Factors Affecting Basilar Artery Pulsatility Index on Transcranial Doppler

Ho Tae Jeong,김대식,Kun Woo Kang,Yun Teak Nam,오지은,조은경 대한임상검사과학회 2018 대한임상검사과학회지(KJCLS) Vol.50 No.4

Transcranial doppler is a non-invasive method that measures the blood flow velocity and the direction of cerebral blood vessels through the doppler principle. The pulsatility index is an index for measuring the transcranial doppler that reflects the distal vascular resistance and is used as an index for the presence and diffusion of cerebral small vessel diseases. The purpose of this study was to evaluate the risk factors affecting the basilar artery pulsatility index in ischemic stroke patients. From January 2014 to May 2015, 422 patients were selected by measuring the transcranial doppler pulsatility index, considering their basilar artery pulsatility index. Univariate analysis was performed using the basilar artery pulsatility index as a dependent variable. Multiple regression analysis was performed considering the factors affecting the pulsatility index as variables. Univariate analysis revealed age, presence of hypertension, presence of diabetes mellitus, presence of hyperlipidemia, and hematocrit (P<0.1) as factors. Multiple regression analysis showed statistically significant results with age (P<0.001), presence of diabetes (P=0.004), and presence of hyperlipidemia (P=0.041). The risk factors affecting the basilar artery pulsatility index of transcranial doppler were age, diabetes, and hyperlipidemia. Further research will be needed to increase the cerebral pulsatility index as a surrogate marker of the elderly, diabetes, and hyperlipidemia.

Echocardiographic Assessment of Pulmonary Arteries Pulsatility Index in Fontan Circulation

Reza Shabanian,Mohammad Reza Mirzaaghayan,Minoo Dadkhah,Mehdi Hosseini,Mitra Rahimzadeh,Parvin Akbari Asbagh,Mohammad Ali Navabi 한국심초음파학회 2015 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.23 No.4

Background: Late complications after Fontan procedure may be due to the absence of pump and pulsatile pulmonary blood flowin this type of palliation. Our aim was to quantify the degree of pulsation by echocardiographic method in patients with extracardiactotal cavopulmonary connection (ECTCPC) in comparison with biventricular circulation and few cases of pulsatile Fontan. Methods: In a case series study, pulsatility index (PI) derived by echocardiographic method were compared between 20 patientswith ECTCPC, 6 patients with pulsatile Fontan and 18 normal individual aged 4 to 20 years old. All patients were in New YorkHeart Association class of I and there was no report of complication. Results: In patients with ECTCPC pulmonary artery branches Doppler flow study showed lower peak and mean velocitiescompared to the pulsatile Fontan and normal groups. ECTCPC patients had PI of 0.59 ± 0.14 and 0.59 ± 0.09 for right and leftpulmonary arteries (RPA and LPA) respectively. PI was higher in patients with preserved antegrade flow (RPA PI = 0.94 ± 0.26,LPA PI = 0.98 ± 0.27) and in normal individuals (RPA PI = 1.59 ± 0.12, LPA PI = 1.64 ± 0.17) for both branches (p = 0.000). Conclusion: Using a Doppler derived index for pulsatility, patients with ECTCPC had the least pulsation. The pulmonary arteryflow pattern in patients with preserved antegrade flow showed higher pulsatility indices in both branches. Normal individualshad the greatest pulsatility index.

Pulsatility of middle cerebral arteries is better correlated with white matter hyperintensities than aortic stiffening

Lee, Sang-Hwa,Kim, Yerim,Lee, Yeongbae,Lee, Ju-Hun The Korean Society of Clinical Neurophysiology 2018 Annals of Clinical Neurophysiology Vol.20 No.2

Background: Pulsatility of cerebral arteries and aortic stiffness have been associated with white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct. Methods: We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate-to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis. Results: Eighty-three patients (56 males, mean age $61.5{\pm}11.4$) participated in the study. Uni-variate analysis showed old age and high PI-MCA were significantly correlated with moderate-to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719. Conclusions: PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.

