 62±7 yrs, mean±S.D.) completed a randomized, crossover study of 4 weeks of both low and normal sodium intake. Vascular endothelial function (endothelium-dependent dilation; EDD), nitric oxide (NO)/tetrahydrobiopterin (BH4) bioavailability and oxidative stress-associated mechanisms were assessed following each condition. Results Urinary sodium excretion was reduced by ~50% (to 70±30 mmol/day), and conduit (brachial artery flow-mediated dilation [FMDBA]) and resistance (forearm blood flow responses to acetylcholine [FBFACh]) artery EDD were 68% and 42% (peak FBFACh) higher following the low sodium diet (psodium markedly enhanced NO- mediated EDD (greater ΔFBFACh with endothelial NO synthase [eNOS] inhibition) without changing eNOS expression/activation (Ser1177 phosphorylation), restored BH4 bioactivity (less ΔFMDBA with acute BH4), abolished tonic superoxide suppression of EDD (less ΔFMDBA and ΔFBFACh with ascorbic acid infusion), and increased circulating superoxide dismutase activity (p<0.05). These effects were independent of ΔSBP. Other subject characteristics/dietary factors and endothelium-independent dilation were unchanged. Conclusions DSR largely reverses both macro- and microvascular endothelial dysfunction by enhancing NO and BH4 bioavailability and reducing oxidative stress. Our findings support the emerging concept that DSR induces “vascular protection” beyond that attributable to its BP-lowering effects. PMID

Systolic reconstruction in patients with low heart rate using coronary dual-source CT angiography

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Okada, Munemasa, E-mail: radokada@yamaguchi-u.ac.jp [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Nakashima, Yoshiteru; Shigemoto, Youko; Matsunaga, Naofumi [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Miura, Toshiro; Nao, Tomoko [Department of Cardiology, Yamaguchi University Graduate School of Medicine (Japan); Sano, Yuichi; Narazaki, Akiko [Department of Radiology, Yamaguchi University Hospital (Japan); Kido, Shoji [Computer-aided Diagnosis and Biomedical Imaging Research Biomedical Engineering, Applied Medical Engineering Science Graduate School of Medicine, Yamaguchi University (Japan)

2011-11-15

Objectives: The purpose of our study was to determine the relationship between the predictive factors and systolic reconstruction (SR) as an optimal reconstruction window in patients with low heart rate (LHR; less than 65 bpm). Methods: 391 patients (262 male and 129 female, mean age; 67.1 {+-} 10.1 years of age) underwent coronary CTA without the additional administration of a beta-blocker. Affecting factors for SR were analyzed in age, gender, body weight (BW), diabetes mellitus (DM), coronary arterial disease (CAD), ejection fraction (EF), systolic and diastolic body pressure (BP) and heart rate variability (HRV) during coronary CTA. Results: In 29 (7.4%) of the 391 patients, SR was needed, but there was no apparent characteristic difference between the systolic and diastolic reconstruction groups in terms of gender, age, BW, DM, CAD and EF. In a multivariate analysis, the co-existence of DM [P < 0.05; OR, 0.27; 95% CI, 0.092-0.80], diastolic BP [P < 0.01; OR, 0.95; 95% CI, 0.92-0.98] and HRV [P < 0.01; OR, 0.98; 95% CI, 0.96-0.99] were found to be the factors for SR. In gender-related analysis, HRV was an important factor regardless of sex, but co-existence of DM affected especially for female and BP for male. Conclusion: Especially in the patients with LHR who had a medication of DM, high HRV or high BP, SR, in addition to DR, was needed to obtain high-quality coronary CTA images.

Systolic reconstruction in patients with low heart rate using coronary dual-source CT angiography

International Nuclear Information System (INIS)

Okada, Munemasa; Nakashima, Yoshiteru; Shigemoto, Youko; Matsunaga, Naofumi; Miura, Toshiro; Nao, Tomoko; Sano, Yuichi; Narazaki, Akiko; Kido, Shoji

2011-01-01

Objectives: The purpose of our study was to determine the relationship between the predictive factors and systolic reconstruction (SR) as an optimal reconstruction window in patients with low heart rate (LHR; less than 65 bpm). Methods: 391 patients (262 male and 129 female, mean age; 67.1 ± 10.1 years of age) underwent coronary CTA without the additional administration of a beta-blocker. Affecting factors for SR were analyzed in age, gender, body weight (BW), diabetes mellitus (DM), coronary arterial disease (CAD), ejection fraction (EF), systolic and diastolic body pressure (BP) and heart rate variability (HRV) during coronary CTA. Results: In 29 (7.4%) of the 391 patients, SR was needed, but there was no apparent characteristic difference between the systolic and diastolic reconstruction groups in terms of gender, age, BW, DM, CAD and EF. In a multivariate analysis, the co-existence of DM [P < 0.05; OR, 0.27; 95% CI, 0.092-0.80], diastolic BP [P < 0.01; OR, 0.95; 95% CI, 0.92-0.98] and HRV [P < 0.01; OR, 0.98; 95% CI, 0.96-0.99] were found to be the factors for SR. In gender-related analysis, HRV was an important factor regardless of sex, but co-existence of DM affected especially for female and BP for male. Conclusion: Especially in the patients with LHR who had a medication of DM, high HRV or high BP, SR, in addition to DR, was needed to obtain high-quality coronary CTA images.

Heparin-bonded, expanded polytetrafluoroethylene-lined stent graft in the treatment of femoropopliteal artery disease: 1-year results of the VIPER (Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease) trial.

Science.gov (United States)

Saxon, Richard R; Chervu, Arun; Jones, Paul A; Bajwa, Tanvir K; Gable, Dennis R; Soukas, Peter A; Begg, Richard J; Adams, John G; Ansel, Gary M; Schneider, Darren B; Eichler, Charles M; Rush, Michael J

2013-02-01

To evaluate the performance of a heparin-bonded, expanded polytetrafluoroethylene (ePTFE)-lined nitinol endoprosthesis in the treatment of long-segment occlusive disease of the femoropopliteal artery (FPA) and to identify factors associated with loss of patency. In a single-arm, prospective, 11-center study (VIPER [Gore Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease] trial), 119 limbs (113 patients; 69 men; mean age, 67 y), including 88 with Rutherford category 3-5 disease and 72 with Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) C or D lesions of the FPA, underwent stent graft implantation. The mean lesion length was 19 cm; 56% of lesions were occlusions. Follow-up evaluations included color duplex ultrasonography in all patients, with patency defined as a peak systolic velocity ratio20% was 70% (P = .047). Primary patency was not significantly affected by device diameter (5 vs 6 vs 7 mm) or lesion length (≤20 cm vs>20 cm). The 30-day major adverse event rate was 0.8%. The heparin-bonded, ePTFE/nitinol stent graft provided clinical improvement and a primary patency rate of 73% at 1 year in the treatment of long-segment FPA disease. Careful sizing of the device relative to vessel landing zones is essential for achieving optimal outcomes. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

Central aortic systolic blood pressure can predict prolonged QTc duration better than brachial artery systolic blood pressure in rural community residents.

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Huang, Yuqing; Tang, Songtao; Chen, Ji-Yan; Huang, Cheng; Li, Jie; Cai, An-Ping; Feng, Yingqing

2018-01-01

Previous studies have suggested that prolonged electrocardiogram QTc duration was independent risk factor for both increased cardiovascular and all-cause mortality, but there was no dating about the relationship between central aortic systolic blood pressure (CASP) and QTc duration. The aim of this study was to analyze the relationship between CASP and QTc duration, and assess whether CASP can predict prolonged QTc duration more than BSBP. A total of 500 patients were enrolled in this study, central and brachial aortic blood pressure and electrocardiogram QTc duration were measured. Pearson correlation was assessed for determining the associations of QTc duration with clinical conditions. Multivariate logistic regression analyses were performed to determine the independent predictor of prolonged QTc duration. Receiver operating characteristic (ROC) curve was used to evaluate the utility of blood pressure for prolonged QTc duration. We found QTc durations were significantly positive with CASP (r = 0.308, p AUC: 0.771 vs. 0.646, p < 0.001) BSBP. Our results suggested that the non-invasive CASP is independently correlated with QTc duration, and CASP can predict prolonged QTc duration more than BSBP.

Cardiac PET/CT for the diagnosis and prognostic evaluation of coronary artery disease

International Nuclear Information System (INIS)

Geronazzo, R.J.; Romero, R.L.; Campisi, R.

2014-01-01

Coronary artery disease is considered by de World Health Organization (WHO) to be pandemic. Eighty percent of the deaths occurs secondary to coronary artery disease, stroke and diabetes, thus they can be prevented. All of them are related to the same risk factors. Ischemic heart disease is the mayor cause of death in Argentina in the elderly population. Primary prevention strategies are essential in the health system. Hence, image complementary methods are very important to accomplish risk stratification, secondary prevention and pre-surgical evaluation. Nuclear cardiology has occupied this place through myocardial perfusion studies with radiopharmaceuticals, using SPECT (Single photon emission computed tomography) that have improved the level of sensitivity and specificity with ECG gated. Furthermore, positron emission tomography (PET) can evaluate relative myocardial perfusion, quantify absolute myocardial blood flow and coronary flow reserve. With its capacity to quantify rest-peak stress left ventricular systolic function we can underscore for example “balance ischemia”. By using hybrid PET/CT, also we can get information of coronary artery calcium scoring and coronary angiography. Currently, with the available softwares, we can acquire images in List mode. It means, from a single acquisition, it allows multiple image reconstructions, along with the associated electrocardiographic phase. PET/CT uses radiopharmaceuticals with short physical half life, and in conjunction with the possibility of acquiring in 3D mode, the perfusion studies can be done in a short time and offers lower radiation exposure to the patient. The new softwares for routine correction of misalignments between transmission and emission images have helped to reduce the frequency of artifacts and improve diagnostic accuracy. Hybrid PET/CT technology allows functional evaluation of myocardial perfusion combined with anatomic characterization of the epicardial coronary arteries, thereby

Relationship of hemoglobin and hematocrit to systolic function in advanced heart failure.

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Guglin, Maya; Darbinyan, Nellie

2012-01-01

The dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provides a rare opportunity to evaluate the whole spectrum of associations of hemoglobin (HB) and hematocrit (HCT) in heart failure (HF). In that trial, subjective and objective data were recorded at multiple time points when HB and HCT were also measured. We investigated the relationship between anemia and ventricular systolic function. A limited access dataset from the ESCAPE trial, provided by the National Heart, Lung and Blood Institute, was analyzed. Linear regression analysis, correlation coefficients and Student's t test were utilized. Besides the known association of anemia with poor prognosis, more severe symptoms, decreased functional capacity and impaired kidney function, we found a significant and very consistent inverse correlation between HB and HCT and ventricular contractility. Both left ventricular ejection fraction and right ventricular fractional area change improved with a decrease in HB and vice versa. We hypothesize that this effect can result from a change in viscosity, which decreases with a decrease in HCT, and may facilitate adaptation of the heart to a volume overload state accompanied by hemodilution. In HF, anemia is associated with poor prognosis and functional impairment, but also with mildly improved systolic function. It may represent an adaptive reaction to congestion. Copyright © 2012 S. Karger AG, Basel.

Peak negative myocardial velocity gradient in early diastole as a noninvasive indicator of left ventricular diastolic function: comparison with transmitral flow velocity indices.

Science.gov (United States)

Shimizu, Y; Uematsu, M; Shimizu, H; Nakamura, K; Yamagishi, M; Miyatake, K

1998-11-01

We sought to assess the clinical significance of peak negative myocardial velocity gradient (MVG) in early diastole as a noninvasive indicator of left ventricular (LV) diastolic function. Peak systolic MVG has been shown useful for the quantitative assessment of regional wall motion abnormalities, but limited data exist regarding the diastolic MVG as an indicator of LV diastolic function. Peak negative MVG was obtained from M-mode tissue Doppler imaging (TDI) in 43 subjects with or without impairment of systolic and diastolic performance: 12 normal subjects, 12 patients with hypertensive heart disease (HHD) with normal systolic performance and 19 patients with dilated cardiomyopathy (DCM), and was compared with standard Doppler transmitral flow velocity indices. In a subgroup of 30 patients, effects of preload increase on these indices were assessed by performing passive leg lifting. In an additional 11 patients with congestive heart failure at the initial examination, the measurements were repeated after 26+/-16 days of volume-reducing therapy. Peak negative MVG was significantly depressed both in HHD (-3.9+/-1.3/s, p indices failed to distinguish DCM from normal due to the pseudonormalization. Transmitral flow velocity indices were significantly altered (peak early/late diastolic filling velocity [E/A]=1.1+/-0.5 to 1.5+/-0.7, p indicator of LV diastolic function that is less affected by preload alterations than the transmitral flow velocity indices, and thereby could be used for the follow-up of patients with nonischemic LV dysfunction presenting congestive heart failure.

Evaluation of factors influencing arterial Doppler waveforms in an in vitro flow phantom

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Sung, Chang Kyu [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul (Korea, Republic of); Lee, Kyoung Ho [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Kim, Seung Hyup [Dept. of Radiology and the Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of)

2017-01-15

The aim of this study was to investigate factors that influence arterial Doppler waveforms in an in vitro phantom to provide a more accurate and comprehensive explanation of the Doppler signal. A flow model was created using a pulsatile artificial heart, rubber or polyethylene tubes, a water tank, and a glass tube. Spectral Doppler tracings were obtained in multiple combinations of compliance, resistance, and pulse rate. Peak systolic velocity, minimum diastolic velocity, resistive index (RI), pulsatility index, early systolic acceleration time, and acceleration index were measured. On the basis of these measurements, the influences of the variables on the Doppler waveforms were analyzed. With increasing distal resistance, the RI increased in a relatively linear relationship. With increasing proximal resistance, the RI decreased. The pulsus tardus and parvus phenomenon was observed with a small acceleration index in the model with a higher grade of stenosis. An increase in the distal resistance masked the pulsus tardus and parvus phenomenon by increasing the acceleration index. Although this phenomenon occurred independently of compliance, changes in the compliance of proximal or distal tubes caused significant changes in the Doppler waveform. There was a reverse relationship between the RI and the pulse rate. Resistance and compliance can alter the Doppler waveforms independently. The pulse rate is an extrinsic factor that also influences the RI. The compliance and distal resistance, as well as proximal resistance, influence the pulsus tardus and parvus phenomenon.

Reliability of Doppler and stethoscope methods of determining systolic blood pressures: considerations for calculating an ankle-brachial index.

Science.gov (United States)

Chesbro, Steven B; Asongwed, Elmira T; Brown, Jamesha; John, Emmanuel B

2011-01-01

The purposes of this study were to: (1) identify the interrater and intrarater reliability of systolic blood pressures using a stethoscope and Doppler to determine an ankle-brachial index (ABI), and (2) to determine the correlation between the 2 methods. Peripheral arterial disease (PAD) affects approximately 8 to 12 million people in the United States, and nearly half of those with this disease are asymptomatic. Early detection and prompt treatment of PAD will improve health outcomes. It is important that clinicians perform tests that determine the presence of PAD. Two individual raters trained in ABI procedure measured the systolic blood pressures of 20 individuals' upper and lower extremities. Standard ABI measurement protocols were observed. Raters individually recorded the systolic blood pressures of each extremity using a stethoscope and a Doppler, for a total of 640 independent measures. Interrater reliability of Doppler measurements to determine SBP at the ankle was very strong (intraclass correlation coefficient [ICC], 0.93-0.99) compared to moderate to strong reliability using a stethoscope (ICC, 0.64-0.87). Agreement between the 2 devices to determine SBP was moderate to very weak (ICC, 0.13-0.61). Comparisons of the use of Doppler and stethoscope to determine ABI showed weak to very weak intrarater correlation (ICC, 0.17-0.35). Linear regression analysis of the 2 methods to determine ABI showed positive but weak to very weak correlations (r2 = .013, P = .184). A Doppler ultrasound is recommended over a stethoscope for accuracy in systolic pressure readings for ABI measurements.

The relationship between occupational exposure to lead and manifestation of cardiovascular complications in persons with arterial hypertension

International Nuclear Information System (INIS)

Poreba, Rafal; Gac, Pawel; Poreba, Malgorzata; Andrzejak, Ryszard

2010-01-01

The chronic exposure to lead represents a risk factor of arterial hypertension development. Ambulatory blood pressure monitoring is the most prognostically reliable method of measuring of arterial blood pressure. The study is aimed at evaluating the relationship between occupational exposure to lead and manifestation of cardiovascular complications in patients with arterial hypertension. The studies included 73 men (mean age, 54.26 ± 8.17 years) with arterial hypertension, treated with hypotensive drugs: group I-persons occupationally exposed to lead (n = 35) and group II-individuals not exposed to lead (n = 38). An analysis of results obtained during ambulatory blood pressure monitoring disclosed significantly higher values of mean systolic blood pressure, mean blood pressure, pulse pressure, and variability of systolic blood pressure in the group of hypertensive patients occupationally exposed to lead as compared to patients with arterial hypertension but not exposed to lead. The logistic regression showed that a more advanced age, higher concentration of blood zinc protoporphyrin, and a higher mean value of pulse pressure represented independent risk factors of left ventricular hypertrophy in the group of persons with arterial hypertension and chronically exposed to lead (OR age = 1.11; OR ZnPP = 1.32; OR PP = 1,43; p < 0.05). In view of the above data demonstration that occupational exposure to lead represents an independent risk factor of increased pulse pressure may be of key importance in the process of shaping general social awareness as to harmful effects of lead compounds on human health.

[Echocardiographic indices of the right heart in patients with coronary artery disease in different age groups].

Science.gov (United States)

Gajfulin, R A; Sumin, A N; Arhipov, O G

2016-01-01

The aim of study was to examine echocardiographic indices of right heart chambers in patients with coronary artery disease in different age groups. On 678 patients aged 38-85 years, who underwent echocardiography, are including with the use of spectral tissue Doppler. Obtained 2 age groups: 1st - patients up to 60 years (n=282) and group 2nd - patients 60 years and older (n=396). In the analysis the obtained results in patients with coronary heart disease in older age groups showed an increase in right ventricular wall thickness, systolic and average pressure in the pulmonary artery. These changes were accompanied by deterioration in left ventricular diastolic function, while the systolic function of the left and right ventricle were independent of age. Thus, the results can be recommended for assessment of right ventricular dysfunction in patients of older age groups.

[Twenty-four hour time and frequency domain variability of systolic blood pressure and heart rate in an experimental model of arterial hypertension plus obesity].

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Pelat, M; Verwaerde, P; Lazartiques, E; Cabrol, P; Galitzky, J; Berlan, M; Montastruc, J L; Senard, J M

1998-08-01

Modifications of heart rate (HR) and systolic blood pressure (SBP) variabilities (V) have been reported in the human syndrome arterial hypertension plus insulin-resistance. The aim of this study was to characterize the 24 h SBPV and HRV in both time and frequency domains during weight increase in dogs fed ad libitum with a high fat diet. Implantable transmitter units for measurement of blood pressure and heart rate were surgically implanted in five beagle male dogs. BP and HR were continuously recorded using telemetric measurements during 24 hours, before and after 6 and 9 weeks of hypercaloric diet in quiet animals submitted to a 12h light-dark cycle. To study nychtemeral cycle of SBP and HR, two periods were chosen: day (from 6.00 h to 19.00 h) and night (from 23.00 h to 6.00 h). Spontaneous baroreflex efficiency was measured using the sequence method. Spectral variability of HR and SBP was analyzed using a fast Fourier transformation on 512 consecutive values and normalized units of low (LF: 50-150 mHz, reflecting sympathetic activity) and high (HF: respiratory rate +/- 50 mHz, reflecting parasympathetic activity) frequency bands were calculated. The energy of total spectrum (from 0.004 to 1 Hz) was also studied. Body weight (12.4 +/- 0.9 vs 14.9 +/- 0.9 kg, p vs 147 +/- 1 mmHg, p vs night: 71 +/- 1 bpm) but not after 9 weeks (day: 91 +/- 4 bpm ; night: 86 +/- 2 bpm). Concomitantly, the efficiency of spontaneous baroreflex decreased at 6 weeks (36 +/- 1 vs 42 +/- 2 mmHg/ms, p energy of HRV was found after 6 but not after 9 weeks. LF energy of SBPV was increased at 6 but not at 9 weeks (table). [table: see text] In conclusion, this study shows that an hyperlipidic and hypercaloric diet induces transient variations in autonomic nervous system activity which could be the physiopathological link between obesity, insulin-resistance and arterial hypertension.

Correlation between genetic polymorphism of matrix metalloproteinase-9 in patients with coronary artery disease and cardiac remodeling.

Science.gov (United States)

Yu, Qibin; Li, Hanmei; Li, Linlin; Wang, Shaoye; Wu, Yongbo

2015-01-01

To explore the correlation between genetic polymorphism of matrix metalloproteinase-9 (MMP-9) in patients with coronary artery disease (CAD) and cardiac remodeling. A total of 272 subjects who received coronary angiography in our hospital from July 2008 to September 2013 were selected, including 172 CAD patients (CAD group) and another 100 ones (control group). Both groups were subjected to MMP-9 and ultrasonic detections to determine vascular remodeling and atherosclerotic plaques. C1562G polymorphism of MMP-9 gene was detected, and correlation with vascular remodeling and atherosclerotic plaque was analyzed. Serum MMP-9 level of CAD group (330.87±50.39 ng/ml) was significantly higher than that of control group (134.87±34.02 ng/ml) (P<0.05). Compared with control group, CAD group had significantly higher intima-media thickness, and significantly lower systolic peak velocity, mean systolic velocity and end-diastolic velocity (P<0.05). Total area of stenotic blood vessels was 67.34±22.98 mm(2), while that of control blood vessels was 64.00±20.83 mm(2). G/G, G/C and C/C genotype frequencies of MMP-9 differed significantly in the two groups (P<0.05). G and C allele frequencies of CAD group (70.9% and 29.1%) were significantly different from those of control group (50.0% and 50.0%) (P<0.05). G/G, G/C and C/C genotypes were manifested as lipid-rich, fibrous and calcified or ulcerated plaques respectively. Total area of stenotic blood vessels of G/G genotype significantly exceeded those of G/C and C/C genotypes (P<0.05), whereas the latter two had no significant differences. CAD promoted 1562C-G transformation of MMP-9 gene into genetic polymorphism, thus facilitating arterial remodeling and increasing unstable atherosclerotic plaques.

Spiral CT angiography (SCTA) study of celiac artery and superior mesenteric artery

International Nuclear Information System (INIS)

Yuan Zhenguo; Zhou Cunsheng; Xu Zuodong; Shi Hao; Wang Tao

1999-01-01

Objective: To study the visualization capability and scanning technique of SCTA in celiac artery, superior mesenteric artery (SMA) and other branches. Methods: Thirty patients, with normal abdominal SCTA results, were given small injection test dose after plain scan. The abdominal aorta parallel to the body of pancreas was chosen as target vessel, the peak-time plus 2 seconds as the best delay scan time. Iodine contrast medium 90∼110 ml was injected into antecubital vein at the speed of 3.5 ml/s, then scan from cranial to caudal was performed. Pitch 1.0 and slice thickness 3.2 mm were selected as the scan parameters. Maximum intensity projection (MaxIP) was employed in all patients and shaded surface display (SSD) in 23 cases. Results: The display rate using MaxIP and SSD of celiac artery, splenic artery, common hepatic artery, proper hepatic artery and SMA were all 100%, the gastroduodenal artery 100% and 91%, the left gastric artery 83% and 87%, respectively. Conclusions: SCTA as a minimally invasive examination is a valuable method to detect and diagnose disease or variations of celiac artery, its branches and SMA. Spiral scanning technique and image processing have a decisive effect on the image quality

Pressure-volume Relationship in the Stress-echocardiography Laboratory: Does (Left Ventricular End-diastolic) Size Matter?

Science.gov (United States)

Bombardini, Tonino; Mulieri, Louis A; Salvadori, Stefano; Costantino, Marco Fabio; Scali, Maria Chiara; Marzilli, Mario; Picano, Eugenio

2017-02-01

The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. Whether and to what extent it depends on end-diastolic volume remains unclear. The aim of this study was to assess the dependence of the delta rest-stress end-systolic pressure-volume relation on end-diastolic volume in patients with negative stress echo and all ranges of resting left ventricular function. We analyzed interpretable data obtained in 891 patients (593 men, age 63 ± 12 years) with ejection fraction 47% ± 12%: 338 were normal or near-normal or hypertensive; 229 patients had coronary artery disease; and 324 patients had ischemic or nonischemic dilated cardiomyopathy. They were studied with exercise (n = 172), dipyridamole (n = 482) or dobutamine (n = 237) stress echocardiography. The end-systolic pressure-volume relation was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson rule 2-dimensional echocardiography. Absolute values of delta rest-stress end-systolic pressure-volume relation were higher for exercise and dobutamine than for dipyridamole. In the overall population, an inverse relationship between end-systolic pressure-volume relation and end-diastolic volume was present at rest (r 2 = 0.69, P stress (r 2 = 0.56, P stress end-systolic pressure-volume relation was considered (r 2 = 0.13). Left ventricular end-diastolic volume does not affect the rest-stress changes in end-systolic pressure-volume relation in either normal or abnormal left ventricles during physical or pharmacological stress. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis.

Science.gov (United States)

Nalbant, Ahmet; Aydin, Ayhan; Karacan, Alper; Onmez, Attila; Tamer, Ali; Cinemre, Hakan

2017-01-01

During the course of the autoimmune thyroid diseases, ultrasonography change parallel to histopathology. Vitamin D is associated with autoimmune diseases and thus can affect thyroid blood flow. Our aim was to investigate the relationship between vitamin D insufficiency/deficiency and thyroid hemodynamic indices in patients with Hashimoto thyroiditis. A total of 93 patients who presented to Sakarya University Endocrinology outpatient clinic from April to September 2016 and diagnosed with Hashimoto thyroiditis were included in this study. Clinical and serologic data, thyroid antibodies and 25(OH)D3 were evaluated. Mean peak systolic velocity(mPSV), mean end-diastolic velocity (EDV), mean resistive index (RI) flows of superior and inferior thyroid arteries were measured with B-mode Doppler ultrasonography. Vitamin D insufficiency/deficiency was detected in 59 (63.4%). TPO Ab and TgAb levels were found higher in patients with vitamin D insufficiency/deficiency. In the normal vitamin D group, superior thyroid artery mPSV (32.21±6.73cm/s) and EDV(13.27±2.80 cm/s) were higher than in the low vitamin D group [mPSV (28.32±8.99cm/s) and EDV(10.67±3.68 cm/s)] (P=0.034, P=0.001, respectively). Inferior thyroid artery EDV value was higher in the normal compared to the low vitamin D group (0.032). RI measured in all arteries were higher in the vitamin D insufficient/deficient group compared to the Vitamin D normal group (p=0.001). Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients.

The Relationship of Carotid Arterial Stiffness and Left Ventricular Concentric Hypertrophy in Hypertension.

Science.gov (United States)

Jaroch, Joanna; Łoboz-Grudzień, Krystyna; Magda, Stefania; Florescu, Maria; Bociąga, Zbigniew; Ciobanu, Andrea O; Kruszyńska, Ewa; Dudek, Krzysztof; Vinereanu, Dragos

2016-01-01

Left ventricular hypertrophy (LVH) and geometry patterns vary in different hemodynamic profiles The concentric hypertrophy (CH) pattern has been proved to have the worst prognosis. The aim of the study was to test the hypothesis that carotid artery stiffness, as a marker of vascular damage, is associated with CH, independently of other potential determinants such as demographic factors (age, sex, BMI), clinical parameters (smoking, diabetes, creatinine level) and hemodynamic variables (blood pressure, pulse pressure [PP]). The study involved 262 subjects (89 men): 202 patients with hypertension (153 untreated, 49 on medication), aged 55.7 ± 10 years, and 60 age-matched normal controls. The subjects were examined by echocardiography and carotid ultrasound with a high-resolution echo-tracking system. Based on the left ventricular mass index (LVMI) and relative wall thickness (RWT), the patients with hypertension were divided into four patterns of LVH and geometry: normal geometry (N, n = 57), concentric remodeling (CR, n = 48), concentric hypertrophy CH (n = 62) and eccentric hypertrophy (EH, n = 35). Intima-media thickness (IMT) and the parameters of arterial stiffness were also assessed using the β stiffness index (β), Young elastic modulus (Ep), arterial compliance (AC), one-point pulse wave velocity (PWVβ) and the wave reflection augmentation index (AI). Univariate analysis showed that the following variables are significant in determining CH: β > 8.4, Ep > 136 kPa, PWVβ > 7.1 m/s, AI > 21.9%, systolic BP > 151 mm Hg, PP > 54, IMT > 0.56 and the presence of diabetes. However, by multivariate analysis only AI (OR 3.65, p = 0.003), PWVβ > 7.1 m/s (OR 2.86, p = 0.014), systolic BP (OR 3.12, p = 0037) and the presence of diabetes (OR 3.75, p = 0.007) were associated independently with the occurrence of CH. Concentric hypertrophy in hypertension is strongly associated with carotid arterial stiffness and wave reflection parameters, independently of the influence

Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension.

Science.gov (United States)

Fengler, Karl; Ewen, Sebastian; Höllriegel, Robert; Rommel, Karl-Philipp; Kulenthiran, Saaraaken; Lauder, Lucas; Cremers, Bodo; Schuler, Gerhard; Linke, Axel; Böhm, Michael; Mahfoud, Felix; Lurz, Philipp

2017-08-10

Single-electrode ablation of the main renal artery for renal sympathetic denervation showed mixed blood pressure (BP)-lowering effects. Further improvement of the technique seems crucial to optimize effectiveness of the procedure. Because sympathetic nerve fibers are closer to the lumen in the distal part of the renal artery, treatment of the distal main artery and its branches has been shown to reduce variability in treatment effects in preclinical studies and a recent randomized trial. Whether this optimized technique improves clinical outcomes remains uncertain. We report a 2-center experience of main renal artery and combined main renal artery plus branches renal denervation in patients with resistant hypertension using a multielectrode catheter. Twenty-five patients with therapy-resistant hypertension underwent renal sympathetic denervation with combined main renal artery and renal branch ablation and were compared to matched controls undergoing an ablation of the main renal artery only. BP change was assessed by ambulatory measurement at baseline and after 3 months. At baseline, BP was balanced between the groups. After 3 months, BP changed significantly in the combined ablation group (systolic/diastolic 24-hour mean and daytime mean BP -8.5±9.8/-7.0±10.7 and -9.4±9.8/-7.1±13.5 mm Hg, P renal artery and branches appears to improve BP-lowering efficacy and should be further investigated. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Treatment of anemia with darbepoetin alfa in systolic heart failure

DEFF Research Database (Denmark)

Swedberg, Karl; Young, James B; Anand, Inder S

2013-01-01

Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia.......Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia....

