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

Sung, Chang Kyu; Lee, Kyung Ho; Kim, Seung Hyup

doi:10.14366/usg.15055

Cited by 16 publications

(26 citation statements)

References 20 publications

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“…In addition, determining the severity of PAD in patients with CLI can be challenging as a result of the presence of noncompressible arteries. 12 Sung et al 32 showed no consistent tendency of the influence of the compliance on the changes in peak systolic velocity, AT, or acceleration index, thus suggesting there is also no influence in ACC max when the compliance changes, as in a calcified vessel. Therefore, we conclude that ACC max can be clinically superior to other noninvasive measurements, particularly in patients with diabetes and/or CLI, as ACC max is measured distal to the stenosis.…”

Section: Discussionmentioning

confidence: 99%

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

Brouwers

Doorn

Wissen

et al. 2020

Journal of Vascular Surgery

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Background: Because of the presence of medial calcific sclerosis, both ankle-branchial index and toe pressure measures can yield misleading results when attempting to diagnose peripheral artery disease (PAD). A new ultrasound parameter, maximal systolic acceleration (ACC max ), can be an accurate tool for diagnosing PAD, including in diabetic patients. However, it has not been evaluated thoroughly. The aim of this study was to assess the feasibility of using ACC max to diagnose and assess the severity of PAD.Methods: The human circulatory system was simulated using an in vitro circulatory system driven by a pulsatile pneumatic pump. Arterial stenosis of various degrees (50%, 70%, 80%, and 90%) was simulated in order to investigate the change in several ultrasound parameters (including ACC max ), as well as the intraluminal mean arterial pressure gradient. In a separate set of measurements, interobserver variability was measured using two investigators who were unaware of the degree of stenosis.Results: ACC max significantly decreased (P < .001), and the pressure gradient increased (P < .001) as the degree of stenosis increased. Moreover, we found a strong correlation between ACC max and the pressure gradient (R 2 ¼ 0.937). Finally, interobserver variability with respect to ACC max was extremely low, with an intraclass correlation coefficient of 0.99. Conclusions:The results of this flow model study suggest that ACC max can be a valid, noninvasive tool for diagnosing PAD. Moreover, our finding that ACC max decreases as the severity of stenosis increases, together with the strong correlation between ACC max and the pressure gradient, suggests that ACC max may be useful as an alternative diagnostic tool for assessing the severity of PAD. These promising in vitro data warrant further study in a clinical setting. (J Vasc Surg 2020;71:242-9.)Clinical Relevance: Limb pressure measurements and the determination of pressure index values (ankle-branchial index and toe pressure) are commonly used in patients with symptoms consistent with peripheral arterial disease. However, ankle-branchial index and toe pressure can be falsely elevated or falsely normal due to medial calcific sclerosis. In this in vitro flow-model study, the maximal systolic acceleration (ACC max ) significantly decreased as the degree of stenosis increased. Furthermore, there was a strong correlation between ACC max and the intraluminal pressure gradient. These results suggest ACC max may provide a robust noninvasive technique for assessing the severity of peripheral arterial disease.

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Section: Discussionmentioning

confidence: 99%

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

Brouwers

Doorn

Wissen

et al. 2020

Journal of Vascular Surgery

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“…Also, the study recruited selected population with many exclusion criteria to avoid confounding variables; thus, the results cannot be applied to general ADHF population. Renal AT depends on heart rate, 22,23 and because renal AT was not adjusted to the heart rate in our study, our results should be applied with caution in patients with heart rate outside the range (70–115 beats per minute) of heart rate in our population.…”

Section: Renal Resistivity Index and Worsening Of Renal Functionmentioning

confidence: 79%

“…Intrarenal variables include maximal velocity of blood flow, arterial compliance, and vascular resistance 22,23 while cardiovascular variables include systolic and diastolic pressure and time, pulse pressure, cardiac output, and heart rate. 22,23 Accordingly, AT in ADHF is a moving target that reflects the dynamic interactions of the aforementioned variables. This was obvious in our study where renal AT showed significant shortening in the first 24 h when compared with admission values; on the other hand, renal AT was longer in patients with WRF compared with patients without.…”

