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Hyperemic Brachial Artery Blood Flow Velocity
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. (PIVUS / Lars Lind)
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aims to evaluate the blood flow velocity in the Brachial artery during reactive hyperemia. Primarily to appraise the information it might contain regarding cardiovascular function and cardiovascular risk.

Ultrasonographic doppler measurements of the Brachial artery were made on the 1016 men and women aged 70 included in the prospective investigation of the vasculature in Uppsala seniors (PIVUS) study. Analysis of the blood flow velocity in the forearm was made in comparison to established methods of estimating endothelial function, clinical markers of cardiovascular risk, the Framingham risk score and global atherosclerosis determined by whole body magnetic resonance angiography.

Systolic blood flow velocity was positively related to cardiovascular risk whereas the diastolic velocity was inversely correlated. However, the systolic to diastolic blood flow velocity (SDFV) ratio was more closely associated with cardiovascular risk than its components apart.

Ultrasonographic markers of Carotid atherosclerosis were related to the SDFV ratio. Concentric left ventricular remodeling and left ventricular mass index were also associated with the SDFV ratio, but not to its numerator or denominator separately. A similar pattern was found when assessing SDFV ratio in relation to global atherosclerosis, as well as to established markers of arterial compliance and vasodilation.

In conclusion, during reactive hyperemia of the Brachial artery, the systolic to diastolic blood flow velocity ratio appears to contain information of additional value than its components separately, independently of established cardiovascular risk factors. Possibly, the SDFV ratio could offer a promising means to estimate cardiovascular risk in aging populations.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2010. , p. 79
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 620
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-132918ISBN: 978-91-554-7942-8 (print)OAI: oai:DiVA.org:uu-132918DiVA, id: diva2:359636
Public defence
2010-12-15, Enghoffsalen, Ingång 50, Akademiska Sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Projects
PIVUS
Available from: 2010-11-24 Created: 2010-10-28 Last updated: 2011-01-13Bibliographically approved
List of papers
1. Hyperaemic blood-flow velocities in systole and diastole relate to coronary risk in divergent ways
Open this publication in new window or tab >>Hyperaemic blood-flow velocities in systole and diastole relate to coronary risk in divergent ways
2008 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 28, no 3, p. 189-95Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A recent study suggested blood-flow velocity in diastole during reactive hyperaemia as a major driver of flow-mediated vasodilation (FMD) of the brachial artery, also being related to cardiovascular risk factors. The present study aimed to investigate the relative importance of hyperaemic systolic and diastolic blood-flow velocity in the forearm regarding both FMD and cardiovascular risk factors. METHODS: In the Prospective Investigation of the Vasculature in Uppsala Seniors study, conducted in 1016 subjects aged 70 years, FMD, systolic and diastolic blood hyperaemic flow velocities in the brachial artery were evaluated by ultrasound. RESULTS: Hyperaemic blood-flow velocity both in systole and diastole were related to FMD (r = 0.14-0.19, P<0.0001). However, while hyperaemic systolic blood-flow velocity was related to coronary risk (Framingham risk score) in a positive way (r = 0.08, P = 0.013), diastolic blood-flow velocity was inversely related to coronary risk (r = -0.08, P = 0.016). Therefore, the systolic to diastolic hyperaemic blood-flow velocity ratio was more powerful related to coronary risk (r = 0.23, P = 0.0001). In a multiple regression model, both FMD and the systolic to diastolic hyperaemic blood-flow velocity ratio were independent predictors of coronary risk (P = 0.018 and P = 0.0001). CONCLUSION: As hyperaemic blood-flow velocities in systole and diastole in the brachial artery were related to coronary risk in divergent ways, the ratio thereof is a promising index of vascular function providing independent information regarding coronary risk when compared with FMD.

Keyword
brachial blood velocity systole diastole hyperemia cardiovascular risk
National Category
Medical and Health Sciences
Research subject
Medicine; Internal Medicine; Cardiology
Identifiers
urn:nbn:se:uu:diva-103741 (URN)10.1111/j.1475-097X.2008.00797.x (DOI)000254807900008 ()18355345 (PubMedID)
Projects
PIVUS
Available from: 2009-05-20 Created: 2009-05-20 Last updated: 2017-12-13Bibliographically approved
2. Brachial artery hyperemic blood flow velocities are related to carotid atherosclerosis
Open this publication in new window or tab >>Brachial artery hyperemic blood flow velocities are related to carotid atherosclerosis
2009 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 29, no 5, p. 360-365Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Cardiovascular (CV) risk relates to the blood flow velocity pattern in the brachial artery during hyperemia, especially to the hyperaemic systolic to diastolic mean blood flow velocity (SDFV) ratio. Here, we investigated the relations between SDFV in the brachial artery and different characteristics of carotid atherosclerosis. MATERIAL AND METHODS: Data were collected from 1016 70-year-olds participating in the Prospective Investigation of Uppsala Seniors study. Doppler recordings of blood flow velocity during hyperemia were analysed in the brachial artery. In the carotid artery, intima-media thickness (IMT) was recorded together with an assessment of echogenicity by the Grey scale median (GSM) method in both overt plaques and in the intima-media complex (IM-GSM). RESULTS: The SDFV ratio was related to the number of carotid arteries affected by plaque (P = 0.018) and inversely to plaque echogenicity (P = 0.0003). The SDFV ratio was also related to IMT (P = 0.0022) and inversely to IM-GSM (P = 0.0001). These relations were statistically significant also after adjusting for major CV risk factors, individually as well as summarised as the Framingham risk score. CONCLUSION: Our results indicate that the hyperemic systolic to diastolic blood flow velocity ratio in the brachial artery is related to atherosclerosis in the carotid artery.