Evaluation of pulmonary artery flow in acute massive pulmonary thromboembolism with MRI

International Nuclear Information System (INIS)

Li Yongzhong; Li Kuncheng; Zhao Xigang; Zhao Hong

2004-01-01

Objective: To probe into the value of MR imaging in evaluating the pulmonary artery hemodynamics and pulmonary artery pressure in acute massive pulmonary embolism. Methods: MR studies were performed in 21 patients with acute massive pulmonary embolism (diagnosed by contrast enhanced MR pulmonary angiography) and 20 healthy volunteers. The pulmonary artery hemodynamic parameters, such as the diameters of main and right pulmonary artery, peak velocity, average velocity, flow volume, flow patterns, and ejection acceleration time in main pulmonary artery were measured. The findings in patients and volunteers were compared. The hemodynamic parameters in patients were correlated with mean pulmonary artery pressure acquired with right heart catheterization. Results: The diameters of main pulmonary artery (2.93 vs 2.52 cm) and right pulmonary artery (2.49 vs 1.92 cm) in patients and volunteers showed significant differences (t=3.55, P<0.01 and t=4.19, P<0.01, respectively); Peak velocity (85.29 vs 100.63 cm/s), average velocity (11.00 vs 17.12 cm/s), flow volume (89.15 vs 98.96 ml/s), and ejection acceleration time (105.09 vs 163.85 ms) in main pulmonary artery were significantly different between patients and volunteers (t values were 2.89, 6.37, 2.21, and 9.46, respectively; P values were 0.01, <0.01, 0.03, and <0.01, respectively). The peak velocity-time curve of main pulmonary artery acquired with velocity encoded cine of MR in patients demonstrated earlier and lower peak velocity as well as abnormal retrograde flow. In addition, linear correlations were seen between the mean pulmonary pressure and the diameter of main pulmonary artery (r=0.62, P=0.001), diameter of right pulmonary artery (r=0.63, P=0.001), and ejection acceleration time (r=-0.55, P=0.005). Conclusion: MR imaging is a promising technique not only for the detection of pulmonary thromboemboli but also for the evaluation of hemodynamic parameters in pulmonary hypertension. (author)

Genome-wide association study identifies six new loci influencing pulse pressure and mean arterial pressure

NARCIS (Netherlands)

L.V. Wain (Louise); G.C. Verwoert (Germaine); P.F. O'Reilly (Paul); G. Shi (Gang); T. Johnson (Toby); M. Bochud (Murielle); K. Rice (Kenneth); P. Henneman (Peter); A.V. Smith (Albert Vernon); G.B. Ehret (Georg); N. Amin (Najaf); M.G. Larson (Martin); V. Mooser (Vincent); D. Hadley (David); M. Dörr (Marcus); J.C. Bis (Joshua); T. Aspelund (Thor); T. Esko (Tõnu); A.C.J.W. Janssens (Cécile); J.H. Zhao (Jing Hua); S.C. Heath (Simon); M. Laan (Maris); J. Fu (Jingyuan); G. Pistis (Giorgio); J. Luan; G. Lucas (Gavin); N. Pirastu (Nicola); I. Pichler (Irene); A.U. Jackson (Anne); R.J. Webster (Rebecca J.); F.F. Zhang; J. Peden (John); R. Schmidt (Reinhold); T. Tanaka (Toshiko); H. Campbell (Harry); W. Igl (Wilmar); Y. Milaneschi (Yuri); J.J. Hottenga (Jouke Jan); V. Vitart (Veronique); D.I. Chasman (Daniel); S. Trompet (Stella); J.L. Bragg-Gresham (Jennifer L.); B.Z. Alizadeh (Behrooz); J.C. Chambers (John); X. Guo (Xiuqing); T. Lehtimäki (Terho); B. Kuhnel (Brigitte); L.M. Lopez; O. Polasek (Ozren); M. Boban (Mladen); C.P. Nelson (Christopher P.); A.C. Morrison (Alanna); V. Pihur (Vasyl); S.K. Ganesh (Santhi); A. Hofman (Albert); S. Kundu (Suman); F.U.S. Mattace Raso (Francesco); F. Rivadeneira Ramirez (Fernando); E.J.G. Sijbrands (Eric); A.G. Uitterlinden (André); S.J. Hwang; R.S. Vasan (Ramachandran Srini); Y.A. Wang (Ying); S.M. Bergmann (Sven); P. Vollenweider (Peter); G. Waeber (Gérard); J. Laitinen (Jaana); A. Pouta (Anneli); P. Zitting (Paavo); W.L. McArdle (Wendy); H.K. Kroemer (Heyo); U. Völker (Uwe); H. Völzke (Henry); N.L. Glazer (Nicole); K.D. Taylor (Kent); T.B. Harris (Tamara); H. Alavere (Helene); T. Haller (Toomas); A. Keis (Aime); M.L. Tammesoo; Y.S. Aulchenko (Yurii); K-T. Khaw (Kay-Tee); P. Galan (Pilar); S. Hercberg (Serge); G.M. Lathrop (Mark); S. Eyheramendy (Susana); E. Org (Elin); S. Sõber (Siim); X. Lu (Xiaowen); I.M. Nolte (Ilja); B.W.J.H. Penninx (Brenda); T. Corre (Tanguy); C. Masciullo (Corrado); C. Sala (Cinzia); L. Groop (Leif); B.F. Voight (Benjamin); O. Melander (Olle); C.J. O'Donnell (Christopher); V. Salomaa (Veikko); P. d' Adamo (Pio); A. Fabretto (Antonella); F. Faletra (Flavio); S. Ulivi (Shelia); F. Del Greco M (Fabiola); M.F. Facheris (Maurizio); F.S. Collins (Francis); R.N. Bergman (Richard); J.P. Beilby (John); J. Hung (Judy); A.W. Musk (Arthur); M. Mangino (Massimo); S.Y. Shin (So Youn); N. Soranzo (Nicole); H. Watkins (Hugh); A. Goel (Anuj); A. Hamsten (Anders); P. Gider (Pierre); M. Loitfelder (Marisa); M. Zeginigg (Marion); D.G. Hernandez (Dena); S.S. Najjar (Samer); P. Navarro (Pau); S.H. Wild (Sarah); A.M. Corsi (Anna Maria); A. Singleton (Andrew); E.J.C. de Geus (Eco); G.A.H.M. Willemsen (Gonneke); A.N. Parker (Alex); L.M. Rose (Lynda); B.M. Buckley (Brendan M.); D.J. Stott (David. J.); M. Orrù (Marco); M. Uda (Manuela); M.M. van der Klauw (Melanie); X. Li (Xiaohui); J. Scott (James); Y.D.I. Chen (Yii-Der Ida); G.L. Burke (Greg); M. Kähönen (Mika); J. Viikari (Jorma); A. Döring (Angela); T. Meitinger (Thomas); G.S. Davis; J.M. Starr (John); V. Emilsson (Valur); A.S. Plump (Andrew); J.H. Lindeman (Jan H.); P.A.C. 't Hoen (Peter); I.R. König (Inke); J.F. Felix (Janine); R. Clarke; J. Hopewell; H. Ongen (Halit); M.M.B. Breteler (Monique); S. Debette (Stéphanie); A.L. DeStefano (Anita); M. Fornage (Myriam); G.F. Mitchell (Gary); H. Holm (Hilma); K. Stefansson (Kari); G. Thorleifsson (Gudmar); U. Thorsteinsdottir (Unnur); N.J. Samani (Nilesh); M. Preuss (Michael); I. Rudan (Igor); C. Hayward (Caroline); I.J. Deary (Ian); H.E. Wichmann (Heinz Erich); O. Raitakari (Olli); W. Palmas (Walter); J.S. Kooner (Jaspal); R.P. Stolk (Ronald); J.W. Jukema (Jan Wouter); A.F. Wright (Alan); D.I. Boomsma (Dorret); S. Bandinelli (Stefania); U. Gyllensten (Ulf); J.F. Wilson (James); L. Ferrucci (Luigi); M. Farrall (Martin); T.D. Spector (Timothy); L.J. Palmer; J. Tuomilehto (Jaakko); A. Pfeufer (Arne); P. Gasparini (Paolo); D.S. Siscovick (David); D. Altshuler (David); R.J.F. Loos (Ruth); D. Toniolo (Daniela); H. Snieder (Harold); C. Gieger (Christian); P. Meneton (Pierre); N.J. Wareham (Nick); B.A. Oostra (Ben); A. Metspalu (Andres); L.J. Launer (Lenore); R. Rettig (Rainer); D.P. Strachan (David); J.S. Beckmann (Jacques); J.C.M. Witteman (Jacqueline); J.A.P. Willems van Dijk (Ko); E.A. Boerwinkle (Eric); M. Boehnke (Michael); P.M. Ridker (Paul); M.R. Järvelin; A. Chakravarti (Aravinda); J. Erdmann (Jeanette); V. Gudnason (Vilmundur); C. Newton-Cheh (Christopher); D. Levy (Daniel); P. Arora (Pankaj); P. Munroe (Patricia); B.M. Psaty (Bruce); M. Caulfield (Mark); D.C. Rao (Dabeeru C.); P. Elliott (Paul); P. Tikka-Kleemola (Päivi); G.R. Abecasis (Gonçalo); I.E. Barroso (Inês)

2011-01-01

textabstractNumerous genetic loci have been associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Europeans. We now report genome-wide association studies of pulse pressure (PP) and mean arterial pressure (MAP). In discovery (N = 74,064) and follow-up studies (N =

Diagnosis of coronary artery disease

International Nuclear Information System (INIS)

Pfisterer, M.; Gordon, D.; Battler, A.; Ashburn, W.; Froelicher, V.; Kantonsspital Basel

1979-01-01

In order to compare the three non-invasive exercise tests Ecg, Thallium myocardial perfusion imaging and radionuclide angiography in the diagnosis of coronary artery disease, the results of these tests in a consecutive series of 30 patients and 14 controls were analyzed. In all 88 symptom-limited exercise tests a significantly higher double product (heart rate x systolic blood pressure, mm Hg/min) was reached on a treadmill test (for Ecg and Thallium scintigraphy) as compared to the supine bicycle ergometer exercise (for radionuclide angiography): 243.1 +- 61.1 vs. 215.2 +- 46.5 x 10 2 (p [de

Vertebral Artery Diameter and Flow: Nature or Nurture.

Science.gov (United States)

Tarnoki, Adam Domonkos; Fejer, Bence; Tarnoki, David Laszlo; Littvay, Levente; Lucatelli, Pierleone; Cirelli, Carlo; Fanelli, Fabrizio; Sacconi, Beatrice; Fagnani, Corrado; Medda, Emanuela; Farina, Filippo; Meneghetti, Giorgio; Horvath, Tamas; Pucci, Giacomo; Schillaci, Giuseppe; Stazi, Maria Antonietta; Baracchini, Claudio

2017-09-01

In contrast with the carotid arteries, the vertebral arteries (VAs) show considerable variation in length, caliber, and vessel course. This study investigated whether the variation in diameter and flow characteristics of the VAs might be inherited. A total of 172 Italian twins from Padua, Perugia, and Terni (54 monozygotic, 32 dizygotic) recruited from the Italian Twin Registry underwent B-mode and pulsed-wave Doppler ultrasound assessment of their VAs. VA diameters, peak systolic velocity (PSV) and end diastolic velocity (EDV) were assessed at the level of a horizontal V2 segment. Univariate quantitative genetic modeling was performed. Fourteen percent of the sample had VA hypoplasia. Within pair correlation in monozygotic twins was higher than in dizygotics (.552 vs. .229) for VA diameter. Age- and sex-adjusted genetic effect, under the most parsimonious model, accounted for 54.7% (95% CI: 42.2-69.1%) of the variance of VA diameter, and unshared environmental effect for 45.3% (95% CI: 30.9-57.8%). No heritability was found for the PSV of VA, but shared (34.1%; 95% CI: 16.7-53.7%) and unshared (65.9%; 95% CI: 45.9-83.1%) environmental factors determined the variance. EDV of VA is moderately genetically influenced (42.4%; 95% CI: 16.1-64.9%) and also determined by the unshared environment (57.6%; 95% CI: 34.7-83.7%). The diameter of the VAs is moderately genetically determined. Different factors influence the PSV and EDV of VAs, which may highlight the complex hemodynamic background of VA flow and help to understand the vertebral flow anomalies found by ultrasound. Copyright © 2017 by the American Society of Neuroimaging.

Peripheral vascular disease in patients with coronary artery disease

International Nuclear Information System (INIS)

Bashir, E. A.; Aslam, N.

2001-01-01

Objective: The prevalence of peripheral vascular disease (PVD) in patients with coronary artery disease (CAD) has been investigated in many different ways. It depends on the diagnostic methods used and definition of atherosclerotic manifestations in the different vascular beds. This study was carried out to determine the prevalence of PVD in the lower limbs in group of patients with CAD. Design: This is a prospective observational study. Place and duration of study: The study was conducted at Combined Military Hospital/Armed Forces institute of Cardiology, Rawalpindi, over a period of one year (January 1998 to January 1999). Subjects and methods: A total number of 200 patient (171 male and 29 females) aged 55-77 years with CAD. Diagnosed by coronary angiography were included in the study. In all patients blood pressure was recorded in both arms by sphygmomanometer and ankle systolic pressure by Doppler ultrasound. Ankle branchial index was calculated. Demographic data were obtained from the patient's hospital files. Results: The prevalence of PVD was 22.5% in patients with CAD in agreement with the results of most previous investigation. There was tendency towards increasing prevalence of PVD with more advanced CAD. Thirty patients (27%) showed evidence of triple vessel disease as compared to 13 patient (18%) with double vessel and 2 patients (1%) with single vessel disease. Conclusion: A non-invasive investigation of peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary artery disease. Ankle systolic pressure appears to be simple and cheap technique for evaluation of results. (author)

Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients.

Science.gov (United States)

Chung, Hyemoon; Jung, Young Hak; Kim, Ki-Hyun; Kim, Jong-Youn; Min, Pil-Ki; Yoon, Young Won; Lee, Byoung Kwon; Hong, Bum-Kee; Rim, Se-Joong; Kwon, Hyuck Moon; Choi, Eui-Young

2016-01-01

Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated. A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque. The mean follow-up duration was 1386±461 days and the mean age of the study population was 60±12 years. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global χ(2)=59.0 vs. 62.8, p=0.029). Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

Physiological Mechanisms Mediating the Coupling between Heart Period and Arterial Pressure in Response to Postural Changes in Humans

OpenAIRE

Silvani, Alessandro; Calandra-Buonaura, Giovanna; Johnson, Blair D.; van Helmond, Noud; Barletta, Giorgio; Cecere, Anna G.; Joyner, Michael J.; Cortelli, Pietro

2017-01-01

The upright posture strengthens the coupling between heart period (HP) and systolic arterial pressure (SAP) consistently with a greater contribution of the arterial baroreflex to cardiac control, while paradoxically decreasing cardiac baroreflex sensitivity (cBRS). To investigate the physiological mechanisms that mediate the coupling between HP and SAP in response to different postures, we analyzed the cross-correlation functions between low-frequency HP and SAP fluctuations and estimated cBR...

[Prevalence of carotid artery stenosis in nonagenarians: Survey in a primary care hospital].

Science.gov (United States)

Bohlender, J; Nussberger, J; Ménard, J; Bohlender, B

2017-06-01

Carotid artery stenosis increases with age and may cause brain ischemia if arterial hypotension occurs. We performed a monocentric pilot study to investigate its prevalence in the very elderly and to assess its potential influence on blood pressure (BP) goals during antihypertensive treatment. All patients≥90 years of a primary care medical ward were prospectively included over 15 months. Ultrasound exams of the precerebral arteries were offered to all elderly patients for routine evaluation of their cardiovascular risk. Frequencies of stenosed common, internal and external carotid arteries (CCA, ICA, ECA) were analyzed together with clinical BP and antihypertensive therapy. Patients with circulatory shock and readmissions were excluded. Sixty-three patients aged 92±3 years (78% female) hospitalized for a median of 11 days were included. On admission, 76% were on antihypertensive drugs vs. 86% at discharge. Mean admission BP was 149/77 vs. 129/72mmHg at discharge; systolic BP<140mmHg 36% vs 64% (P<0.05). Mean intima-media thickness (ACC, right/left) was 8.7/9.4mm. Prevalence of plaque or stenosis<60% was: CCA 19.0%, ICA 19.0%, ECA 31.7%, bulb 74.6%; of stenosis≥60%: CCA 0%, ICA 7.9%, ECA 19.0%, ICA bilateral 1.6% (unilateral occlusion 3.1%, no bilateral). Coincidence of systolic BP<120mmHg and ACI stenosis≥60% had a probability of 1-2%. Concerning the risk of brain ischemia due to carotid artery stenosis, a BP goal<140mmHg should be safe for most nonagenarians. If individual BP goals are lower, searching for significant stenosis by ultrasound may be useful. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Assessment of haemodynamic changes and acid-base equilibrium during hypovolaemia and after infusion of plasma substitutes in dogs.

Science.gov (United States)

Filczewski, M; Oledzka, K; Szymańska-Kosmala, M; Bogucka, E

1980-01-01

The following haemodynamic values were determined in anaesthetized mongrel dogs: heart rate, systolic blood pressure in the ascending aorta, left ventricular pressure at the peak dp/dt, left ventricular end-diastolic pressure, time interval from Q in ECG to the onset of the systolic wave of dp/dt, time interval from Q in ECG to peak dp/dt, maximum rate of left ventricular pressure rise, femoral arterial flow, and certain indices of left ventricular contractility. It was concluded from the results of these experiments that infusion of a modified gelatin solution Fluigel prevented haemodynamic and metabolic changes produced by experimental hypovolaemia more effectively than infusion of Plasmagel.

Hyper-systolic matrix multiplication

NARCIS (Netherlands)

Lippert, Th.; Petkov, N.; Palazzari, P.; Schilling, K.

A novel parallel algorithm for matrix multiplication is presented. It is based on a 1-D hyper-systolic processor abstraction. The procedure can be implemented on all types of parallel systems. (C) 2001 Elsevier Science B,V. All rights reserved.

The importance of echocardiography in diagnostics of idiopathic pulmonary arterial hypertension: A case report

Directory of Open Access Journals (Sweden)

Stojković Gabrijela

2011-01-01

Full Text Available Introduction. Idiopathic pulmonary arterial hypertension (IPAH is rare and difficult progressive disease with prevalence of approximately 15 cases per million residents, with predominant female cases. Case Outline. A 47-year-old female presented with symptoms and signs of the right heart chambers failure. Over prior seven years the patient had the feeling of suffocation and fatigue when walking, and received treatment for bronchial asthma. Physical examination revealed a marked loud second heart sound over the pulmonary artery. Electrocardiogram: right ventricular hypertrophy. Spirometric (pulmonary capacity test, cardiac perfusion scan and spiral CT scanning excluded secondary pulmonary arterial hypertension. Blood testing for connective tissue diseases and HIV were within normal reference limits. Transthoracic colour Doppler echocardiography demonstrated a mild tricuspid regurgitation with high values of estimated maximal and middle systolic pressure of the right ventricle (135/110 mm Hg, and excluded previous heart disease. Cardiac catheterization confirmed IPAH diagnosis, with systolic right ventricular pressure of 101/47/66 mm Hg and pulmonary capillary pressure of 30/13/10 mm Hg. Basic therapy with sildenafil, nevertheless, considerable limitations of strain tolerance was still present. Conclusion. IPAH is a severe heart disease with non-specific signs and symptoms. Screening for IPAH is transthoracic colour Doppler echocardiography shows high correlation with cardiac catheterization.

Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers

DEFF Research Database (Denmark)

Krähenbühl, B; Nielsen, S L; Lassen, N A

1977-01-01

Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers by ...

Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?

International Nuclear Information System (INIS)

Rokni Yazdi, Hadi; Faraji, Safoura; Ahmadi, Farokhlegha; Shahmirzae, Reza

2012-01-01

Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases. In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question. Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease. The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery. The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital

Stiffness of the large arteries in individuals with and without Down syndrome

Directory of Open Access Journals (Sweden)

Nunes Rodrigues A

2011-06-01

Full Text Available Anabel N Rodrigues1,2, Luan Cesar Coelho1, Washington LS Goncalves1,2, Sonia Alves Gouvea2, Maria José Rossi Vasconcellos1, Roberto S Cunha2, Glaucia R Abreu21School of Medicine, University Center of Espírito Santo, Colatina; 2Postgraduate Program in Physiological Sciences, Center for Health Sciences, Federal University of Espirito Santo, Vitória, BrazilBackground: Down syndrome is known to cause premature aging in several organ systems. However, it remains unclear whether this aging effect also affects the structure and function of the large arterial trunks. In this controlled study, the possibility of changes in the large arteries due to aging was evaluated in patients with Down syndrome.Methods: Eighty-two subjects of both genders were selected. The Down syndrome group had 41 active subjects consisting of 19 males and 22 females (mean age 21 ± 1, range 13–42 years without cardiovascular complications and who did not use vasoactive drugs. The control group consisted of 41 healthy individuals without trisomy 21 of the same gender and age as the Down syndrome group and who did not use vasoactive medication. Carotid–femoral pulse wave velocity was obtained as an index of aortic stiffness using an automatic noninvasive method.Results: Individuals with Down syndrome had significantly lower blood pressure than those in the control group. Systolic blood pressure for the Down syndrome group and control group was 106 ± 2 mmHg vs 117 ± 2 mmHg (P < 0.001, respectively; diastolic blood pressure was 66 ± 2 mmHg vs 77 ± 2 mmHg (P <0.001; and mean arterial pressure was 80 ± 1 mmHg vs 90 ± 1 mmHg (P < 0.001. Only age and systolic blood pressure were shown to correlate significantly with pulse wave velocity, but the slopes of the linear regression curves of these two variables showed no significant difference between the two study groups. Pulse wave velocity, which was initially significantly lower in the Down syndrome group (7.51 ± 0.14 m/s vs

Hypertension, Diabetes Type II, and Their Association: Role of Arterial Stiffness.

Science.gov (United States)

Smulyan, Harold; Lieber, Ari; Safar, Michel E

2016-01-01

In patients with both hypertension and type II diabetes, the systolic blood pressure (SBP) increases linearly with age, while that of diastolic blood pressure (DBP) declines curvilinearly as early as age 45, all suggesting the development of increased arterial stiffness. Increased stiffness is an important, independent, and significant risk predictor in subjects with hypertension and diabetes. In patients with both diseases, stiffness assessed at the same mean arterial pressure (MAP) was significantly higher in diabetic patients. Arterial stiffness is related to age, heart rate (HR), and MAP, but in diabetic patients, it also related to diabetes duration and insulin treatment (IT). In the metabolic syndrome (MetSyn), diabetes also acts on the small arteries through capillary rarefaction to reduce the effective length of the arterial tree, increases the reflected pulse wave and thus the pulse pressure (PP). These studies indicate that diabetes and hypertension additively contribute to increased pulsatility and suggest that any means to reduce stiffness would be beneficial in these conditions. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Could quantitative longitudinal peak systolic strain help in the detection of left ventricular wall motion abnormalities in our daily echocardiographic practice?

Science.gov (United States)

Benyounes, Nadia; Lang, Sylvie; Gout, Olivier; Ancédy, Yann; Etienney, Arnaud; Cohen, Ariel

2016-10-01

Transthoracic echocardiography is the most commonly used tool for the detection of left ventricular wall motion (LVWM) abnormalities using "naked eye evaluation". This subjective and operator-dependent technique requires a high level of clinical training and experience. Two-dimensional speckle-tracking echocardiography (2D-STE), which is less operator-dependent, has been proposed for this purpose. However, the role of on-line segmental longitudinal peak systolic strain (LPSS) values in the prediction of LVWM has not been fully evaluated. To test segmental LPSS for predicting LVWM abnormalities in routine echocardiography laboratory practice. LVWM was evaluated by an experienced cardiologist, during routine practice, in 620 patients; segmental LPSS values were then calculated. In this work, reflecting real life, 99.6% of segments were successfully tracked. Mean (95% confidence interval [CI]) segmental LPSS values for normal basal (n=3409), mid (n=3468) and apical (n=3466) segments were -16.7% (-16.9% to -16.5%), -18.2% (-18.3% to -18.0%) and -21.1% (-21.3% to -20.9%), respectively. Mean (95% CI) segmental LPSS values for hypokinetic basal (n=114), mid (n=116) and apical (n=90) segments were -7.7% (-9.0% to -6.3%), -10.1% (-11.1% to -9.0%) and -9.3% (-10.5% to -8.1%), respectively. Mean (95% CI) segmental LPSS values for akinetic basal (n=128), mid (n=95) and apical (n=91) segments were -6.6% (-8.0% to -5.1%), -6.1% (-7.7% to -4.6%) and -4.2% (-5.4% to -3.0%), respectively. LPSS allowed the differentiation between normal and abnormal segments at basal, mid and apical levels. An LPSS value≥-12% detected abnormal segmental motion with a sensitivity of 78% for basal, 70% for mid and 82% for apical segments. Segmental LPSS values may help to differentiate between normal and abnormal left ventricular segments. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The conundrum of arterial stiffness, elevated blood pressure, and aging.

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AlGhatrif, Majd; Lakatta, Edward G

2015-02-01

Isolated systolic hypertension is a major health burden that is expanding with the aging of our population. There is evidence that central arterial stiffness contributes to the rise in systolic blood pressure (SBP); at the same time, central arterial stiffening is accelerated in patients with increased SBP. This bidirectional relationship created a controversy in the field on whether arterial stiffness leads to hypertension or vice versa. Given the profound interdependency of arterial stiffness and blood pressure, this question seems intrinsically challenging, or probably naïve. The aorta's function of dampening the pulsatile flow generated by the left ventricle is optimal within a physiological range of distending pressure that secures the required distal flow, keeps the aorta in an optimal mechanical conformation, and minimizes cardiac work. This homeostasis is disturbed by age-associated, minute alterations in aortic hemodynamic and mechanical properties that induce short- and long-term alterations in each other. Hence, it is impossible to detect an "initial insult" at an epidemiological level. Earlier manifestations of these alterations are observed in young adulthood with a sharp decline in aortic strain and distensibility accompanied by an increase in diastolic blood pressure. Subsequently, aortic mechanical reserve is exhausted, and aortic remodeling with wall stiffening and dilatation ensue. These two phenomena affect pulse pressure in opposite directions and different magnitudes. With early remodeling, there is an increase in pulse pressure, due to the dominance of arterial wall stiffness, which in turn accelerates aortic wall stiffness and dilation. With advanced remodeling, which appears to be greater in men, the effect of diameter becomes more pronounced and partially offsets the effect of wall stiffness leading to plateauing in pulse pressure in men and slower increase in pulse pressure (PP) than that of wall stiffness in women. The complex nature of

Effects of foot reflexology on anxiety and physiological parameters in patients undergoing coronary artery bypass graft surgery: A clinical trial.

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Abbaszadeh, Yaser; Allahbakhshian, Atefeh; Seyyedrasooli, Alehe; Sarbakhsh, Parvin; Goljarian, Sakineh; Safaei, Naser

2018-05-01

This study aimed to investigate the effect of foot reflexology on anxiety and physiological parameters in patients after CABG surgery. This was a single-blind, three-arm, parallel-group, randomized controlled trial with three groups of 40 male patients undergoing CABG. Participants were placed in three groups, named intervention, placebo, and control. Physiological parameters were measured including systolic and diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, percutaneous oxygen saturation, and anxiety of participants. Results showed a statistically significant difference between intervention and control groups in terms of the level of anxiety (p foot reflexology may be used by nurses as an adjunct to standard ICU care to reduce anxiety and stabilize physiological parameters such as systolic, diastolic, mean arterial pressure, and heart rate. Copyright © 2018 Elsevier Ltd. All rights reserved.

Measurement of Blood Pressure Using an Arterial Pulsimeter Equipped with a Hall Device

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Jong-Gu Choi

2011-01-01

Full Text Available To measure precise blood pressure (BP and pulse rate without using a cuff, we have developed an arterial pulsimeter consisting of a small, portable apparatus incorporating a Hall device. Regression analysis of the pulse wave measured during testing of the arterial pulsimeter was conducted using two equations of the BP algorithm. The estimated values of BP obtained by the cuffless arterial pulsimeter over 5 s were compared with values obtained using electronic or liquid mercury BP meters. The standard deviation between the estimated values and the measured values for systolic and diastolic BP were 8.3 and 4.9, respectively, which are close to the range of values of the BP International Standard. Detailed analysis of the pulse wave measured by the cuffless radial artery pulsimeter by detecting changes in the magnetic field can be used to develop a new diagnostic algorithm for BP, which can be applied to new medical apparatus such as the radial artery pulsimeter.

Transcatheter Treatment of “Pulmonary Artery Hypertension” due to Patent Ductus Arteriosus and Pulmonary Artery Stenosis

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Gaio, Gianpiero; Santoro, Giuseppe; D'Alto, Michele; Palladino, Maria Teresa; Russo, Maria Giovanna; Caianiello, Giuseppe; Calabrò, Raffaele

2006-01-01

The association between large, left-sided patent ductus arteriosus and severe, peripheral, right pulmonary artery stenosis with no other cardiac malformation is an unreported condition that might be misdiagnosed as pulmonary hypertension due to long-standing ductal shunt. A 57-year-old man with supposed hypertensive patent ductus arteriosus underwent confirmatory cardiac catheterization. At angiography, a severe pre-hilar right pulmonary artery stenosis (peak pressure gradient, 65 mmHg) was f...

Does the presence of accessory renal arteries affect the efficacy of renal denervation?

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Id, Dani; Kaltenbach, Benjamin; Bertog, Stefan C; Hornung, Marius; Hofmann, Ilona; Vaskelyte, Laura; Sievert, Horst

2013-10-01

This study sought to assess the efficacy of catheter-based renal sympathetic denervation in patients with accessory renal arteries and to compare the blood pressure (BP)-lowering effect with that observed in patients with bilateral single renal arteries after renal denervation. Catheter-based renal sympathetic denervation causes significant BP reductions in patients with resistant hypertension. Seventy-four patients were included in this study. Patients were assigned to 2 main groups: a bilateral single renal arteries group I (n = 54) and an accessory renal arteries group II (n = 20). Group II consisted of 9 patients whose accessory renal arteries were all denervated (group IIa), and 11 patients whose accessory renal arteries were not, or only incompletely, denervated (group IIb). The primary endpoint was the change in office systolic BP after 6 months. The procedure was successful in all patients. Group I: mean BP at baseline was 166.2/89.4 ± 20.5/14.6 mm Hg and decreased by -16.6 (p renal denervation in patients with accessory renal arteries is less pronounced than in patients with bilateral single renal arteries. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Evaluation of arterial digital blood flow using Doppler ultrasonography in healthy dairy cows.

