Biomedical subjects

P Arbeille

Publications and source records attributed to P Arbeille.

At least 19 recordsLinked to original sources

PubMed1999

Accuracy of the main Doppler methods for evaluating the degree of carotid stenoses (continuous wave, pulsed wave, and color Doppler).

OBJECTIVE: To compare the accuracy of the main Doppler methods for quantifying the degree of carotid stenoses in 133 patients. METHOD: seven parameters were measured: maximum velocity (V.max) inside the stenosis (by pulsed wave [PW]), grade and index of spectral disturbance (STI) at the outlet of the stenosis (by PW and continuous wave [CW]), ratio of velocities I(IC/CC) in the internal and common carotid (by PW), and ratio of vessel cross-section and residual lumen area (%Color) inside the stenosis (color Doppler). The reference methods were the grades of spectral disturbance and the STI (by CW), already validated against endarterectomy specimens. CONCLUSION: For poststenosis measurements, a high correlation was found between the grades or STI measured by PW and CW (reference method). The measurement of these parameters was easier in PW mode. For intrastenotic velocity, the increase in V.max was not proportional to the degree of stenosis, and V.max showed large fluctuations for the same degree of stenosis. I(IC/CC) also showed large fluctuations for the same degree of stenosis. The correlation was poor for these two parameters, which could only be used for detecting two groups of stenosis: >75% or >90% in area. Color Doppler (conventional and power) routinely overestimated the degree of stenosis by 10%-15% but correlated better with the reference method and was more accurate and reproducible than V.max. A special procedure can be used to avoid this overestimation and improve the accuracy of the color Doppler.

Blood Flow Velocity↗

PubMed1998

Femoral to cerebral arterial blood flow redistribution and femoral vein distension during orthostatic tests after 4 days in the head-down tilt position or confinement.

The first objective of this study was to confirm that 4 days of head-down tilt (HDT) were sufficient to induce orthostatic intolerance, and to check if 4 days of physical confinement may also induce orthostatic intolerance. Evidence of orthostatic intolerance during tilt-up tests was obtained from blood pressure and clinical criteria. The second objective was to quantify the arterial and venous changes associated with orthostatic intolerance and to check whether abnormal responses to the tilt test and lower body negative pressure (LBNP) may occur in the absence of blood pressure or clinical signs of orthostatic intolerance. The cerebral and lower limb arterial blood flow and vascular resistance, the flow redistribution between these two areas, and the femoral vein distension were assessed during tilt-up and LBNP by ultrasound. Eight subjects were given 4 days of HDT and, 1 month later, 4 days of physical confinement. Tilt and LBNP test were performed pre- and post-HDT and confinement. Orthostatic intolerance was significantly more frequent after HDT (63%) than after confinement (25%, P < 0.001). Cerebral haemodynamic responses to tilt-up and LBNP tests were similar pre- and post-HDT or confinement. Conversely, during both tilt and LBNP tests the femoral vascular resistances increased less (P < 0.002), and the femoral blood flow reduced less (P < 0.001) after HDT than before HDT or after confinement. The cerebral to femoral blood flow ratio increased less after HDT than before (P < 0.002) but remained unchanged before and after confinement. This ratio was significantly more disturbed in the subjects who did not complete the tilt test. The femoral superficial vein was more distended during post-HDT LBNP than pre-HDT or after confinement (P < 0.01). In conclusion, 4 days of HDT were enough to alter the lower limb arterial vasoconstriction and venous distensibility during tilt-up and LBNP, which reduced the flow redistribution in favour of the brain in all HDT subjects. Confinement did not alter significantly the haemodynamic responses to orthostatic tests. The cerebral to femoral blood flow ratio measured during LBNP was the best predictor of orthostatic intolerance.

Adult↗

PubMed1998

Cardiovascular echographic and Doppler parameters for the assessment of orthostatic intolerance.

