Sandra Pereira Leite

Reliability of brachial artery flow-mediated dilatation measurement using ultrasound

OBJECTIVE To determine the reliability of the baseline (BBAB) and post occlusion (POBAD) brachial artery diameters, brachial artery flow-mediated dilatations (BAFMD) measurements, and to quantify the typical error of the measurements (TEM). METHODS Internal consistency (2 measurements on the same day) was determined in 10 volunteers, whereas stability (2 measurements on separate days) was determined in 13 volunteers. All the volunteers looked healthy and were nonsmokers. The brachial artery images were obtained using a two dimensional Doppler ultrasound instrument: a 14 MHz transducer was used. The distances between the intima-lumen interfaces were measured before and after the blood flow had been stopped by means of a cuff on the arm for five minutes. BAFMD was considered as the percentile increase of POBAD in relation to BBAD. RESULTS ANOVA did not identify any significant differences between the measurements taken on the same and separate days. For BAFMD, the intraclass correlation coefficients between the measurements taken on the same and separate days were: R = 0.7001 and R = 0.8420, respectively (p < 0.05). The variation coefficients were 5.8% and 12.4% and the relative SMEs were 13.8% and 14.9%, respectively, for the measurements taken on the same and separate days. Analysis of the Bland-Altman graphs indicated that the variables did not present heteroscedastic errors. CONCLUSION The BBAD, POBAD and BAFMD measurements using the manual ultrasound technique were highly reliable for both the same and separate day measurements and therefore can be used to diagnose and monitor endothelial function.

Confiabilidade da medida de espessuras musculares pela ultrassonografia

PURPOSE: To determine the reliability of muscle thickness measurements of elbow and knee flexors and extensors using ultrasound, and to quantify the typical error associated to the measurements (TEM). METHODS: The test-retest reliability was determined in 15 apparently healthy volunteers (8 women, 34 ± 11 years, 76 ± 21 kg, 170 ± 10 cm). The images of elbow flexors (EF) and extensors (EE) and knee flexors (KF) and extensors (KE) were obtained using a two dimensional mode B ultrasound instrument with a 7.5 MHz transducer. Muscle thickness between the adipose tissue and bone interfaces were measured at anatomical landmarks previously identified and recorded to assure the exact site for the retest. RESULTS: ANOVA did not identify any significant differences between the repeated measurements. Intraclass correlation coefficients (ICC) of each pair of measure were EF = 0.970, EE = 0.971, KF = 0.555 e KE = 0.929 (P < 0.05 for all). The coefficients of variation were 3.9 %, 6.1 %, 6.6 % e 4.6 %, and TEM 1.3 mm, 1.6 mm, 4.9 mm e 1.9 mm, respectively, for the EF, EE, KF and KE thickness. Analysis of the Bland-Altman plot charts indicated that the variables did not present heterocedastic errors. CONCLUSION: EF, EE and KE muscle thickness measurements using the current method were highly reliable and can be used to measure and monitor changes in diet, physical training and rehabilitation programs. Nevertheless, KF measure should not be recommended since it presented low reliability and high TEM.

Dilatação fluxo-mediada da artéria braquial em mulheres com artrite reumatóide

OBJETIVO: Avaliar a funcao endotelial em pacientes com artrite reumatoide, pela dilatacao fluxo-mediada da arteria braquial. MATERIAIS E METODOS: Sessenta e oito pacientes, sendo 32 com artrite reumatoide e 36 do grupo controle, foram avaliadas pela dilatacao fluxo-mediada da arteria braquial (metodo ultra-sonografico, no modo B, de avaliacao de risco cardiovascular). Em um segundo tempo, foi avaliada a correlacao entre a dilatacao fluxo-mediada da arteria braquial, a proteina C reativa e o tempo de doenca em pacientes com artrite reumatoide. RESULTADOS: A dilatacao fluxo-mediada da arteria braquial na artrite reumatoide foi igual a 5,6 ± 9,69% e no grupo controle foi igual a 23,24 ± 5,65%, diferenca estatisticamente significante (p < 0,00001). A proteina C-reativa teve resultado de 4,8 ± 9,1 mg/l. A correlacao entre a idade, a dilatacao fluxo-mediada da arteria braquial e a proteina C reativa nas pacientes com artrite reumatoide nao mostrou resultado estatisticamente significante. CONCLUSAO: Mulheres com artrite reumatoide apresentam importante disfuncao endotelial quando comparadas com mulheres normais.