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Müller, H; Heinrich, M; Mielenz, N; Reese, S; Steiner, A; Starke, A

2017-06-06

Local circulatory disturbances have been implicated in the development of foot disorders in cattle. The goals of this study were to evaluate the suitability of the interdigital artery in the pastern region in both hind limbs using pulsed-wave (PW) Doppler ultrasonography and to investigate quantitative arterial blood flow variables at that site in dairy cows. An Esaote MyLabOne ultrasound machine with a 10-MHz linear transducer was used to assess blood flow in the interdigital artery in the pastern region in both hind limbs of 22 healthy German Holstein cows. The cows originated from three commercial farms and were restrained in a standing hoof trimming chute without sedation. A PW Doppler signal suitable for analysis was obtained in 17 of 22 cows. The blood flow profiles were categorised into four curve types, and the following quantitative variables were measured in three uniform cardiac cycles: vessel diameter, pulse rate, maximum systolic velocity, maximum diastolic velocity, end-diastolic velocity, reverse velocity, maximum time-averaged mean velocity, blood flow rate, resistance index and persistence index. The measurements did not differ among cows from the three farms. Maximum systolic velocity, vessel diameter and pulse rate did not differ but other variables differed significantly among blood flow profiles. Differences in weight-bearing are thought to be responsible for the normal variability of blood flow profiles in healthy cows. The scanning technique used in this report for evaluation of blood flow in the interdigital artery appears suitable for further investigations in healthy and in lame cows.

Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease.

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Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A; Kappelle, L Jaap; de Borst, Gert Jan; Cramer, Maarten J; Visseren, Frank L J; Aboyans, Victor; Westerink, Jan

2017-10-01

Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and without manifest vascular disease. In a cohort of 7344 patients with manifest vascular disease or vascular risk factors alone enrolled in the Second Manifestations of ARTerial disease (SMART) study, single bilateral non-simultaneous blood pressure measurements were performed. Logistic and Cox regression was used to identify determinants of large inter-arm SBPD (≥15mmHg) and to investigate the relation between inter-arm SBPD and vascular events (composite of non-fatal myocardial infarction, stroke, and vascular mortality) and all-cause mortality. In all patients the median inter-arm SBPD was 7mmHg (IQR 3-11) and 1182 (16%) patients had inter-arm SBPD ≥15mmHg. Higher age, higher systolic blood pressure, diabetes mellitus, peripheral artery disease, carotid artery stenosis, higher carotid intima-media thickness, and lower ankle-brachial indices were related to large inter-arm SBPD (≥15mmHg). Each 5mmHg increase in inter-arm SBPD was related to a 12% higher risk of vascular events in patients without manifest vascular disease (HR 1.12; 95% CI 1.00-1.27), whereas no relation was apparent in patients with manifest vascular disease (HR 0.98; 95% CI 0.93-1.04, interaction p-value 0.036). Inter-arm SBPD was not related to all-cause mortality (HR 1.05; 95% CI 0.93-1.19). Inter-arm SBPD relates to a higher risk of vascular events in patients without manifest vascular disease, whereas this relation is not apparent in patients with manifest vascular disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Too old to benefit from sports? The cardiovascular effects of exercise training in elderly subjects treated for isolated systolic hypertension.

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Westhoff, Timm H; Franke, Nadine; Schmidt, Sven; Vallbracht-Israng, Katja; Meissner, Romy; Yildirim, Havva; Schlattmann, Peter; Zidek, Walter; Dimeo, Fernando; van der Giet, Markus

2007-01-01

Hypertension in the elderly is commonly characterized by an elevation of pulse pressure. With regard to advanced arteriosclerosis and limited physical fitness, doubt was casted whether elderly patients still achieve relevant cardiovascular benefits by physical exercise. The present work examines the impact of pulse pressure as a footprint of vascular ageing on cardiovascular benefits of endurance training in elderly hypertensives. 54 patients > or =60 years with systolic 24-hour ambulatory blood pressure (ABP) >140 mm Hg and/or antihypertensive treatment and diastolic ABP hypertensives with markedly increased arterial stiffness. Copyright 2007 S. Karger AG, Basel.

Soybean oil increases SERCA2a expression and left ventricular contractility in rats without change in arterial blood pressure

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Vassallo Dalton

2010-05-01

Full Text Available Abstract Background Our aim was to evaluate the effects of soybean oil treatment for 15 days on arterial and ventricular pressure, myocardial mechanics and proteins involved in calcium handling. Methods Wistar rats were divided in two groups receiving 100 μL of soybean oil (SB or saline (CT i.m. for 15 days. Ventricular performance was analyzed in male 12-weeks old Wistar rats by measuring left ventricle diastolic and systolic pressure in isolated perfused hearts according to the Langendorff technique. Protein expression was measured by Western blot analysis. Results Systolic and diastolic arterial pressures did not differ between CT and SB rats. However, heart rate was reduced in the SB group. In the perfused hearts, left ventricular isovolumetric systolic pressure was higher in the SB hearts. The inotropic response to extracellular Ca2+ and isoproterenol was higher in the soybean-treated animals than in the control group. Myosin ATPase and Na+-K+ATPase activities, the expression of sarcoplasmic reticulum calcium pump (SERCA2a and sodium calcium exchanger (NCX were increased in the SB group. Although the phosfolamban (PLB expression did not change, its phosphorylation at Ser16 was reduced while the SERCA2a/PLB ratio was increased. Conclusions In summary, soybean treatment for 15 days in rats increases the left ventricular performance without affecting arterial blood pressure. These changes might be associated with an increase in the myosin ATPase activity and SERCA2a expression.

Association of Aortic Valve Sclerosis with Previous Coronary Artery Disease and Risk Factors

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Filipe Carvalho Marmelo

2014-11-01

Full Text Available Background: Aortic valve sclerosis (AVS is characterized by increased thickness, calcification and stiffness of the aortic leaflets without fusion of the commissures. Several studies show an association between AVS and presence of coronary artery disease. Objective: The aim of this study is to investigate the association between presence of AVS with occurrence of previous coronary artery disease and classical risk factors. Methods: The sample was composed of 2,493 individuals who underwent transthoracic echocardiography between August 2011 and December 2012. The mean age of the cohort was 67.5 ± 15.9 years, and 50.7% were female. Results: The most frequent clinical indication for Doppler echocardiography was the presence of stroke (28.8%, and the most common risk factor was hypertension (60.8%. The most prevalent pathological findings on Doppler echocardiography were mitral valve sclerosis (37.1% and AVS (36.7%. There was a statistically significant association between AVS with hypertension (p < 0.001, myocardial infarction (p = 0.007, diabetes (p = 0.006 and compromised left ventricular systolic function (p < 0.001. Conclusion: Patients with AVS have higher prevalences of hypertension, stroke, hypercholesterolemia, myocardial infarction, diabetes and compromised left ventricular systolic function when compared with patients without AVS. We conclude that there is an association between presence of AVS with previous coronary artery disease and classical risk factors.

Acute and chronic dissection of pulmonary artery: new challenges in pulmonary arterial hypertension?

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Florczyk, Michał; Wieteska, Maria; Kurzyna, Marcin; Gościniak, Piotr; Pepke-Żaba, Joanna; Biederman, Andrzej; Torbicki, Adam

2018-01-01

Right ventricular failure is a leading cause of mortality in patients with pulmonary arterial hypertension (PAH). However, up to 25% of such patients die unexpectedly, without warning signs of hemodynamical decompensation. We previously documented that pulmonary artery (PA) dilatation significantly increases the risk of those deaths. Some of them may be due to dissection of PA resulting in cardiac tamponade. However, direct confirmation of this mechanism is difficult as most of such deaths occur outside hospitals. We present 4 patients with severe PAH and PA dilatation in whom PA dissection has been confirmed. Three patients had IPAH, one had PAH associated with congenital heart disease. All patients had mean pulmonary artery pressure (PAP) > 50 mmHg at diagnosis and dissection occurred late in the course of apparently well controlled disease (6 to 14 years). Several clinical elements were common to our patients - high systolic PAP, long lasting PH, progressive dilatation of PA to more than 50 mm with chest pain prior to dissection. However, clinical course followed three different patterns: sudden death due to cardiac tamponade, hemopericarditis caused by blood leaking from dissected aneurysm with imminent but not immediate cardiac tamponade, or chronic asymptomatic PA dissection. Indeed, two of our patients are alive and on lung transplantation waiting list for more than 2 years now. Further research is needed to suggest optimal management strategies for patients with stable PAH but significantly dilated proximal pulmonary arteries or confirmed PA dissection depending on the clinical presentation and expected outcome.

The genetic basis for altered blood vessel function in disease: large artery stiffening

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Alex Agrotis

2005-12-01

Full Text Available Alex AgrotisThe Cell Biology Laboratory, Baker Heart Research Institute, Melbourne, Victoria, AustraliaAbstract: The progressive stiffening of the large arteries in humans that occurs during aging constitutes a potential risk factor for increased cardiovascular morbidity and mortality, and is accompanied by an elevation in systolic blood pressure and pulse pressure. While the underlying basis for these changes remains to be fully elucidated, factors that are able to influence the structure and composition of the extracellular matrix and the way it interacts with arterial smooth muscle cells could profoundly affect the properties of the large arteries. Thus, while age and sex represent important factors contributing to large artery stiffening, the variation in growth-stimulating factors and those that modulate extracellular production and homeostasis are also being increasingly recognized to play a key role in the process. Therefore, elucidating the contribution that genetic variation makes to large artery stiffening could ultimately provide the basis for clinical strategies designed to regulate the process for therapeutic benefit.Keywords: arterial stiffness, genes, polymorphism, extracellular matrix proteins

Determination of Testicular Blood Flow in Camelids Using Vascular Casting and Color Pulsed-Wave Doppler Ultrasonography

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Kutzler, Michelle; Tyson, Reid; Grimes, Monica; Timm, Karen

2011-01-01

We describe the vasculature of the camelid testis using plastic casting. We also use color pulsed-wave Doppler ultrasonography to measure testicular blood flow and compare the differences between testicular blood flow in fertile and infertile camelids. The testicular artery originates from the ventral surface of the aorta, gives rise to an epididymal branch, and becomes very tortuous as it approaches the testis. Within the supratesticular arteries, peak systolic velocity (PSV) was higher in f...

Hypertrophic remodeling and increased arterial stiffness in patients with intracranial aneurysms.

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Maltete, David; Bellien, Jeremy; Cabrejo, Lucie; Iacob, Michele; Proust, François; Mihout, Bruno; Thuillez, Christian; Guegan-Massardier, Evelyne; Joannides, Robinson

2010-08-01

Because an underlying arteriopathy might contribute to the development of intracranial aneurysms (IAs), we assessed the elastic properties of proximal conduit arteries in patients with IA. In 27 patients with previous ruptured IA and 27 control subjects matched for age, gender and BMI, we determined arterial pressure, internal diameter, intima-media thickness (IMT), circumferential wall stress (CWS) and elastic modulus (wall stiffness) in common carotid arteries using applanation tonometry and echotracking. Moreover, carotid augmentation index (AIx, arterial wave reflections) and carotid-to-femoral pulse wave velocity (PWV, aortic stiffness) were assessed. Compared with controls, patients with IA exhibited higher brachial and carotid systolic and diastolic blood pressures, with similar brachial but higher carotid artery pulse pressure (35 + or - 6mm Hg vs. 41 + or - 8mm Hg, P=0.014). Moreover, patients have higher PWV (7.8 + or - 1.2ms(-1) vs. 8.3 + or - 1.1ms(-1), P=0.048) and AIx (15.8 + or - 10.8% vs. 21.1 + or - 8.5%, PIA display a particular carotid artery phenotype with an exaggerated hypertrophic remodeling and altered elastic properties. Thus, a systemic arteriopathy might contribute, together with the arterial wall fatiguing effect of the increased pulsatile stress, to the pathogenesis of IA. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Angiographic characteristics of premature coronary artery disease in pakistan population; a prospective cross-sectional study

International Nuclear Information System (INIS)

Mustafa, B.; Rahman, H.U.

2015-01-01

Objective: To study the angiographic characteristics of premature coronary artery disease in our population. Methodology: From April 2014 to March 2015, coronary angiograms of 102 patients less than 40 years of age with a definitive diagnosis of ischemic heart disease were studied. Traditional risk factors of atherosclerosis were documented. Mode of presentation and symptoms were recorded along with angiographic findings of coronary artery disease severity, degree of coronary involvement, culprit vessel, lesion morphology, coronary dominance, coronary ectasia and left ventricular systolic function. Results: Mean age was 36.4 ± 4.1 years and 91% were male. Overall, left ventricular systolic function were fairly preserved (82%). 52% patients had single vessel CAD, 25% had double vessel while 19% had triple vessel coronary artery disease. Four patients had no luminal stenosis on coronary angiogram. LAD was the culprit vessel in 58.8%, RCA in 24.5% and left circumflex artery in 16.7% cases. More than 82% culprit lesions were severe or critical. 58% lesions were morphologically complex B2/C type while only 42% lesions were type A/B1. Coronary ectasia was seen in nearly 25% cases and all had ACS presentation. Right dominance was more common than left (57.8% vs 37.3%) while only 4.9% cases had dual posterior septal supply. Conclusion: Premature CAD in our population is acutely symptomatic, severe, complex (B2/C), single vessel disease. (author)

Effect of age on left ventricular function during exercise in patients with coronary artery disease

International Nuclear Information System (INIS)

Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

1983-01-01

The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease

[Major tricuspid insufficiency and absence of systolic valvular coaptation. Echocardiographic study. Apropos of 6 cases].

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Roudaut, R; Héraudeau, A; Gosse, P; Aouizerate, E; Dequecker, J L; Dallocchio, M

1986-09-01

In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases. Changed contractility of the right ventricle is the only element allowing to distinguish tricuspid regurgitation with and without a coaptation defect. Clinically this abnormality always points to an advanced stage of severe tricuspid regurgitation.

Physical Training, Hemodynamic Parameters and Arterial Stiffness: Friends or Foes of the Hypertensive Patient?

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Iurciuc, Stela; Avram, Claudiu; Turi, Vladiana; Militaru, Anda; Avram, Adina; Cimpean, Anca Maria; Iurciuc, Mircea

2016-01-01

To evaluate the impact of physical training on central hemodynamic parameters and elasticity of large arteries in hypertensive patients. A total of 129 hypertensive patients were divided into two groups: group A followed lifestyle changes and physical training; and group B acted as a control group; seven parameters were recorded: Pulse wave velocity (PWVao), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), central aortic systolic blood pressure (SBPao), aortic diastolic blood pressure (DBPao), and central aortic pulse pressure (PPao). The difference between values at 4 months and baseline (Δ) were as follows: ΔPWVao was -1.02 m/s (p<0.001) versus 0.17 m/s (p=0.035), ΔSBPao was -9.6 mmHg (p=0.009) versus 1.6 mmHg (p=0.064), and ΔPPao was -6.8 mmHg (p<0.001) versus 3.2 mmHg, (p=0.029) in group A versus B, respectively. Exercise training improves SBP, PP, SBPao, PPao and may delay arterial ageing. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Echocardiographic estimation of right ventricular stroke work in children with pulmonary arterial hypertension: comparison with invasive measurements.

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Di Maria, Michael V; Burkett, Dale A; Younoszai, Adel K; Landeck, Bruce F; Mertens, Luc; Ivy, D Dunbar; Friedberg, Mark K; Hunter, Kendall S

2015-11-01

Right ventricular (RV) failure is a key determinant of mortality in children with pulmonary arterial hypertension (PAH). RV stroke work (RVSW) can be estimated as the product of RV systolic pressure and stroke volume. The authors have shown that RVSW predicts adverse outcomes in this population when derived from hemodynamic data; noninvasive assessment of RVSW may be advantageous but has not been assessed. There are few data validating noninvasive versus invasive measurements in children with PAH. The aim of this study was to compare echocardiographically derived RVSW with RVSW determined from hemodynamic data. This was a retrospective study, including subjects with idiopathic PAH and minor or repaired congenital heart disease. Forty-nine subjects were included, in whom cardiac catheterization and echocardiography were performed within 1 month. Fourteen additional patients were included in a separate cohort, in whom catheterization and echocardiography were performed simultaneously. Catheterization-derived RVSW was calculated as RV systolic pressure × (cardiac output/heart rate). Echocardiographically derived RVSW was calculated as 4 × (peak tricuspid regurgitant jet velocity)(2) × (pulmonary valve area × velocity-time integral). Statistics included the intraclass correlation coefficient and Bland-Altman analysis. Echocardiographically derived RVSW was linearly correlated with invasively derived RVSW (r = 0.74, P work was related to indexed pulmonary vascular resistance (r = 0.43, P = .002), tricuspid annular plane systolic excursion (r = 0.41, P = .004), and RV wall thickness (r = 0.62, P work, a potential novel index of RV function, can be estimated noninvasively and is related to pulmonary hemodynamics and other indices of RV performance. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Comparison of adenosine and treadmill exercise thallium-201 stress tests for the detection of coronary artery disease

International Nuclear Information System (INIS)

Abe, Shinya; Takeishi, Yasuchika; Chiba, Junya; Ikeda, Kozue; Tomoike, Hitonobu

1993-01-01

To determine the clinical usefulness of adenosine Tl-201 imaging for the evaluation of coronary artery disease, 22 patients with suspected coronary artery disease who underwent adenosine and exercise Tl-201 single photon emission computed tomography (SPECT) were studied. The peak levels of heart rate (83 vs 123 bpm, p<0.001), systolic blood pressure (124 vs 164 mmHg, p<0.001), diastolic blood pressure (70 vs 86 mmHg, p<0.01) and rate pressure products (10220 vs 20410 bpm x mmHg, p<0.001) were markedly smaller during adenosine infusion than during exercise. Segmental agreements between adenosine and exercise tests were 90% (218 of 242 segments) regarding the presence of perfusion defects and 89% (215 of 242 segments) regarding the presence of redistribution. Regional Tl-201 uptake (r=0.85, p<0.001) and the extent (r=0.75, p<0.001) and intensity (r=0.83, p<0.001) of Tl-201 defects during adenosine testing were closely correlated with those of exercise testing. Adenosine and exercise tests showed similar sensitivities for the identification of individual coronary stenosis (85% vs 78%). However, in patients who were unable to perform adequate exercise (maximal heart rate<120 bpm), the sensitivity of adenosine imaging tended to be higher than that of exercise imaging (92% vs 69%, p=0.07). Adenosine Tl-201 imaging is an alternative to the exercise test for assessing the severity and loci of coronary artery disease, especially in patients who are unable to perform adequate physical exercise. (author)

Anticoncepcionais orais e pressão arterial: pesquisa epidemiológica de hipertensão arterial no Rio Grande do Sul

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Célia L. Szwarcwald

1985-06-01

Full Text Available O presente trabalho teve por objetivo descrever a relação entre o uso de anticoncepcionais orais e a pressão arterial em mulheres residentes nas áreas urbana, rural e metropolitana no Rio Grande do Sul situado no extremo sul do Brasil Os dados utilizados nesta análise provêm de um inquérito de hipertensão arterial conduzido neste Estado, em 1978. Através de uma análise de covariâncias, controlando-se idade e índice de Quetelet, as médias de pressão sistólica e diastólica das mulheres usuárias e ex-usuárias de pílulas, foram comparadas com as médias de pressão das mulheres que nunca tomaram anticoncepcionais. Observou-se que, para a pressão sistólica, houve, sistematicamente, nos quatro estratos considerados na pesquisa (Interior Rural, Interior Urbano, Cinturão Metropolitano e Porto Alegre, uma diferença positiva para as mulheres que estão tomando pílula atualmente. Esta diferença mostrou-se significativa (p The present paper describes the relationship between the use of oral contraceptives and arterial blood pressure among women residing in rural, urban and metropolitan areas of Rio Grande do Sul, the southernmost state of Brazil. The analysis is based on data from a cross-sectional survey of blood pressure carried out in Rio Grande do Sul, in 1978. In an analysis ofcovariance, controlling forage and Quetelet Index, the average systolic and diastolic pressures of oral contraceptive users or ex-users were compared to the average pressure of never-users. A positive difference in systolic pressure was observed systematically for all four study strata (Rural Interior, Urban Interior, Capital and its Metropolitan Belt, among women using oral contraceptives at the time of interview. The difference was found to be significant (p < 1% for women residing in the Metropolitan Belt using oral contraceptives for more than 2 y ears. The effect on diastolic pressure, although generally positive, were smaller and not significant

Arterial-ventricular coupling in type 1 diabetes

DEFF Research Database (Denmark)

Theilade, Simone; Rossing, Peter; Jensen, Jan S

2018-01-01

echocardiography. METHODS: In 305 type 1 diabetes (T1D) patients without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF > 45%), we measured arterial stiffness as pulse wave velocity (PWV) and performed conventional and speckle-tracking echocardiography assessing global...... longitudinal strain (GLS) as a measure of systolic myocardial function. Associations between PWV and myocardial function were reported as standardized beta values from adjusted regression models including age, sex, mean arterial pressure, body mass index, HbA1c, diabetes duration, estimated glomerular...... filtration rate, degree of albuminuria, total cholesterol, heart rate and smoking. RESULTS: Patients were 54 (12) years [mean (SD)], 152 (50%) females, diabetes duration 31 (16) years, HbA1c65 (12) mmol/mol, LVEF 58 (5) %, GLS -18.2 (2.6) % and PWV 10.2 (3.4) m/s. There was no association between PWV...

Gender-related difference in arterial elastance during exercise in patients with hypertension.

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Park, Sungha; Ha, Jong-Won; Shim, Chi Young; Choi, Eui-Young; Kim, Jin-Mi; Ahn, Jeong-Ah; Lee, Se-Wha; Rim, Se-Joong; Chung, Namsik

2008-04-01

Exercise intolerance and heart failure with preserved ejection fraction are common in females. Recently, arterial stiffness has been suggested to be a significant contributor in the development of heart failure. How gender difference affects arterial stiffening and its response to exercise is not well known. We hypothesized that arterial elastance index during exercise would be more abnormal in females with hypertension than males. Arterial elastance index was estimated as arterial end systolic pressure/stroke volume controlled for body surface area and was measured at rest and during graded supine bicycle exercise (25 watts, 3-minute increments) in 298 patients with hypertension (149 males; 149 females; mean age, 59). The subjects were divided into 2 groups by gender. Exercise duration was significantly shorter in females compared to males (692+/-222 versus 483+/-128 seconds, Pexercise being significantly higher in females compared to males (0.69+/-0.83 versus 0.43+/-0.69, P=0.018). Arterial elastance index at each stage of exercise up to 75 W was independently associated with decreased exercise duration. In conclusion, despite lower arterial elastance index at rest, the increase during exercise was steeper in women with hypertension, suggesting a gender-related difference in dynamic arterial stiffness. The arterial elastance index during exercise was significantly associated with exercise duration in patients with hypertension.

Correlation between spirometry values and pulmonary artery pressure in young healthy subjects.

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Grossman, Alon; Benderly, Michal; Prokupetz, Alex; Gordon, Barak; Kalter-Leibovici, Ofra

2014-03-01

Pulmonary hypertension is frequently associated with parenchymal lung disease. We evaluated the association between spirometry values and pulmonary artery systolic pressure (PASP) in young subjects without lung disease : We studied applicants to the Israeli Air Force, who undergo routine evaluation that includes resting spirometry and echocardiography. Applicants with overt lung disease were excluded. All echocardiographic studies performed in the years 1994 through 2010 (n = 6,598) were screened, and files that included PASP and spirometry values were analyzed for the association between PASP and FVC, FEV1, FEV1/FVC, peak expiratory flow, and forced expiratory flow during the middle half of the FVC maneuver. Of the 647 air force applicants who underwent echocardiography in which PASP was measurable and had spirometry data, 607 (94%) were male, and their average age was 18.16 ± 0.73 years. Mean PASP was 26.4 ± 5.2 mm Hg (range 10-41 mm Hg). None of the spirometry values significantly correlated with PASP. PASP in young healthy subjects is not significantly associated with spirometry values. Lung mechanics probably do not contribute significantly to PASP in this population.

Exercise training in older patients with systolic heart failure

DEFF Research Database (Denmark)

Prescott, Eva; Hjardem-Hansen, Rasmus; Dela, Flemming

2009-01-01

Training improves exercise capacity in patients with heart failure (CHF) but most evidence is on selected younger patients with systolic CHF.......Training improves exercise capacity in patients with heart failure (CHF) but most evidence is on selected younger patients with systolic CHF....

Prevalence of arterial hypertension in diabetic patients before and after the JNC-V

DEFF Research Database (Denmark)

Tarnow, L; Rossing, P; Gall, Mari-Anne

1994-01-01

OBJECTIVE: To compare the prevalence of arterial hypertension in patients with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) according to blood pressure (BP) criteria from the World Health Organization (WHO) and The Fifth Report of the Joint National...... had stage 2 (160-179/100-109 mmHg) hypertension. Two out of three untreated hypertensive patients had isolated systolic hypertension. CONCLUSIONS: The new JNC-V criteria approved by the American Diabetes Association leads to a considerable increase in the prevalence of arterial hypertension...... treatment were classified as hypertensives. RESULTS: In IDDM patients, the prevalence of arterial hypertension rose from 15 to 42% in the normoalbuminuric group, from 26 to 52% in the microalbuminuric group, and from 61 to 79% in the macroalbuminuric group when WHO and JNC-V criteria were compared...

Renal artery stenting in solitary functioning kidneys: Technical and clinical results

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Sahin, Sinan; Cimsit, Cagatay; Andac, Nurten; Baltacioglu, Feyyaz; Tuglular, Serhan; Akoglu, Emel

2006-01-01

Objective: To evaluate the clinical and technical results of renal artery stenting for the treatment of renovascular hypertension and renal failure in patients with solitary functioning kidney. Materials and methods: Fifteen patients with solitary functioning kidney underwent renal artery stenting and were followed up for 12-60 months. Before the procedures, systolic and diastolic blood pressures and serum creatinine levels were measured and the number of antihypertensive drugs was recorded and followed up after stenting. In case of restenosis, either in-stent percutaneous transluminal renal angioplasty or stent-in-stent placement was performed. Results: Primary technical success rate was 100%. One lesion was nonostial while 14 were ostial. Primary patency rates were 100% for 6 months, 92.3% for 12 months, and 69.2% for 24 months. The secondary patency rate at 24 months was 100%. The differences between the baseline and postprocedural values of systolic blood pressures, diastolic blood pressures and the number of antihypertensive drug were statistically significant (P < 0.05), except the values of serum creatinine. Hypertension was cured in 1 (6.7%) patient, improved in 4 (26.6%) and stabilized in 10 (66.7%) patients. Renal function improved in 9 (60%), stabilized in 4 (26.6%), and deteriorated in 2 (13.4%) patients. Minor complication rate was 13.4% and major complication rate was 13.4%. Conclusion: Revascularization of renal artery stenosis using stent in solitary functioning kidneys is a safe and efficient procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has an improving and controlling effect on blood pressure and renal functions

Renal artery stenting in solitary functioning kidneys: Technical and clinical results

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Sahin, Sinan [Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Department of Radiology, Istanbul (Turkey)]. E-mail: sinan.sahin@e-kolay.net; Cimsit, Cagatay [Marmara University, School of Medicine, Department of Radiology, Istanbul (Turkey); Andac, Nurten [Marmara University, School of Medicine, Department of Radiology, Istanbul (Turkey); Baltacioglu, Feyyaz [Marmara University, School of Medicine, Department of Radiology, Istanbul (Turkey); Tuglular, Serhan [Marmara University, School of Medicine, Department of Nephrology, Istanbul (Turkey); Akoglu, Emel [Marmara University, School of Medicine, Department of Nephrology, Istanbul (Turkey)

2006-01-15

Objective: To evaluate the clinical and technical results of renal artery stenting for the treatment of renovascular hypertension and renal failure in patients with solitary functioning kidney. Materials and methods: Fifteen patients with solitary functioning kidney underwent renal artery stenting and were followed up for 12-60 months. Before the procedures, systolic and diastolic blood pressures and serum creatinine levels were measured and the number of antihypertensive drugs was recorded and followed up after stenting. In case of restenosis, either in-stent percutaneous transluminal renal angioplasty or stent-in-stent placement was performed. Results: Primary technical success rate was 100%. One lesion was nonostial while 14 were ostial. Primary patency rates were 100% for 6 months, 92.3% for 12 months, and 69.2% for 24 months. The secondary patency rate at 24 months was 100%. The differences between the baseline and postprocedural values of systolic blood pressures, diastolic blood pressures and the number of antihypertensive drug were statistically significant (P < 0.05), except the values of serum creatinine. Hypertension was cured in 1 (6.7%) patient, improved in 4 (26.6%) and stabilized in 10 (66.7%) patients. Renal function improved in 9 (60%), stabilized in 4 (26.6%), and deteriorated in 2 (13.4%) patients. Minor complication rate was 13.4% and major complication rate was 13.4%. Conclusion: Revascularization of renal artery stenosis using stent in solitary functioning kidneys is a safe and efficient procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has an improving and controlling effect on blood pressure and renal functions.

Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension.

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Castelain, V; Hervé, P; Lecarpentier, Y; Duroux, P; Simonneau, G; Chemla, D

2001-03-15

The purpose of this time-domain study was to compare pulmonary artery (PA) pulse pressure and wave reflection in chronic pulmonary thromboembolism (CPTE) and primary pulmonary hypertension (PPH). Pulmonary artery pressure waveform analysis provides a simple and accurate estimation of right ventricular afterload in the time-domain. Chronic pulmonary thromboembolism and PPH are both responsible for severe pulmonary hypertension. Chronic pulmonary thromboembolism and PPH predominantly involve proximal and distal arteries, respectively, and may lead to differences in PA pressure waveform. High-fidelity PA pressure was recorded in 14 patients (7 men/7 women, 46 +/- 14 years) with CPTE (n = 7) and PPH (n = 7). We measured thermodilution cardiac output, mean PA pressure (MPAP), PA pulse pressure (PAPP = systolic - diastolic PAP) and normalized PAPP (nPAPP = PPAP/MPAP). Wave reflection was quantified by measuring Ti, that is, the time between pressure upstroke and the systolic inflection point (Pi), deltaP, that is, the systolic PAP minus Pi difference, and the augmentation index (deltaP/PPAP). At baseline, CPTE and PPH had similar cardiac index (2.4 +/- 0.4 vs. 2.5 +/- 0.5 l/min/m2), mean PAP (59 +/- 9 vs. 59 +/- 10 mm Hg), PPAP (57 +/- 13 vs. 53 +/- 13 mm Hg) and nPPAP (0.97 +/- 0.16 vs. 0.89 +/- 0.13). Chronic pulmonary thromboembolism had shorter Ti (90 +/- 17 vs. 126 +/- 16 ms, p PPAP (0.26 +/- 0.01 vs. 0.09 +/- 0.07, p < 0.01). Our study indicated that: 1) CPTE and PPH with severe pulmonary hypertension had similar PA pulse pressure, and 2) wave reflection is elevated in both groups, and CPTE had increased and anticipated wave reflection as compared with PPH, thus suggesting differences in the pulsatile component of right ventricular afterload.

