AIMS: Recipients of left ventricular assist devices (LVAD) are exposed to increased risk of adverse clinical events. One of the potential contributing factors is non-pulsatile flow generated by LVAD. We evaluated the association of flow patterns in carotid arteries and of increased arterial stiffness with death and cerebrovascular events in LVAD recipients. METHODS AND RESULTS: We analysed data from 83 patients [mean age 54 ± 15 years; 12 women; HeartMate II (HMII), n = 34; HeartMate 3 (HM3), n = 49]. Pulsatile and resistive indexes, atherosclerotic changes in carotid arteries (measured by duplex ultrasound), and arterial stiffness [measured by Endo-PAT 2000 as the augmentation index standardized for heart rate (AI@75)] were evaluated 3 and 6 months after LVAD implantation. Sixteen patients died during follow-up (27.3 months; interquartile range 15.7-44.3). After adjusting for the main variables examined, the pulsatility index measured at 3 months was positively associated with increased hazard ratios (HR) for death and cerebrovascular events [HR 9.8, 95% confidence interval (CI) 1.62-59.42], with HR increasing after adding AI@75 to the model (HR 18.8, 95% CI 2.44-145.50). In HM3 recipients, HR was significantly lower than in HMII recipients (HR 0.31, 95% CI 0.11-0.91), but the significance disappeared after adding AI@75 to the model (HR 0.33, 95% CI 0.09-1.18). CONCLUSIONS: The risk of death and cerebrovascular events in LVAD recipients is associated with increased pulsatility index in carotid arteries and potentiated by increased arterial stiffness. The same risk is attenuated by HM3 LVAD implantation, but this effect is weakened by increased arterial stiffness.

• MeSH
• ateroskleróza * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• podpůrné srdeční systémy * MeSH
• senioři MeSH
• srdeční selhání * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• arteria cerebri anterior MeSH
• arteria cerebri media MeSH
• dospělí MeSH
• gestační stáří MeSH
• hypoxie MeSH
• lidé MeSH
• pulzatilní průtok MeSH
• rizikové těhotenství ultrasonografie   MeSH
• růstová retardace plodu ultrasonografie   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH

Súhrn: Určiť diagnostický význam parametrov pulzatility index (PI) a rezistens index (RI) vo fetálnejaorte počas tehotnosti s detekovanou intrauterinnou retardáciou rastu (IUGR). Vyšetrenia- ABUSONIC 8, ALOKA 680 SSD, transabdominálnou 3,5 MHz sondou s farebným dopplerovskýmmodulom.Názov a sídlo pracoviska: II. Gynekologicko-pôrodnícka klinika, LF UPJŠ a FN L. Pasteura, Košice,Slovenská republika, Obst/Gynae Dpt., Victoria Hospital, Mahé, Seychelles Republic, IndianaOcean.Súbor a metóda: Vyhodnotili sme prospektívnu komparatívnu štúdiu dvoch skupín rizikových tehotností.Skupina A 112 gravidít s klinickými známkami preeklampsie s detekovanou IUGR plodu, ktorúsme podľa klasifi kácie foriem preeklampsie na miernu, strednú a ťažkú diferencovali na podskupinyA1 A2, A3 a A4 s eklampsiou a komparatívnu skupinu B 106 gravidít. V skupinách sme vyhodnocovaliPI, RI aorta descendens v oblasti bifurkácie v priebehu gestácie od 28. týždňa až do ukončenia gravidity.Parametre boli merané v týždňových intervaloch podľa klinického ultrasonografi ckého protokolu.Porovnali sme priemerne hodnoty PI, RI v priebehu gravidity v skupine A a skupine B v korešpondujúcichtýždňoch gravidity. V podskupinách-A1, A2, A3 sme vyhodnotili výskyt plodov s IUGR.Výsledky: Aorta descendens PI, RI vykazuje u plodov v skupine A signifi kantne vyššie priemernehodnoty PI, RI oproti komparatívnej skupine B. V skupine A sme nezaznamenali zníženie rezistenciev descendentnej aorte po 34. týždni tehotenstva. V komparatívnej skupine B po 34. týždnisignifi kantne hodnoty PI, RI klesajú. Z celkového počtu 112 tehotenstiev v skupine A s preeklampsioua eklampsiou vykazovalo až 52,6 % retardáciu prírastku bioparametrov - IUGR, aleboreštrikciu a nulový prírastok. V podskupine A1 ľahkých foriem preeklampsie to bolo 20,5 %detekovaných plodov s IUGR. V podskupine A2 stredných foriem preeklampsie to bolo 51,3 % plodov a v podskupine A3 ťažkých foriem až 87,8 % plodov s IUGR alebo reštrikciou prírastku.U všetkých 3 plodov pri eklampsii. Podskupina A4 išlo o reštrikciu rastu a reverzný tok v descendentnejaorte.Hlavný záver: Funkčné vyšetrenie prietoku v descendentnej fetálnej aorte je súčasťou komplexnejanalýzy fetálnej cirkulácie v rámci nadstavbového ultrazvukového protokolu a je významnoumetódou na diferenciáciu rizikových gravidít so suspektným ohrozením plodu a intrauterinnourastovou retardáciou. Relatívne nízky podiel IUGR v skupine dáva možnosť dobrej prognózy rastupri efektívnej vazodilatačnej liečbe.