OBJECTIVE: To quantify the hemodynamic changes associated with orthostatic intolerance. METHODS: The aortic flow, the cerebral and lower limb arterial flow and resistance, the flow redistribution between these two areas, and the femoral vein distension were assessed during two orthostatic tests (tilt-up and LBNP:lower body negative pressure) by echography and doppler. Eight subjects stayed 4 days in HDT (head down tilt) in order to induce orthostatic intolerance, and 1 month later, 4 days in confinement. Tilt and LBNP were performed pre- and post-HDT and confinement. RESULTS: Orthostatic intolerance was significantly more frequent after HDT (63%) than after confinement (25%). At rest, the stroke volume was significantly decreased after HDT (-16%, P<0.01) but not after confinement. Cardiac and cerebral hemodynamic responses to tilt-up and LBNP were similar pre- and post-HDT or confinement. Conversely, during both tilt and LBNP the femoral resistances increased less (P<0.002), and the femoral flow reduced less (P<0.001) after HDT than before HDT or after confinement. The cerebral to femoral flow ratio increased less after HDT than before (P<0.002) but remained unchanged before and after confinement. This ratio was significantly more disturbed on the tilt test non-finisher subjects. The femoral superficial vein was more distended during post-HDT LBNP than pre-HDT or after confinement (IP<0.01). In conclusion, 4 days in HDT were enough to alter the lower limb arterial and venous response to tilt-up and LBNP and reduced the flow redistribution in favor of the brain in all subjects. Confinement did not alter significantly the hemodynamic response to orthostatic tests. CONCLUSION: The femoral resistance index, and the cerebral to femoral flow ratio measured by doppler during LBNP were the best predictors for orthostatic intolerance.

Adult↗

PubMed1998

Fetal cerebral and umbilical artery blood flow changes during pregnancy complicated by malaria.

The objectives of our study were to quantify the fetal cerebral artery and umbilical artery blood flow changes daily during a malaria crisis in a pregnant patient and evaluate the sensitivity and the specificity of Doppler indices for the prediction of acute fetal distress at the end of the pregnancy. The study, designed as a prospective and observational one, was carried out in the obstetric department of a government hospital in French Guiana, on 23 women with pregnancies complicated by malaria (age range, 23 +/- 5 years; primiparas, 30%); crisis date: 30.8 +/- 2.5 weeks of gestation; start of treatment: 3.7 +/- 1.3 days after crisis started). The main measures of outcome consisted of daily determinations of fetal Doppler indices during the crisis, evidence of fetal distress (fetal heart rate decelerations) during labor, Apgar scores after birth, gestational age at birth, mode of delivery, and birth weight. During the crisis umbilical artery resistance index increased by 5 to 20% (P < 0.05), cerebral artery resistance index decreased by 5 to 20% (P < 0.05), and CURR decreased by 10 to 35% (P < 0.01), indicating flow redistribution toward the brain. No relationship was found between the CURR value and the following data: parasitemia grade, parity, gestational age of the crisis, date and mode of delivery, and fetal weight. A change in the hypoxia index (% change in CURR during the crisis x number of days of crisis) greater than 150 was associated with abnormal fetal heart rate in 75% of the cases, and a hypoxia index lower than 150 was associated with normal fetal heart rate in 90% of the cases (sensitivity, 89%; specificity, 77%). Lastly, the combination (hypoxia index > 150 and CURR < 1) was associated with abnormal fetal heart rate in 80% of the cases, and one or two of these normal parameters were associated with normal fetal heart rate in 84.6% of the cases (sensitivity, 80%; specificity, 84%). The CURR and the hypoxia index during the malaria crisis can be used to predict acute fetal distress at delivery.

Acute Disease↗

PubMed1998

[Pregnancy and malaria. Study of 143 cases in French Guyana].

Malaria is the most frequent infection world wide affecting pregnant women. The association of malaria and pregnancy sometimes has serious repercussions on the foetus and increases maternal morbidity. We report 143 cases of pregnant women infected by Plasmodium falciparum in French Guyana. The consequences on the fetus in this area, where the maternal premunition rate is low, are serious: the rates of prematurity, hypotrophy and stillbirth are 3 times higher among pregnant women infected by malaria. The consequences for the fetus are all more serious if the infestation is repeated or prolonged, the closer one is to delivery, and if the parity is low. The histologic study of the placenta shows a significant correlation between the placental infection and the fetal hypotrophy. We tried to detect in utero the consequences malaria infection has on the fetus: the presence of an echographic oligoamnios and alterations of the Doppler ratings would be predictive of deleterious consequences of malaria on the fetus. We emphasize the need for rapid treatment as soon as the attack begins, before serious placental lesions occur.