Renal sympathetic denervation in uncontrolled arterial hypertension after successful repair for aortic coarctation.

Science.gov (United States)

Lurz, Philipp; Okon, Thomas; Riede, Thomas; Wagner, Robert; Schuler, Gerhard; Daehnert, Ingo; Desch, Steffen

2016-01-01

Uncontrolled arterial hypertension is a frequent problem after successful repair of CoA and has been attributed to increased central sympathetic drive as well as a blunted baroreceptor reflex. RSD is a promising therapy to reduce central sympathetic drive and improve baroreflex sensitivity. 8 patients (age: 27±6 years) with previous surgical and/or percutaneous repair of CoA, absence of any relevant restenosis (invasive gradient across the site of previous treatment 3±4 mmHg) and resistant arterial hypertension (daytime SBP≥140 mmHg on 24 hour ambulatory blood pressure measurements [ABPM] in spite of the concurrent use of 3 antihypertensive agents of different classes or intolerance to BP medications) were included. Bilateral RSD was performed using the Symplicity Flex™ catheter (Medtronic, MN, USA). RSD was successful in all patients with no procedural complications and no evidence for renal artery stenosis 6 months post procedure. From baseline to 6 month follow-up, RSD was followed by a significant reduction in average daytime systolic BP (150.4±7.8 to 143.1±8.0 mmHg; p=0.0117) as well as systolic BP throughout 24 h (146.8±7.3 vs. 140.5±7.8, p=0.04). The BP reductions observed in these patients justify engaging in a larger clinical trial on the efficacy of RSD in this specific type of secondary hypertension and bares the hope that RSD might extend the currently very limited armory against arterial hypertension in young adults with previous repair of CoA. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Cognitive disturbances in patients with arterial hypertension].

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Starchina, Iu A; Parfenov, V A; Chazova, I E; Pustovitova, T S; Iakhno, N N

2008-01-01

Memory impairment, headaches and vertigo are considered as initial appearances of chronic cerebral vascular disorder in patients with arterial hypertension (AH). The complex analysis of complaints, cognitive functioning, emotional state and MRI data was conducted in 60 patients with AH, mean age 58,4+/-7,8 years, without a history of stroke and 30 controls matched for age, sex and education. Impairment of cognitive functioning was assessed by the Psychiatric Status Scale (a short version), the Clock Drawing Test, tests of auditory and verbal memory, attention concentration, speed of test performance, speech fluency and spatial orientation. The deterioration effect of systolic arterial pressure on cognitive functioning was found. The lesions of white matter (subcortical and/or periventricular leucoaraiosis) were observed in 76% of patients and single asymptomatic lacunar infarctions--in 20%. Cerebral vascular lesions were correlated with cognitive impairment. Anxiety and anxiety-depressive disorders which were not associated with the cerebral vascular lesion but related in large to the patient's complaints on headaches and vertigo were revealed in 62% of cases. The results of the study suggest that cognitive dysfunction proves to be the early and reliable predictor of chronic cerebral vascular disorder in patients with arterial hypertension.

Arterial stiffness and its association with clustering of metabolic syndrome risk factors

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Wanda R. P. Lopes-Vicente

2017-10-01

Full Text Available Abstract Background Metabolic syndrome (MetS is associated with structural and functional vascular abnormalities, which may lead to increased arterial stiffness, more frequent cardiovascular events and higher mortality. However, the role played by clustering of risk factors and the combining pattern of MetS risk factors and their association with the arterial stiffness have yet to be fully understood. Age, hypertension and diabetes mellitus seem to be strongly associated with increased pulse wave velocity (PWV. This study aimed at determining the clustering and combining pattern of MetS risk factors and their association with the arterial stiffness in non-diabetic and non-hypertensive patients. Methods Recently diagnosed and untreated patients with MetS (n = 64, 49 ± 8 year, 32 ± 4 kg/m2 were selected, according to ATP III criteria and compared to a control group (Control, n = 17, 49 ± 6 year, 27 ± 2 kg/m2. Arterial stiffness was evaluated by PWV in the carotid-femoral segment. Patients were categorized and analyzed according MetS risk factors clustering (3, 4 and 5 factors and its combinations. Results Patients with MetS had increased PWV when compared to Control (7.8 ± 1.1 vs. 7.0 ± 0.5 m/s, p < 0.001. In multivariate analysis, the variables that remained as predictors of PWV were age (β = 0.450, p < 0.001, systolic blood pressure (β = 0.211, p = 0.023 and triglycerides (β = 0.212, p = 0.037. The increased number of risk factors reflected in a progressive increase in PWV. When adjusted to systolic blood pressure, PWV was greater in the group with 5 risk factors when compared to the group with 3 risk factors and Control (8.5 ± 0.4 vs. 7.5 ± 0.2, p = 0.011 and 7.2 ± 0.3 m/s, p = 0.012. Similarly, the 4 risk factors group had higher PWV than the Control (7.9 ± 0.2 vs. 7.2 ± 0.3, p = 0.047. Conclusions The number of risk factors seems to increase arterial stiffness. Notably, besides

IMPLEMENTATION OF BIOFEEDBACK IN A CLOSED LOOP OF HEART RATE VARIABILITY AND PACED BREATHING IN PATIENTS WITH ARTERIAL HYPERTENSION

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O. L. Kulik

2014-06-01

Full Text Available The effectiveness of biofeedback in a closed loop of heart rate variability (HRV and paced breathing in patients with arterial hypertension was studied. 61 subjects with arterial hypertension (31 females and 30 males, mean age 56.8 ± 6.2 years were examined. In accordance with the objective of the study all subjects were divided into 2 groups: 1 – biofeedback group (34 subjects and 2 – the comparison group (27 subjects. 5 biofeedback sessions were performed in biofeedback group. In the comparison group only two biofeedback sessions were performed – at admission and before discharge from the hospital. Efficacy of biofeedback was evaluated by comparing the values of systolic and diastolic blood pressure (SBP and DBP, respectively, heart rate (HR, HRV indices, indicators of optimality (O, sensitivity (S and efficiency (E and BQI index at admission and discharge in both groups of patients. The use of biofeedback in arterial hypertension subjects allowed to achieve better control of heart rate, systolic and diastolic blood pressure and improves HRV indices. The positive dynamics of optimality and the integral BQI values indicated a training effect of regulation systems.

[CARDIOREABILITATION PECULIARITIES AND CORRECTION OF VIOLATIONS OF SISTOLIC, DIASOLIC FUNCTION AND HEART RATE VARIABILITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND CORONARY ARTERY REVASCULARIZATION].

Science.gov (United States)

Shved, M; Tsuglevych, L; Kyrychok, I; Levytska, L; Boiko, T; Kitsak, Ya

2017-04-01

In patients with acute coronary syndrome (ACS) who underwent coronary arteries revascularization, violations of hemodynamics, metabolism and heart rate variability often develop in the postoperative period, therefore, the goal of the study was to establish the features of disturbances and the effectiveness of correction of left ventricular systolic and diastolic dysfunction and heart rate variability in stages of cardiorehabilitation in patients with acute coronary syndrome who underwent coronary arteries revascularization. The experimental group included 40 patients with ACS in the postoperative period who underwent balloon angioplasty and stenting of the coronary arteries (25 patients with ST-segment elevation ACS and 15 patients without ST-segment elevation ACS). The age of examined patients was 37 to 74 years, an average of 52.6±6.7 years. The control group consisted of 20 patients, comparable in age and clinico-laboratory manifestations of ACS, who underwent drug treatment with direct anticoagulants, double antiplatelet therapy, β-blockers, ACE inhibitors and statins. Clinical efficacy of cardiorespiratory process in patients of both groups was assessed by the dynamics of general clinical symptoms and parameters of natriuretic propeptide, systolic and diastolic function of the left ventricle and heart rate variability. In the initial state, clinical and laboratory-instrumental signs of myocardial ischemia disappear in patients with ACS undergoing surgical revascularization of the coronary arteries, but clinical and subclinical manifestations of heart failure were diagnosed. The use of the accelerated program of cardiac rehabilitation already during the first month of studies leads to a decreasement of the signs of systolic and diastolic dysfunction, the level of NT-proBNP and improve in the variability of the heart rhythm wich significantly improves the life quality of patients with ACS. To monitor the effectiveness and safety of cardiac rehabilitation in

Near-infrared transillumination back scattering sounding--new method to assess brain microcirculation in patients with chronic carotid artery stenosis.

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Andrzej F Frydrychowski

Full Text Available PURPOSE: The purpose of the study was to assess the responses of pial artery pulsation (cc-TQ and subarachnoid width (sas-TQ to acetazolamide challenge in patients with chronic carotid artery stenosis and relate these responses to changes in peak systolic velocity (PSV, cerebral blood flow (CBF, cerebral blood volume (CBV, mean transit time (MTT and time to peak response (TTP. METHODS: Fifteen patients with carotid artery stenosis ≥ 90% on the ipsilateral side and <50% on the contralateral side were enrolled into the study. PSV was assessed using colour-coded duplex sonography, CBF, CBV, MTT and TTP with perfusion computed tomography, cc-TQ and sas-TQ with near-infrared transillumination/backscattering sounding (NIR-T/BSS. RESULTS: Based on the ipsilateral/contralateral cc-TQ ratio after acetazolamide challenge two groups of patients were distinguished: the first group with a ratio ≥ 1 and the second with a ratio <1. In the second group increases in CBF and CBV after the acetazolamide test were significantly higher in both hemispheres (ipsilateral: +33.0% ± 8.1% vs. +15.3% ± 4.4% and +26.3% ± 6.6% vs. +14.3% ± 5.1%; contralateral: +26.8% ± 7.0% vs. +17.6% ± 5.6% and +20.0% ± 7.3% vs. +10.0% ± 3.7%, respectively, cc-TQ was significantly higher only on the ipsilateral side (+37.3% ± 9.3% vs. +26.6% ± 8.6% and the decrease in sas-TQ was less pronounced on the ipsilateral side (-0.7% ± 1.5% vs. -10.2% ± 1.5%, in comparison with the first group. The changes in sas-TQ following the acetazolamide test were consistent with the changes in TTP. CONCLUSIONS: The ipsilateral/contralateral cc-TQ ratio following acetazolamide challenge may be used to distinguish patient groups characterized by different haemodynamic parameters. Further research on a larger group of patients is warranted.

Systolic pulmonary artery pressure assessed during routine exercise Doppler echocardiography: insights of a real-world setting in patients with elevated pulmonary pressures.

Science.gov (United States)

Korff, Susanne; Enders-Gier, Patricia; Uhlmann, Lorenz; Aurich, Matthias; Greiner, Sebastian; Hirschberg, Kristof; Katus, Hugo A; Mereles, Derliz

2018-03-19

Pulmonary hypertension is a marker of disease severity. Exercise Doppler echocardiography (EDE) has proven to be feasible and reliable to assess pulmonary pressure. Increase in systolic pulmonary artery pressure (sPAP) has diagnostic and prognostic value in controlled studies. However, its value when assessed during routine examination in patients with cardiopulmonary diseases and resting sPAP > 35 mmHg is not clearly defined. Clinical documentation and offline reevaluation of digitally stored EDE examinations of patients with appropriate clinical indications for EDE were analyzed. N = 278 patients with sPAP at rest > 35 mmHg met inclusion criteria. One patient was lost to follow-up. Mean age of patients was 72 ± 10 years, 178 (64%) of the study population were men. There were no relevant differences among survivors and non-survivors concerning comorbidities. Exercise performance (3.6 ± 1.2 vs. 4.9 ± 1.4 MET, p  45 mm (HR = 2.58, p  42 mmHg (HR = 1.94, p = 0.010) and ΔsPAP increase ≥ 0.23 mmHg/Watt (HF = 1.92, p = 0.010). After multivariate analysis, NYHA functional class III (HR = 2.35, p < 0.001), LA diameter (HR = 2.28, p = 0.003) and sPAP increase ≥ 0.23 mmHg/Watt (HF = 2.19, p = 0.002) remained significant predictors of mortality, whereas a double product (HR = 0.42, p = 0.005) was associated with better prognosis. sPAP assessment during routine EDE provides relevant prognostic information comparable to findings in studies in selected populations. A higher sPAP increase at lower exercise performance shows significant association with increased of mortality.

The prevalence and clinical predictors of incidental atherosclerotic renal artery stenosis

Energy Technology Data Exchange (ETDEWEB)

Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey)], E-mail: radugur@yahoo.com; Oguzkurt, Levent; Tercan, Fahri [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey); Nursal, Tarik Z. [Baskent University Faculty of Medicine, Department of General Surgery, Ankara/Turkey (Turkey)

2009-03-15

Objective: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). Materials and methods: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age {+-} S.D.: 61.5 {+-} 11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis ({>=}60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). Results: Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n = 60) had significant ({>=}60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140 mmHg or diastolic >90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5 {+-} 8.9 years compared with 61 {+-} 11.2 years for patients without RAS (p < 0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p = 0.01). Conclusion: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

Renovascular hypertension in spontaneous hypertensive rats: an experimental model of renal artery stenosis superimposed on essential hypertension.

Science.gov (United States)

Rosenthal, T; Bass, A; Grossman, E; Shani, M; Griffel, B; Adar, R

1987-09-01

Renovascular hypertension superimposed on essential hypertension, a condition encountered in the elderly, was studied. An experimental animal model consisting of a two-kidney one-clip Goldblatt preparation in the spontaneous hypertensive (SHR) rat, that would simulate this condition, was designed. A 0.25 mm silver clip was placed on the left renal artery of SHR male rats. The same procedure performed on WKY rats served as control. All experiments were performed on low, normal, and rich sodium diet. Systolic blood pressure (BP) was measured by tail-cuff method. Plasma renin concentration (PRC) was determined before and after clipping of the renal artery. Results were as follows: Mean systolic BP increased significantly in clipped rats fed with normal and rich sodium diets. SHR showed an increase from 144 +/- 3 (mean + s.e.m.) to 168 +/- 3 mmHg, and WKY rats showed an increase from 120 +/- 2 to 139 +/- 5 mmHg. There was a two- to threefold rise in PRC. A low-salt diet given prior to clipping prevented the appearance of renovascular hypertension despite a significant rise in PRC. We concluded that renal artery narrowing plays a significant role in the rise of BP in the basically essential type of hypertension.

Using the Initial Systolic Time Interval to assess cardiac autonomic function in Parkinson’s disease

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Jan H. Meijer

2011-12-01

Full Text Available The Initial Systolic Time Interval (ISTI has been defined as the time difference between the peak electrical and peak mechanical activity of the heart. ISTI is obtained from the electro-cardiogram and the impedance cardiogram. The response of ISTI while breathing at rest and to a deep breathing stimulus was studied in a group of patients suffering from Parkinson's disease (PD and a group of healthy control subjects. ISTI showed substantial variability during these manoeuvres. The tests showed that the variability of RR and ISTI was substantially different between PD patients and controls. It is hypothesized that in PD patients the sympathetic system compensates for the loss of regulatory control function of the blood-pressure by the parasympathetic system. It is concluded that ISTI is a practical, additional and independent parameter that can be used to assist other tests in evaluating autonomic control of the heart in PD patients.doi:10.5617/jeb.216 J Electr Bioimp, vol. 2, pp. 98-101, 2011

Whole-body vibration exercise training reduces arterial stiffness in postmenopausal women with prehypertension and hypertension.

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Figueroa, Arturo; Kalfon, Roy; Madzima, Takudzwa A; Wong, Alexei

2014-02-01

The purpose of this study was to examine the impact of whole-body vibration (WBV) exercise training on arterial stiffness (pulse wave velocity [PWV]), blood pressure (BP), and leg muscle function in postmenopausal women. Twenty-five postmenopausal women with prehypertension and hypertension (mean [SE]; age, 56 [1] y; systolic BP, 139 [2] mm Hg; body mass index, 34.7 [0.8] kg/m2) were randomized to 12 weeks of WBV exercise training (n = 13) or to the no-exercise control group. Systolic BP, diastolic BP, mean arterial pressure, heart rate, carotid-femoral PWV, brachial-ankle PWV, femoral-ankle PWV (legPWV), leg lean mass, and leg muscle strength were measured before and after 12 weeks. There was a group-by-time interaction (P exercise training compared with no change after control. Heart rate decreased (-3 [1] beats/min, P exercise training, but there was no interaction (P > 0.05). Leg lean mass and carotid-femoral PWV were not significantly (P > 0.05) affected by WBV exercise training or control. Our findings indicate that WBV exercise training improves systemic and leg arterial stiffness, BP, and leg muscle strength in postmenopausal women with prehypertension or hypertension. WBV exercise training may decrease cardiovascular and disability risks in postmenopausal women by reducing legPWV and increasing leg muscle strength.

Serum 25-hydroxyvitamin D is associated with both arterial and ventricular stiffness in healthy subjects.

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Şeker, Taner; Gür, Mustafa; Kuloğlu, Osman; Kalkan, Gülhan Yüksel; Şahin, Durmuş Yıldıray; Türkoğlu, Caner; Elbasan, Zafer; Baykan, Ahmet Oytun; Gözübüyük, Gökhan; Çaylı, Murat

2013-12-01

Vitamin D regulates the renin-angiotensin system, suppresses proliferation of vascular smooth muscle and improves endothelial cell dependent vasodilatation. These mechanisms may play a role on pathogenesis of arterial and left ventricular stiffness. We aimed to investigate the association between serum 25-hydroxyvitamin D with arterial and left ventricular stiffness in healthy subjects. We studied 125 healthy subjects without known cardiovascular risk factors or overt heart disease (mean age: 60.2 ± 11.9 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. The subjects were divided into two groups according to the serum vitamin D level; vitamin D sufficient (≥ 20 ng/ml, n = 56) and vitamin D deficient (stiffness such as E/A and E/E' were measured. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph(®) ARC solver algorithm. Systolic blood pressure, level of serum calcium, PWV and E/E' values were higher and E/A values were lower in vitamin D deficient group compared with vitamin D sufficient group. Multiple linear regression analysis showed that vitamin D level was independently associated with E/E' (β = -0.364, pstiffness as well as systolic blood pressure in healthy subjects. Copyright © 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Intracranial artery velocity measurement using 4D PC MRI at 3 T: comparison with transcranial ultrasound techniques and 2D PC MRI

International Nuclear Information System (INIS)

Meckel, Stephan; Leitner, Lorenz; Schubert, Tilman; Bonati, Leo H.; Lyrer, Philippe; Santini, Francesco; Stalder, Aurelien F.; Markl, Michael; Wetzel, Stephan G.

2013-01-01

4D phase contrast MR imaging (4D PC MRI) has been introduced for spatiotemporal evaluation of intracranial hemodynamics in various cerebrovascular diseases. However, it still lacks validation with standards of reference. Our goal was to compare blood flow quantification derived from 4D PC MRI with transcranial ultrasound and 2D PC MRI. Velocity measurements within large intracranial arteries [internal carotid artery (ICA), basilar artery (BA), and middle cerebral artery (MCA)] were obtained in 20 young healthy volunteers with 4D and 2D PC MRI, transcranial Doppler sonography (TCD), and transcranial color-coded duplex sonography (TCCD). Maximum velocities at peak systole (PSV) and end diastole (EDV) were compared using regression analysis and Bland-Altman plots. Correlation of 4D PC MRI measured velocities was higher in comparison with TCD (r = 0.49-0.66) than with TCCD (0.35-0.44) and 2D PC MRI (0.52-0.60). In mid-BA and ICA C7 segment, a significant correlation was found with TCD (0.68-0.81 and 0.65-0.71, respectively). No significant correlation was found in carotid siphon. On average over all volunteers, PSVs and EDVs in MCA were minimally underestimated compared with TCD/TCCD. Minimal overestimation of velocities was found compared to TCD in mid-BA and ICA C7 segment. 4D PC MRI appears as valid alternative for intracranial velocity measurement consistent with previous reference standards, foremost with TCD. Spatiotemporal averaging effects might contribute to vessel size-dependent mild underestimation of velocities in smaller (MCA), and overestimation in larger-sized (BA and ICA) arteries, respectively. Complete spatiotemporal flow analysis may be advantageous in anatomically complex regions (e.g. carotid siphon) relative to restrictions of ultrasound techniques. (orig.)

Biphasic threat to femoral head perfusion in abduction: arterial hypoperfusion and venous congestion

Energy Technology Data Exchange (ETDEWEB)

Yousefzadeh, David K. [Comer Children' s Hospital, Department of Radiology, Chicago, IL (United States); University of Chicago, Department of Radiology, Chicago, IL (United States); Jaramillo, Diego [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Johnson, Neil [Cincinnati Children' s Hospital, Department of Radiology, Cincinnati, OH (United States); Doerger, Kirk [Radiology Associates of Northern Kentucky, Crestview Hills, KY (United States); Sullivan, Christopher [University of Chicago, Department of Surgery, Chicago, IL (United States)

2010-09-15

Hip abduction can cause avascular necrosis (AVN) of the femoral head in infants. To compare the US perfusion pattern of femoral head cartilage in neutral position with that in different degrees and duration of abduction, testing the venous congestion theory of post-abduction ischemia. In 20 neonates, the Doppler flow characteristics of the posterosuperior (PS) branch of the femoral head cartilage feeding vessels were evaluated in neutral and at 30 , 45 , and 60 abduction. In three neonates the leg was held in 45-degree abduction and flow was assessed at 5, 10, and 15 min. Male/female ratio was 11/9 with a mean age of 1.86 {+-} 0.7 weeks. The peak systolic velocities (PSV) declined in all three degrees of abduction. After 15 min of 45-degree abduction, the mean PSV declined and showed an absent or reversed diastolic component and undetectable venous return. No perfusion was detected at 60-degree abduction. Abduction-induced femoral head ischemia is biphasic and degree- and duration-dependent. In phase I there is arterial hypoperfusion and in phase II there is venous congestion. A new pathogeneses for femoral head ischemia is offered. (orig.)

Development of a Duplex Ultrasound Simulator and Preliminary Validation of Velocity Measurements in Carotid Artery Models.

Science.gov (United States)

Zierler, R Eugene; Leotta, Daniel F; Sansom, Kurt; Aliseda, Alberto; Anderson, Mark D; Sheehan, Florence H

2016-07-01

Duplex ultrasound scanning with B-mode imaging and both color Doppler and Doppler spectral waveforms is relied upon for diagnosis of vascular pathology and selection of patients for further evaluation and treatment. In most duplex ultrasound applications, classification of disease severity is based primarily on alterations in blood flow velocities, particularly the peak systolic velocity (PSV) obtained from Doppler spectral waveforms. We developed a duplex ultrasound simulator for training and assessment of scanning skills. Duplex ultrasound cases were prepared from 2-dimensional (2D) images of normal and stenotic carotid arteries by reconstructing the common carotid, internal carotid, and external carotid arteries in 3 dimensions and computationally simulating blood flow velocity fields within the lumen. The simulator displays a 2D B-mode image corresponding to transducer position on a mannequin, overlaid by color coding of velocity data. A spectral waveform is generated according to examiner-defined settings (depth and size of the Doppler sample volume, beam steering, Doppler beam angle, and pulse repetition frequency or scale). The accuracy of the simulator was assessed by comparing the PSV measured from the spectral waveforms with the true PSV which was derived from the computational flow model based on the size and location of the sample volume within the artery. Three expert examiners made a total of 36 carotid artery PSV measurements based on the simulated cases. The PSV measured by the examiners deviated from true PSV by 8% ± 5% (N = 36). The deviation in PSV did not differ significantly between artery segments, normal and stenotic arteries, or examiners. To our knowledge, this is the first simulation of duplex ultrasound that can create and display real-time color Doppler images and Doppler spectral waveforms. The results demonstrate that an examiner can measure PSV from the spectral waveforms using the settings on the simulator with a mean absolute error

The partitioning of nanoparticles to endothelium or interstitium during ultrasound-microbubble-targeted delivery depends on peak-negative pressure

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Hsiang, Y.-H.; Song, J.; Price, R. J., E-mail: rprice@virginia.edu [University of Virginia, Department of Biomedical Engineering (United States)

2015-08-15

Patients diagnosed with advanced peripheral arterial disease often face poor prognoses and have limited treatment options. For some patient populations, the therapeutic growth of collateral arteries (i.e. arteriogenesis) that bypass regions affected by vascular disease may become a viable treatment option. Our group and others are developing therapeutic approaches centered on the ability of ultrasound-activated microbubbles to permeabilize skeletal muscle capillaries and facilitate the targeted delivery of pro-arteriogenic growth factor-bearing nanoparticles. The development of such approaches would benefit significantly from a better understanding of how nanoparticle diameter and ultrasound peak-negative pressure affect both total nanoparticle delivery and the partitioning of nanoparticles to endothelial or interstitial compartments. Toward this goal, using Balb/C mice that had undergone unilateral femoral artery ligation, we intra-arterially co-injected nanoparticles (50 and 100 nm) with microbubbles, applied 1 MHz ultrasound to the gracilis adductor muscle at peak-negative pressures of 0.7, 0.55, 0.4, and 0.2 MPa, and analyzed nanoparticle delivery and distribution. As expected, total nanoparticle (50 and 100 nm) delivery increased with increasing peak-negative pressure, with 50 nm nanoparticles exhibiting greater tissue coverage than 100 nm nanoparticles. Of particular interest, increasing peak-negative pressure resulted in increased delivery to the interstitium for both nanoparticle sizes, but had little influence on nanoparticle delivery to the endothelium. Thus, we conclude that alterations to peak-negative pressure may be used to adjust the fraction of nanoparticles delivered to the interstitial compartment. This information will be useful when designing ultrasound protocols for delivering pro-arteriogenic nanoparticles to skeletal muscle.

The partitioning of nanoparticles to endothelium or interstitium during ultrasound-microbubble-targeted delivery depends on peak-negative pressure

International Nuclear Information System (INIS)

Hsiang, Y.-H.; Song, J.; Price, R. J.

2015-01-01

Patients diagnosed with advanced peripheral arterial disease often face poor prognoses and have limited treatment options. For some patient populations, the therapeutic growth of collateral arteries (i.e. arteriogenesis) that bypass regions affected by vascular disease may become a viable treatment option. Our group and others are developing therapeutic approaches centered on the ability of ultrasound-activated microbubbles to permeabilize skeletal muscle capillaries and facilitate the targeted delivery of pro-arteriogenic growth factor-bearing nanoparticles. The development of such approaches would benefit significantly from a better understanding of how nanoparticle diameter and ultrasound peak-negative pressure affect both total nanoparticle delivery and the partitioning of nanoparticles to endothelial or interstitial compartments. Toward this goal, using Balb/C mice that had undergone unilateral femoral artery ligation, we intra-arterially co-injected nanoparticles (50 and 100 nm) with microbubbles, applied 1 MHz ultrasound to the gracilis adductor muscle at peak-negative pressures of 0.7, 0.55, 0.4, and 0.2 MPa, and analyzed nanoparticle delivery and distribution. As expected, total nanoparticle (50 and 100 nm) delivery increased with increasing peak-negative pressure, with 50 nm nanoparticles exhibiting greater tissue coverage than 100 nm nanoparticles. Of particular interest, increasing peak-negative pressure resulted in increased delivery to the interstitium for both nanoparticle sizes, but had little influence on nanoparticle delivery to the endothelium. Thus, we conclude that alterations to peak-negative pressure may be used to adjust the fraction of nanoparticles delivered to the interstitial compartment. This information will be useful when designing ultrasound protocols for delivering pro-arteriogenic nanoparticles to skeletal muscle

Evaluation of arterial stiffness in nondiabetic chronic kidney disease patients

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Bodanapu Mastanvalli

2017-01-01

Full Text Available Chronic kidney disease (CKD is a growing problem worldwide. Clinical and epidemiologic studies have shown that structural and functional changes that occur in major arteries are a major contributing factor to the high mortality in uremic patients. Recent studies have shown a stepwise increase of the carotid-femoral pulse wave velocity (cfPWV from CKD Stage 1 to Stage 5. We evaluated the cfPWV and augmentation index (AIx, as indirect markers of arterial stiffness in patients with nondiabetic CKD and compared the values with normal population; we also evaluated the relationship between various stages of CKD and arterial stiffness markers. This cross-sectional study was carried out in the Department of Nephrology for a duration of two years from January 15, 2012, to January 14, 2014. Fifty patients with nondiabetic CKD were studied along with 50 healthy volunteers who did not have CKD, who served as controls. Assessment of arterial stiffness (blood pressure, PWV, heart rate, aortic augmentation pressure, and AIx was performed using the PeriScope device. PWV positively correlated with systolic and diastolic blood pressure, mean aortic arterial pressure, serum creatinine, and serum uric acid and negatively correlated with estimated glomerular filtration rate. Arterial stiffness increased as CKD stage increased and was higher in nondiabetic CKD group than in the general population. Arterial stiffness progressed gradually from CKD Stage 2 to 5, and then abruptly, in dialysis patients. Measures to decrease the arterial stiffness and its influence on decreasing cardiovascular events need further evaluation.

Metformin, but not glimepiride, improves carotid artery diameter and blood flow in patients with type 2 diabetes mellitus

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Helena Atroch Machado

2012-07-01

Full Text Available OBJECTIVE: To compare the effects of glimepiride and metformin on vascular reactivity, hemostatic factors and glucose and lipid profiles in patients with type 2 diabetes. METHODS: A prospective study was performed in 16 uncontrolled patients with diabetes previously treated with dietary intervention. The participants were randomized into metformin or glimepiride therapy groups. After four months, the patients were crossed over with no washout period to the alternative treatment for an additional four-month period on similar dosage schedules. The following variables were assessed before and after four months of each treatment: 1 fasting glycemia, insulin, catecholamines, lipid profiles and HbA1 levels; 2 t-PA and PAI-1 (antigen and activity, platelet aggregation and fibrinogen and plasminogen levels; and 3 the flow indices of the carotid and brachial arteries. In addition, at the end of each period, a 12-hour metabolic profile was obtained after fasting and every 2 hours thereafter. RESULTS: Both therapies resulted in similar decreases in fasting glucose, triglyceride and norepinephrine levels, and they increased the fibrinolytic factor plasminogen but decreased t-PA activity. Metformin caused lower insulin and pro-insulin levels and higher glucagon levels and increased systolic carotid diameter and blood flow. Neither metformin nor glimepiride affected endothelial-dependent or endothelial-independent vasodilation of the brachial artery. CONCLUSIONS: Glimepiride and metformin were effective in improving glucose and lipid profiles and norepinephrine levels. Metformin afforded more protection against macrovascular diabetes complications, increased systolic carotid artery diameter and total and systolic blood flow, and decreased insulin levels. As both therapies increased plasminogen levels but reduced t-PA activity, a coagulation process was likely still ongoing.