Summary pregnancycomplicated by ultrasonografi cally detected intrauterine growth retardation-IUGR.Setting: Dpt. of Obstetric and Gynaecology, Safarik‘s University and University Hospital L. Pasteur,Kosice, Slovak Republic, Obst/Gynae Dpt., Victoria Hospital, Mahé, Seychelles Republic,Indian Ocean.Subject and Method: The autors measured fetal circulation on the level of descending aortal bifurcation.The results were compared in the Group-A of 112 pregnancies complicated by mild,moderate and several praeeclampsia, eclampsia with detected IUGR, and comparative Group-Bof 106 pregnancies.Intervention: The ACUSONIC 8, ALOKA 680 SSD using transabdominal 3.5 MHz probe with collordoppler facility. The parameters were measured in weekly intervals according the clinical protocolfor management of high risk pregnancies.Subjects: There was opened a prospective comparative study of 112 risk pregnancies (Group-A) anda comparative Group-B of 106 pregnancies with normal growth of fetuses. Group-A was devided accordingclassifi cation of praeeclampsia to Subgroup-A1, mild praeeclampsia, Subgroup-A2, moderatepraeeclampsia, Subgroup-A3, severe praeclampsia and Subgroup-A4, eclampsia. Parameters of vascularresistance in descending aorta were calculated from 28th week of gestation to termination ofpregnancy and compared average values in corresponding stage in the Group-A and the comparativeGroup-B. Number of IUGR fetuses or restricted with the growth were calculated in Subgroups - A.Results: Descending aorta presents signifi cantly higher average values of PI, RI during pregnancyfrom 28th week of gestation in Group-A. There is no evidence of diastolic decrease after 34thweek of gestation in Group-A. In Group-A 52.6% fetuses were ultrasonografi caly IUGR detected orrestricted. In Subgroup-A1 of mild praeeclampsia were 20.5% of the IUGR fetuses. Subgroup-A2 ofmoderate praeeclampsia showed 51.3% and Subgroup-A3 severe praeeclampsia 87.8% of the IUGRfetuses of restricted. Three cases of eclampsia were restricted for growth .Main outcome - functional assessment of the descending aorta fl ow is the most reliable method fordifferentiation of praeclamptic and eclamptic pregnancies with suspected fetal starvation andintrauterine growth retardation.

• MeSH
• aorta MeSH
• dospělí MeSH
• komplikace těhotenství diagnóza   patologie   MeSH
• lidé MeSH
• preeklampsie patologie   MeSH
• pulzatilní průtok MeSH
• růstová retardace plodu diagnóza   patologie   MeSH
• srdeční frekvence plodu MeSH
• těhotenství MeSH
• ultrasonografie dopplerovská barevná metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH

INTRODUCTION: Long-term use of continuous-flow left ventricular assist devices may have negative consequences for autonomic, cardiovascular and gastrointestinal function. It has thus been suggested that non-invasive monitoring of arterial pulsatility in patients with a left ventricular assist device is highly important for ensuring patient safety and longevity. We have developed a novel, semi-automated frequency-domain-based index of arterial pulsatility that is obtained during suprasystolic occlusions of the upper arm: the 'cuff pulsatility index'. PURPOSE: The purpose of this study was to evaluate the relationship between the cuff pulsatility index and invasively determined arterial pulsatility in patients with a left ventricular assist device. METHODS: Twenty-three patients with a left ventricular assist device with end-stage heart failure (six females: age = 65 ± 9 years; body mass index = 30.5 ± 3.7 kg m-2) were recruited for this study. Suprasystolic occlusions were performed on the upper arm of the patient's dominant side, from which the cuff pressure waveform was obtained. Arterial blood pressure was obtained from the radial artery on the contralateral arm. Measurements were obtained in triplicate. The relationship between the cuff pressure and arterial blood pressure waveforms was assessed in the frequency-domain using coherence analysis. A mixed-effects approach was used to assess the relationship between cuff pulsatility index and invasively determined arterial pulsatility (i.e. pulse pressure). RESULTS: The cuff pressure and arterial blood pressure waveforms demonstrated a high coherence up to the fifth harmonic of the cardiac frequency (heart rate). The cuff pulsatility index accurately tracked changes in arterial pulse pressure within a given patient across repeated measurements. CONCLUSIONS: The cuff pulsatility index shows promise as a non-invasive index for monitoring residual arterial pulsatility in patients with a left ventricular assist device across time.