Section: Discussionmentioning

confidence: 99%

New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure

et al. 2020

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Aims Worsening of renal function (WRF) is a common complication in patients with acute decompensated heart failure (ADHF). We aimed to evaluate the role of intrarenal Doppler ultrasound (IRD) in the early prediction of WRF in this patient group. Methods and results Among 90 patients (age: 57.5 ± 11.1 years; 62% male) hospitalized with ADHF, resistivity index (RI), acceleration time (AT), and pulsatility index (PI) were measured on admission and at 24 and 72 h. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline. Adverse clinical outcomes were defined as the composite of death, use of vasopressors, and need for ultrafiltration for refractory oedema. WRF developed in 40% of patients. Mean values of renal AT, RI, and PI on admission were 59.7 ± 15, 0.717 ± 0.08, and 1.5 ± 0.48 ms, respectively. At 24 h, there was significant decrease in AT (to 56.7 ± 10 ms, P = 0.02) and renal RI (to 0.732 ± 0.07; P < 0.001); these changes were maintained up to 72 h. Renal PI showed no significant changes. Independent predictors of WRF were renal AT at 24 h and admission values of renal RI, left ventricular ejection fraction, and plasma cystatin C. Renal AT at 24 h ≥ 57.8 ms had 89% sensitivity and 70% specificity for the prediction of WRF. Independent predictors for adverse clinical outcomes were left ventricular end systolic dimension and WRF. Conclusions Among ADHF patients receiving diuretic therapy, measurement of renal AT and RI by IRD can help identify patients at increased risk for WRF.

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“…Sung et al [13] studied factors affecting the pulsed Doppler waveform using a closed-circuit in vitro blood flow model. They reported that in cases, where the vascular compliance at the distal and the proximal locations of pulsed Doppler waveform measurement was low, it rapidly reached a peak in the initial systolic period, and also presented a mild bimodal peak pattern.…”

Section: Discussionmentioning

confidence: 99%

Suitable methods of measuring acceleration time in the diagnosis of internal carotid artery stenosis

et al. 2020

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Purpose To enhance the utility of acceleration time (AcT) in the diagnosis of internal carotid artery (ICA) stenosis, we assessed the value of AcT measurements with different waveform patterns. Methods Ninety-three patients with acute atherothrombotic cerebral infarction were enrolled, and they underwent both carotid ultrasonography and digital subtraction angiography (DSA). AcT was determined by a conventional procedure (using the first peak point or the bending point) and the peak systolic velocity (PSV) procedure. The AcT ratio was calculated as (AcT of ICA)/(AcT of the ipsilateral common carotid artery). We evaluated the correlation of stenosis rate as assessed by the North American Symptomatic Carotid Endarterectomy Trial method using DSA (DSA-NASCET) with the AcT of ICA (ICA-AcT), the AcT ratio measured by the conventional procedure (conventional AcT ratio), and the AcT ratio measured by the PSV procedure (PSV AcT ratio). The area under receiver operating characteristic curves (AUC) for DSA-NASCET was calculated based on the ICA-AcT and AcT ratio. Results Forty-five vessels had 50% or greater ICA stenosis. DSA-NASCET was positively correlated with the conventional AcT ratio (r = 0.723), conventional ICA-AcT (r = 0.638), and PSV AcT ratio (r = 0.245). The corresponding AUCs for ICA stenosis ≥ 50% were 0.971, 0.886, and 0.572, respectively. Conclusion We demonstrated the usefulness of the conventional procedure for diagnosing stenosis of ICA origin using AcT and showed that the AcT ratio was a more beneficial parameter than AcT.

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

Cited by 16 publications

References 20 publications

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure

Suitable methods of measuring acceleration time in the diagnosis of internal carotid artery stenosis

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