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ObjectivesAnkle-brachial index (ABI) is commonly used for screening lower extremity peripheral artery disease (PAD) according to the international guidelines. Arterial Doppler waveform recordings is a tool to diagnose and assess PAD severity. We hypothesized that ABI measurement could be simplified by measuring only the pressure where the best arterial flow is recorded. The aim of this study was to evaluate the concordance between ABI performed according to the American Heart Association guidelines (AHA-ABI) and ABI measured according to best arterial waveform (FLOW-ABI).DesignThis was a monocentric cross-sectional study.MethodsWe included patients with exertional limb symptoms suspected of PAD. Arterial Doppler waveforms and ABI were acquired on both lower extremities at the pedis and tibial posterior arteries. Each arterial waveform was classified using the Saint-Bonnet classification. Concordances were analyzed with the kappa coefficient (confidence interval 95%). Exercise PAD study was registered n° NCT03186391.ResultsIn total, one hundred and eighty-eight patients (62+/−12 years and 26.8+/−4.5 kg/m2) with exertional limb symptoms were included from May 2016 to June 2019. On each extremity, FLOW-ABI had excellent concordance for the diagnosis of PAD with the AHA-ABI with a kappa of 0.95 (95% CI: 0.90, 0.99) in the right extremity and 0.91 (95% CI: 0.86, 0.97) in the left extremity.ConclusionThere is almost perfect concordance between AHA-ABI and FLOW-ABI. Thus, ABI can be simplified into five pressure measurements instead of seven in patient suspected of PAD with exertional limb symptoms. The question remains in patients with chronic limb ischemia.

Background: Patients with peripheral artery disease (PAD) are at increased risk for major adverse limb and cardiac events including mortality. Developing screening tools capable of accurate PAD identification is a necessary first step for strategies of adverse outcome prevention. This study aimed to determine whether machine analysis of a resting Doppler waveform using deep neural networks can accurately identify patients with PAD. Methods: Consecutive patients (4/8/2015 - 12/31/2020) undergoing rest and postexercise ankle-brachial index (ABI) testing were included. Patients were randomly allocated to training, validation, and testing subsets (70%/15%/15%). Deep neural networks were trained on resting posterior tibial arterial Doppler waveforms to predict normal (> 0.9) or PAD (0.9) using rest and postexercise ABI. A separate dataset of 151 patients who underwent testing during a period after the model had been created and validated (1/1/2021 - 3/31/2021) was used for secondary validation. Area under the receiver operating characteristic curves (AUC) were constructed to evaluate test performance. Results: Among 11,748 total patients, 3432 patients met study criteria: 1941 with PAD (mean age 69 ± 12 years) and 1491 without PAD (64 ± 14 years). The predictive model with highest performance identified PAD with an AUC 0.94 (CI = 0.92-0.96), sensitivity 0.83, specificity 0.88, accuracy 0.85, and positive predictive value (PPV) 0.90. Results were similar for the validation dataset: AUC 0.94 (CI = 0.91-0.98), sensitivity 0.91, specificity 0.85, accuracy 0.89, and PPV 0.89 (postexercise ABI comparison). Conclusion: An artificial intelligence-enabled analysis of a resting Doppler arterial waveform permits identification of PAD at a clinically relevant performance level. [ABSTRACT FROM AUTHOR]

The article discusses the study on the comparison of the placental features between selective intrauterine growth restriction (sIUGR) patients with dynamic classification (DC) and stable classifications (SC). The results indicate that the prevalence of large artery-artery anastomosis (AAA) is significantly higher in sIUGR with DC than sIUGR with SC, which suggests that large AAA is probably associated with sIUGR with dynamic classification.

Objective: Arterial Doppler waveform recordings are commonly used to assess lower extremity arterial disease (LEAD) severity. However, little is known about the relationship between arterial Doppler waveform profiles and patients' walking capacity. The purpose of this study was to assess whether arterial Doppler waveforms are independently associated with maximal walking distance (MWD) in patients experiencing exertional limb symptoms.Materials and Methods: This cross-sectional study included suspected LEAD patients experiencing exertional limb symptoms. In both lower extremities, arterial Doppler waveforms and ankle-brachial index (ABI) values were obtained from the pedis and tibial posterior arteries. Each arterial flow measurement was ranked using the Saint-Bonnet classification system. Treadmill stress testing (3.2 km/h, 10% slope) coupled with exercise oximetry (Exercise-TcPO2) were used to determine MWD. Delta from rest oxygen pressure (DROP) was calculated. Following treadmill stress testing, post-exercise ABI values were recorded. Univariate and multivariate analyses were used to determine the clinical variables associated with MWD.Results: 186 patients experiencing exertional limb symptoms (62 ± 12 years and 26.8 ± 4.5 kg/m2) were included between May 2016 and June 2019. Median [25th; 75th] treadmill MWD was 235 [125;500]m. Better arterial Doppler waveforms were associated with better walking distance (p = 0.0012). Whereas, median MWD was 524 [185;525]m in the group that yielded the best Doppler waveforms, it was 182 [125,305]m in the group with the poorest Doppler waveforms (p = 0.0012). MWD was significantly better (p = 0.006) in the patients with the best ABIs. However, arterial Doppler waveforms alone were significantly associated with MWD (p = 0.0009) in the multivariate model. When exercise variables (post-exercise ABI or DROP) were incorporated into the multivariate model, these were the only variables to be associated with MWD.Conclusion: Of the various clinical parameters at rest, Doppler flow waveform profiles were associated with MWD in suspected LEAD patients. A stronger link was however found between exercise variables and MWD.