Pulsatility of middle cerebral arteries is better correlated with white matter hyperintensities than aortic stiffening

이상화,김예림,Yeong Bae Lee,이주헌 대한임상신경생리학회 2018 Annals of Clinical Neurophysiology Vol.20 No.2

Background: Pulsatility of cerebral arteries and aortic stiffness have been associated with white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct. Methods: We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate- to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis. Results: Eighty-three patients (56 males, mean age 61.5 ± 11.4) participated in the study. Univariate analysis showed old age and high PI-MCA were significantly correlated with moderate- to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719. Conclusions: PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.

Uterine artery Doppler indices: pulsatility index and resistance index as predictive tools for the incidence of heavy menstrual bleeding related to copper intrauterine contraceptive device

Alaa Mohamed Attia,Mohammed El-Husseiny Radwan,Yousef Abo Elwan,Hend Salah Abdo Saleh 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.3

ObjectivesTo assess the predictive value of the initial uterine artery Doppler indices, the pulsatility index (PI), and resistanceindex (RI) in the prediction of heavy menstrual bleeding before and after copper intrauterine contraceptive device(IUCD) insertion. MethodsThe current prospective clinical study included 100 women who intended to use a copper IUCD (Cu T-380A) and metthe inclusion criteria. Uterine artery Doppler PI and RI indices were calculated before IUCD insertion and at three andsix months after insertion. Based on the presence or absence of menorrhagia, all women were classified into twogroups: non-bleeding (n=52) and extreme menstrual bleeding (n=48). Receiver operating curve analysis was used todetermine the predictive value of uterine artery PI and RI in patients with menorrhagia relevant to IUCD. ResultsThe PI and RI indices displayed a highly significant difference between the IUCD groups at three and six months afterinsertion (P<0.001). Uterine artery PI ≤2.02 (sensitivity of 95.8%, specificity of 100%, and area below the curve [AUC]of 0.97 at P-value<0.001) and RI ≤0.83 (sensitivity of 93.8%, specificity of 100%, and AUC of 0.949 at P-value<0.001)were correlated with significant menstrual bleeding following insertion of IUCD. ConclusionThe presented results confirmed our assumption that the initial studies of uterine artery Doppler can predict heavymenstrualbleeding associated with IUCD and therefore, should be conducted in women pursuing reversible longactingcontraception.

제 2형 당뇨병 환자에서 인슐린 저항성 개선제가 뇌혈류 개선에 미치는 영향

이유정,김선아,이은경,박종숙,안철우,곽혜선,하헌주 한국병원약사회 2005 병원약사회지 Vol.22 No.4

Atherogenic cerebrovascular disease is one of the major causes of morbidity and mortality in patients with type 2 diabetes mellitus. Pioglitazone is an insulin-sensitizing agent that has been reported to have antiatherogenic effect. The aim of this study was to investigate whether pioglitazone affects the cerebrovascular blood flow by reducing intima-media thickness and pulsatility index. Total of 40 type 2 diabetic patients were included and divided into two groups: the pioglitazone-treated group (pioglitazone 15 mg/day with gliclazide 80~320 mg/day for 12 weeks)(n=20) and control group (gliclazide 80~320 mg/day for 12 weeks)(n=20). The changes in lipid profile, insulin resistance, intimamedia thickness, pulsatility index were monitored to determine that pioglitazone improves cerebrovascular blood flow. The pioglitazone treatment significantly reduced total cholesterol, triglyceride, LDL-C, insulin resistance and pulsatility index. Intima-media thickness tended to decrease but was not significant. This study revealed that treatment with pioglitazone was associated with the improvement of cerebrovascular blood flow. We found that pioglitazone have improved insulin resistance, lipid profile and reduced carotid intima-media thickness and pulproliferasatility index after the 12 week adminstration. Thus, pioglitazone appears to be effective for the improvement of cerebrovascular blood flow in type 2 diabetic patients.