Two-years therapy with bosentan of pulmonary arterial hypertension related to connective tissue diseases

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M. Rizzo

2011-09-01

Full Text Available Objective: Pulmonary arterial hypertension (PAH is a rare but severe complication of connective tissue diseases (CTD, with a negative impact on patients survival. Bosentan, a receptor antagonist of endothelin, has been proved effective for the treatment of PAH. The aim of this study was to evaluate the effects and the safety of bosentan administered for 2 years in a group of patients with PAH related to CTD. Methods: Twelve patients with PAH related to systemic sclerosis (8 cases, SLE (2 cases, mixed connective tissue disease (1 case and polymyositis (1 case attending the Rheumatology Unit of Padova University were treated with bosentan for two years. Distance walked in 6 minutes, right ventricular systolic pressure and mean pulmonary artery pressure estimated by doppler echocardiography were evaluated at baseline and after 6, 12, 18 and 24 months of treatment. Safety was assessed by laboratory tests performed every two months. Results: During bosentan treatment, a significant decrease of right ventricular systolic pressure was observed after 6, 12, 18 and 24 months in comparison to baseline, whereas pulmonary artery mean pressure remained unchanged. Distance walked in 6 minutes slightly increased after 6 and 12 months, but significantly decreased after 18 and 24 months, mostly because complications of CTD which compromised the ability to walk arose in 4 patients. Adverse events related to bosentan were observed in 2 cases. Conclusions: Bosentan has been demonstrated effective in reducing pulmonary arterial pressure in a two-year period of treatment. Exercise capacity improved only in the first year of therapy and worsened thereafter, suggesting the opportunity of a combination therapy for a long-term treatment of PAH related to CTD.

Correlation between US-PSV and MDCTA in the quantification of carotid artery stenosis

International Nuclear Information System (INIS)

Saba, Luca; Sanfilippo, Roberto; Montisci, Roberto; Mallarini, Giorgio

2010-01-01

Purpose: Stroke is a major cause of death and serious long-lasting neurological disability and the severity of carotid artery stenosis is one of the most important determinants of cerebrovascular events. The purpose of this paper is to evaluate the correlation between multi-detector-row CT angiography (MDCTA) and ultra-sound peak-systolic-velocity (US-PSV) in the quantification of carotid artery stenosis. Methods and material: 52 patients were retrospectively studied by using four-detector row CT and ultra-sound. Each patient was assessed for stenosis degree by using NASCET method when studied by using MDCT and by using PSV when studied by using US. Statistic analysis was performed to determine the entity of correlation (method of Pearson) between MDCTA and US-PSV. The Bland-Altman analysis was applied to assess the level of inter-technique agreement. Results: Sonographic PSV measurements ranged from 70 to 589 cm/s. Distal ICA velocities ranged from 29 to 238 cm/s. Linear regression analysis showed a good correlation (r 2 = 0.613) between MDCTA-NASCET linear percentage stenosis and PSV and measured. PSV value that corresponded to a NASCET linear percentage stenosis of 70% was 283 cm/s and with this values sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 75%, 88.6%, 90.7% and 70.5%, respectively. Conclusions: Results of our study suggest that NASCET stenosis measured in MDCTA and PSV values have a good correlation. The use of a threshold of 283 cm/s allows obtaining good value of sensitivity and specificity.

Hemodynamic alterations after stent implantation in 15 cases of intracranial aneurysm.

Science.gov (United States)

Wang, Chao; Tian, Zhongbin; Liu, Jian; Jing, Linkai; Paliwal, Nikhil; Wang, Shengzhang; Zhang, Ying; Xiang, Jianping; Siddiqui, Adnan H; Meng, Hui; Yang, Xinjian

2016-04-01

Stent-assisted coiling technology has been widely used in the treatment of intracranial aneurysms. In the current study, we investigated the intra-aneurysmal hemodynamic alterations after stent implantation and their association with the aneurysm location. We first retrospectively studied 15 aneurysm cases [8 internal carotid artery-ophthalmic artery (ICA-OphA) aneurysms and 7 posterior communicating artery (PcoA) aneurysms] treated with Enterprise stents and coils. Then, based on the patient-specific geometries before and after stenting, we built virtual stenting computational fluid dynamics (CFD) simulation models. Before and after the stent deployment, the average wall shear stress (WSS) on the aneurysmal sac at systolic peak changed from 7.04 Pa (4.14 Pa, 15.77 Pa) to 6.04 Pa (3.86 Pa, 11.13 Pa), P = 0.001; the spatially averaged flow velocity in the perpendicular plane of the aneurysm dropped from 0.5 m/s (0.28 m/s, 0.7 m/s) to 0.33 m/s (0.25 m/s, 0.49 m/s), P = 0.001, respectively. Post stent implantation, the WSS in ICA-OphA aneurysms and PcoA aneurysms decreased by 14.4 % (P = 0.012) and 16.6 % (P = 0.018), respectively, and the flow velocity also reduced by 10.3 % (P = 0.029) and 10.5 % (P = 0.013), respectively. Changes in the WSS, flow velocity, and pressure were not significantly different between ICA-OphA and PcoA aneurysms (P > 0.05). Stent implantation did not significantly change the peak systolic pressure in either aneurysm type. After the stent implantation, both the intra-aneurysmal flow velocity and WSS decreased independently of aneurysm type (ICA-OphA and PcoA). Little change was observed in peak systolic pressure.

Noninvasive 24-hour ambulatory arterial blood pressure monitoring in cirrhosis

DEFF Research Database (Denmark)

Møller, Søren; Wiinberg, N; Henriksen, Jens Henrik

1995-01-01

Cirrhotic patients have disturbed systemic hemodynamics with reduced arterial blood pressure, but this has not been investigated during daily activity and sleep. Systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MAP), and heart rate (HR) were measured by an automatic ambulant...... device for monitoring blood pressure in 35 patients with cirrhosis and 35 healthy matched controls. During the daytime, SBP, DBP, and MAP were significantly lower in the patients than in the controls (median 118 vs. 127; 70 vs. 78; 86 vs. 94 mm Hg, P blood pressures...... were almost similar in the two groups (108 vs. 110; 65 vs. 67; 78 vs. 82 mm Hg, NS). Conversely, HR was significantly higher in the patients both in the daytime (86 vs. 72/min, P blood pressure and HR from daytime...

Heart and coronary artery damage related to Kawasaki syndrome

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A. A. Leontyeva

2014-01-01

Full Text Available Kawasaki syndrome is an acute systemic vasculitis of unknown etiology, which mainly affects children within the first 5 years of fife. At the present time, Kawasaki syndrome is recognized to be a leading cause of acquired organic heart diseases in children, which may result in coronary heart disease, myocardial infarction, and sudden death in children and young people. Most complications are associated with the cardiovascular system, with coronary artery changes in particular. Transthoracic echocardiography, which, besides coronary artery assessment, makes it possible to evaluate right and left ventricular systolic and diastolic functions and to study the cardiac valves and changes in pericardial effusion, is a major technique in Kawasaki syndrome. The paper outlines an update on the epidemiology, etiology, pathogenetic mechanisms, and pathomorphology of Kawasaki syndrome and considers possible coronary and noncoronary changes, outcomes, and clinical manifestations.

Whole-body vibration as a potential countermeasure for dynapenia and arterial stiffness

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Arturo Figueroa

2016-09-01

Full Text Available Age-related decreases in muscle mass and strength are associated with decreased mobility, quality of life, and increased cardiovascular risk. Coupled with the prevalence of obesity, the risk of death becomes substantially greater. Resistance training (RT has a well-documented beneficial impact on muscle mass and strength in young and older adults, although the high-intensity needed to elicit these adaptations may have a detrimental or negligible impact on vascular function, specifically on arterial stiffness. Increased arterial stiffness is associated with systolic hypertension, left ventricular hypertrophy, and myocardial ischemia. Therefore, improvements of muscle strength and arterial function are important in older adults. Recently, whole-body vibration (WBV exercise, a novel modality of strength training, has shown to exhibit similar results on muscle strength as RT in a wide-variety of populations, with the greatest impact in elderly individuals with limited muscle function. Additionally, WBV training has been shown to have beneficial effects on vascular function by reducing arterial stiffness. This article reviews relevant publications reporting the effects of WBV on muscle strength and/or arterial stiffness. Findings from current studies suggest the use of WBV training as an alternative modality to traditional RT to countermeasure the age-related detriments in muscle strength and arterial stiffness in older adults.

Whole-body vibration as a potential countermeasure for dynapenia and arterial stiffness.

Science.gov (United States)

Figueroa, Arturo; Jaime, Salvador J; Alvarez-Alvarado, Stacey

2016-09-01

Age-related decreases in muscle mass and strength are associated with decreased mobility, quality of life, and increased cardiovascular risk. Coupled with the prevalence of obesity, the risk of death becomes substantially greater. Resistance training (RT) has a well-documented beneficial impact on muscle mass and strength in young and older adults, although the high-intensity needed to elicit these adaptations may have a detrimental or negligible impact on vascular function, specifically on arterial stiffness. Increased arterial stiffness is associated with systolic hypertension, left ventricular hypertrophy, and myocardial ischemia. Therefore, improvements of muscle strength and arterial function are important in older adults. Recently, whole-body vibration (WBV) exercise, a novel modality of strength training, has shown to exhibit similar results on muscle strength as RT in a wide-variety of populations, with the greatest impact in elderly individuals with limited muscle function. Additionally, WBV training has been shown to have beneficial effects on vascular function by reducing arterial stiffness. This article reviews relevant publications reporting the effects of WBV on muscle strength and/or arterial stiffness. Findings from current studies suggest the use of WBV training as an alternative modality to traditional RT to countermeasure the age-related detriments in muscle strength and arterial stiffness in older adults.

[The heart catheter table is not the operating table : Intraindividual comparison of pulmonary artery pressures].

Science.gov (United States)

Ziegler, M U; Reinelt, H

2018-05-01

Patients undergoing cardiac surgery need extensive and invasive monitoring, which needs to be individually adapted for each patient and requires a diligent risk-benefit analysis. The use of a pulmonary artery catheter (PAC) seems to be justifiable in certain cases; therefore, the preoperative diagnosis of pulmonary hypertension represents an indication for perioperative monitoring with PAC in the S3 guidelines of the German Society for Anesthesiology and Intensive Care Medicine (DGAI). In many cases, however, this preoperative diagnosis cannot be confirmed intraoperatively. We wanted to find out whether this is just an impression or whether there actually are significant differences between preoperative, intraoperative and postoperative pulmonary artery pressures. After obtaining ethical approval, we retrospectively compared the pulmonary pressures of cardiac surgery patients with an elevated pulmonary pressure during preoperative right heart catheterization with those obtained intraoperatively and postoperatively by means of a PAC. All patients with a preoperatively documented pulmonary artery pressure of 40 mmHg or above and an intraoperative use of a PAC during a 4-year period were included. Exclusion criteria were intracardiac shunts, cardiogenic shock, emergency procedures, pulmonary hypertension of non-cardiac origin and a time span of more than 1 year between right heart catheterization and surgery. We included 90 patients. In the whole group and in the subgroups (according to diagnosis, time elapsed between heart catheterization and operation and pulmonary pressure), there were significant differences between preoperative and intraoperative pulmonary and systemic pressures. Systemic and pulmonary artery pressures were significantly higher during preoperative catheterization than intraoperatively. The systemic systolic pressure/systolic pulmonary pressure ratio, however, remained constant. The intraoperative and postoperative systemic and pulmonary

Threshold value of home pulse pressure predicting arterial stiffness in patients with type 2 diabetes: KAMOGAWA-HBP study.

Science.gov (United States)

Kitagawa, Noriyuki; Ushigome, Emi; Matsumoto, Shinobu; Oyabu, Chikako; Ushigome, Hidetaka; Yokota, Isao; Asano, Mai; Tanaka, Muhei; Yamazaki, Masahiro; Fukui, Michiaki

2018-03-01

This cross-sectional multicenter study was designed to evaluate the threshold value of home pulse pressure (PP) and home systolic blood pressure (SBP) predicting the arterial stiffness in 876 patients with type 2 diabetes. We measured the area under the receiver-operating characteristic curve (AUC) and estimated the ability of home PP to identify arterial stiffness using Youden-Index defined cut-off point. The arterial stiffness was measured using the brachial-ankle pulse wave velocity (baPWV). AUC for arterial stiffness in morning PP was significantly greater than that in morning SBP (P AUC for arterial stiffness in evening PP was also significantly greater than that in evening SBP (P < .001). The optimal cut-off points for morning PP and evening PP, which predicted arterial stiffness, were 54.6 and 56.9 mm Hg, respectively. Our findings indicate that we should pay more attention to increased home PP in patients with type 2 diabetes. ©2018 Wiley Periodicals, Inc.

Central Arterial Function Measured by Non-invasive Pulse Wave Analysis is Abnormal in Patients with Duchenne Muscular Dystrophy.

Science.gov (United States)

Ryan, Thomas D; Parent, John J; Gao, Zhiqian; Khoury, Philip R; Dupont, Elizabeth; Smith, Jennifer N; Wong, Brenda; Urbina, Elaine M; Jefferies, John L

2017-08-01

Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder caused by mutation of dystrophin. Cardiovascular involvement includes dilated cardiomyopathy. Non-invasive assessment of vascular function has not been evaluated in DMD. We hypothesize arterial wave reflection is abnormal in patients with DMD. Pulse wave analysis was performed on DMD patients with a SphygmoCor SCOR-PVx System to determine central blood pressure and augmentation index (AIx) as an assessment of arterial wave reflection. Results were compared to a control group. A total of 43 patients with DMD were enrolled, and compared to 43 normal controls. Central systolic blood pressure was lower, while both AIx-75 (7.8 ± 9.6% vs. 2.1 ± 10.4%, p 0.01, DMD vs. normal) and AIx-not corrected (16.8 ± 10.1% vs. -3.6 ± 10.9, p wave reflection when compared to normal controls, which may represent increased arterial stiffness. Overall there appears to be no effect on ventricular systolic function, however the long-term consequence in this group is unknown. Further study is required to determine the mechanism of these differences, which may be related to the effects of systemic steroids or the role of dystrophin in vascular function.

Hypertensive peaks in the pathogenesis of intraventricular hemorrhage in the newborn. Abolition by phenobarbitone sedation

DEFF Research Database (Denmark)

Wimberley, P D; Lou, H C; Pedersen, H

1982-01-01

that the large increases in arterial blood pressure which occur with both spontaneous motor activity and in association with nursing procedures, are an important cause of development of IVH in very low birth weight infants. An example is given to show that pressure peaks can be abolished by phenobarbitone......Mean arterial blood pressure (MABP) was measured continuously for 3 to 5 days after birth in 27 premature infants with a birth weight under 1500 g, and who required umbilical artery catheterisation. All had respiratory distress syndrome (RDS). Intraventricular hemorrhage (IVH) occurred in 9 infants...

Pulse Wave Variation during the Menstrual Cycle in Women with Menstrual Pain

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Soo Hyung Jeon

2016-01-01

Full Text Available Objective. This study is performed to obtain objective diagnostic indicators associated with menstrual pain using pulse wave analysis. Methods. Using a pulse diagnostic device, we measured the pulse waves of 541 women aged between 19 and 30 years, placed in either an experimental group with menstrual pain (n=329 or a control group with little or no menstrual pain (n=212. Measurements were taken during both the menstrual and nonmenstrual periods, and comparative analysis was performed. Results. During the nonmenstrual period, the experimental group showed a significantly higher value in the left radial artery for the radial augmentation index (RAI (p=0.050 but significantly lower values for pulse wave energy (p=0.021 and time to first peak from baseline (T1 (p=0.035 in the right radial artery. During the menstrual period, the experimental group showed significantly lower values in the left radial artery for cardiac diastole and pulse wave area during diastole and significantly higher values for pulse wave area during systole, ratio of systolic phase to the full heartbeat, and systolic-diastolic ratio. Conclusion. We obtained indicators of menstrual pain in women during the menstrual period, including prolonged systolic and shortened diastolic phases, increases in pulse wave energy and area of representative pulse wave, and increased blood vessel resistance.

Massachusetts Institute of Technology Consortium Agreement. Phase II

Science.gov (United States)

1999-03-01

pressure at end diastole, dP/dt during diastole, the time to peak pressure, the time to the dicrotic notch , and so forth. Additional features such as...individual. These changes are based on such factors as arterial geometry, peripheral resistance, and cardiac contractility. Thus, the potential exists to... notch dP/dt, diastolic total cycle period max. P max. PdP/dt, peak systolic T_ ".....-- mean pressure [time to pe t pressure dP/dt, diastolic total cycle

[The effect of calcitonin gene-related peptide on collagen accumulation in pulmonary arteries of rats with hypoxic pulmonary arterial hypertension].

Science.gov (United States)

Li, Xian-Wei; Du, Jie; Li, Yuan-Jian

2013-03-01

To observe the effect of calcitonin gene-related peptide (CGRP) on pulmonary vascular collagen accumulation in hypoxia rats in order to study the effect of CGRP on hypoxic pulmonary vascular structural remodeling and its possible mechanism. Rats were acclimated for 1 week, and then were randomly divided into three groups: normoxia group, hypoxia group, and hypoxia plus capsaicin group. Pulmonary arterial hypertension was induced by hypoxia in rats. Hypoxia plus capsaicin group, rats were given capsaicin (50 mg/(kg x d), s.c) 4 days before hypoxia to deplete endogenous CGRP. Hypoxia (3% O2) stimulated proliferation of pulmonary arterial smooth muscle cells (PASMCs) and proliferation was measured by BrdU marking. The expression levels of CGRP, phosphorylated ERK1/2 (p-ERK1/ 2), collagen I and collagen III were detected by real-time PCR or Western blot. Right ventricle systolic pressure (RVSP) and mean pulmonary arterial pressure (mPAP) of pulmonary arterial hypertension (PAH) rats induced by hypoxia were higher than those of normoxia rats. By HE and Masson staining, it was demonstrated that hypoxia also significantly induced hypertrophy of pulmonary arteries and increased level of collagen accumulation. Hypoxia dramatically decreased the CGRP level and increased the expression of p-ERK1/2, collagen I, collagen III in pulmonary arteries. All these effects of hypoxia were further aggravated by pre-treatment of rats with capsaicin. CGRP concentration-dependently inhibited hypoxia-induced proliferation of PASMCs, markedly decreased the expression of p-ERK1/2, collagen I and collagen III. All these effects of CGRP were abolished in the presence of CGRP8-37. These results suggest that CGRP might inhibit hypoxia-induced PAH and pulmonary vascular remodeling, through inhibiting phosphorylation of ERK1/2 and alleviating the collagen accumulation of pulmonary arteries.

THE INFLUENCE OF BIOFEEDBACK SESSIONS IN CLOSED LOOP OF HEART RATE VARIABILITY AND PACED BREATHING ON SYSTOLIC BLOOD PRESSURE CONTROL DURING STANDARD DRUG THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION

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S. A. S. Belal

2015-06-01

Full Text Available Changes of systolic blood pressure (SBP in biofeedback (BFB sessions with closed loop of paced breathing (PB and heart rate variability (HRV during standard drug therapy of arterial hypertension (AH was studied. 275 patients with 1-3 degree of AH (143 men and 132 women, mean age 58,55 ± 7,99 years was divided into two comparable groups: 1 - BFB (139 patients in investigated PB loop, 2 - control group (136 patients with BFB without PB. In both groups was performed 10 sessions of BFB. Changes of SBP depending on the stage and degree of AH, gender and age was assessed. BP was measured by the method of Korotkov’s with monometer Microlife BP AG1-20 in same conditions. Data were processed by parametric and nonparametric statistics. It is proved that the use of biofeedback in the loop of PB and HRV significantly (p < 0.01 exceeds in efficiency an isolated drug therapy in control of SBP at any stage and degree of AH in patients of both sexes in all age groups. Extent of the effect increases with the stage and degree of the disease and not related to the sex and age of the patient. Findings allow to recommend this technique in clinical practice.

Assessment of the left ventricular systolic and diastolic function by the left ventricular density curve derived from intravenous digital subtraction angiography in children

International Nuclear Information System (INIS)

Horigome, Hitoshi; Satoh, Hideo; Isobe, Takeshi; Takita, Hitoshi

1991-01-01

To evaluate the left ventricular (LV) systolic and diastolic function, fifty-four children with various heart diseases underwent intravenous digital subtraction angiography (IV-DSA). Global left ventricular density curve was obtained through densitometry of the DSA images. The curve was smoothed by a third-degree Fourier transformation and systolic and diastolic indexes were obtained. In the control group, consisting of Kawasaki disease without coronary lesion and mild pulmonary stenosis, the peak ejection rate (PER) and the peak filling rate in early diastole (PFR-E) correlated positively with the heart rate (HR) in a quadratic curve manner [PER: r= 0.93 p<0.01, PFR-E: r= 0.94 p<0.01]. Time from end-diastolic to PER (T-PER) and time from end-systolic to PFR (T-PFR) were correlated negatively with HR [T-PER: r=-0.86 p<0.01, T-PFR: r=-0.91 p<0.01]. However, T-PER/RR and T-PFR/RR values were rather constant (20.9±3.2%, 17.0±2.6%, respectively). We also found significant correlations of PER and PFR-E with left ventricular ejection fraction (LVEF). Patients with corrected tetralogy of Fallot and with cardiomyopaties showed not only abnormal systolic indexes but some depressed diastolic indexes. LV density curve also disclosed isolated diastolic dysfunction in a group of aortic stenosis and in two patients with coronary lesions. A correlation of LVEF derived from the density curve and conventional area-length method was high [r= 0.91 p<0.001]. To evaluate the reproducibility, we were able to obtain the digital data twice with over one month interval on 24 patients. The intraobserver correlation was satisfactory. We applied the remasking method, resulting in improving the quality of digital images under spontaneous breathing. Our results indicated that IV-DSA was a less-invasive and clinically reliable method for assessment of LV function in children. (author)

Assessment of the left ventricular systolic and diastolic function by the left ventricular density curve derived from intravenous digital subtraction angiography in children

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Horigome, Hitoshi; Satoh, Hideo; Isobe, Takeshi; Takita, Hitoshi (Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine)

1991-05-01

To evaluate the left ventricular (LV) systolic and diastolic function, fifty-four children with various heart diseases underwent intravenous digital subtraction angiography (IV-DSA). Global left ventricular density curve was obtained through densitometry of the DSA images. The curve was smoothed by a third-degree Fourier transformation and systolic and diastolic indexes were obtained. In the control group, consisting of Kawasaki disease without coronary lesion and mild pulmonary stenosis, the peak ejection rate (PER) and the peak filling rate in early diastole (PFR-E) correlated positively with the heart rate (HR) in a quadratic curve manner (PER: r= 0.93 p<0.01, PFR-E: r= 0.94 p<0.01). Time from end-diastolic to PER (T-PER) and time from end-systolic to PFR (T-PFR) were correlated negatively with HR (T-PER: r=-0.86 p<0.01, T-PFR: r=-0.91 p<0.01). However, T-PER/RR and T-PFR/RR values were rather constant (20.9+-3.2%, 17.0+-2.6%, respectively). We also found significant correlations of PER and PFR-E with left ventricular ejection fraction (LVEF). Patients with corrected tetralogy of Fallot and with cardiomyopaties showed not only abnormal systolic indexes but some depressed diastolic indexes. LV density curve also disclosed isolated diastolic dysfunction in a group of aortic stenosis and in two patients with coronary lesions. A correlation of LVEF derived from the density curve and conventional area-length method was high (r= 0.91 p<0.001). To evaluate the reproducibility, we were able to obtain the digital data twice with over one month interval on 24 patients. The intraobserver correlation was satisfactory. We applied the remasking method, resulting in improving the quality of digital images under spontaneous breathing. Our results indicated that IV-DSA was a less-invasive and clinically reliable method for assessment of LV function in children. (author).

Effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy: pressure-volume analysis with a nonimaging scintillation probe.

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Bonow, R O; Ostrow, H G; Rosing, D R; Cannon, R O; Lipson, L C; Maron, B J; Kent, K M; Bacharach, S L; Green, M V

1983-11-01

To investigate the effects of verapamil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy, we studied 14 patients at catheterization with a nonimaging scintillation probe before and after serial intravenous infusions of low-, medium-, and high-dose verapamil (total dose 0.17 to 0.72 mg/kg). Percent change in radionuclide stroke counts after verapamil correlated well with percent change in thermodilution stroke volume (r = .87), and changes in diastolic and systolic counts were used to assess relative changes in left ventricular volumes after verapamil. Verapamil produced dose-related increases in end-diastolic counts (19 +/- 9% increase; p less than .001), end-systolic counts (91 +/- 54% increase; p less than .001), and stroke counts (7 +/- 10% increase; p less than .02). This was associated with a decrease in ejection fraction (83 +/- 8% control, 73 +/- 10% verapamil; p less than .001) and, in the 10 patients with left ventricular outflow tract gradients, a reduction in gradient (62 +/- 27 mm Hg control, 32 +/- 35 mm Hg verapamil; p less than .01). The end-systolic pressure-volume relation was shifted downward and rightward in all patients, suggesting a negative inotropic effect. In 10 patients, left ventricular pressure-volume loops were constructed with simultaneous micromanometer pressure recordings and the radionuclide time-activity curve. In five patients, verapamil shifted the diastolic pressure-volume curve downward and rightward, demonstrating improved pressure-volume relations despite the negative inotropic effect, and also increased the peak rate of rapid diastolic filling. In the other five patients, the diastolic pressure-volume relation was unaltered by verapamil, and increased end-diastolic volumes occurred at higher end-diastolic pressures; in these patients, the peak rate of left ventricular diastolic filling was not changed by verapamil. The negative inotropic effects of intravenous verapamil are

Assessment of effect of intravitreal ranibizumab injection on the ocular blood flow in patients with neovascular age-related macular degeneration

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V. V. Neroev

2014-07-01

Full Text Available Purpose: To evaluate the effect of intravitreal ranibizumab injection on the ocular blood flow in patients with neovascular agerelatedmacular degeneration (AMD.Methods: 35 patients with wet AMD undergone intravitreal 0.5 mg ranibizumab injection. Color Doppler Imaging (CDI and dopplerographywere used to measure hemodynamic parameters including the peak systolic velocity (Vsyst, cm / s, end-diastolic velocity (V diast, cm / s, and resistance index (RI of blood flow in the central retinal artery (CRA, the short posterior ciliary arteries (PCA, and the ophthalmic artery (OA. All patients were examined before and after injection on day 1‑7 and 30 day during the 3‑month follow up period.Results: Before intravitreal injection Vsyst was decreased in short PCA (p<0.05, RI in CRA and in short PCA significantly increased in comparison with normal index in same vessels. The peak systolic velocity in OA, in CRA and in short PCA was not significantly changed. After second injection resistance index in CRA and in short PCA was normalized.Conclusion: There was not impairment of ocular blood flow in retinal and choroidal after monthly intravitreal injection of ranibizumab during the 3‑month follow up period.

Assessment of effect of intravitreal ranibizumab injection on the ocular blood flow in patients with neovascular age-related macular degeneration

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V. V. Neroev

2013-01-01

Full Text Available Purpose: To evaluate the effect of intravitreal ranibizumab injection on the ocular blood flow in patients with neovascular agerelatedmacular degeneration (AMD.Methods: 35 patients with wet AMD undergone intravitreal 0.5 mg ranibizumab injection. Color Doppler Imaging (CDI and dopplerographywere used to measure hemodynamic parameters including the peak systolic velocity (Vsyst, cm / s, end-diastolic velocity (V diast, cm / s, and resistance index (RI of blood flow in the central retinal artery (CRA, the short posterior ciliary arteries (PCA, and the ophthalmic artery (OA. All patients were examined before and after injection on day 1‑7 and 30 day during the 3‑month follow up period.Results: Before intravitreal injection Vsyst was decreased in short PCA (p<0.05, RI in CRA and in short PCA significantly increased in comparison with normal index in same vessels. The peak systolic velocity in OA, in CRA and in short PCA was not significantly changed. After second injection resistance index in CRA and in short PCA was normalized.Conclusion: There was not impairment of ocular blood flow in retinal and choroidal after monthly intravitreal injection of ranibizumab during the 3‑month follow up period.

The prevalence and clinical predictors of incidental atherosclerotic renal artery stenosis

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Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri; Nursal, Tarik Z.

2009-01-01

Objective: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). Materials and methods: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age ± S.D.: 61.5 ± 11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis (≥60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). Results: Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n = 60) had significant (≥60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140 mmHg or diastolic >90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5 ± 8.9 years compared with 61 ± 11.2 years for patients without RAS (p < 0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p = 0.01). Conclusion: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

Digital capillaroscopy as important tool for early diagnostics of arterial hypertension

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Gurfinkel, Yu. I.; Sasonko, M. L.; Priezzhev, A. V.

2015-03-01

The study is aimed to determine the digital capillaroscopy possibilities in early diagnostics of an arterial hypertension. A total of 123 adult persons were examined in the study. The first group consisted of 40 patients with prehypertension (BP 130-139/85-89 mm Hg). The second group included 36 patients with 1-2 stage of hypertension (mean systolic BP 152.7±12 mm Hg). Patients in both groups did not receive regular drug therapy. The group of volunteers (n=47) included healthy adults without signs of cardiovascular pathology. The capillary circulation was examined on the nailbed using the optical digital capillaroscope developed by the company "AET", Russia. Diameters of the arterial and venous segments, perivascular zone size, capillary blood velocity, the degree of arterial loops narrowing and the density of the capillary network were estimated. In patients with arterial hypertension and even in patients with prehypertension remodeling and rarefaction of capillaries and the expressed narrowing their arterial loops were manifested. The results of the study revealed the presence of abnormalities of microcirculation parameters in patients of both groups. The capillaries density in both groups of patients was significantly lower than in healthy persons. The significant narrowing of arterial loops was revealed in patients with both arterial hypertension and prehypertension, in comparison with healthy volunteers. Capillary blood velocity did not differ significantly between healthy volunteers group and the group of prehypertensive patients. However in patients with hypertension this parameter was significantly lower in comparison with control group.