Background: Non-invasive Doppler waveform (DW) analysis is a widely adopted method for detecting and evaluating lower extremity peripheral artery disease (PAD). Previous investigations have reported that broad heterogeneity in the description of Doppler waveforms is reduced by using a classification method. The reliability of arterial Doppler classification, however, is unknown.Purpose: The purpose of this study is to assess the reliability of a 4-category arterial DW classification method among Chinese sonographers.Methods: During a national ultrasound conference in China attendees were invited to classify thirty arterial Doppler waveforms. After viewing a 4-category (triphasic, biphasic, monophasic, and other) arterial Doppler waveform descriptor presentation, attendees were asked to classify 15 continuous wave (CW) and 15 pulsed wave (PW) Doppler waveforms. Their responses were recorded via mobile phone and the reliability of this 4-category classification was estimated by Fleiss' Kappa inter-rater statistical analysis.Results: One hundred and seventy-eight attendees participated in the analysis. The Kappa coefficient of Fleiss (κ) for all attendees was 0.522 (p < 0.005) with 95% confidence interval (CI): 0.520–0.523. The reliability of the waveform descriptor triphasic was the highest (κ = 0.621, p < 0.005), and other was the lowest (κ = 0.341, p < 0.005).Conclusion: The inter-rater reliability of a 4-category arterial Doppler waveform classification by Chinese sonographers is considered weak (κ = 0.522, CI95%: 0.520–0.523, p < 0.005). This study reinforces the importance of assessing DW classification reliability and the development of DW descriptors that are more accurately predictive of clinical hemodynamic events.

Background: Early detection of fetal risk is one of the main issues in today's obstetrics. Ultrasound diagnosis plays a significant role, as the introduction of the Doppler imaging method in the evaluation of blood flow has enabled non- invasive assessment of uteroplacental circulation. Objective: To assess the impact of maternal dexamethasone on doppler waveforms velocity flow of the fetal umbilical and middle cerebral arteries and maternal uterine arteries in pregnant women at risk of preterm labor with normal fetal vascular resistance. Patients and methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology at Menoufia University hospital on 36 patients who were diagnosed as having threatened preterm birth. All the patients were enrolled in the study with routine follow up according to local protocols in the period between January 2019 and November 2019. Full history taking, full general, obstetric examination, and Ultrasound examination was performed. Results: After dexamethasone administration, Umbilical A resistive and Pulsatility indexes were significantly decreased to (1.084 ± 0.118 and 0.66 ± 0.054) in comparison to before dexamethasone (1.121±0.124 and 0.70±0.058). Regarding the Uterine Doppler values, mean Pulsatility index before dexamethasone was 0.79±0.049 (right) and 0.78 ±0.038 (left) decreased significantly to 0.78±0.044 (right) and 0.77±0.036 (left) after dexamethasone. Similarly, the mean Resistive index before dexamethasone was 0.55±0.027 (right) and 0.54±0.026 (left) decreased significantly to 0.53±0.023 (for right and left) after dexamethasone. Conclusions: dexamethasone administration for the pregnant mothers at risk of preterm labor enhance the flow of blood to the fetal umbilical, middle cerebral arteries and maternal uterine arteries 24 hrs. after its administration. [ABSTRACT FROM AUTHOR]

Endofibrosis (EF) of the iliac arteries is a flow-limiting condition typically seen in highly trained endurance athletes. Thirty-seven athletes (74 limbs) were referred to our department with suspected EF. All patients had a pre- and postexercise color Doppler ultrasound (CDU) of the iliac arteries. Doppler waveform and peak systolic velocity (PSV) and end-diastolic velocity (EDV) were assessed pre- and postexercise. Endofibrosis was diagnosed with CDU in 24 athletes (29 limbs). Arterial wall and course abnormalities were detected at rest in 20 (67%) symptomatic limbs of athletes with and 4 (22%) symptomatic limbs of athletes without EF. Postexercise abnormal waveforms of the stenotic/damped type were seen in the iliac arteries in all 29 limbs of athletes diagnosed with EF. These waveform changes were accompanied by high PSV (>350 cm/s) and EDV (>150 cm/s), with (n = 10; 34%) or without (n = 19; 66%) the evidence of reduced arterial lumen caliber. Color Doppler ultrasound can be used to detect EF. [ABSTRACT FROM AUTHOR]