Female↗

PubMed1997

Effect of long-term cocaine administration to pregnant ewes on fetal hemodynamics, oxygenation, and growth.

OBJECTIVE: To assess uterine and fetal blood flows by Doppler velocimetry and fetal growth and oxygenation in pregnant ewes treated daily with cocaine and to determine whether cocaine impairs fetal cardiac and cerebral reactivity. METHODS: The study groups received 70 mg (n = 7) or 140 mg (n = 7) of cocaine and the control group (n = 7) received placebo injected intramuscularly daily on days 60-134. Hemodynamic data were measured at rest and during two acute hypoxic tests at cesarean delivery performed on day 134. RESULTS: The fetal heart rate (FHR) and umbilical and uterine resistance indices (RIs) were higher in the cocaine groups than in the control group (FHR: 187 +/- 8 and 166 +/- 8 beats per minute at 83 and 123 days, respectively, in controls and 9-11% higher in cocaine groups; umbilical RI: 0.79 +/- 0.06, 0.60 +/- 0.04, and 0.52 +/- 0.06, at 83, 105, and 123 days, respectively, in controls and 11-17% higher in the cocaine groups [P < .01]; and uterine RI: 0.40 +/- 0.05, 0.40 +/- 0.04, and 0.37 +/- 0.04, at 83, 105, and 123 days, respectively, in controls and 13-35% higher in cocaine groups [P < .05]). At delivery on day 134, the following characteristics were found to be different in the cocaine groups: fetal weight (4.03 +/- 0.2 kg in controls and 15-21% lower in the cocaine groups [P < .02]), partial pressure of oxygen (26.5 +/- 1.4 mmHg in controls and 15-16% lower in cocaine groups [P < .05]), umbilical RI (0.40 +/- 0.03 in controls and 11-17% higher in cocaine groups [P < .01]), cerebral RI (0.61 +/- 0.03 in controls and 9-15% lower in cocaine groups [P < .01]), and cerebral-umbilical ratio (1.52 +/- 0.04 in controls and 22-23% lower in cocaine groups [P < .001]). During the hypoxic tests, the cerebral RI (P < .05) and the cerebral-umbilical ratio (P < .05) decreased significantly less in the two cocaine groups. The FHR response was reduced significantly in the two cocaine groups (P < .05). CONCLUSION: Long-term exposure to cocaine induces uterine and fetal blood flow disorders, fetal growth restriction, and hypoxia. It reduces the capability of the cerebral vessels to vasodilate and the heart rate to increase during acute hypoxia.

Animals↗

PubMed1997

Fetal arterial Doppler-IUGR and hypoxia.

Vascular resistances of various fetal areas are assessed by Doppler ultrasound. The PI, RI and S/D indices are measured on the cerebral, renal, aortic and umbilical Doppler spectrum. Ratios of these indices based on the comparison of the cerebral (Rc) and the umbilical (Rp) resistances, or carotid (Rcc) and umbilical resistances, or cerebral (Rc) and aortic (Rao) resistances (Rc/Rp or Rp/Rcc, or Rc/Rao), measure the flow redistribution between the placenta and brain. The umbilical resistance indices, when greater than the upper limit of the normal range (> 2sd) are frequently associated with IUGR. (Sensitivity about 65 to 70%). Absent end diastolic flow is most of the time associated with severe IUGR and hypoxia and poor fetal outcome. A fairly good correlation was found between the existence of significantly decreased (< .2.sd) cerebral resistance and the development of post asphyxial encephalopathy in the neonate (Specificity 75% Sensitivity 87%). The earliest detectors of IUGR and hypoxia are the cerebral-umbilical cerebral-carotid, or cerebral-aortic ratios (Sensitivity 85% specificity 90%). When used as predictor of poor perinatal outcome in growth retarded fetuses, the cerebral umbilical ratio shows a sensitivity of 90% compared with 78% of the middle cerebral artery, and 83% for the umbilical artery indices. Changes of this ratio are well correlated with the fetal pO2 changes. The renal flow response to hypoxia depends on the degree of hypoxia. Opposite responses were found in case of moderate, and severe IUGR or hypoxia. Thus, it is too early to conclude if the renal indices are reliable parameters for the evaluation of fetal hypoxia. The sensitivity in predicting IUGR was for the aortic PI: 41% and for the aortic BFC (Blood flow classes): 57%. In predicting delivery for fetal distress, the corresponding values were 76 and 87%, respectively. Because the resistance indices are heart rate-dependent, it is dangerous to draw any conclusion from one single value of any of these parameters. Only several successive measurement of the Doppler indices or of their ratio, may lead to a reliable evaluation of fetal hemodynamics. In the case of significant IUGR with abnormal Doppler indices it is recommended to repeat the Doppler measurements daily both at the cerebral and umbilical or aortic level in order to follow up the fetal flow redistribution which is highly correlated with the fetal pO2 changes.