만성두통 환자에서 한방 치료 후 인영혈 부위의 뇌혈류에 대한 연구

이충식 ( Chung Sik Lee ),박보라 ( Bo Ra Park ),박인숙 ( In Suk Park ),김지훤 ( Ji Hwon Kim ),이상언 ( Sang Eon Lee ),임진영 ( Jin Young Lim ),류영수 ( Yeoung Su Lyu ),강형원 ( Hyung Won Kang ),김태헌 ( Tae Heon Kim ) 대한한방신경정신과학회 2009 동의신경정신과학회지 Vol.20 No.1

Objectives: This study was performed to change of blood flow in In-Young(ST9) after treatment on chronic daily headache patients. Methods: Monitoring of TCD was examined in 10`s chronic daily headache patients before and after treatment. Mean velocity flow, systolic velocity and pulsatility index were analyzed from TCD at In-Young(ST9). The patients was laid for 20 minutes before treatment and also for treatment. Results: The results showed a significant(p<0.05: Paired T-test) decrease in mean velocity flow and systolic velocity. but there were no significant differences in pulsatility index. Conclusions: These results suggest that there were significant change on blood flow in In-young of chronic daily headache patients.

난소암 진단에 있어서 초음파에 의한 형태학적 특성 및 혈관지수의 유용성

이재영 ( Jae Young Lee ),박소정 ( So Jeong Park ),박지노 ( Ji No Park ),기다린 ( Da Rin Ki ),김기민 ( Ki Min Kim ),조문경 ( Moon Kyoung Jo ),김철홍 ( Chul Hong Kim ),김석모 ( Seok Mo Kim ),최호선 ( Ho Sun Choi ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.6

목적: 수술전 난소 종양의 악성여부를 판단하는 것은 현재 매우 어려운 현실이다. 이에 따라 본 연구에서는 초음파로 측정한 형태학적 점수 평가 (Morphologic score, MS) 및 도플러 검사 중 혈관저항지수 (Resistance index, RI)와 박동성지수 (Pulsatility index, PI)가 난소종양을 가진 환자에서 수술 전 악성과 양성을 얼마나 정확하게 구분할 수 있는지를 수술 후 조직학적 소견과 비교하여 알아보고자 하였다. 연구 방법: 2001년 1월부터 2003년 12월까지 본원에서 난소 종양으로 진단받은 환자 중 골반 초음파를 시행하여 MS 및 도플러 검사로 혈류파형이 감지되어 RI 및 PI를 측정하고 수술을 시행한 99예의 환자를 대상으로 하였다. 결과: MS에 따른 악성 종양의 진단은 민감도 69.6%, 특이도 69.8%, 양성예측치 75.0%, 음성예측치 63.8%를 보였으며, 악성 종양의 평균 점수는 9.8±2.64로 양성 종양의 7.5±2.44보다 통계적으로 유의하게 높았다. (p[t]<0.05). 도플러 검사에 의한 RI와 PI값에 따른 악성 종양의 진단은 각각 민감도 19.6%/44.6%, 특이도 97.6%/81.3%, 양성예측치 91.6%/75.7%, 음성예측치 48.2%/53.0%를 보였으며 RI와 PI의 평균값은 악성 종양에서 각각 0.64±0.277과 1.34±0.982를 보여 양성 종양의 0.78±0.299와 2.06±1.310 보다 통계적으로 유의하게 낮았다. (p[t]<0.05). MS에 RI를 조합한 경우, 민감도 69.6%, 특이도 69.7% 양성예측치 75.0%, 음성예측치 63.8%를 보였으며, PI를 조합한 경우 민감도 78.6%, 특이도 60.5%, 양성예측치 72.1%, 음성예측치 68.4%를 보여 민감도는 높아지나 상대적으로 특이도와 양성예측치가 떨어지는 결과를 보였다. 결론: 악성 종양의 진단에 있어 도플러 초음파를 이용한 RI 및 PI의 측정은 이론적 배경인 악성종양의 혈류저항 감소를 보이나 특이도가 각각 97.6%, 81.3%로 매우 높음에도 불구하고 민감도가 각각 19.6%, 44.6%로 매우 낮은 결과를 보인다. 따라서 도플러 초음파를 이용한 RI 및 PI의 측정은 난소 종양의 악성여부를 구분하는데 있어 진단적 가치가 낮으므로 단독으로 또는 MS에 대한 보조검사로서 임상에서 사용하기에는 의의가 없는 것으로 사료된다. Objective: The aim of this study was to know whether we can distinguish benign from malignant ovarian tumors according to morphologic scoring system (MS), blood flow characteristics (Resistance index (RI), Pulsatility index (PI)) using color doppler sonography and a combination of both in patients undergoing laparotomy or laparoscopy for a clinically diagnosed ovarian mass. Methods: From January 2001 to December 2003, 99 patients with ovarian tumors scheduled for laparotomy or laparoscopy were studied at our institute. Ultrasound was carried out to study the ovarian morphology followed by color doppler sonography. A score of 9 on ≥9 on MS, a PI≤1 or a RI≤0.4 was taken as suspicious for malignancy. Results: A score of ≥9 on MS as indicative of malignancy was associated with the following statistical parameters: sensitivity 69.6%, specificity 69.8%, positive predictive value (PPV) 75.0%, negative predictive value (NPV) 63.8%. A mean score of malignant tumor (9.8±2.64) is significantly higher than that of benign tumor (7.5±2.44). This was statistically significant (p[t]<0.05). A resistance index (RI)≤0.4 was associated with sensitivity 19.6%, specificity 97.6%, PPV 91.6%, NPV 48.2%. A pulsatility index (PI) ≤1.0 was associated with sensitivity 44.6%, specificity 81.3%, PPV 75.7%, NPV 53.0%. A mean of RI in malignancy (0.64±0.277) is lower than that of RI in benign tumor (0.79±0.299). A mean of PI in malignancy (1.34±0.982) is lower than that of PI in benign tumor (2.06±1.310). These was statistically significant (p[t]<0.05). The addition of RI or PI to MS did not improve the accuracy in predicting ovarian malignancy. Conclusion: Although RI or PI achieved better specificity and PPV compared to MS, the addition of RI or PI to MS did not increase its accuracy in the discrimination between benign and malignant ovarian tumors.