Keyword
carotid atherosclerosis brachial velocity hyperemia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-124222 (URN)10.1111/j.1475-097X.2009.00879.x (DOI)000268981800007 ()19508277 (PubMedID)
Projects
PIVUS
Available from: 2010-05-03 Created: 2010-05-03 Last updated: 2017-12-12Bibliographically approved
3. Brachial artery hyperemic blood flow velocity and left ventricular geometry
Open this publication in new window or tab >>Brachial artery hyperemic blood flow velocity and left ventricular geometry
(English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527Article in journal (Other academic) Submitted
Abstract [en]

ABSTRACT

OBJECTIVE

Cardiovascular risk factors and carotid atherosclerosis relates to blood flow velocity in the brachial artery during induced hyperemia. This relation proved to be particularly strong when using the hyperemic systolic to diastolic blood flow velocity (SDFV) ratio. In this study, we further investigated this ratios value as a marker of vascular risk in relation to left ventricular (LV) geometry.

MATERIAL AND METHODS

In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, 1016 70-year-olds participated. Blood flow velocity during hyperemia of the brachial artery by Doppler was analysed. Echocardiography was performed, allowing analysis of LV geometry, categorised into four different groups: normal, concentric remodeling, concentric- and eccentric- hypertrophy.

RESULTS                                                                                                                                    

The SDFV ratio was increased in subjects with concentric LV -remodeling (p=0.006) or -hypertrophy (p=0.001), but not in those with eccentric hypertrophy (p=0.12) when compared to the group with normal LV geometry. These associations remained significant after adjustment for gender, blood pressure, blood glucose, body mass index and antihypertensive treatment.

CONCLUSION

The hyperemic systolic to diastolic blood flow velocity ratio in the brachial artery was related to concentric geometry of the LV in an elderly population sample, suggesting this new hemodynamic variable as a marker of increased afterload.

Keyword
brachial blood flow velocity left ventricular geometry
National Category
Cardiac and Cardiovascular Systems
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-132916 (URN)
Projects
PIVUS studien
Available from: 2010-10-28 Created: 2010-10-28 Last updated: 2017-12-12Bibliographically approved
4. Brachial artery hyperemic blood flow velocity in relation to established indices of vascular function and global atherosclerosis
Open this publication in new window or tab >>Brachial artery hyperemic blood flow velocity in relation to established indices of vascular function and global atherosclerosis
Show others...
2012 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 32, no 3, p. 227-233Article in journal (Other academic) Published
Abstract [en]

Background

Systolic to diastolic blood flow velocity (SDFV) ratio in the Brachial artery recently proved to be related to cardiovascular risk and Carotid atherosclerosis. We hypothesized that the SDFV ratio was related to established markers of vascular function and global atherosclerosis. 

 

Methods

Established markers of endothelial function in forearm resistance vessels, flow-mediated vasodilation and arterial stiffness were assessed in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study including 1016 individuals aged 70. Whole body magnetic resonance angiography was performed in a random 306 of the participants. Atherosclerotic lesions were summarized in a total atherosclerotic score (TAS). Before and during hyperemia of the Brachial artery, systolic and diastolic blood flow velocities were measured by Doppler.

 

Results

The SDFV ratio was positively related to endothelium-independent vasodilatation, while inverse relations to flow-mediated dilation, common carotid artery distensibility and the stroke volume to pulse pressure ratio were found. Endothelium-dependent vasodilatation and total peripheral resistance index were not significantly related to the SDFV ratio.

The SDFV ratio (p=0.015) and the blood flow increase during hyperemia (p= 0.020) were both significantly related to TAS after gender adjustment. When adjusted for the Framingham risk score, both the SDFV ratio (p= 0.057) and blood flow increase (p= 0.078) lost somewhat in significance.

 

Conclusion

The SDFV ratio was related to established markers of both vasodilation and arterial compliance, and to global atherosclerosis. Future larger studies have to evaluate if the SDFV ratio is related to global atherosclerosis independently of traditional risk factors.

Keyword
atherosclerosis; brachial; hyperaemic; vascular function
National Category
Cardiac and Cardiovascular Systems
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-132917 (URN)10.1111/j.1475-097X.2011.01117.x (DOI)000302545300010 ()22487158 (PubMedID)
Projects
PIVUS
Available from: 2010-10-28 Created: 2010-10-28 Last updated: 2017-12-12Bibliographically approved

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