Variability of the fractal dimension of the left coronary tree in-patient with disease arterial severe occlusive

International Nuclear Information System (INIS)

Rodriguez, Javier; Alvarez, Luisa F; Marino, Martha E and others

2004-01-01

Fractal geometry is a chapter of mathematics that allows the measurement of irregularity in natural objects. The adequate measures in order to characterize the forms of the human body are the fractal dimensions. Coronary ramification is a fractal object, which enables the diagnosis of occlusive arterial disease by the measurement of an arterial segment obtained by coronary angiography, without measuring the impact of the obstruction in the whole ramification. Fractal dimension evaluates the irregularity of the whole coronary ramification. The right anterior oblique projection (RAO) of the left coronary ramifications (LCR) obtained through arteriography is evaluated with fractal dimensions, using the box counting method. Images of the ramification between systole and diastole were measured in 14 patients, 7 of them without occlusive arterial disease, group 1, and 7 with severe occlusive arterial disease, group 2. Patients without occlusive arterial disease showed a greater variability in the fractal dimensions sequence evaluated with the net difference, being in general this difference other than zero

Renal artery stent angioplasty for renovascular hypertension

International Nuclear Information System (INIS)

Li Gang; Li Haiqing; Wang Lin

2005-01-01

Objective: To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods: 15 patients (10 men and 5 women, 41-75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent angioplasty including renal arterial stenosis 89%(n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of fluoroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinical and angiographic follow up. Results: Technical success (residual stenosis <30%) was achieved in all patients without serious complication. During the follow-up (6-15 months; mean, 8 ± 4 months), hypertension was improved in 9 patients and cured in 4 patients with a total benefit of 86% and no efficacy in 2(13%). The average systolic blood pressure decreased from 27.12 ± 3.09 kPa to 18.62 ± 3.12 kPa and the average diastolic blood pressure decreased from 17.73 ± 1.92 kPa to 11.12 ± 2.43 kPa after stent treatment (P<0.05). Serum creatinine remained stable in 60% (n=9) patients with improvement in 33% (n=5) and worsened in 6% (n=1) patients. Follow-up angiography was performed in all patients with 1 case of a restenosis. 6 months after expanding through stent by using balloon, the two follow up angiographies showed a stable restenosis about 20%. Conclusions: Percutaneous transluminal stent placement is highly beneficial for patients who had renal arterial obstructive disease. The success of stent angioplasty of complete obstructive renal arteries reveals wide prospects for interventional method. (authors)

Predictors of high central blood pressure in young with isolated systolic hypertension

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Radchenko GD

2016-08-01

Full Text Available G D Radchenko, O O Torbas, Yu M Sirenko State Institute National Scientific Center, M.D. Strazhesko Institute of Cardiology, National Academy of Medical Science, Kyiv, Ukraine Objective: According to the European Society of Cardiology/European Society of Hypertension 2013 guidelines, evaluation of aortic blood pressure (BP is needed in young with isolated systolic hypertension (ISH, but using special devices is not common, especially in Ukraine, where only a few centers have these devices. The purpose of our study was to identify the simple clinical predictors for differentiation (with or without elevated aortic systolic BP [SBP] of the young with ISH without the need for further extensive work-up. Patients and methods: The study included 44 young men (mean age: 32.2±1.3 years with office SBP ≥140 mmHg and office diastolic BP (DBP <90 mmHg (average: 153.4±2.1 mmHg and 83.4±1.7 mmHg, respectively. The following procedures were performed in all the subjects: body weight and height evaluation; measurement of office SBP, DBP, and heart rate; ambulatory BP monitoring; measurement of pulse wave velocity in arteries of elastic and muscle types and central SBP (cSBP; biochemical blood tests; electrocardiography; echocardiography; and carotid ultrasound investigations. Step-by-step multifactor regression analyses were used for finding the predictors of high cSBP. Results: Depending on the cSBP level, all the patients were divided into two groups: first group (n=17, subjects with normal cSBP, and second group (n=27, subjects with elevated cSBP. Patients in the second group were significantly older, with less height and higher body mass index; they had significantly higher levels of office SBP and DBP. Characteristics of target organ damage were within normal limits in both groups and did not differ significantly. Only pulse wave velocity in arteries of elastic type was significantly higher in the second group. The independent predictors of

[Ultrasonographic evaluation of selected parameters of the endothelial function in brachial arteries and IMT measurements in carotid arteries in children with diabetes type 1 using personal insulin pumps--preliminary report].

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Tołwińska, Joanna; Głowińska-Olszewska, Barbara; Urban, Mirosława; Florys, Bozena; Peczyńska, Jadwiga

2006-01-01

Type 1 diabetes is a known risk factor for arterial atherosclerosis. The first symptoms can be found even in childhood. The ultrasonographic measurements of intimal plus medial thickness in carotid arteries (IMT) and flow mediated dilatation (FMD) evaluated in brachial arteries, play a known role in the detection in these cases. The diabetes treatment intensification is an important factor in delaying early atherosclerotic changes. Currently, intensive treatment of children's diabetes with use of continuous subcutaneous insulin infusion with personal insulin pumps is gaining more and more popularity. THE AIM OF THIS STUDY was the evaluation of IMT and FMD indexes in children suffering from type 1 diabetes in the context of treatment intensification (multidose insulin injections v. personal insulin pumps). We examined 64 children (29 boys and 35 girls) in the mean age 15.5 years treated with the multidose insulin injections method and 10 children using personal insulin pumps (4 girls and 6 boys) in the mean age 14.5 years. Using high resolution ultrasonography we evaluated IMT values in carotid arteries and FMD parameters in brachial arteries. In our analysis we estimated the blood concentration of lipid parameters, values of systolic and diastolic blood pressure, the age of diabetes onset, duration time of the illness and the values of HbA1c as a marker of metabolic control. We noticed significantly higher FMD values in patients treated with personal insulin pumps (13.7 vs. 5.5%, p=0.001). IMT values were similar in both groups (0.52 vs. 0.5 mm, p=0. 41). The level of HDL cholesterol was higher and triglycerides lower in the group with treatment intensification. The metabolic control was the same in both groups. In patients treated by the multidose insulin injections IMT correlated with systolic blood pressure values. We didn't notice any correlation between IMT and FMD in any group. 1. Treatment intensification (personal insulin pumps) influences better vascular

Physiological Responses Associated with Nordic-Walking Training in Systolic Hypertensive Postmenopausal Women

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Latosik Ewelina

2014-12-01

Full Text Available Loss of physical strength and hypertension are among the most pronounced detrimental factors accompanying aging. The aim of this study was to evaluate the influence of a supervised 8-week Nordic-walking training program on systolic blood pressure in systolic-hypertensive postmenopausal women. This study was a randomized control trial on a sample of 24 subjects who did not take any hypertension medications. There was a statistically significant decrease in systolic blood pressure and an increase in lower and upper-body strength in the group following Nordic-walking training. There was a decrease in serum levels of total cholesterol, triglycerides, and low-density cholesterol. The obtained results indicate that an 8-week Nordic-walking program may be efficiently employed for counteracting systolic hypertension through a direct abatement of systolic blood pressure and an increase of maximal aerobic capacity.

Evaluation of ventricular function in patients with coronary artery disease

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Rocco, T.P.; Dilsizian, V.; Fischman, A.J.; Strauss, H.W.

1989-01-01

The recent expansion of interventional cardiovascular technologies has stimulated a concomitant expansion of noninvasive cardiac studies, both to assist in diagnosis and to evaluate treatment outcomes. Radionuclide ventricular function studies provide a reliable, reproducible means to quantify global left ventricular systolic performance, a critical determinant of prognosis in patients with cardiovascular disease. In addition, the ability to evaluate regional left ventricular wall motion and to assess ventricular performance during exercise have secured a fundamental role for such studies in the screening and treatment of patients with coronary artery disease. Radionuclide techniques have been extended to the evaluation of left ventricular relaxation/filling events, left ventricular systolic/diastolic function in the ambulatory setting, and with appropriate technical modifications, to the assessment of right ventricular performance at rest and with exercise. As a complement to radionuclide perfusion studies, cardiac blood-pool imaging allows for thorough noninvasive description of cardiac physiology and function in both normal subjects and in patients with a broad range of cardiovascular diseases. 122 references

Do implantable cardioverter defibrillators improve survival in patients with severe left ventricular systolic dysfunction after coronary artery bypass graft surgery?

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Fazal, Iftikhar A; Bates, Matthew G D; Matthews, Iain G; Turley, Andrew J

2011-06-01

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether implantable cardioverter defibrillators (ICD) improve survival in patients with severe left ventricular systolic dysfunction (LVSD) after coronary artery bypass graft (CABG) surgery. ICDs are designed to terminate potentially fatal cardiac tachyarrhythmias. A right ventricular lead is mandatory for detection, pacing and defibrillation capabilities. Dual chamber ICDs have an additional right atrial lead and are used for patients with conventional atrioventricular pacing indications. More sophisticated, biventricular devices exist to provide cardiac resynchronisation therapy (CRT) in addition to defibrillation (CRT-D). ICDs have been extensively investigated in patients with LVSD post myocardial infarction and in patients with non-ischaemic cardiomyopathy for both secondary prevention (history of ventricular arrhythmias) and primary prevention (deemed high risk for ventricular arrhythmias). This best evidence topic aims to review the evidence and its applicability to patients post CABG. Nine hundred and sixteen papers were identified using the search method outlined. Eight randomised controlled trials, two meta-analyses, and one non-randomised trial, in addition to international guidelines presented the best evidence to answer the clinical question. The current evidence base and guidelines suggest that ICDs should be considered for all patients with LVSD [ejection fraction (EF) ≤30-40%] receiving optimal pharmacological management, who are ≥40 days post MI [four weeks for National Institute for Health and Clinical Excellence (NICE)] and in New York Heart Association (NYHA) class I-III. UK NICE guidelines require in addition; non-sustained ventricular tachycardia (NSVT) on a Holter monitor and inducible ventricular tachycardia at electrophysiological study for EF between 30 and 35%; or a QRS >120 ms if EF <30%. The North American guidelines

Biosensor cell assay for measuring real-time aldosterone-induced release of histamine from mesenteric arteries

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Dalgaard, Emil G; Andersen, Kenneth; Svenningsen, Per

2017-01-01

as a sensitive biosensor assay for histamine release from isolated mouse mesenteric arteries. Activation of the H1 receptor by histamine was measured as an increased number of intracellular Ca(2+) transient peaks using fluorescence imaging RESULTS: The developed biosensor was sensitive to histamine...... in physiological relevant concentrations and responded to substances released by the artery preparation. Aldosterone treatment of mesenteric arteries from wild type mice for 50 minutes resulted in an increased number of intracellular Ca(2+) transient peaks in the biosensor cells, which was significantly inhibited...... by the histamine H1 blocker pyrilamine. Mesenteric arteries from mast cell deficient SASH mice induced similar pyrilamine-sensitive Ca(2+) transient response in the biosensor cells. Mesenteric arteries from wild type and SASH mice expressed histamine decarboxylase mRNA, indicating that mast cells are not the only...

Ulnar Artery Compression: A Feasible and Effective Approach to Prevent the Radial Artery Occlusion after Coronary Intervention

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Jun Tian

2015-01-01

Full Text Available Background: Radial artery (RA occlusion (RAO is not rare in patients undergoing coronary intervention by transradial approach (TRCI. Predictors of and prevention from RAO have not been systematically studied. This study aimed to analyze the risk factors of the weakness of RA pulsation (RAP and its predictive value for RAO after TRCI, and simultaneously to describe a feasible and effective approach to maintain RA patency. Methods: Between June 2006 and March 2010, all patients who underwent TRCI were classified according to the weakness of RAP after removing compression bandage with confirmation by Doppler ultrasound for the first 30 consecutive patients. Among a total of 2658 patients studied, 187 (7% patients having a weaker RAP were prospectively monitored. At 1 h after bandage removal, the ulnar artery in puncture side of all patients was blocked with manual compression to favor brachial and collateral artery blood flow through the RA until a good RAP was restored. The primary analysis was the occurrence of RAO. Results: Doppler ultrasound demonstrated the significant reduction of both systolic velocity (61.24 ± 3.95 cm/s vs. 72.31 ± 3.57 cm/s and diastolic velocity (1.83 ± 0.32 cm/s vs. 17.77 ± 3.97 cm/s in RA at access side as compared to the contralateral RA (all P < 0.001, but these velocities in ipsilateral ulnar artery (81.2 ± 2.16 cm/s and 13.1 ± 2.86 cm/s, respectively increased profoundly. The average time of ulnar artery compression was 4.1 ± 1.2 h (ranged 2.5-6.5 h. There were two patients experienced persistent RAO with a success rate of 98.9% and RAO in 0.075% of patients after ulnar artery compression was applied. The pulsation of the ulnar artery after compression was removed had not been influenced by the compression. Conclusions: After intervention using TRCI approach, the presence of a weaker RAP is an indicator of imminent RAO. The continuing compression of ipsilateral ulnar artery is an effective approach to

Does dairy food intake predict arterial stiffness and blood pressure in men?: Evidence from the Caerphilly Prospective Study.

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Livingstone, Katherine M; Lovegrove, Julie A; Cockcroft, John R; Elwood, Peter C; Pickering, Janet E; Givens, D Ian

2013-01-01

Arterial stiffness is an independent predictor of cardiovascular disease events and mortality, and like blood pressure, may be influenced by dairy food intake. Few studies have investigated the effects of consumption of these foods on prospective measures of arterial stiffness. The present analysis aimed to investigate the prospective relationship between milk, cheese, cream, and butter consumption and aortic pulse wave velocity, augmentation index, systolic and diastolic blood pressure, as well as cross-sectional relationships between these foods and systolic and diastolic blood pressure and metabolic markers using data from the Caerphilly Prospective Study. Included in this cohort were 2512 men, aged 45 to 59 years, who were followed up at 5-year intervals for a mean of 22.8 years (number follow-up 787). Augmentation index was 1.8% lower in subjects in the highest quartiles of dairy product intake compared with the lowest (P trend=0.021), whereas in the highest group of milk consumption systolic blood pressure was 10.4 mm Hg lower (P trend=0.033) than in nonmilk consumers after a 22.8-year follow-up. Cross-sectional analyses indicated that across increasing quartiles of butter intake, insulin (P trend=0.011), triacylglycerol (P trend=0.023), total cholesterol (P trend=0.002), and diastolic blood pressure (P trend=0.027) were higher. Across increasing groups of milk intake and quartiles of dairy product intake, glucose (P trend=0.032) and triglyceride concentrations (P trend=0.031) were lower, respectively. The present results confirm that consumption of milk predicts prospective blood pressure, whereas dairy product consumption, excluding butter, is not detrimental to arterial stiffness and metabolic markers. Further research is needed to better understand the mechanisms that underpin these relationships.

Influence of ageing on carotid baroreflex peak response latency in humans

DEFF Research Database (Denmark)

Fisher, J.P.; Kim, A.; Young, C.N.

2009-01-01

The stability of a physiological control system, such as the arterial baroreflex, depends critically upon both the magnitude (i.e. gain or sensitivity) and timing (i.e. latency) of the effector response. Although studies have examined resting arterial baroreflex sensitivity in older subjects......, little attention has been given to the influence of ageing on the latency of peak baroreflex responses. First, we compared the temporal pattern of heart rate (HR) and mean arterial blood pressure (BP) responses to selective carotid baroreceptor (CBR) unloading and loading in 14 young (22 +/- 1 years......) and older (61 +/- 1 years) subjects, using 5 s pulses of neck pressure (NP, +35 Torr) and neck suction (NS, -80 Torr). Second, CBR latency was assessed following pharmacological blockade of cardiac parasympathetic nerve activity in eight young subjects, to better understand how known age-related reductions...

Estimation of the displacement of cardiac substructures and the motion of the coronary arteries using electrocardiographic gating

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Tan W

2013-09-01

Full Text Available Wenyong Tan,1,* Liying Xu,2,* Xiaohong Wang,1 Dasheng Qiu,3 Guang Han,1 Desheng Hu1 1Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, People’s Republic of China; 2Department of Radiology, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China; 3PET-CT Center, Hubei Cancer Hospital, Wuhan, People’s Republic of China *These authors have contributed equally to this paper Purpose: The aim of this study was to quantify the displacement of cardiac substructures, including the anterior myocardial territory (AMT, left ventricle, and coronary arteries during a normal cardiac cycle. Materials and methods: Computed tomography (CT images with retrospective electrocardiographic gating of 17 eligible patients were obtained. All images were reconstructed automatically for the end-diastolic and end-systolic phases. CT scanning without contrast at a random phase and a selected vertebral body were used as references to measure three-dimensionaldisplacements of the cardiac substructures. Results: The displacement between the end-diastolic and end-systolic phases (Dd-s was greater than that between the end-systolic and random phases and between the end-diastolic and random cardiac phases. The largest displacements for the heart were in the left, posterior, and inferior directions with an average Dd-s of approximately 4–6 mm. The average Dd-s for the AMT and left ventricle was 1.2–2.7 mm in the anterior and right directions, 4.3–7.8 mm in left and posterior directions, and 4.9–6.3 mm in superior and inferior directions. For the coronary arteries, the average Dd-s was 2.8–5.9 mm in the anterior-posterior direction, 3.5–6.6 mm in left-right direction, and 3.8–5.3 mm in the superior-inferior direction. Inter-observer agreement was excellent for the heart, AMT, and left ventricle (kappa coefficient, >0.75 for all and good for most coronary arteries in three dimensions (kappa coefficient, 0.511–0.687. The Dd-s did not

Coronary artery assessment by multidetector computed tomography in patients with prosthetic heart valves

International Nuclear Information System (INIS)

Habets, Jesse; Mali, Willem P.T.M.; Budde, Ricardo P.J.; Brink, Renee B.A. van den; Uijlings, Ruben; Spijkerboer, Anje M.; Chamuleau, Steven A.J.

2012-01-01

Patients with prosthetic heart valves may require assessment for coronary artery disease. We assessed whether valve artefacts hamper coronary artery assessment by multidetector CT. ECG-gated or -triggered CT angiograms were selected from our PACS archive based on the presence of prosthetic heart valves. The best systolic and diastolic axial reconstructions were selected for coronary assessment. Each present coronary segment was scored for the presence of valve-related artefacts prohibiting coronary artery assessment. Scoring was performed in consensus by two observers. Eighty-two CT angiograms were performed on a 64-slice (n = 27) or 256-slice (n = 55) multidetector CT. Eighty-nine valves and five annuloplasty rings were present. Forty-three out of 1160 (3.7%) present coronary artery segments were non-diagnostic due to valve artefacts (14/82 patients). Valve artefacts were located in right coronary artery (15/43; 35%), left anterior descending artery (2/43; 5%), circumflex artery (14/43; 32%) and marginal obtuse (12/43; 28%) segments. All cobalt-chrome containing valves caused artefacts prohibiting coronary assessment. Biological and titanium-containing valves did not cause artefacts except for three specific valve types. Most commonly implanted prosthetic heart valves do not hamper coronary assessment on multidetector CT. Cobalt-chrome containing prosthetic heart valves preclude complete coronary artery assessment because of severe valve artefacts. circle Most commonly implanted prosthetic heart valves do not hamper coronary artery assessment circle Prosthetic heart valve composition determines the occurrence of prosthetic heart valve-related artefacts circle Bjoerk-Shiley and Sorin tilting disc valves preclude diagnostic coronary artery segment assessment. (orig.)

Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

International Nuclear Information System (INIS)

Lee, Heon; Kim, Seok Yeon; Lee, Soo Jeong; Kim, Jae Kyun; Reddy, Ryan P.; Schoepf, U.J.

2012-01-01

To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. 104 patients (72.47 ± 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RV V /LV V ) were calculated. RV V /LV V was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. In the hypertensive group, the mean PASP was 46.29 ± 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RV V /LV V and PASP (R = 0.82, p V /LV V were 0.990 and 0.892. RV V /LV V was 1.01 ± 0.44 (0.51-2.77) in the hypertensive and 0.72 ± 0.14 (0.52-1.11) in the normotensive group (P V /LV V , sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity. (orig.)

Disruption of transitional stages in 24-h blood pressure in renal transplant recipients

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Marcelo E Katz

2012-03-01

Full Text Available Patients with kidney replacement exhibit disrupted circadian rhythms. Most studies measuring blood pressure use the dipper/non-dipper classification, which does not consider analysis of transitional stages between low and high blood pressure, confidence intervals nor shifts in the time of peak, while assuming subjective onsets of night and day phases. In order to better understand the nature of daily variation of blood pressure in these patients, we analyzed 24h recordings from 41 renal transplant recipients using the non-symmetrical double-logistic fitting assessment which does not assume abruptness nor symmetry in ascending and descending stages of the blood pressure profile, and a cosine best-fitting regression method (Cosinor. Compared with matched controls, double-logistic fitting showed that the times for most of transitional stages (ascending systolic and descending systolic, diastolic and mean arterial pressure had a wider distribution along the 24 h. The proportion of individuals without daily blood pressure rhythm in the transplanted group was larger only for systolic arterial pressure, and the amplitude showed no significant difference. Furthermore, the transplant recipient group had a less pronounced slope in descending systolic and ascending mean blood pressure. Cosinor analysis confirmed the phase related changes, showing a wider distribution of times of peak (acrophases. We conclude that daily disruptions in renal transplant recipients can be explained not only by absence in diurnal variation, but also in changes in waveform-related parameters of the rhythm, and that distortions in the phase of the rhythm are the most consistent finding for the patients.

Reducing maternal mortality: Systolic blood pressure

African Journals Online (AJOL)

2006-03-21

Mar 21, 2006 ... While deaths due to fluid overload have ... of better fluid balance management, we have made .... systolic blood pressure plays a significant role in the .... one looks at the work of Martin et al.5 ... Promoting Healthy Life.

Acute interventional diagnosis and treatment of upper gastrointestinal arterial hemorrhage: its clinical value and influence factors

International Nuclear Information System (INIS)

Wang Yongli; Cui Shitao; Zhang Jiaxing; Ru Fuming; Xu Jiahua; Xu Jichong

2009-01-01

Objective: To evaluate emergent angiography and interventional management in treating massive upper gastrointestinal (GI) arterial hemorrhage, and to discuss the factors influencing the angiographic bleeding signs and the interventional therapeutic results. Methods: The clinical data of 56 patients with massive upper GI arterial hemorrhage, who underwent diagnostic arteriography and interventional management with trans-catheter vasopressin infusion and embolization, were retrospectively analyzed. Systolic blood pressure of both pre-and post-interventional therapy was recorded and statistically analyzed. The arteriographic positive rates were separately calculated according to the catheter tip's location, being placed at the 2nd grade branch or at the 3 rd -4 th grade branch of the artery, and the relation of the positive rate with the tip's location was analyzed. A comparison of the hemostatic effect between trans-catheter vasopressin infusion and trans-catheter embolization was made. Results: The average systolic blood pressure of pre-and post-procedure was (93.14 ± 18.63) mmHg and (11.64 ± 13.61) mmHg respectively, with a significant difference (P = 0.023). The angiographic bleeding signs were demonstrated in 12 cases (21.4%) with the catheter's tip at the 2nd grade branch and in 56 cases (100%) with the catheter's tip at the 3 rd -4 th grade branch,the difference between the two was of statistically significance (P < 0.05). The technical success rate and the clinical hemostasis rate of via catheter vasopressin infusion was 80% (16 / 20) and 55% (11/20) respectively. Of nine re-bleeding cases, seven were successfully controlled with embolization therapy by using microcatheter and two had to receive surgery because of arterial rupture which was proved by angiography. The technical and the clinical rates of success for transcatheter embolization therapy were 93% (42 / 45) and 89% (40 / 45) respectively. Recurrence of bleeding was seen in two patients who got

Spectral color Doppler in the diagnosis and follow-up of Graves' disease

International Nuclear Information System (INIS)

Sponza, Massimo; Bertolotto, Michele; Ricci, Claudio; Fabris, Bruno; Armini, Lorenzo

1997-01-01

Hyperthyroidism in Graves' disease is caused by the presence of circulating autoantibodies to the THS receptors on the thyroid cells. Thyroid-suppression therapy prevents hormone production directly, without affecting the pathogenetic process. They performed color Doppler US of the thyroid gland and pulsed Doppler analysis of thyroid artery flow in 21 patients with Graves' disease before and during medical treatment. US results were compared with those of a control group of 40 healthy subjects and correlated with the values of thyroid hormones, TSH and thyroid microsomal and thyroglobulin antibodies. The thyroid gland was hypo vascularized in the control group. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity of PSV 20 ± 4 cm/s, diastolic velocity of 8 ± 1 cm/s, and resistive index of 0.60 ± 0.04. The thyroid gland of Graves' disease patients was hyper vascularized. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity (PSV = 51 ± 12 cm/s), end diastolic velocity (VD = 15 ± 4 cm/s) and resistive index (RI = 0.71 ± 0.04) significantly higher than in normal subjects (p < 0.001). Circulating thyroid hormones and flow parameters normalized after 6-8 months of medical therapy (PSV = 20 ± 6 cm/s, VD = 9 ± 3 cm(s, RI = 0.58 ± 0.07). The color Doppler patterns normalized only in a patient with normal TSH and antibodies. Sampling of the thyroid arteries proved more repeatable than sampling of parenchymal vessels

Spectral color Doppler in the diagnosis and follow-up of Graves` disease; Ruolo dell`eco color Doppler e dell`analisi flussimetrica nella diagnosi e nel follow-up della malattia dei Graves

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Sponza, Massimo; Bertolotto, Michele; Ricci, Claudio [Ospedale di Cattinara, Trieste (Italy). Istituto di Medicina Clinica; Fabris, Bruno; Armini, Lorenzo [Ospedale di Cattinara, Trieste (Italy). Istituto di Radiologia

1997-04-01

Hyperthyroidism in Graves` disease is caused by the presence of circulating autoantibodies to the THS receptors on the thyroid cells. Thyroid-suppression therapy prevents hormone production directly, without affecting the pathogenetic process. They performed color Doppler US of the thyroid gland and pulsed Doppler analysis of thyroid artery flow in 21 patients with Graves` disease before and during medical treatment. US results were compared with those of a control group of 40 healthy subjects and correlated with the values of thyroid hormones, TSH and thyroid microsomal and thyroglobulin antibodies. The thyroid gland was hypo vascularized in the control group. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity of PSV 20 {+-} 4 cm/s, diastolic velocity of 8 {+-} 1 cm/s, and resistive index of 0.60 {+-} 0.04. The thyroid gland of Graves` disease patients was hyper vascularized. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity (PSV = 51 {+-} 12 cm/s), end diastolic velocity (VD = 15 {+-} 4 cm/s) and resistive index (RI = 0.71 {+-} 0.04) significantly higher than in normal subjects (p < 0.001). Circulating thyroid hormones and flow parameters normalized after 6-8 months of medical therapy (PSV = 20 {+-} 6 cm/s, VD = 9 {+-} 3 cm/s, RI = 0.58 {+-} 0.07). The color Doppler patterns normalized only in a patient with normal TSH and antibodies. Sampling of the thyroid arteries proved more repeatable than sampling of parenchymal vessels.

Risk following hospitalization in stable chronic systolic heart failure

DEFF Research Database (Denmark)

Abrahamsson, Putte; Swedberg, Karl; Borer, Jeffrey S

2013-01-01

We explored the impact of being hospitalized due to worsening heart failure (WHF) or a myocardial infarction (MI) on subsequent mortality in a large contemporary data set of patients with stable chronic systolic heart failure (HF).......We explored the impact of being hospitalized due to worsening heart failure (WHF) or a myocardial infarction (MI) on subsequent mortality in a large contemporary data set of patients with stable chronic systolic heart failure (HF)....

Electrocardiograph-gated single photon emission computed tomography radionuclide angiography presents good interstudy reproducibility for the quantification of global systolic right ventricular function.

Science.gov (United States)

Daou, Doumit; Coaguila, Carlos; Vilain, Didier

2007-05-01

Electrocardiograph-gated single photon emission computed tomography (SPECT) radionuclide angiography provides accurate measurement of right ventricular ejection fraction and end-diastolic and end-systolic volumes. In this study, we report the interstudy precision and reliability of SPECT radionuclide angiography for the measurement of global systolic right ventricular function using two, three-dimensional volume processing methods (SPECT-QBS, SPECT-35%). These were compared with equilibrium planar radionuclide angiography. Ten patients with chronic coronary artery disease having two SPECT and planar radionuclide angiography acquisitions were included. For the right ventricular ejection fraction, end-diastolic volume and end-systolic volume, the interstudy precision and reliability were better with SPECT-35% than with SPECT-QBS. The sample sizes needed to objectify a change in right ventricular volumes or ejection fraction were lower with SPECT-35% than with SPECT-QBS. The interstudy precision and reliability of SPECT-35% and SPECT-QBS for the right ventricle were better than those of equilibrium planar radionuclide angiography, but poorer than those previously reported for the left ventricle with SPECT radionuclide angiography on the same population. SPECT-35% and SPECT-QBS present good interstudy precision and reliability for right ventricular function, with the results favouring the use of SPECT-35%. The results are better than those of equilibrium planar radionuclide angiography, but poorer than those previously reported for the left ventricle with SPECT radionuclide angiography. They need to be confirmed in a larger population.

Correlation of Color Doppler with Multidetector CT Angiography Findings in Carotid Artery Stenosis

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Živorad N. Savic

2010-01-01

Full Text Available The aim of this paper was to examine the correlation between the Color Doppler ultrasound (CD-US and multidetector CT angiography (MDCTA diagnostic methods, and to define the degree and extent of stenosis in patients with internal carotid artery stenosis. This was a cross-sectional study with a consecutive series of patients. All US examinations were always carried out by the same physician-angiologist, while all CT examinations were always carried out by the same physician-radiologist. Both worked independently from each other. The stenosis area was measured at the narrowest point by NASCET criteria for US/CT. Peak systolic velocity (PSV over 210 cm/sec and end diastolic velocity (EDV over 110 cm/sec criteria were applied for stenoses with lumen narrowed over 70%, while PSV under 130 cm/sec and EDV under 100 cm/sec criteria were applied for those with lumen narrowed under 70%. A total of 124 carotid arteries were observed; namely, 89 narrowed and 68 surgically treated. All patients were reviewed by US and then by MDCTA; patients with 70–99% stenosis underwent surgery. The correlation coefficient between stenosis degree measured by US and MDCTA was 0.922; p 0.05. The US and CT matching level for stenoses from 70 to 99% was very high (κ = 0.778, p < 0.01. In conclusion, there is a highly significant statistical correlation among both diagnostic methods when measuring stenosis degree and extent. US is more dependent on the physician, while MDCTA is more objective and independent from the physician. We think it would be appropriate to undertake an MDCTA exam for those patients who are candidates for carotid endarterectomy.