Experimental Investigation of Pulsatility Effect on the Deformability and Hemolysis of Blood Cells

Kang, Yang Jun,Kim, Myoung Gon,Son, Kuk Hui,Lim, Choon Hak,Son, Ho Sung,Yoon, Sang Youl,Kwon, Hyuk Sang,Yang, Sung Blackwell Publishing Inc 2010 Artificial Organs Vol.34 No.4

<P>Abstract</P><P>In this study, we investigated the differences between pulsatile cardiopulmonary bypass (CPB) procedure and nonpulsatile CPB procedure in terms of their effects on hemolysis and deformability of red blood cells (RBCs) under various shear stress conditions. In order to research the effects on hemolysis and deformability, four parameters—free hemoglobin (fHb) concentration, normalized index of hemolysis (NIH), deformability index (DI) of RBCs, and elongation index of RBCs—have been deeply investigated. For these investigations, two randomly assigned adult mongrel dog groups—nonpulsatile group (NP, <I>n</I> = 6) and pulsatile group (P, <I>n</I> = 6)—were examined. According to our results, both types of perfusion did not show any statistical differences in terms of the concentrations of fHb as well as NIH. In addition, there were no significant differences in RBC deformability between perfusion types within an operation time of 3 h. Therefore, our studies suggest that pulsatile perfusion has no significant difference from nonpulsatile perfusion in terms of hemolysis and deformability of RBCs.</P>

Hemodynamic Controller for Left Ventricular Assist Device Based on Pulsatility Ratio

Choi, Seongjin,Boston, J. Robert,Antaki, James F. WILEY-BLACKWELL PUBLISHING, INC 2007 Artificial Organs Vol.31 No.2

<P>Abstract: </P><P>Hemodynamic control of left ventricular assist devices (LVADs) is generally a complicated problem due to diverse operating environments and the variability of the patients: both the changes in the circulatory and metabolic parameters as well as disturbances that require adjustment to the operating point. This challenge is especially acute with control of turbodynamic blood pumps. This article presents a pulsatility ratio controller for LVAD that provides a proper perfusion according to the physiological demands of the patient, while avoiding adverse conditions. It utilizes the pulsatility ratio of the flow through the pump and pressure difference across the pump as a control index and adjusts the pump speed according to the reference pulsatility ratio under the different operating conditions. The simulation studies were performed to evaluate the controller in consideration of the sensitivity to afterload and preload, influence of the contractility, and effect of suction sensitivity. The controller successfully adjusts the pump speed according to the reference pulsatility ratio, and supports the natural heart under diverse pump operating conditions. The resulting safe pump operations demonstrate the solid performance of the controller in terms of sensitivity to afterload and preload, influence of the contractility, and effect of suction sensitivity. </P>