• MeSH
• arterie patofyziologie   MeSH
• asistovaná cirkulace přístrojové vybavení   metody   MeSH
• diagnostické techniky kardiovaskulární MeSH
• krevní tlak fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• podpůrné srdeční systémy * MeSH
• pulz metody   MeSH
• pulzatilní průtok fyziologie   MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• srdeční selhání * patofyziologie   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. METHODS: We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to .75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to .9 or more was considered predictive of definite PAD. RESULTS: We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P = .60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR], .68; 95% CI, .22-2.12; P = .51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P = .002 and OR, 3.20; 95% CI, 1.51-6.77; P = .002, respectively). CONCLUSIONS: Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.

• MeSH
• cévní mozková příhoda komplikace   ultrasonografie   MeSH
• fibrilace síní komplikace   ultrasonografie   MeSH
• ischemie mozku komplikace   ultrasonografie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový krevní oběh * MeSH
• onemocnění periferních arterií komplikace   ultrasonografie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• tlakový index kotník-paže MeSH
• tranzitorní ischemická ataka komplikace   ultrasonografie   MeSH
• ultrasonografie dopplerovská transkraniální MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The differentiation between chronic pulmonary thromboembolic hypertension (CTEPH) and pulmonary arterial hypertension (PAH) remains a clinical challenge. The aim of our study was to evaluate the usefulness of both echocardiographically and invasively derived pulmonary artery pulsatility indexes in the etiologic differentiation of patients with CTEPH and PAH. We retrospectively analyzed the results of echocardiographic and invasive hemodynamic examinations in 125 patients with either CTEPH (n = 62) or PAH (n = 63). Invasive data were obtained in 52 patients with CTEPH and 43 PAH patients. Using echocardiography, pulmonary artery systolic (PASP), diastolic (PADP) and mean (PAMP) pressures were estimated from velocities of tricuspid regurgitation and pulmonary regurgitation, respectively. Pulse pressure (PP) was calculated as the difference between PASP and PADP. To obtain pulmonary artery pulsatility indexes, we normalized PP by PASP (PP/PASP), by PAMP (PP/PAMP) and by PADP (PP/PADP). Pulsatility indexes assessed by echocardiography did not differ between CTEPH and PAH patients except for PP/PAMP [PP/PAMP (1.82 ± 0.33 vs. 1.40 ± 0.3, p < 0.001)]. Invasively derived pulsatility indexes were significantly higher in subjects with CTEPH (0.60 ± 0.08 vs. 0.53 ± 0.09 for PP/PASP; 0.98 ± 0.21 vs. 0.81 ± 0.21 for PP/PAMP; 1.58 ± 0.52 vs. 1.21 ± 0.41 for PP/PADP; all p < 0.001). The areas under the receiver-operating characteristic curves analysis showed that no cutoff value allowed discriminating between CTEPH and PAH by using echocardiographically or invasively derived pulsatility indices. Invasively derived pulmonary artery pulsatility indexes as well as echocardiographically determined PP/PAMP indexes are higher in CTEPH compared to PAH. However, due to the important overlap no optimal threshold values of these parameters can be given to allow satisfactory discrimination of the two diseases in clinical practice.