Female↗

PubMed1997

Doppler sensors and harnesses for cardiac and peripheral arterial flow monitoring.

The objective of the present work was to design Doppler sensors and harnesses for monitoring in real time the cardiac stroke volume and output, the cerebral flow volume and resistance and the lower limb arterial flow and resistance changes. For the middle cerebral artery investigation we used a 2-MHz transcranial pulsed wave (PW) Doppler probe (commercial probe) mounted on a rotula, fixed on the horizontal branch of a headset designed like an audio headset. The arch of the headset passed over the top of the skull. For the common carotid investigation, a 4-MHz continuous-wave (CW) or PW flat Doppler probe was inserted in a circular silicone support of 5-cm diameter and 0.6-cm thickness. This soft support could adapt to the irregular surface of the neck, and the silicone material, which is fairly adhesive to the skin, made the system stable. The transducers were preoriented at 45 degrees from the support, which provided an acceptable orientation of the Doppler beam. The aortic Doppler harness consisted of a 2-MHz PW Doppler probe, mounted on a rotula fixed on a plastic rigid support 7 x 1.5 cm2 in area (parallel to the sternum) whose length could be changed (4-7 cm) to localize the rotula and its sensor on the suprasternal area. This flat segment was fixed on a rotating platform, part of a solid square plastic support (10 x 10 cm2) placed on the upper part of the sternum. This system was maintained by elastic bands passing around the shoulder and the chest. The femoral Doppler harness consisted of a 4-MHz CW or PW flat Doppler probe, inserted in a flat and rectangular rigid plastic support 10 x 3 cm2 in area. This rigid support was well adapted to the flat surface of the internal part of the thigh, which made the system stable. Two elastic bands passed around the thigh and the abdomen, which avoided any translation of the support and kept the sensor in contact with the skin. The transducers were preoriented at 45 degrees from the support, which provided an acceptable orientation of the Doppler beam. The whole Doppler monitoring system was successfully tested during orthostatic tests, such as lower body negative pressure or tilt table tests performed in pre and post head-down tilt experiments and space flights, with the objective of assessing and quantifying the cardiac and peripheral arterial hemodynamic changes associated with orthostatic intolerance.

Cardiac Output↗

PubMed1997

[A comparative study of the Doppler methods for evaluation of the degree of carotid artery stenosis. Continuous, pulsed, color Doppler].

OBJECTIVE: Compare various Doppler methods for the quantification of the degree of stenosis on 85 patients. METHOD: the following parameters were measured: maximal velocity (Vmax) inside the stenosis (PW), grades of spectral disturbances at the outlet of the stenosis (PW-CW), index of spectral disturbance (STI) at the outlet of the stenosis (PW-CW), ratio of velocities I(IC/CC) in internal and common carotid (PW), ratio of vessel cross section and residual lumen area (% STEN) by color Doppler. The reference method was the Grades of spectral disturbance and the index of stenosis measured post stenosis. (Method validated against angiography and pieces of endarterectomy.) The following comparisons were done; grades and STI by CW against grades and STI by PW, Vmax (PW) against grade and STI, % STEN (color) against grade and STI, % STEN (color) against Vmax (PW), I(IC/CC) (PW) against grade and STI, I(IC/CC) (PW) against Vmax. CONCLUSION: (a) grades or stenosis index : showed the best reproductibility; (b) a high correlation was found between the grades or stenosis index post stenosis measured by CW or PW; (c) Vmax was not proportional to the stenosis degree and showed large fluctuations for the same stenosis degree; (d) the I(IC/CC) showed large fluctuations for the same stenosis degree, the correlation was poor for this velocity ratio. Both Vmax and I(IC/CC) allow to detect only 2 groups of stenosis > 75% or > 90% in area; (e) color doppler over-estimate stenosis degree by approximately 20% but was more accurate and reproducible than Vmax. An appropriate procedure was designed to avoid this over estimation.