Duplex sonography of extracranial arteries is one of the best tools for identifying stenoses and other diseases of the carotid, vertebral, and subclavian arteries. Abnormal Doppler waveforms in vertebral arteries could be evidence of subclavian steal syndrome. The difference of 15 to 20 mm Hg or more in systolic bilateral brachial arterial blood pressure measurements provides important clinical information in patients with subclavian steal syndrome. Complementary to duplex sonographic scanning, radiologists use computerized tomography angiography, magnetic resonance angiography, and digital subtraction angiography for preoperative planning. [ABSTRACT FROM PUBLISHER]

Aim: We examined whether the Doppler waveforms of the maternal renal main arteries are altered in women with twin pregnancy compared with those in singleton pregnancy. Methods: The indices of vascular resistance and acceleration time of the maternal main renal arteries were obtained from 19 healthy women at 37-38 weeks of singleton gestation and 17 women at the same gestational age with non-preeclamptic twin gestation. Results: There were no significant differences in the indices of vascular resistance between the singleton and twin groups. However, the acceleration time was significantly prolonged in the twin pregnancy group compared with that in the singleton pregnancy group (83.7 +/- 24 vs. 59.8 +/- 12 ms, p < 0.01). Conclusion: The current results imply that maternal renal arteries are more significantly affected by hemodynamic changes in twin pregnancy than in singleton pregnancy. [ABSTRACT FROM AUTHOR]

Keywords: Doppler classification; Doppler waveforms; duplex ultrasound; peripheral artery disease (PAD); vascular imaging/diagnostics EN Doppler classification Doppler waveforms duplex ultrasound peripheral artery disease (PAD) vascular imaging/diagnostics 221 222 2 06/19/20 20200601 NES 200601 Doppler ultrasound waveform analysis is routinely used for diagnosis and evaluation of arterial stenosis in patients suffering from peripheral artery disease (PAD).[1],[2] It was previously demonstrated that there is significant heterogeneity of descriptions of Doppler waveforms by French vascular residents.[3] However, this heterogeneity was significantly reduced when using a four-item Doppler classification.[3],[4] The aim of the present study was to assess the heterogeneity of Doppler waveform descriptions among Chinese ultrasound specialists and the impact of a four-item Doppler classification. Doppler classification, Doppler waveforms, duplex ultrasound, peripheral artery disease (PAD), vascular imaging/diagnostics. [Extracted from the article]

To evaluate the role of Doppler waveforms of uterine vessels and electromyography (EMG) of the uterus in predicting preterm labor.One hundred ante-natal women at≥24 weeks of gestation who fulfilled the selection criteria were included in the study. A single Doppler recording for bilateral uterine vessels was taken at≥26 weeks gestation using the transvaginal route. Transabdominal EMG of the uterus was recorded serially at 4-week intervals from 24 weeks until delivery or until 37 weeks were completed.Women with a sensation of heaviness in the lower abdomen during pregnancy had a significant association with preterm delivery. Of the three Doppler indices, the systolic/diastolic ratio and the resistivity index of uterine vessels were found to have a sensitivity as high as 83–95% for the prediction of preterm labor. The electrical activity of uterine musculature, as recorded using EMG, showed that there was a statistically significant difference between the electrical activity recorded for the two groups at 31 weeks and later, while the duration of burst activity was significantly longer in the preterm group at 26 weeks and later.Patients with a dull aching sensation in the lower abdomen should not be neglected. Doppler of the uterine vessels and EMG of the uterus could prove to be a good predictor of preterm labor. [ABSTRACT FROM AUTHOR]

An 85-year-old man presented with bilateral leg edema and urinary incontinence. Abdominal examination revealed a severely distended bladder. Venous duplex of the legs demonstrated monophasic waveforms bilaterally, suggesting obstruction of proximal lower extremity veins. Relief of urinary obstruction was associated with the prompt return of normal respiratory variation of flow in the veins and improvement of leg swelling. Non-thrombotic obstruction of the proximal veins of the lower extremities by a severely enlarged urinary bladder is an infrequent yet potentially reversible cause of lower extremity edema. Subtle clues in the Doppler waveforms of an otherwise normal lower extremity venous duplex examination are crucial in establishing this diagnosis. [ABSTRACT FROM AUTHOR]