• MeSH
• arteria pulmonalis patofyziologie   ultrasonografie   MeSH
• chronická nemoc MeSH
• diferenciální diagnóza MeSH
• dopplerovská echokardiografie MeSH
• dospělí MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• lineární modely MeSH
• plicní embolie diagnóza   patofyziologie   ultrasonografie   MeSH
• plicní hypertenze diagnóza   patofyziologie   ultrasonografie   MeSH
• plicní oběh MeSH
• prediktivní hodnota testů MeSH
• pulzatilní průtok MeSH
• retrospektivní studie MeSH
• ROC křivka MeSH
• senioři MeSH
• srdeční katetrizace MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Ankle brachial index (ABI) has been increasingly used in general practice to identify individuals with low ABI at high cardiovascular risk. However, there has been no consensus on the clinical significance of high ABI. The aim of our study was to compare aortic stiffness as a marker of cardiovascular risk in individuals with low (<1.0), normal (1.0-1.4), and high ABI (>1.4). METHODS: A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, aged 54 ± 13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device. RESULTS: Of the 911 individuals, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in individuals with low and high ABI compared with the normal ABI group (11.1 ± 2.8, 8.3 ± 2.3, p < 0.001; 10.8 ± 2.5, 8.3 ± 2.3 m/s, p < 0.001, respectively). In a model adjusted for age, sex, systolic, diastolic, mean blood pressure and examiner, aPWV remained increased in both extreme ABI groups compared with the normal ABI group. In logistic regression analysis, aPWV together with glucose level, male sex, and a history of deep venous thrombosis were independent predictors of high ABI, while cholesterol was not. CONCLUSION: This is the first study showing increased aortic stiffness in individuals with high ABI, presumably responsible for increased left ventricular mass described previously in this group. These findings suggest increased cardiovascular risk of high ABI individuals.

• MeSH
• analýza rozptylu MeSH
• aorta patofyziologie   ultrasonografie   MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• kardiovaskulární nemoci diagnóza   etiologie   patofyziologie   ultrasonografie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• poddajnost MeSH
• prediktivní hodnota testů MeSH
• pulzatilní průtok MeSH
• rizikové faktory MeSH
• senioři MeSH
• tlakový index kotník-paže MeSH
• ultrasonografie dopplerovská MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVE: Aortic stiffness is increased in lacunar stroke. The precise mechanism linking aortic stiffness to symptomatic lacunar stroke is not well understood. The aim of this study was to compare the effects of aortic stiffness, carotid stiffness, central blood pressure, and cerebrovascular resistance on carotid flow pulsatility according to stroke subtype. METHODS: Two hundred and one consecutive patients were examined 13 months after hospitalization for their first-ever ischemic stroke. The stroke subtype was classified using the Causative Classification of Stroke System. Carotid-femoral pulse wave velocity (PWV) was used as a measure of aortic stiffness. Common carotid flow pulsatility was expressed as resistive index. Central blood pressure was measured using applanation tonometry. RESULTS: Complete data were available for 174 patients (mean age… 67 ± 10 years, 64% men). In patients with lacunar stroke, aortic PWV was higher (13.11 ± 2.74 m/s) than in individuals with large artery atherosclerosis (9.98 ± 1.87 m/s, P <0.001), cardioembolic (11.31 ± 3.18 m/s, P = 0.04) or cryptogenic stroke (11.13 ± 3.2 m/s, P = 0.01). Similarly, central SBP and resistive index were higher in patients with lacunar stroke (145 ± 23 mmHg and 0.80 ± 0.04, respectively) than those with large artery atherosclerosis (128 ± 18 mmHg, P <0.01 and 0.74 ± 0.07, P <0.01, respectively) or cryptogenic stroke (132 ± 18 mmHg, P <0.01 and 0.76 ± 0.07, P <0.05, respectively). In multivariate analysis, aortic stiffness and central pulse pressure were the main determinants of resistive index independent of stroke subtype. CONCLUSION: Our results suggest that aortic stiffening, by reducing the buffering function of the aorta and thereby increasing the transmission of pressure and flow pulsatility into the cerebral arterioles, may contribute to the pathogenesis of lacunar stroke.

• MeSH
• analýza pulzové vlny MeSH
• arteriae carotides patofyziologie   MeSH
• cévní mozková příhoda patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• přežívající * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tuhost cévní stěny * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• arteriae umbilicales MeSH
• financování organizované MeSH
• lidé MeSH
• novorozenec MeSH
• pulzatilní průtok MeSH
• růstová retardace plodu MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• abstrakty MeSH

• MeSH
• arteria radialis patofyziologie   MeSH
• dospělí MeSH
• kardiovaskulární nemoci epidemiologie   MeSH
• kohortové studie MeSH
• krevní glukóza metabolismus   MeSH
• LDL-cholesterol krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pružnost fyziologie   MeSH
• pulzatilní průtok fyziologie   MeSH
• rizikové faktory MeSH
• štítná žláza patofyziologie   MeSH
• studie případů a kontrol MeSH
• syndrom rezistence k thyreoidálním hormonům komplikace   krev   patofyziologie   MeSH
• thyreotropin krev   MeSH
• thyroxin krev   MeSH
• trijodthyronin krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• souhrny MeSH