Systolic automata for VLSI on balanced trees

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Culik, K Ii; Gruska, J; Salomaa, A

1983-01-01

Systolic tree automata with a binary (or, more generally, balanced) underlying tree are investigated. The main emphasis is on input conditions, decidability, and characterization of acceptable languages. 4 references.

Downstream Hepatic Arterial Blood Pressure Changes Caused by Deployment of the Surefire AntiReflux Expandable Tip

International Nuclear Information System (INIS)

Rose, Steven C.; Kikolski, Steven G.; Chomas, James E.

2013-01-01

Purpose: The purpose of this work was to evaluate blood pressure changes caused by deployment of the Surefire antireflux expandable tip. The pressure measurements are relevant because they imply changes in hepatoenteric arterial blood flow within this liver compartment during hepatic artery delivery of cytotoxic agents. Methods: After positioning the Surefire antireflux system in the targeted hepatic artery, blood pressure was obtained initially with the tip collapsed (or through a femoral artery sheath), then again after the tip was expanded before chemoembolization or yttrium 90 ( 90 Y) radioembolization. Results: Eighteen patients with liver malignancy underwent 29 procedures in 29 hepatic arteries (3 common hepatic, 22 lobar, 4 segmental). Systolic, diastolic, and mean blood pressure were all decreased by a mean of 29 mm Hg (p = 0.000004), 14 mm Hg (p = 0.0000004), and 22 mm Hg (p = 0.00000001), respectively. Conclusion: When the Surefire expandable tip is deployed to prevent retrograde reflux of agents, it also results in a significant decrease in blood pressure in the antegrade distribution, potentially resulting in hepatopedal blood flow in vessels that are difficult to embolize, such as the supraduodenal arteries

MRI-based flow measurements in the main pulmonary artery to detect pulmonary arterial hypertension in patients with cystic fibrosis; MRT-basierte Flussmessungen im Truncus pulmonalis zur Detektion einer pulmonal-arteriellen Hypertonie in Patienten mit zystischer Fibrose

Energy Technology Data Exchange (ETDEWEB)

Wolf, T.; Anjorin, A.; Abolmaali, N. [TU Dresden (Germany). OncoRay, Biologisches und Molekulares Imaging; Posselt, H. [Frankfurt Univ. (Germany). Klinik fuer Paediatrie I, Muskoviszidoseambulanz; Smaczny, C. [Frankfurt Univ. (Germany). Medizinische Klinik I, Pneumologie und Allergologie; Vogl, T.J. [Frankfurt Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

2009-02-15

Development of pulmonary arterial hypertension (PH) is a common problem in the course of patients suffering from cystic fibrosis (CF). This study was performed to evaluate MRI based flow measurements (MR{sub venc}; Velocity ENCoding) to detect signs of an evolving PH in patients suffering from CF. 48 patients (median age: 16 years, range: 10 - 40 years, 25 female) suffering from CF of different severity (mean FEV1: 74 % {+-} 23, mean Shwachman-score: 63 {+-} 10) were examined using MRI based flow measurements of the main pulmonary artery (MPA). Phase-contrast flash sequences (TR: 9.6 ms, TE: 2.5 ms, bandwidth: 1395 Hertz/Pixel) were utilized. Results were compared to an age- and sex-matched group of 48 healthy subjects. Analyzed flow data where: heart frequency (HF), cardiac output (HZV), acceleration time (AT), proportional acceleration time related to heart rate (ATr), mean systolic blood velocity (MFG), peak velocity (Peak), maximum flow (Fluss{sub max}), mean flow (Fluss{sub mitt}) and distensibility (Dist). The comparison of means revealed significant differences only for MFG, Fluss{sub max} and Dist, but overlap was marked. However, using a scatter-plot of AT versus MFG, it was possible to identify five CF-patients demonstrating definite signs of PH: AT = 81 ms {+-} 14, MFG = 46 {+-} 11 cm/s, Dist = 41 % {+-} 7. These CF-patients where the most severely affected in the investigated group, two of them were listed for complete heart and lung transplantation. The comparison of this subgroup and the remaining CF-patients revealed a highly significant difference for the AT (p = 0.000001) without overlap. Screening of CF-patients for the development of PH using MR{sub venc} of the MPA is not possible. In later stages of disease, the quantification of AT, MFG and Dist in the MPA may be useful for the detection, follow-up and control of therapy of PH. MR{sub venc} of the MPA completes the MRI-based follow-up of lung parenchyma damage in patients suffering from CF

Determinants of exercise-induced pulmonary arterial hypertension in systemic sclerosis.

Science.gov (United States)

Voilliot, Damien; Magne, Julien; Dulgheru, Raluca; Kou, Seisyou; Henri, Christine; Laaraibi, Saloua; Sprynger, Muriel; Andre, Béatrice; Pierard, Luc A; Lancellotti, Patrizio

2014-05-15

Exercise-induced pulmonary arterial hypertension (EIPH) in systemic sclerosis (SSc) has already been observed but its determinants remain unclear. The aim of this study was to determine the incidence and the determinants of EIPH in SSc. We prospectively enrolled 63 patients with SSc (age 54±3years, 76% female) followed in CHU Sart-Tilman in Liège. All patients underwent graded semi-supine exercise echocardiography. Systolic pulmonary arterial pressure (sPAP) was derived from the peak velocity of the tricuspid regurgitation jet and adding the estimation of right atrial pressure, both at rest and during exercise. Resting pulmonary arterial hypertension (PH) was defined as sPAP > 35 mmHg and EIPH as sPAP > 50 mmHg during exercise. The following formulas were used: mean PAP (mPAP) = 0.61 × sPAP + 2, left atrial pressure (LAP)=1.9+1.24 × left ventricular (LV) E/e' and pulmonary vascular resistance (PVR)=(mPAP-LAP)/LV cardiac output (CO) and slope of mPAP-LVCO relationship=changes in mPAP/changes in LVCO. Resting PH was present in 3 patients (7%) and 21 patients developed EIPH (47%). Patients with EIPH had higher resting LAP (10.3 ± 2.2 versus 8.8 ± 2.3 mmHg; p = 0.03), resting PVR (2.6 ± 0.8 vs. 1.4 ± 1.1 Woods units; p=0.004), exercise LAP (13.3 ± 2.3 vs. 9 ± 1.7 mmHg; p exercise PVR (3.6 ± 0.7 vs. 2.1 ± 0.9 Woods units; p = 0.02) and slope of mPAP-LVCO (5.8 ± 2.4 vs. 2.9 ± 2.1 mmHg/L/min; p age and gender, exercise LAP (β=3.1 ± 0.8; p=0.001) and exercise PVR (β=7.9 ± 1.7; p=0.0001) were independent determinants of exercise sPAP. EIPH is frequent in SSc patients and is mainly related to both increased exercise LV filling pressure and exercise PVR. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Postoperative Functional Outcome After Off-Pump Versus On-Pump Coronary Artery Bypass Grafting Using Gated Myocardial SPECT: A Comparison by Propensity Score Analysis

International Nuclear Information System (INIS)

Lee, Jong Jin; Paeng, Jin Chul; Lee, Dong Soo; Kim, Ki Bong; Chung, June Key; Lee, Myung Chul; Kang, Won Jun

2010-01-01

We evaluated the short-term and mid-term differences in perfusion and function after off-pump and on-pump coronary artery bypass grafting (CABG) using gated myocardial single photon emission computed tomography. A total of 70 patients with coronary artery disease who underwent CABG were included based on the propensity score matching results from 165 patients. Thirty-five patients underwent off-pump and 35 patients on-pump CABG. Rest 201 TI/dipyridamole stress 99m Tc-methoxyisobutylisonitrile gated single photon emission computed thermographs were performed preoperatively and postoperatively at short-term (103±23 days after surgery) and mid-term follow-up (502±111 days after surgery). Changes in left ventricular ejection fraction, end systolic volume, stress and rest segmental perfusion, and segmental wall thickening were compared between the two groups. The segments with preoperative rest 201 T1 uptake under 60% of maximum uptake were included in the segmental analysis. Left ventricular ejection fraction (P=0.001) and end systolic volume (P=0.008) showed significant improvement in both groups. There were no significant short-term and mid-term differences between the two groups in terms of left ventricular ejection fraction (P=0.309) and end systolic volume (P=0.938). Likewise, segmental rest (P=0.178) and stress perfusion (P=0.071), and systolic wall thickening (P=0.241) showed significant improvement in both groups with similar time courses. Off-pump CABG resulted in significant improvements in left ventricular ejection fraction, end systolic volume, and regional myocardial perfusion and function that are comparable to on-pump CABG at short-term and mid-term. Gated myocardial SPECT successfully revealed that off-pump CABG is as good as on-pump CABG from the viewpoint of myocardial perfusion and function.

Left ventricular mechanics in humans with high aerobic fitness: adaptation independent of structural remodelling, arterial haemodynamics and heart rate

Science.gov (United States)

Stöhr, Eric J; McDonnell, Barry; Thompson, Jane; Stone, Keeron; Bull, Tom; Houston, Rory; Cockcroft, John; Shave, Rob

2012-01-01

Individuals with high aerobic fitness have lower systolic left ventricular strain, rotation and twist (‘left ventricular (LV) mechanics’) at rest, suggesting a beneficial reduction in LV myofibre stress and more efficient systolic function. However, the mechanisms responsible for this functional adaptation are not known and the influence of aerobic fitness on LV mechanics during dynamic exercise has never been studied. We assessed LV mechanics, LV wall thickness and dimensions, central augmentation index (AIx), aortic pulse wave velocity (aPWV), blood pressure and heart rate in 28 males (age: 21 ± 2 years SD) with a consistent physical activity level (no change >6 months). Individuals were examined at rest and during exercise (40% peak exercise capacity) and separated post hoc into a moderate and high aerobic fitness group (: 49 ± 5 and 63 ± 7 ml kg−1 min−1, respectively, P 0.05). However, for the same AIx, the high group had significantly lower LV apical rotation (P = 0.002) and LV twist (P = 0.003) while basal rotation and strain indices did not differ between groups (P > 0.05). We conclude that young males with high aerobic fitness have lower LV apical rotation at rest and during submaximal exercise that can occur without changes in gross LV structure, arterial haemodynamics or heart rate. The findings suggest a previously unknown type of physiological adaptation of the left ventricle that may have important implications for exercise training in older individuals and patient populations in which exercise training has previously failed to show clear benefits for LV function. PMID:22431336

Octant vectorcardiography - the evaluation by peaks.

Science.gov (United States)

Laufberger, V

1982-01-01

From the Frank lead potentials a computer prints out an elementary table. Therein, the electrical space of left ventricle depolarization is divided into eight spatial parts labelled by numbers 1-8 and called octants. Within these octants six peaks are determined labelled with letters ALPR-IS. Their localization is described by six-digit topograms characteristic for each patient. From 300 cases of patients after myocardial infarction, three data bases were compiled enabling every case to be classified into classes, subclasses and types. The follow up of patients according to these principles gives an objective and detailed image about the progress of coronary artery disease.

The Posterior Cerebral Artery and its Main Cortical Branches Identified with Noninvasive Transcranial Color-Coded Duplex Sonography.

Science.gov (United States)

Frid, P E; Schreiber, S J; Pade, O; Doepp, F; Valdueza, J

2015-11-01

To differentiate PCA segments and cortical branches by means of transcranial color-coded duplex sonography (TCCD) and to measure flow parameters at rest and during visual stimulation. 60 healthy subjects with a good acoustic temporal bone window were examined. The main stem of the PCA (P1, P2 and P3) and 4 main cortical branches - the anterior temporal artery (ATA), the occipital temporal artery (OTA), the parietooccipital artery (POA) and the calcarine artery (CA) - were assessed using an axial transtemporal approach. Systolic and diastolic blood flow velocities (BFVs) were recorded at rest and during visual stimulation. Identification of the P1 segment of the PCA was successful in 97.5% (117/120) of cases. The P2 and P3 segments were visualized in all cases. The 4 main cortical branches could be identified to varying degrees: ATA in 88%, OTA in 96%, POA in 69% and CA in 62%. There was an evoked flow response in the P2 main stem and in all cortical branches. The most pronounced increase in diastolic/systolic BFV after visual stimulation test was seen in the CA (42%/35%), followed by P2 (30%/24%), the POA (27%/27%), the OTA (16%/13%) and the ATA (9%/8%). Insonation through the temporal bone window with TCCD confidently allows the assessment of the P1 to P3 segments of the PCA as well as the 2 proximal branches, the ATA and the OTA. An ultrasound-based classification of PCA anatomy and its cortical branches may be used as a noninvasive method for the evaluation of posterior circulation pathology.

Non-constrained monitoring of systolic blood pressure on a weighing scale

International Nuclear Information System (INIS)

Shin, Jae Hyuk; Lee, Kang Moo; Park, Kwang Suk

2009-01-01

In this study, we developed a novel technique for estimating non-constrained and cuffless blood pressure (BP) that was based on electrocardiogram (ECG) and ballistocardiogram (BCG). The BCG was non-invasively measured using a common electronic weighing scale when a subject was standing on it. The ECG was measured using three different methods: on the chest using Ag/AgCl electrodes, on the hands using dry electrodes and on the feet also using dry electrodes. For a BP correlated parameter, a time interval parameter, which was defined as the time difference between the ECG R-peak and BCG J-peak, was employed for evaluating and estimating beat-to-beat BP. Under a BP varying experiment with a Valsalva manoeuvre, the R–J intervals were extracted at every beat cycle and a systolic blood pressure (SBP) estimation equation was established using linear regression analysis for each subject. In the case of feet delivered ECG (F-ECG), an ensemble average technique synchronized at the BCG J-peak point was applied to extract the ECG signal from the feet. The performance of the proposed method was evaluated using Finapres, a non-invasive blood pressure measurement system, as a reference BP signal, and a scatter plot was used to find the regression line between the reference values and estimated BPs. A moving-window averaging technique was applied to remove the high-frequency noise in the R–J intervals and was applied to enhance the accuracy of the SBP estimation. For all individuals, the estimated SBP was similar to the measured SBP with a reliable correlation, which makes the proposed method suitable for use in a home healthcare system to monitor blood pressure on a weighing scale at the same time as measuring weight

Hipertensión arterial sistólica. Impacto sobre la enfermedad cerebrovascular.

Directory of Open Access Journals (Sweden)

María C. Valle Campo

2011-08-01

Full Text Available Fundamento: La aterosclerosis es un proceso multifactorial sobre el cual actúan varios factores de riesgo. Constituye la principal causa de muerte y de morbilidad en ingresados hospitalarios, y puede ocasionar una acentuada disminución del flujo sanguíneo hacia todos los órganos del cuerpo humano
Objetivo: Determinar el impacto de la hipertensión arterial sistólica sobre la enfermedad cerebrovascular.
Métodos: Se realizó un estudio transversal, observacional y analítico, en 59 fallecidos hipertensos. Se analizaron las arterias cerebrales y se cuantificó la lesión aterosclerótica y su variedad, aplicándose el sistema aterométrico, teniendo en cuenta los tipos de hipertensión arterial. Se emplearon procedimientos estadísticos (medidas de tendencia central y comparativos (prueba de comparación de media aritmética basadas en el test “t” de student.
Resultados: Los infartos cerebrales recientes fueron más frecuentes en hipertensos sistodiastólicos. No hubo diferencia significativa en cuanto a la edad en el momento de aparición de las lesiones para ambos sexos, pero las mujeres con hipertensión sistólica, fueron significativamente más dañadas desde el punto de vista morfométrico. Se observó correlación significativa para ambos grupos de hipertensos entre tipo de accidente cerebrovascular y variables del sistema aterométrico. Conclusiones: La hipertensión arterial sistólica es un factor importante en la génesis de la enfermedad vasculocerebral y está asociada con la progresión de la placa de ateroma.

SYSTOLIC HYPERTENSION. IMPACT ON CEREBROVASCULAR DISEASE

Background: Atherosclerosis is a multifactor process in which several risk factors are involved. It is the leading cause of death and morbidity in hospital admitted patients, and it may cause

Relationship of left ventricular, elastic and muscular arteries remodeling in patients with uncontrolled arterial hypertension

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S. Ya. Dotsenko

2013-04-01

Full Text Available Introduction. Uncontrolled hypertension is observed in 65-92% of hypertensive patients. It plays an important role in the development of adverse cardiovascular events and survival, which depend on subclinical target organ damage. There are reports on the relationship between ineffective hypertension control and left ventricular (LV hypertrophy or large arteries stiffness. However, the nature of the remodeling in uncontrolled hypertension remains poorly understood. Objective: to study the character and relationship of left ventricular and arterial remodeling depending on effectiveness of hypertension control. Design and method. We performed a study of 363 hypertensive patients (160 men and 203 women aged 50,8 ± 1,2 years without comorbidities, which were divided into 3 groups according to the effectiveness of blood pressure (BP control: 160 patients with controlled hypertension, 142 patients with uncontrolled hypertension and 61 patients with resistant hypertension. Uncontrolled BP based on measured systolic BP≥140 mmHg and diastolic BP≥90 mmHg. Remodeling indexes of left ventricular, elastic (common carotid and muscular (brachial artery were evaluated by the ultrasonic method. The severity and character of diastolic dysfunction, hypertrophy, types of remodeling and stiffness were assessed. Statistical processing of the results was performed using Student's t criterion and Pearson correlation analysis. Results and discussion. According to the results of the study, uncontrolled hypertension affected the development of subclinical cardiovascular lesions negatively. Thus, LV hypertrophy was detected more frequently in the third group (91,8% in resistant hypertension versus 46,8% in controlled hypertension, p<0,05. Differences in LV geometry with increasing of concentric remodeling types were also observed more frequently in the third group, where concentric remodeling and concentric hypertrophy types were founded in 14,8% and 59

Tricuspid annular plane systolic excursion and response to cardiac resynchronization therapy

DEFF Research Database (Denmark)

Kjaergaard, Jesper; Ghio, Stefano; St John Sutton, Martin

2011-01-01

The aims of this study were to evaluate tricuspid annular plane systolic excursion (TAPSE) as a predictor of left ventricular (LV) reverse remodeling and clinical benefit of cardiac synchronization therapy (CRT) and to evaluate the effect of CRT on TAPSE in patients with mildly symptomatic systol...

The effects of nisoldipine on left ventricular filling rate in patients with ischemic heart disease measured with radionuclide gated blood pool scintigraphy

International Nuclear Information System (INIS)

Otto, A.C.; Viviers, A.C.

1988-01-01

Nisoldipine is a newly developed calcium channel blocker with outstanding vasodilatory properties especially with regard to the coronary arteries. Thus it may find wide-spread application as a therapeutic agent in various ischemic heart disease syndromes. The purpose of this study was to evaluate the effect of nisoldipine on the diastolic function of the left ventricle (LV) in the clinical situation. A patient group on nisoldipine treatment was compared to a control group. In the nisoldipine group a maximum decrease of 17 mmHg in the mean systolic blood pressure with an increase in the mean peak ejection rate (0.78 EDV/s) and peak filling rate (0.52 EDV/s) were observed. Mean LV ejection fraction increased by 6.4% and the time to peak filling rate decreased by 36.5 ms. After eight weeks of treatment the acute effects of nisoldipine were similar to the previous study. Nisoldipine therefore tends to improve both the diastolic and systolic function of the left ventricle. (orig.)

[Effect of twirling-reinforcing-reducing needling manipulations on contents of serum acetylcholine and arterial NOS and cGMP in stress-induced hypertension rats].

Science.gov (United States)

Liu, Wei; Zhu, Ling-Qun; Chen, Si-Si; Lu, Shu-Chao; Tang, Jie; Liu, Qing-Guo

2015-04-01

To observe the effect of twirling-reinforcing or reducing needling manipulations on plasma acetylcholine (Ach) content and expression of nitric oxide synthetase (NOS) and cyclic guanosine monophosphate (cGMP) in thoracic artery tissue in stress-induced hypertension rats. A total of 60 male rats were randomly divided into blank control, model, acupuncture (no-needle-manipulation) , twirling-reinforcing needling and twirling-reducing needling groups (n = 12 in each group). The stress hypertension model was established by giving the animals with noise and electric shock stimulation (paw), twice a day for 15 days. Acupuncture stimulation was applied to bilateral "Taichong" (LR 3) for 1 min, followed by retaining the needles for 20 min. The treatment was conducted once daily for 7 days. Systolic blood pressure of the rat's tail was detected with non-invasive method and plasma Ach, and NOS and cGMP contents in the thoracic artery tissue were measured using ELISA method. Compared with the control group, the systolic blood pressure was significantly higher in the model group after 15 days' stress stimulation (P arterial NOS and cGMP were markedly down-regulated (P arterial cGMP content was found in the no-needle-manipulation group (P > 0.05). The effect of the twirling-reducing needling was superior to that of no-needle-manipulation and twirling-reinforcing needling in lowering blood pressure and raising plasma Ach content (P hypertensive effect in stress hypertension rats, which may be associated with its effects in raising blood Ach, and arterial NOS and cGMP levels.

The impact of renal artery stent revascularization on blood pressure: 1-year follow-up of 110 cases

International Nuclear Information System (INIS)

Wang Chao; Zou Yinghua; Yang Min; Wang Jian; Tong Xiaoqiang; Song Li

2007-01-01

Objective: To investigate the effect of renal artery revascularization through renal artery stenting(PTRAS)on blood pressure in patients with renal artery stenosis. Methods: During April 2000 through May 2005 110 cases of renal artery stenosis received PTRAS and followed up for at least 1 year with blood pressure measurements pre-and 1 year post-PTRAS. Results: The technical success rate was 100% for all 110 cases. The renal artery stenosis were decreased from 60%-100% before PTRAS to 0%-15% after the stent placement. There was significant difference between blood pressure pre-and 1 year post PTRAS. Systolic pressures decreased from(153 ± 32) mmHg to(131 ± 27) mmHg and diastolic pressures from(87 ± 19) mmHg to(75 ± 19) mmHg. The administration of antihypertensive diugs reduced from(2.6 ± 0.9 ) sorts to(1.9 ± 0.9) sorts. Conclusions: PTRAS revascularization is an effective procedure for blood pressure control in renal vascular hypertension during one year follow up. (authors)

[Oxygen peak consumption is a better predictor of cardiovascular risk than handgrip strength in older Chilean women].

Science.gov (United States)

Farías-Valenzuela, Claudio; Pérez-Luco, Cristian; Ramírez-Campillo, Rodrigo; Álvarez, Cristian; Castro-Sepúlveda, Mauricio

Handgrip strength (HS) and peak oxygen consumption (Vo2peak) are powerful predictors of cardiovascular risk, although it is unknown which of the two variables is the better predictor. The objective of the following study was to relate HS and Vo2peak to cardiovascular risk markers in older Chilean women. Physically active adult women (n=51; age, 69±4.7years) participated in this study. The HS and Vo2peak were evaluated and related to the anthropometric variables of body mass, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist ratio (WR), and waist height ratio (WHR), as well as with the cardiovascular variables systolic (SBP) and diastolic (DBP) and cardiac recovery in one minute (RHR1). A multilinear regression model was used for the analysis of the associated variables (Pcardiovascular risk markers associated (Pcardiovascular risk markers, Vo2peak offers greater associative power with these cardiovascular risk factors. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk stratification: a systemic review and meta-analysis.

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Singh, Sukhchain; Sethi, Ankur; Singh, Mukesh; Khosla, Kavia; Grewal, Navsheen; Khosla, Sandeep

2015-08-01

Association of inter-arm systolic blood pressure difference (IASBPD) with cardiovascular (CV) morbidity and mortality remains controversial. We aimed to thoroughly examine all available evidence on inter-limb blood pressure (BP) difference and its association with CV risk and outcomes. We searched PubMed, EMBASE, CINAHL, Cochrane library, and Ovid for studies reporting bilateral simultaneous BP measurements in arms or legs and risk of peripheral arterial disease (PAD), coronary artery disease, cerebrovascular disease, subclavian stenosis, or mortality. Random-effect meta-analysis was performed to compare effect estimates. Twenty-seven studies met inclusion criteria, but only 17 studies (18 cohorts) were suitable for analysis. IASBPD of 10 mmHg or more was associated with PAD (risk ratios, 2.22; 1.41-3.5; P = .0006; sensitivity 16.6%; 6.7-35.4; specificity 91.9%; 83.1-96.3; 8 cohorts; 4774 subjects), left ventricular mass index (standardized mean difference 0.21; 0.03-0.39; P = .02; 2 cohort; 1604 subjects), and brachial-ankle pulse wave velocity (PWV) (one cohort). Association of PAD remained significant at cutoff of 15 mmHg (risk ratios, 1.91; 1.28-2.84; P = .001; 5 cohorts; 1914 subjects). We could not find statistically significant direct association of coronary artery disease, cerebrovascular disease, CV, and all-cause mortality in subjects with IASBPD of 10 mmHg or more, 15 mmHg or more, and inter-leg systolic BP difference of 15 mmHg or more. Inter-leg BP difference of 15 mmHg or more was strong predictor of PAD (P = .0001) and brachial-ankle PWV (P = .0001). Two invasive studies showed association of IASBPD and subclavian stenosis (estimates could not be combined). In conclusion, inter-arm and leg BP differences are strong predictors of PAD. IASBPD may be associated with subclavian stenosis, high left ventricular mass effect, and higher brachial-ankle PWVs. Inter-leg BP difference may also be associated with high left ventricular mass effect and higher

Characterization of volumetric flow rate waveforms at the carotid bifurcations of older adults

International Nuclear Information System (INIS)

Hoi, Yiemeng; Xie, Yuanyuan J; Steinman, David A; Wasserman, Bruce A; Najjar, Samer S; Lakatta, Edward G; Ferruci, Luigi; Gerstenblith, Gary

2010-01-01

While it is widely appreciated that volumetric blood flow rate (VFR) dynamics change with age, there has been no detailed characterization of the typical shape of carotid bifurcation VFR waveforms of older adults. Toward this end, retrospectively gated phase contrast magnetic resonance imaging was used to measure time-resolved VFR waveforms proximal and distal to the carotid bifurcations of 94 older adults (age 68 ± 8 years) with little or no carotid artery disease, recruited from the BLSA cohort of the VALIDATE study of factors in vascular aging. Timings and amplitudes of well-defined feature points from these waveforms were extracted automatically and averaged to produce representative common, internal and external carotid artery (CCA, ICA and ECA) waveform shapes. Relative to young adults, waveforms from older adults were found to exhibit a significantly augmented secondary peak during late systole, resulting in significantly higher resistance index (RI) and flow augmentation index (FAI). Cycle-averaged VFR at the CCA, ICA and ECA were 389 ± 74, 245 ± 61 and 125 ± 49 mL min −1 , respectively, reflecting a significant cycle-averaged outflow deficit of 5%, which peaked at around 10% during systole. A small but significant mean delay of 13 ms between arrivals of ICA versus CCA/ECA peak VFR suggested differential compliance of these vessels. Sex and age differences in waveform shape were also noted. The characteristic waveforms presented here may serve as a convenient baseline for studies of VFR waveform dynamics or as suitable boundary conditions for models of blood flow in the carotid arteries of older adults

Echocardiography in Arterial Hypertension.

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de Simone, Giovanni; Mancusi, Costantino; Esposito, Roberta; De Luca, Nicola; Galderisi, Maurizio

2018-05-02

Hypertension is a condition characterized by pressure and/or volume overloads and echocardiography is helpful and feasible to understand hemodynamic mechanisms. Echocardiographic information is sometimes critical and susceptible of modifying decision making. In this review, we provide detailed descriptions of the parameters that can be derived from a standard transthoracic echocardiogram, including some more recent techniques. We will also explain how each parameter might have impact in the evaluation of the hypertensive patient and give indications on when to refer patients to echo-labs, which parameters are critical and which ones might be redundant, and how to use the information obtained in the report. Cardiac geometry, LV systolic and diastolic function, LV pump performance, output impedance and left atrial function are parameters that might be altered in arterial hypertension, but not necessarily doctors need the whole information for decision making. The critical measures are provided.

Analysis of digital subtraction angiography for estimating flow reserve in critical coronary artery stenosis

International Nuclear Information System (INIS)

Kotoku, Shinya; Matsuzaki, Masunori; Otani, Nozomi

1988-01-01

To assess the accuracy of digital subtraction angiography in evaluating coronary flow reserve in cases with critical coronary artery stenosis, time-density curves were obtained from digital subtraction coronary angiograms in the myocardial region of interest. Time to peak contrast (TPC) and time constant of the washout exponential curve (T) were measured in 14 patients with stable effort angina pectoris and critical one vessel lesion before and after percutaneous transluminal coronary angioplasty (PTCA). All patients had normal left ventricular ejection fraction (59±7%) and 201 Tl myocardial images at rest. The values of TPC and T were significantly shortened from 5.4±1.3 to 4.5±1.0 sec (p<0.02) and from 10.9±3.8 to 5.3±1.3 sec (p<0.001) after PTCA, respectively. However, in 9 patients TPC values were approximately the same before and after PTCA. In five experimental dogs with critical circumflex coronary artery stenosis, coronary flow (CF; Doppler flowmeter) and systolic thickening of the posterior wall (by sonomicrometry) at rest did not differ from those of the controls. However, contrast media-induced reactive hyperemia was markedly attenuated, accompanied by a significant increase in T (7.7±4.5 vs 15.8±10.9 sec, p<0.01) and totally unchanged TPC (both 6.8 sec). With simultaneous tracings of CF and time-density curves, TPC and washout phases corresponded with contrast-induced transient CF reduction and hyperemic phases, respectively. We concluded that T may be more sensitive for estimating CF maintained nearly normal, e.g., in patients with stable effort angina pectoris having normal left ventricular wall motion at rest. (author)

Clinical observation of intraluminal stent angioplasty in the treatment of renal arterial stenoses

International Nuclear Information System (INIS)

Lu Yanwen; Zhang Jian; Huang Xianglong

2002-01-01

Objective: To evaluate the clinical application of intraluminal stent angioplasty (PTRAS) in the treatment of renal arterial stenoses. Methods: A retrospective study was done in 28 patients with renal arterial stenoses. Primary renal artery stenting was performed in 28 consecutive patients (36 renal arteries). Blood pressure, serum creating, the number of anti-hypertensive medications were recorded at 1, 6, 12 month post stent angioplasty respectively. Arterial angiography was also taken 1 year later to evaluate the incidence of restenosis. Results: Technical success rate was 100% achieving in all patients without serious complications. Primary successful patently rate reached 82% (renal artery 86%), secondary successful rate was 89% (renal artery 90%). Systolic and diastolic blood pressure were reduced significantly (P<0.01) at 1,6,12 month after stent angioplasty comparing with baseline and clinical improvement (cured + improved) of hypertension reached 100%, 92.9%, 89.3% respectively. There were no significant differences between serum creatine level and the number of anti-hypertensive medications before and after stent angioplasty. One year later, 14.3% of all patients showed improvement of renal function, 64.3% remained in stabilization and 21.4% fell into deterioration. Angiographic restenosis was found in 3 cases one year after stent angioplasty. Complications included 1 hematoma at puncture site and 3 transient azotaemia. Conclusions: PTRAS can be performed safely with high technical success and beneficial to the majority of patients with hypertension or renal insufficiency and therefore it should be the first choice in treating renal arterial stenoses

Assessment of Myocardial Bridge and Mural Coronary Artery Using ECG-Gated 256-Slice CT Angiography: A Retrospective Study

Directory of Open Access Journals (Sweden)

En-sen Ma

2013-01-01

Full Text Available Recent clinical reports have indicated that myocardial bridge and mural coronary artery complex (MB-MCA might cause major adverse cardiac events. 256-slice CT angiography (256-slice CTA is a newly developed CT system with faster scanning and lower radiation dose compared with other CT systems. The objective of this study is to evaluate the morphological features of MB-MCA and determine its changes from diastole to systole phase using 256-slice CTA. The imaging data of 2462 patients were collected retrospectively. Two independent radiologists reviewed the collected images and the diagnosis of MB-MCA was confirmed when consistency was obtained. The length, diameter, and thickness of MB-MCA in diastole and systole phases were recorded, and changes of MB-MCA were calculated. Our results showed that among the 2462 patients examined, 336 have one or multiple MB-MCA (13.6%. Out of 389 MB-MCA segments, 235 sites were located in LAD2 (60.41%. The average diameter change of MCA in LAD2 from systole phase to diastole phase was  mm, and 34.9% of MCA have more than 50% diameter stenosis in systole phase. This study suggested that 256-slice CTA multiple-phase reconstruction technique is a reliable method to determine the changes of MB-MCA from diastole to systole phase.