Blood Flow Velocity↗

PubMed1997

[Fetal circulation and malaria].

OBJECTIVE: To quantity the fetal vascular changes during flare-up, and to evaluate the sensitivity and the specificity of Doppler indices for the prediction of acute fetal distress at the end of the pregnancy. METHOD: Every day of flare-up the umbilical resistance (Rp), cerebral resistance (Rc), cerebro-placental ratio (CPR = Rc/Rp), and hypoxia index (HI = delta % CPR x crisis duration) were calculated. RESULTS: Twenty-three pregnancies were investigated at St Laurent du Maroni Hospital (French Guiana). During flare-ups the Doppler placental resistance increased (placental disorder), cerebral resistance decreased (vasodilation), CPR decreased (flow redistribution toward the brain), and HI increased. An abnormal CPR (< 1) was associated with abnormal fetal heart rate (FHR) in 61.5% of the cases, a CPR > 1 was associated with a normal FHR in 80% of the cases. (sensitivity: 80%, specificity 61%). A CPR < 1 was associated with one of the abnormalities (abnormal FHR, cesarean section, abnormal Apgar) in 71% of the cases, a CPR > 1 was associated with normal delivery in 55% of the cases (sensitivity: 71.4%, Specificity 55%). A HI higher than 150 was associated with abnormal FHR in 75% of the cases, a HI < 150 was associated with normal FHR in 90% of the cases (sensitivity: 89%, specificity: 77%). Lastly the combination (HI > 150 + CPR < 1) was associated with abnormal FHR in 80% of the cases, 1 or 2 of these parameters were associated with normal FHR in 84.6% of the cases (sensitivity: 80%, specificity: 84%). The minimum CPR and the HI during malaria flare-up can be used to predict acute fetal distress at delivery.

Acute Disease↗

PubMed1996

Twenty-day cerebral and umbilical Doppler monitoring on a growth retarded and hypoxic fetus.

In one growth retarded and hypoxic fetus, the cerebral and umbilical hemodynamic changes were assessed (by Doppler), daily over 20 days. The fetal brain was investigated by magnetic resonance imaging (MRI) close to the delivery, and because the fetus died at delivery we performed an anatomical study of the fetal brain. The evolution of the fetal hemodynamics (day by day) was interpreted according to the MRI findings and the clinical findings. During the period of observation (under sustained hypoxia) the fetal deterioration was characterized by: (a) the progressive development of the oligohydramnios (190d), (b) the disappearance of the vascular reactivity (eight successive cerebral resistance index (RI) constant at 194d), (c) the occurrence of fetal heart rate decelerations (199d), and finally (d) the increase of the cerebral vascular resistances with reduction of the brain perfusion (204d). The anatomical study of the brain showed a periventricular congestion however the histology revealed hypoxic lesions like gliosis and a marked vasodilation of the anterior and middle cerebral arteries. Finally in addition to single Doppler measurements performed 1 week before delivery (for prediction of fetal outcome), one can suggest to use the 'loss of fluctuation of the cerebral RI' to identify the beginning of the period of very high risk for the fetus. Such hypothesis may have to be confirmed on a larger number of pathological pregnancies.

Adult↗

PubMed1996

Regional blood flow in microgravity: adaptation and deconditioning.