Background: Non-invasive Doppler waveform (DW) analysis is a widely adopted method for detecting and evaluating lower extremity peripheral artery disease (PAD). Previous investigations have reported that broad heterogeneity in the description of Doppler waveforms is reduced by using a classification method. The reliability of arterial Doppler classification, however, is unknown. Purpose: The purpose of this study is to assess the reliability of a 4-category arterial DW classification method among Chinese sonographers. Methods: During a national ultrasound conference in China attendees were invited to classify thirty arterial Doppler waveforms. After viewing a 4-category (triphasic, biphasic, monophasic, and other) arterial Doppler waveform descriptor presentation, attendees were asked to classify 15 continuous wave (CW) and 15 pulsed wave (PW) Doppler waveforms. Their responses were recorded via mobile phone and the reliability of this 4-category classification was estimated by Fleiss' Kappa inter-rater statistical analysis. Results: One hundred and seventy-eight attendees participated in the analysis. The Kappa coefficient of Fleiss (κ) for all attendees was 0.522 ( p < 0.005) with 95% confidence interval (CI): 0.520-0.523. The reliability of the waveform descriptor triphasic was the highest (κ = 0.621, p < 0.005), and other was the lowest (κ = 0.341, p < 0.005). Conclusion: The inter-rater reliability of a 4-category arterial Doppler waveform classification by Chinese sonographers is considered weak (κ = 0.522, CI95%: 0.520-0.523, p < 0.005). This study reinforces the importance of assessing DW classification reliability and the development of DW descriptors that are more accurately predictive of clinical hemodynamic events., (Copyright © 2020 Zhao, Lanéelle, Gao, Fu, Tong, Scissons, Wen and Mahé.)

Background: The analysis of Doppler ultrasound waveforms (DW) provides a method for detecting and evaluating arterial stenosis in the lower limb arteries but no recommendation exists on how to describe the DWs. Aims of this study were to assess the heterogeneity of the description of DWs among vascular residents and the impact of the use of a 4-item classification., Methods: Thirty different DWs were presented to residents using Microsoft PowerPoint ® slides. They were invited to describe the 30 DWs before and after the presentation of a 4-item classification (triphasic, biphasic, monophasic, and others). The heterogeneity was assessed by the number of different answers used by the residents. Nineteen residents with six to eighteen months of vascular medicine training and ultrasound experience were included., Results: The average of different answers was 9 ± 4 for the whole analysis of the 30 DWs without the use of a specific classification, whereas the average was 2 ± 1 using the 4-item classification (p < 0.005). There was a significant difference in correct answers, i. e. in combined continuous waveforms and pulsed waveforms between experienced residents and younger residents (p < 0.05)., Conclusions: Using a 4-item classification for DWs reduced the heterogeneity of the DW description. There is an urgent need to standardize the DW description in order to improve the patients care with peripheral artery disease.

Objective: Selective intrauterine growth restriction (sIUGR) in monochorionic (MC) twins is associated with a substantial increase in perinatal mortality and morbidity for both twins. Clinical evolution depends on the combination of the effects of placental insufficiency in the IUGR twin with inter-twin blood transfer through placental anastomoses. Case 1: It is about a 30 years old women with a Spontaneous monochorionic twin pregnancy. A selective intrauterine growth restriction type 2 was diagnosed at 22 WA with a persistent absent diastolic flow in the umbilical Doppler of the twin with IUGR. The evolution was marked by the deterioration of the Doppler waveforms and the appearance of a reversed end-diastolic flow at 29 WA. Then, because of the faltering growth and the appearance of A reverse atrial flow in the Ductus venosus, a cesarian section was performed at 32 WA. Birth weights were respectively 1200gr and 1800gr for the twin with IUGR and the larger twin. The latest died of a hyaline membrane disease after 5 days. Case 2: It is about a Spontaneous monochorionic diamniotic twin pregnancy with a diagnosis of a type 2 sIUGR at 26 WA. Monitoring was regular and based on the study of fetal growth, and Doppler waveforms. The evolution was marked by a persistent absent diastolic flow in the umbilical Doppler of the twin with sIUGR and the conservation of growth in both twins. Delivery was scheduled at 34 WA. The birth weights were of 1300g and 1700g. At the age of 6 mouths, the pediatric exam did not revealed any brain injury for both twins. Conclusion: SIUGR is a common condition associated with MC pregnancy. It is increasingly considered to be an important complication of MC twins, with potentially significant risks of intrauterine fetal demise or neurological adverse outcome for both twins. Introduction of skilled sonographic evaluation, a better understanding of different Doppler patterns and of the anatomy of MC placenta, together with the development of fetoscopic techniques have all contributed to a deeper scientific understanding of this condition. [ABSTRACT FROM AUTHOR]