Effect of percutaneous coronary intervention on ventricular systolic synchrony and brain natriuretic peptide in acute myocardial infarction patients with aneurysm

International Nuclear Information System (INIS)

Xue Ling; Fu Xianghua; Liu Jun; Wu Weili; Li Liang; Miao Qing; Jiang Yunfa; Gu Xinshun

2010-01-01

Objective: To evaluate the reversed effect on the left ventricular aneurysm (LVA) formation and influence on systolic performance and synchrony using percutaneous coronary intervention (PCI) therapy in patients with acute myocardial infarction (AMI) at different time intervals equilibrium radionuclide angiography (ERNA). Methods: A total of 326 patients with primary anterior AMI accompanied LVA diagnosed by left ventricular graphy were enrolled in this study from January 2001 to July 2004. They were divided into 4 groups according to the time accepting PCI. Group A ( 1 week, n=76). The parameters of the paradox volume image of ventricular movement on the dynamic cine of cardiac blood pool, and the paradox volume index (PVI) as well as the parameters of left ventricular systolic function (LVSF), left ventricular diastolic function (LVDF) and left ventricular systolic synchrony (LVSS) were measured by ERNA with the ventricular phase analysis (PA) at 1st week and 6th month after AMI. The plasma brain natriuretic peptide (BNP) was measured in 18th hour, 5th day and 24th week after AMI. During 3-year follow-up, the major adverse cardiac events (MACE) were recorded.Analysis of variance and χ 2 -test were used. Results: At 6th month post AMI, the left ventricular ejection fraction (LVEF) in group A, B and C was increased than that in group D, hut phase shift (PS) and full width at half maximum (FWHM) were decreased (F=5.90, 6.80, all P 2 =10.05, P<0.05). Conclusion: The early, fully and permanently opening of infarction related artery can effectively inhibit the left ventricular remodeling process, improve its function, prevent LVA formation, and finally improve the prognosis. (authors)

Combined Circumferential and Longitudinal Left Ventricular Systolic Dysfunction in Patients with Rheumatoid Arthritis without Overt Cardiac Disease.

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Cioffi, Giovanni; Viapiana, Ombretta; Ognibeni, Federica; Dalbeni, Andrea; Gatti, Davide; Mazzone, Carmine; Faganello, Giorgio; Di Lenarda, Andrea; Adami, Silvano; Rossini, Maurizio

2016-07-01

Patients with rheumatoid arthritis have an increased risk for cardiovascular disease. Because of accelerated atherosclerosis and changes in left ventricular (LV) geometry, circumferential and longitudinal (C&L) LV systolic dysfunction (LVSD) may be impaired in these patients despite preserved LV ejection fraction. The aim of this study was to determine the prevalence of and factors associated with combined C&L LVSD in patients with rheumatoid arthritis. One hundred ninety-eight outpatients with rheumatoid arthritis without overt cardiac disease were prospectively analyzed from January through June 2014 and compared with 198 matched control subjects. C&L systolic function was evaluated by stress-corrected midwall shortening (sc-MS) and tissue Doppler mitral annular peak systolic velocity (S'). Combined C&L LVSD was defined if sc-MS was cite either of them in the other one and, afterward, we just did not think about this point anymore. Of note, the idea to combine in the analysis longitudinal function came therefore well after the starting process of revision of the paper E and was, in some way inspired by a reviewer's comment. That is why we did not put both findings in the same paper. We think that our explanations provide the broad audience of your journal a perspective of transparency and our respect for the readers' right to understand how the work described in the paper J relates to other work by our research group. Giovanni Cioffi On behalf of all co-authors Ombretta Viapiana, Federica Ognibeni, Andrea Dalbeni, Davide Gatti, Carmine Mazzone, Giorgio Faganello, Andrea Di Lenarda, Silvano Adami, and Maurizio Rossini. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Pulmonary artery wave propagation and reservoir function in conscious man: impact of pulmonary vascular disease, respiration and dynamic stress tests

DEFF Research Database (Denmark)

Su, Junjing; Manisty, Charlotte; Simonsen, Ulf

2017-01-01

Detailed haemodynamic analysis may provide novel insights into the pulmonary circulation. Therefore, wave intensity and reservoir-excess pressure analyses were applied in the pulmonary artery to characterize changes in wave propagation and reservoir function during spontaneous respiration......, recordings were also obtained during Valsalva manoeuvre and handgrip exercise. The asymptotic pressure at which the flow through the microcirculation ceases, the reservoir pressure related to arterial compliance and the excess pressure caused by arterial waves increased in PAH patients compared to controls....... The systolic and diastolic rate constants also increased, while the diastolic time constant decreased. The forward compression wave energy decreased by ∼8% in controls and ∼6% in PAH patients during expiration compared to inspiration, while the wave speed remained unchanged throughout the respiratory cycle...

Bovine aortic arch and idiopathic pulmonary artery aneurysm associated with bronchial compression

Directory of Open Access Journals (Sweden)

Süleyman Sezai Yıldız

2015-09-01

Full Text Available The left common carotid artery originating from the brachiocephalic trunk is termed the bovine aortic arch. Although it is the third most-common normal variant found in 9% humans, the origin of this term remains unclear. Until now, It has not been reported in the literature bovine aortic arch togetherness with pulmonary aneurysm and bronchial compression. Herein, we present a case with bovine aorta arch and pulmonary artery aneurysm associated with bronchial compression, which is incidentally detected by X-ray film. A 56-year-old Caucasian female admitted to the cardiology clinic with complaint of chest pain. Physical examination was unremarkable. Blood biochemistry values and cardiac markers were in normal range. Chest radiography revealed a widened mediastinum and prominent pulmonary conus with no active pulmonary disease. A subsequent transthoracic echocardiography revealed left ventricular hypertrophy, left atrial enlargement (diameter: 41 mm, mild mitral and tricuspid valve insufficiency, dilatation of main pulmonary artery (parasternal short-axis view diameter: 33 mm, normal pulmonary artery pressure and normal left ventricular systolic function. Computed tomography revealed bovine aortic arch associated with pulmonary artery aneurysm (diameter: 53 mm. And left main bronch of trachea was critically squeezed by aortic arch. Aortic and pulmonary vascular anomalies should be considered in patients with chest pain. And, identification with imaging modalities is important for prevention of chronic and irreversible complications.

The systolic blood pressure difference between arms and cardiovascular disease in the Framingham Heart Study.

Science.gov (United States)

Weinberg, Ido; Gona, Philimon; O'Donnell, Christopher J; Jaff, Michael R; Murabito, Joanne M

2014-03-01

An increased interarm systolic blood pressure difference is an easily determined physical examination finding. The relationship between interarm systolic blood pressure difference and risk of future cardiovascular disease is uncertain. We described the prevalence and risk factor correlates of interarm systolic blood pressure difference in the Framingham Heart Study (FHS) original and offspring cohorts and examined the association between interarm systolic blood pressure difference and incident cardiovascular disease and all-cause mortality. An increased interarm systolic blood pressure difference was defined as ≥ 10 mm Hg using the average of initial and repeat blood pressure measurements obtained in both arms. Participants were followed through 2010 for incident cardiovascular disease events. Multivariable Cox proportional hazards regression analyses were performed to investigate the effect of interarm systolic blood pressure difference on incident cardiovascular disease. We examined 3390 (56.3% female) participants aged 40 years and older, free of cardiovascular disease at baseline, mean age of 61.1 years, who attended a FHS examination between 1991 and 1994 (original cohort) and from 1995 to 1998 (offspring cohort). The mean absolute interarm systolic blood pressure difference was 4.6 mm Hg (range 0-78). Increased interarm systolic blood pressure difference was present in 317 (9.4%) participants. The median follow-up time was 13.3 years, during which time 598 participants (17.6%) experienced a first cardiovascular event, including 83 (26.2%) participants with interarm systolic blood pressure difference ≥ 10 mm Hg. Compared with those with normal interarm systolic blood pressure difference, participants with an elevated interarm systolic blood pressure difference were older (63.0 years vs 60.9 years), had a greater prevalence of diabetes mellitus (13.3% vs 7.5%,), higher systolic blood pressure (136.3 mm Hg vs 129.3 mm Hg), and a higher total cholesterol

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results.

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Zhang, Cao-Jin; Huang, Yi-Gao; Huang, Xin-Sheng; Huang, Tao; Huang, Wen-Hui; Xia, Chun-Li; Mo, Yu-Jing

2012-11-01

Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults. After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH, transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months after occlusion. Twenty-nine patients had successful occlusion, pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106 ± 25) mmHg vs. (50 ± 14) mmHg, P closure, the signs and symptoms improved markedly in all 29 patients, and PDAs were completely closed and remained closed during the follow-up. Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion. Nine patients whose pulmonary vascular resistence (PVR) > 6 Wood units accepted targeted PAH therapy. After 1 to 3 months of peroral drug therapy, their exercise tolerance improved from New York Heart Association (NYHA) class III-IV to NYHA class I. During follow-up, no latent arrhythmias were found, the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P closure of large PDA with severe PAH is feasible, effective, and safe in adults. Significant left ventricular systolic changes may occur after closure of large PDA, and left ventricular function usually recovers within a few months.

National variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis.

Science.gov (United States)

Arous, Edward J; Simons, Jessica P; Flahive, Julie M; Beck, Adam W; Stone, David H; Hoel, Andrew W; Messina, Louis M; Schanzer, Andres

2015-10-01

Carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis is among the most common procedures performed in the United States. However, consensus is lacking regarding optimal preoperative imaging, carotid duplex ultrasound criteria, and ultimately, the threshold for surgery. We sought to characterize national variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic CEA. The Society for Vascular Surgery Vascular Quality Initiative (VQI) database was used to identify all CEA procedures performed for asymptomatic carotid artery stenosis between 2003 and 2014. VQI currently captures 100% of CEA procedures performed at >300 centers by >2000 physicians nationwide. Three analyses were performed to quantify the variation in (1) preoperative imaging, (2) carotid duplex ultrasound criteria, and (3) threshold for surgery. Of 35,695 CEA procedures in 33,488 patients, the study cohort was limited to 19,610 CEA procedures (55%) performed for asymptomatic disease. The preoperative imaging modality used before CEA varied widely, with 57% of patients receiving a single preoperative imaging study (duplex ultrasound imaging, 46%; computed tomography angiography, 7.5%; magnetic resonance angiography, 2.0%; cerebral angiography, 1.3%) and 43% of patients receiving multiple preoperative imaging studies. Of the 16,452 asymptomatic patients (89%) who underwent preoperative duplex ultrasound imaging, there was significant variability between centers in the degree of stenosis (50%-69%, 70%-79%, 80%-99%) designated for a given peak systolic velocity, end diastolic velocity, and internal carotid artery-to-common carotid artery ratio. Although 68% of CEA procedures in asymptomatic patients were performed for an 80% to 99% stenosis, 26% were performed for a 70% to 79% stenosis, and 4.1% were performed for a 50% to 69% stenosis. At the surgeon level, the range in the percentage of CEA procedures performed for a duplex ultrasound

Pulse wave analysis in a 180-degree curved artery model: Implications under physiological and non-physiological inflows

Science.gov (United States)

Bulusu, Kartik V.; Plesniak, Michael W.

2013-11-01

Systolic and diastolic blood pressures, pulse pressures, and left ventricular hypertrophy contribute to cardiovascular risks. Increase of arterial stiffness due to aging and hypertension is an important factor in cardiovascular, chronic kidney and end-stage-renal-diseases. Pulse wave analysis (PWA) based on arterial pressure wave characteristics, is well established in clinical practice for evaluation of arterial distensibility and hypertension. The objective of our exploratory study in a rigid 180-degree curved artery model was to evaluate arterial pressure waveforms. Bend upstream conditions were measured using a two-component, two-dimensional, particle image velocimeter (2C-2D PIV). An ultrasonic transit-time flow meter and a catheter with a MEMS-based solid state pressure sensor, capable of measuring up to 20 harmonics of the observed pressure waveform, monitored flow conditions downstream of the bend. Our novel continuous wavelet transform algorithm (PIVlet 1.2), in addition to detecting coherent secondary flow structures is used to evaluate arterial pulse wave characteristics subjected to physiological and non-physiological inflows. Results of this study will elucidate the utility of wavelet transforms in arterial function evaluation and pulse wave speed. Supported by NSF Grant No. CBET- 0828903 and GW Center for Biomimetics and Bioinspired Engineering.

Searching Algorithms Implemented on Probabilistic Systolic Arrays

Czech Academy of Sciences Publication Activity Database

Kramosil, Ivan

1996-01-01

Roč. 25, č. 1 (1996), s. 7-45 ISSN 0308-1079 R&D Projects: GA ČR GA201/93/0781 Keywords : searching algorithms * probabilistic algorithms * systolic arrays * parallel algorithms Impact factor: 0.214, year: 1996

Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial.

Science.gov (United States)

Lal, Brajesh K; Beach, Kirk W; Roubin, Gary S; Lutsep, Helmi L; Moore, Wesley S; Malas, Mahmoud B; Chiu, David; Gonzales, Nicole R; Burke, J Lee; Rinaldi, Michael; Elmore, James R; Weaver, Fred A; Narins, Craig R; Foster, Malcolm; Hodgson, Kim J; Shepard, Alexander D; Meschia, James F; Bergelin, Robert O; Voeks, Jenifer H; Howard, George; Brott, Thomas G

2012-09-01

In the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), the composite primary endpoint of stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke thereafter did not differ between carotid artery stenting and carotid endarterectomy for symptomatic or asymptomatic carotid stenosis. A secondary aim of this randomised trial was to compare the composite endpoint of restenosis or occlusion. Patients with stenosis of the carotid artery who were asymptomatic or had had a transient ischaemic attack, amaurosis fugax, or a minor stroke were eligible for CREST and were enrolled at 117 clinical centres in the USA and Canada between Dec 21, 2000, and July 18, 2008. In this secondary analysis, the main endpoint was a composite of restenosis or occlusion at 2 years. Restenosis and occlusion were assessed by duplex ultrasonography at 1, 6, 12, 24, and 48 months and were defined as a reduction in diameter of the target artery of at least 70%, diagnosed by a peak systolic velocity of at least 3·0 m/s. Studies were done in CREST-certified laboratories and interpreted at the Ultrasound Core Laboratory (University of Washington). The frequency of restenosis was calculated by Kaplan-Meier survival estimates and was compared during a 2-year follow-up period. We used proportional hazards models to assess the association between baseline characteristics and risk of restenosis. Analyses were per protocol. CREST is registered with ClinicalTrials.gov, number NCT00004732. 2191 patients received their assigned treatment within 30 days of randomisation and had eligible ultrasonography (1086 who had carotid artery stenting, 1105 who had carotid endarterectomy). In 2 years, 58 patients who underwent carotid artery stenting (Kaplan-Meier rate 6·0%) and 62 who had carotid endarterectomy (6·3%) had restenosis or occlusion (hazard ratio [HR] 0·90, 95% CI 0·63-1·29; p=0·58). Female sex (1·79, 1·25-2·56), diabetes (2·31, 1·61-3·31

Dairy consumption, systolic blood pressure, and risk of hypertension

DEFF Research Database (Denmark)

Ding, Ming; Huang, Tao; Bergholdt, Helle Km

2017-01-01

Objective To examine whether previous observed inverse associations of dairy intake with systolic blood pressure and risk of hypertension were causal.Design Mendelian randomization study using the single nucleotide polymorphism rs4988235 related to lactase persistence as an instrumental variable...... blood pressure but not risk of hypertension (odds ratio 0.98, 0.97 to 1.00; P=0.11).Conclusion The weak inverse association between dairy intake and systolic blood pressure in observational studies was not supported by a comprehensive instrumental variable analysis and systematic review of existing...

Effects of Restoration of Blood Flow on the Development of Aortic Atherosclerosis in ApoE-/- Mice With Unilateral Renal Artery Stenosis.

Science.gov (United States)

Pathak, Alokkumar S; Huang, Jianhua; Rojas, Mauricio; Bazemore, Taylor C; Zhou, Ruihai; Stouffer, George A

2016-04-03

Chronic unilateral renal artery stenosis (RAS) causes accelerated atherosclerosis in apolipoprotein E-deficient (ApoE(-/-)) mice, but effects of restoration of renal blood flow on aortic atherosclerosis are unknown. Male ApoE(-/-) mice underwent sham surgery (n=16) or had partial ligation of the right renal artery (n=41) with the ligature being removed 4 days later (D4LR; n=6), 8 days later (D8LR; n=11), or left in place for 90 days (chronic RAS; n=24). Ligature removal at 4 or 8 days resulted in improved renal blood flow, decreased plasma angiotensin II levels, a return of systolic blood pressure to baseline, and increased plasma levels of neutrophil gelatinase associated lipocalin. Chronic RAS resulted in increased lipid staining in the aortic arch (33.2% [24.4, 47.5] vs 11.6% [6.1, 14.2]; Prenal blood flow at either 4 or 8 days after unilateral RAS had a beneficial effect on systolic blood pressure, aortic lipid deposition, and atheroma inflammation. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Clinical significance of inter-arm pressure difference and ankle-brachial pressure index in patients with suspected coronary artery disease

International Nuclear Information System (INIS)

Igarashi, Yuko; Chikamori, Taishiro; Tomiyama, Hirofumi; Usui, Yasuhiro; Hida, Satoshi; Tanaka, Hirokazu; Nagao, Tadashi; Yamashina, Akira

2007-01-01

Although measuring blood pressure at the bilateral brachia is common in medical practice, its clinical significance in patients with suspected coronary artery disease (CAD) has not been fully clarified. The method of this study was to define the significance of inter-arm systolic blood pressure difference in patients with suspected CAD, and to assess the relationship between inter-arm pressure difference and CAD, simultaneous brachial and ankle blood pressure measurements and stress myocardial single-photon emission computed tomography (SPECT) were performed in 386 consecutive patients with suspected CAD, excluding those with previous myocardial infarction or coronary revascularization. Subclavian artery stenosis, defined as ≥15 mmHg inter-arm systolic blood pressure difference, was found in 27 patients (7%). Age (65±12 vs 65±11 years), male sex (21/27 vs 244/359), prevalence of hypertension (63% vs 56%), hypercholesterolemia (63% vs 62%), diabetes mellitus (33% vs 38%), cigarette smoking (44% vs 41%) and family history of CAD (15% vs 12%) were similar between patients with subclavian artery stenosis and those without. The incidence of decreased ankle-brachial pressure index (ABI) was higher (37% vs 12%, p=0.001), and percentage ischemic myocardium as assessed by SPECT was greater (9.0±8.5% vs 5.6±6.6%, p=0.05) in patients with subclavian artery stenosis than in those without. Furthermore, significant correlations were observed between inter-arm pressure difference and percentage ischemic myocardium (r=0.13; p=0.01), and ABI (r=-0.26, p<0.0001). Among 386 patients, 283 underwent coronary angiography, and 63% of those who had inter-arm blood pressure difference had CAD. Furthermore, 83% of those CAD patients had multi-vessel CAD, which is regarded as a high-risk subset for subsequent cardiac events. Inter-arm pressure difference is often found in patients with suspected CAD, and is associated with significant CAD and peripheral artery disease. Thus, inter

Arterial stiffness, central hemodynamics, and cardiovascular risk in hypertension

Science.gov (United States)

Palatini, Paolo; Casiglia, Edoardo; Gąsowski, Jerzy; Głuszek, Jerzy; Jankowski, Piotr; Narkiewicz, Krzysztof; Saladini, Francesca; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Van Bortel, Luc; Wojciechowska, Wiktoria; Kawecka-Jaszcz, Kalina

2011-01-01

This review summarizes several scientific contributions at the recent Satellite Symposium of the European Society of Hypertension, held in Milan, Italy. Arterial stiffening and its hemodynamic consequences can be easily and reliably measured using a range of noninvasive techniques. However, like blood pressure (BP) measurements, arterial stiffness should be measured carefully under standardized patient conditions. Carotid-femoral pulse wave velocity has been proposed as the gold standard for arterial stiffness measurement and is a well recognized predictor of adverse cardiovascular outcome. Systolic BP and pulse pressure in the ascending aorta may be lower than pressures measured in the upper limb, especially in young individuals. A number of studies suggest closer correlation of end-organ damage with central BP than with peripheral BP, and central BP may provide additional prognostic information regarding cardiovascular risk. Moreover, BP-lowering drugs can have differential effects on central aortic pressures and hemodynamics compared with brachial BP. This may explain the greater beneficial effect provided by newer antihypertensive drugs beyond peripheral BP reduction. Although many methodological problems still hinder the wide clinical application of parameters of arterial stiffness, these will likely contribute to cardiovascular assessment and management in future clinical practice. Each of the abovementioned parameters reflects a different characteristic of the atherosclerotic process, involving functional and/or morphological changes in the vessel wall. Therefore, acquiring simultaneous measurements of different parameters of vascular function and structure could theoretically enhance the power to improve risk stratification. Continuous technological effort is necessary to refine our methods of investigation in order to detect early arterial abnormalities. Arterial stiffness and its consequences represent the great challenge of the twenty-first century for

Tissue Doppler imaging of carotid plaque wall motion: a pilot study

Directory of Open Access Journals (Sweden)

Naylor A Ross

2003-12-01

Full Text Available Abstract Background Studies suggest the physical and mechanical properties of vessel walls and plaque may be of clinical value in the diagnosis and treatment of cardiovascular atherosclerotic disease. The purpose of this pilot study was to investigate the potential clinical application of ultrasound Tissue Doppler Imaging (TDI of Arterial Wall Motion (AWM and to quantify simple wall motion indices in normal and diseased carotid arteries. Methods 224 normal and diseased carotid arteries (0–100% stenoses were imaged in 126 patients (age 25–88 years, mean 68 ± 11. Longitudinal sections of the carotid bifurcation were imaged using a Philips HDI5000 scanner and L12-5 probe under optimized TDI settings. Temporal and spatial AWMs were analyzed to evaluate the vessel wall displacements and spatial gradients at peak systole averaged over 5 cardiac cycles. Results AWM data were successfully extracted in 91% of cases. Within the carotid bifurcation/plaque region, the maximum wall dilation at peak systole ranged from -100 to 750 microns, mean 335 ± 138 microns. Maximum wall dilation spatial gradients ranged 0–0.49, mean 0.14 ± 0.08. The AWM parameters showed a wide variation and had poor correlation with stenoses severity. Case studies illustrated a variety of pertinent qualitative and quantitative wall motion features related to the biophysics of arterial disease. Conclusion Our clinical experience, using a challenging but realistic imaging protocol, suggests the use of simple quantitative AWM measures may have limitations due to high variability. Despite this, pertinent features of AWM in normal and diseased arteries demonstrate the potential clinical benefit of the biomechanical information provided by TDI.

The Effect of Elective Percutaneous Coronary Intervention of the Right Coronary Artery on Right Ventricular Function

Directory of Open Access Journals (Sweden)

Farahnaz Nikdoust

2014-12-01

Full Text Available Background: Right Ventricular (RV dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson’s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF. P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males. In the pre-procedural echocardiography, 15 patients (50% had normal RV function, 14 patients (46.7% had grade-1 RV dysfunction, and only 1 patient (3.3% had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV function. Conclusions:: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia

Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

International Nuclear Information System (INIS)

Dohan, Anthony; Eveno, Clarisse; Dautry, Raphael; Guerrache, Youcef; Camus, Marine; Boudiaf, Mourad; Gayat, Etienne; Dref, Olivier Le; Sirol, Marc; Soyer, Philippe

2015-01-01

PurposeTo assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).Materials and MethodsSeventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.ResultsSeventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).ConclusionTAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA

Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

Energy Technology Data Exchange (ETDEWEB)

Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Eveno, Clarisse, E-mail: clarisse.eveno@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dautry, Raphael, E-mail: raphael.dautry@lrb.aphp.fr; Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Camus, Marine, E-mail: marine.camus@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France)

2015-08-15

PurposeTo assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).Materials and MethodsSeventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.ResultsSeventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).ConclusionTAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.

Systolic Blood Pressure Accuracy Enhancement in the Electronic Palpation Method Using Pulse Waveform

National Research Council Canada - National Science Library

Sorvoja, H

2001-01-01

.... Systolic pressure errors were defined and correlations with other specific values, like pressure rise time, pulse wave velocity, systolic pressure, augmentation, arm circumference and body mass index were calculated...

Detection of imminent vein graft occlusion: what is the optimal surveillance program?

Science.gov (United States)

Tinder, Chelsey N; Bandyk, Dennis F

2009-12-01

The prediction of infrainguinal vein bypass failure remains an inexact judgment. Patient demographics, technical factors, and vascular laboratory graft surveillance testing are helpful in identifying a high-risk graft cohort. The optimal surveillance program to detect the bypass at risk for imminent occlusion continues to be developed, but required elements are known and include clinical assessment for new or changes in limb ischemia symptoms, measurement of ankle and/or toe systolic pressure, and duplex ultrasound imaging of the bypass graft. Duplex ultrasound assessment of bypass hemodynamics may be the most accurate method to detect imminent vein graft occlusion. The finding of low graft flow during intraoperative assessment or at a scheduled surveillance study predicts failure; and if associated with an occlusive lesion, a graft revision can prolong patency. The most common abnormality producing graft failure is conduit stenosis caused by myointimal hyperplasia; and the majority can be repaired by an endovascular intervention. Frequency of testing to detect the failing bypass should be individualized to the patient, the type of arterial bypass, and prior duplex ultrasound scan findings. The focus of surveillance is on identification of the low-flow arterial bypass and timely repair of detected critical stenosis defined by duplex velocity spectra criteria of a peak systolic velocity 300 cm/s and peak systolic velocity ratio across the stenosis >3.5-correlating with >70% diameter-reducing stenosis. When conducted appropriately, a graft surveillance program should result in an unexpected graft failure rate of <3% per year.

Cardiovascular Structure and Function in Children With Middle Aortic Syndrome and Renal Artery Stenosis.

Science.gov (United States)

Rumman, Rawan K; Slorach, Cameron; Hui, Wei; Matsuda-Abedini, Mina; Langlois, Valerie; Radhakrishnan, Seetha; Lorenzo, Armando J; Amaral, Joao; Mertens, Luc; Parekh, Rulan S

2017-12-01

Middle aortic syndrome (MAS) is a narrowing of the abdominal aorta, often in conjunction with renal artery stenosis (RAS). Structure and function of the cardiovascular system are not well understood. In a prospective cross-sectional study, 35 children with MAS or RAS or both (MAS/RAS) were compared with 140 age-, sex-, and body surface area-matched healthy children. Vascular assessment included carotid intima-media thickness and carotid distensibility using B-mode ultrasound and central and peripheral pulse wave velocities using applanation tonometry. Left ventricular structure and function were assessed by 2-dimensional and speckle-tracking echocardiography. Children with MAS or RAS were 12.5±3.0 years old at enrollment, and 50% were men. Carotid intima-media thickness (0.54±0.10 versus 0.44±0.05 mm; P function (lower E/a ratio and lower e' velocities). Systolic parameters, including ejection fraction, global longitudinal and circumferential strain, were similar to controls. Our findings demonstrate that children with MAS or RAS have evidence of carotid and left ventricular remodeling, without peripheral arterial involvement, which suggests a localized disease process. Left ventricular systolic function is preserved; however, subtle changes in diastolic function are observed. Carotid vessel changes are consistent with a 5- to 10-year aging, which underscores the importance of blood pressure control. © 2017 American Heart Association, Inc.

Peripheral arterial volume distensibility: significant differences with age and blood pressure measured using an applied external pressure

International Nuclear Information System (INIS)

Zheng, Dingchang; Murray, Alan

2011-01-01

A new arterial distensibility measurement technique was assessed in 100 healthy normotensive subjects. Arterial transmural pressures on the whole right arm were reduced with a 50 cm long cuff inflated to 10, 20, 30 and 40 mmHg. The electrocardiogram, and finger and ear photoplethysmograms were recorded simultaneously. Arm pulse propagation time, pulse wave velocity (PWV) and arterial volume distensibility were determined. With a 40 mmHg reduction in transmural pressure, arm pulse propagation time increased from 61 to 83 ms, PWV decreased from 12 to 8 m s −1 and arterial distensibility increased from 0.102% to 0.232% per mmHg (all P < 0.0001). At all cuff pressures, arterial distensibility was significantly related to resting mean arterial pressure (MAP), diastolic blood pressure (DBP) and age, and for systolic blood pressure at 30 and 40 mmHg (all P < 0.05). At 40 mmHg cuff pressure, arterial distensibility fell by 54% for a MAP increase from 75 to 105 mmHg, 57% for a DBP increase from 60 to 90 mmHg and 47% for an age increase from 20 to 70 years. These changes were more than double than those without cuff pressure. Our technique showed that systemic volume distensibility of the peripheral arm artery reduced with age, with a greater effect at higher external and lower transmural pressures