The objectives were to evaluate cardiac and peripheral changes induced by microgravity with and without countermeasures (CM), to assess the peripheral response to orthostatic tests (tilt, LBNP). Inflight or HDT, we used echography and Doppler to assess the left heart function and the peripheral arteries. We studied the cardiovascular system during 1) 21-d and 25-d spaceflights without CM, 2) 14.d spaceflight with "bracelets" CM, 3) 28-d HDT with and without LBNP, and 4) 30-d HDT with and without Exercise+LBNP. Similar peripheral circulation changes were noticed in both astronauts and HDT subjects without CM. There was a decrease in renal, cerebral, and femoral vascular resistances and maintenance of cerebral flow at rest, and a lack of increase in lower limb vascular resistance and abnormal flow redistribution during orthostatic tests. Conversely, with CM at rest, cerebral and renal vascular resistances stayed elevated and femoral resistance decreased, but less than without countermeasures. Lower limb vascular resistance increased normally, peripheral flows were adequately redistributed during orthostatic tests, and no orthostatic intolerance was observed. This confirms the efficiency of countermeasures (LBNP, exercise, cuffs) in preserving the vasomotor tone in most peripheral areas at rest and reducing the development of orthostatic intolerance.

Adaptation, Physiological↗

PubMed1995

Quantification and assessment of carotid artery lesions: degree of stenosis and plaque volume.

Various methods were developed for the quantification of the degree of stenosis: B-mode imaging, CW Doppler with spectral analysis, PW-duplex, and color-flow imaging. The degree of stenosis can be evaluated using transverse views of the carotid in conventional B-mode imaging. The diameters of the residual lumen (Ds) and the external diameter (De) of the artery at the same level are measured and the degree of stenosis (in area) is calculated. Two different Doppler methods have been designed and validated for the quantification of the stenosis degree. The first one is based on the determination of the maximal velocity inside the stenosis and requires the use of a duplex device. The second one, based on the quantification of the hemodynamic disturbances at the outlet of the stenosis, can be used either with a duplex system or with a continuous-wave Doppler system (pencil probe). The color display mode facilitates the determination of the residual lumen and therefore contributes to making the B-mode method more accurate. Moreover, it provides a visualization of the blood flow which avoids most of the misinterpretations of B-mode or Doppler data. Several classification systems based on subjective or semi-quantitative criteria (morphological or hemodynamic) were used to identify different grades of stenosis (< 40%, 40% to 60%, 60% to 90%, etc.) These classifications provide an evaluation of the degree of stenosis accurate enough to discuss the possibility of performing an endarterectomy on a symptomatic patient. When the surgical treatment seems to be inappropriate, the patient is treated medically; the follow-up of the lesion (ie, every 6 months) requires a more precise evaluation of the plaque changes than does stenosis classification. Several parameters have been designed and validated for the quantification of the degree of stenosis by ultrasound. These parameters, whether measured with the B-mode and color image or with the Doppler spectrum, allow quantification of the stenosis degree in percentage of lumen reduction with a precision of approximately +/- 10%. Such a quantitative assessment of carotid lesions for a long period of time may be very helpful in evaluating the beneficial effects of medical treatment or in detecting any significant increase of the stenosis that could lead to surgical treatment. A new method for the plaque volume assessment has been recently validated. The plaque volume index expressed in mm3 is calculated from longitudinal and transversal B mode views of the bifurcation.

Blood Flow Velocity↗

PubMed1995

Vascular resistance quantification in high flow resistance areas using the Doppler method.

The objective of the present study is to define and validate on an animal model (ewe) a new Doppler parameter for the assessment and monitoring of the vascular resistances in high resistance to flow areas (lower limbs, placenta with vascular disease). The high resistance index (HRI) was derived from the transmission line theory and defined as: HRI = D/S with S the amplitude of the systolic peak and D that of the diastolic reverse flow. Validation of the HRI was performed on adult ewes. Distal lower limb vascular resistances were evaluated from the Doppler femoral waveform (HRI) and compared with the classic vascular resistances (Rv), calculated from pressure and flow (mmHg/mL/min). The femoral flow variations were measured by duplex (echo-Doppler) method and the mean pressure through an arterial catheter inserted into the abdominal aorta. Two tests were used in this study: (1) A calibrated venous compression of the lower limbs extremity: The femoral flow dropped by 29%, the pressure and heart rate did not change, the HRI increased by 37% (p < 0.01), and the vascular resistance (Rv) by 46% (p < 0.01). (2) The intravenous injection of 1 mg adrenaline: The arterial pressure increased by 70% (p < 0.001), the heart rate and femoral flow dropped by 50% (p < 0.001), and 35% (p < 0.001), the HRI increased by 70% (p < 0.01) and the vascular resistances (Rv) by 140% (p < 0.01). During the two tests, the HRI changed in proportion with the "classic" vascular resistances.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1995

Assessment of the fetal PO2 changes by cerebral and umbilical Doppler on lamb fetuses during acute hypoxia.