Dilatação fluxo-mediada da artéria braquial e complexo médio-intimal das artérias carótida e braquial: avaliação de indivíduos com e sem fatores de risco para aterosclerose

OBJECTIVE: To evaluate endothelial function in patients with risk factors for atherosclerosis by measuring brachial artery flow-mediated dilatation (BAFMD) and intima-media thickness (IMT) of carotid and brachial arteries. MATERIALS AND METHODS: A cross-sectional, case-control study in which endothelial function was evaluated by measurement of BAFMD and IMT of carotid and brachial arteries and presence or absence of risk factors in 112 patients distributed as follows: women with risk factors (n = 49), women control group (n = 24), men with risk factors (n = 21), men control group (n = 18). RESULTS: BAFMD was significantly compromised in the group with risk factors as compared with the control group, regardless of sex: in women, 15.2 × 25.3 (p < 0.01); in men, 11.8 × 16.8 (p < 0.02). On the other hand, IMT was not significant both for the carotid and brachial arteries, regardless of sex: brachial artery in women, 0.3 × 0.3 (p < 0.06); brachial artery in men, 0.36 × 0.23 (p < 0.07); carotid artery in women, 0.6 × 0.4 (p < 0.07); carotid artery in men, 0.85 × 0.38 (p < 0.08). The significance level was set at 5% (p < 0.05). CONCLUSION: Measurement of BAFMD was effective for detecting endothelial impairment in a population with risk factors for atherosclerosis.

Alterations of Flow-Mediated Dilation of the Brachial Artery in Women after Menopause

Introduction Risk of cardiovascular diseases increases after menopause. Decrease in estrogen alters endothelium function, the first event in the atherosclerotic process. Endothelium function can be assessed by flow-mediated dilatation (FMD) during reactive hyperemia. We compared differences in brachial artery FMD in women before and after menopause. Methods Average ages of control (n = 35) and postmenopausal (n = 38) women were 34 ± 8 (SD) and 57 ± 7 years respectively. No subjects were on estrogen therapy or had known risk factors for cardiovascular disease. Brachial artery FMD was measured 5 cm above the cubital crease, using a 14 MHz transducer. B-mode images were selected during diastole using the flow waveform. Diameter measurements were performed before brachial artery occlusion and 60 seconds after release of a 5-min occlusion accomplished with pneumatic cuff inflation. FMD expressed the percentage change in diameter during reactive hyperemia versus baseline. Results Average FMD was 19 ± 6% (11 – 30%) for controls, decreasing significantly to 14 ± 6% (3–26%) post-menopause (p < 0.001 by t-test). FMD was abnormally lower than 10% in 9 post-menopausal women, 7 older than 60 years, and 8 with menopause ≥10 years. Conclusions FMD decreased significantly post menopause and were abnormally low in older women with longer menopause. Changes in FMD with age, duration of menopause and relation of low FMD to risk development deserves further investigation to determine if FMD can be used as an independent risk factor.

Pre-eclampsia: An overview in placentation, endothelial dysfunction and flow-mediated vasodilation

AbstractThe blastocyst–endometrium interaction requires the perfect synchronization between the development of the embryo and the maturation of the endometrium. The trophoblast starts to invade the decidua and the spiral arteries, forming trophoblastic plugs. These plugs explain why the beginning of placentation and the development of the fetus occur in a hypoxic environment with trophoblastic invasion of the inner third of the myometrium and the physiological transformation of the spiral arteries in this region. Recent studies indicate that many abnormalities in the physiopathology of pre-eclampsia are similar to those in atherosclerosis. The risk factors of this disorder are heterogeneous and are, once more, frequently associated with atherosclerosis. Pre-eclampsia is currently regarded as a two-stage disease: the uteroplacental circulation remains in a high-pressure regimen, corresponding to the first stage of the disease. The second stage includes the maternal response in which there is global activat...

F69Three‐dimensional ultrasound in the diagnosis of uterine malformations

Uterine evaluation by means of 3D US is useful in classifying the main malformations, as it allows the visualisation of the frontal plane, impossible to obtain with conventional sonography. In the frontal plane it is possible to classify the uterine abnormalities, according to the fundal surface, the endometrial cavity and the uterine cervix.