The objective of the present study was to validate one or a combination of fetal Doppler parameters in order to assess acute fetal hypoxia in an ovine model. Acute hypoxia was induced by reducing umbilical, or maternal aortic flow (approx. 70%). A CW Doppler probe was fixed on the fetal cervical skin, facing the internal carotid artery and the fetal abdominal skin adjacent to the umbilical arteries. (The angle between Doppler beam and flow vector remained constant.) A "Doptek 3000" spectrum analyser was used to measure the maximal and mean Doppler frequencies. Heart rate (HR), umbilical blood flow (UBF), carotid blood flow (CBF), umbilical RI (URI), cerebral RI (CRI) and cerebroplacental ratio (CPR = CRI/URI) were calculated in real time. A catheter was inserted into the fetal femoral artery, for blood gas (PO2, PCO2 pH) and blood pressure (BP) measurements. After 1 min of aorta compression (70% aortic flow reduction), the URI increased by 10% (P < 0.05), and the UBF decreased by 10% (P < 0.05), but the CRI decreased by 20% (P < 0.02), and the CBF did not change significantly. Fetal PO2 and CPR fell down after 1 min (59% and 38%, respectively; P < 0.001), although strong fetal heart rate decelerations were observed. The blood pressure, PCO2 and pH did not change significantly during this test. Throughout the 12 min of cord compression (70% umbilical flow reduction) the URI increased (70% to 80% P < 0.001), and the UBF decreased (approx. 60%; P < 0.001), but the CRI decreased (approx. 25%; P < 0.01), and the CBF remained constant (+/- 5%; ns). Fetal PO2 and CPR all decreased during the compression (30% to 44% and 40% to 60%, respectively; P < 0.001). HR, pH and PCO2 did not change significantly. During cord compression the blood pressure did not change significantly. In both cases, the CPR decreased significantly (P < 0.001) with the PO2 in the same direction and with a comparable amplitude (-30% to -50%). Nevertheless, the drop in CPR was greater during cord compression than during aorta compression, probably because the compression of the cord induced a central hypovolemia in addition to the hypoxia. The CPR was found to be the hemodynamic parameter that followed most closely the PO2 acute changes. The amplitude of the variations of this parameter (-30% to -50%) were quite similar to those of the PO2 during the period of acute hypoxia.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗

PubMed1995

Investigation of hormonal effects during 10-h head-down tilt on heart rate and blood pressure variability.

Head-down tilt (HDT) bed rest was used in this study to achieve physiological manipulation of the plasma concentrations of atrial natriuretic peptide (ANP) and the hormones of the renin-angiotensin system. The purpose of this was to achieve a parallel with previous animal experiments in which blockade of the renin-angiotensin system caused significant increases in low-frequency spectral power of heart rate variability, presumably as a consequence of increased blood pressure variability, although this was not measured in these animal experiments. Eight healthy young men completed 10 h of seated control and 6 degrees HDT. To gain a more complete understanding of the interactions between hormonal and neural factors involved in cardiovascular regulation, we measured heart rate, systolic and diastolic pressure variabilities, plasma hormone concentrations, and blood flow to selected vascular beds by pulsed Doppler. Resting R-R interval was not significantly different between seated and HDT tests. Stroke volume and cardiac output were elevated in the first 1-2 h of HDT (P < 0.05), whereas each of systolic (P < 0.01) and diastolic (P < 0.0001) pressures was lower during HDT. Plasma ANP increased as much as 70% during HDT (P < 0.0001). Total variability in each of R-R interval and diastolic blood pressure was reduced during HDT (P < 0.001). Thus, at a time when plasma renin activity was decreased as much as 40% (P < 0.0001), there was in fact a decrease in the variability of R-R interval and diastolic blood pressure in contrast to the hypothesized increase such as found in previous animal experimentation. The data were compatible with tighter autonomic regulation of heart rate about the ideal mean value during HDT.

Adult↗

PubMed1995

[Quantification and monitoring of vascular resistance in the lower limbs by the Doppler method (animal model)].

The object of this study was to define and validate a non-invasive method of evaluation and monitoring of vascular resistances in the leg. Blood flow velocity was measured by Doppler ultrasound in an animal model (ewe) with similar blood flow characteristics in the lower limb as man and allowing access to the required invasive measurements for validation of the method (pressure and flow). Vascular resistances distal to the measuring point (femoral, for example) were assessed using the resistance index R = D/S, S being the peak systolic deflection and D that of diastolic reflux of the Doppler spectral analysis of flow in the femoral artery. The values and variations of this resistance index were compared with the vascular resistances calculated from measurements of pressure and flow at the point of Doppler sampling and expressed in mmHg/ml/min. Femoral flow was measured by Doppler ultrasound (Doppler-echo), and mean pressure by an arterial catheter introduced into the abdominal aorta. Compression of the lower limb veins induced a venous return resulting in a reduction of cardiac output and femoral flow. During compression, femoral flow decreased by an average of 29% (p < 0.001) although mean pressure and heart rate did not change significantly. The femoral resistance index (Rf) increased by an average of 37.5% (p < 0.01) and vascular resistances increased by 45.9% (p < 0.01). Injection of 1 mg adrenaline induced peripheral vasoconstriction with an increase in blood pressure and a decrease in heart rate and femoral flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1995

Femoral flow response to lower body negative pressure: an orthostatic tolerance test.

UNLABELLED: The objective was to check, during a lower body negative pressure (LBNP) test, new vascular parameters for the detection of orthostatic intolerance induced by head-down-tilt (HDT) and spaceflight. METHODS: The lower-limb volume flow and vascular resistance were evaluated by Doppler ultrasound. The HDT population consisted of two groups: control [6 subjects resting in a HDT (-6 degrees) position for 28 d] and countermeasure (6 subjects also in HDT for 28 d, but with repeated LBNP and exercise). The LBNP orthostatic test (four steps: -20, -30, -40, -50 mm Hg, of 3 min each) was performed before, during, and after the HDT. For the 14-d spaceflight (Antares) the cosmonaut underwent the LBNP test (10 min at -25 mm Hg and 10 min at -45 mm Hg), at preflight (3 times), inflight (day 11), and postflight (twice). RESULTS: HDT--As the LBNP pressure decreased, the femoral blood flow decreased and the lower-limb vascular resistances increased in both HDT groups. In the control group the femoral flow was less reduced, at each of the 4 levels of depressure (p < 0.01). The amplitude of the leg vascular resistances was reduced at -40 mm Hg, and at -50 mm Hg, on HDT day 15 in both groups (before LBNP, after 1 week's exercise for the countermeasure group), and on post-HDT day 1 (p < 0.01) only in the control group. The femoral vascular resistance response had completely recovered in the countermeasure group on post-HDT day 1. During the post-HDT tilt table test, all 6 controls had a drop in blood pressure of 20 mm Hg (4 subjects) or 10 mm Hg (2 subjects); 3 had pre-syncopal symptoms. The HDT countermeasure subjects had neither any clinical signs of orthostatic intolerance nor any blood pressure drop. 14d-Spaceflight--During the flight, the cosmonaut did not use any countermeasures (exercise, LBNP). On flight day +11, and on postflight day 3, the femoral vascular resistance response to LBNP was decreased as observed in the control group on HDT day +15 and post HDT. On postflight day 7, the femoral response had completely recovered. The middle cerebral flow response to the various pre-, in-, and postflight LBNP tests consisted of a slight decrease of the cerebral flow together with resistances of comparable amplitude (-10 to -20%) to those measured during the same LBNP test in the HDT control group. CONCLUSION: The femoral hemodynamics are much more disturbed than the cerebral ones in vascular deconditioning. The assessment of the lower limb vascular reactivity will be of interest in predicting orthostatic intolerance, and checking the efficiency of counter-measures.

Cardiovascular Deconditioning↗