Can flavonoid-rich chocolate modulate arterial elasticity and pathological uterine artery Doppler blood flow in pregnant women? A pilot study

Introduction: Dark chocolate has shown beneficial effects on cardiovascular health and might also modulate hypertensive complications in pregnancy and uteroplacental blood flow. Increased uteroplacental resistance is associated with systemic arterial stiffness. We aimed to investigate the short-term effect of flavonoid-rich chocolate on arterial stiffness and Doppler blood flow velocimetry indexes in pregnant women with compromised uteroplacental blood flow. Methods: Doppler blood flow velocimetry and digital pulse wave analysis (DPA) were performed in 25 women pregnant in the second and third trimesters with uterine artery (UtA) score (UAS) 3–4, before and after 3 days of ingestion of chocolate with high flavonoid and antioxidant contents. UtA pulsatility index (PI), UtA diastolic notching, UAS (semiquantitative measure of PI and notching combined), and umbilical artery PI were calculated, and DPA variables representing central and peripheral maternal arteries were recorded. Results: Mean UtA PI (p = .049) and UAS (p = .025) significantly decreased after chocolate consumption. There were no significant changes in UtA diastolic notching or any DPA indexes of arterial stiffness/vascular tone. Conclusion: Chocolate may have beneficial effects on the uteroplacental circulation, but in this pilot study, we could not demonstrate effects on arterial vascular tone as assessed by DPA

Arterial stiffness in normal pregnancy as assessed by digital pulse wave analysis by photoplethysmography – A longitudinal study

Introduction: It might in the future be valuable to screen for increased maternal arterial stiffness, i.e. low compliance, since it is associated with development of hypertensive complications in pregnancy. Digital pulse wave analysis (DPA) is an easy and manageable method for arterial stiffness assessment. We aimed to investigate gestational influence on DPA variables longitudinally, and establish gestational age-adjusted reference values in normal pregnancy. Methods: DPA measurements were performed longitudinally up to five times during pregnancy in 139 healthy women. Reference curves for DPA variables aging index (AI), b/a and d/a relative to gestational age were calculated with linear and polynomial mixed-effects models, and the influences of age and parity investigated with analysis of variance and analysis of covariance. A p < 0.05 was regarded significant. Results: All DPA variables were significantly associated with GA with best fit for a quadratic model. Arterial compliance peaked in the late second trimester. Age and parity independently influenced DPA variables but did not change the associations with gestational age. Conclusions: DPA reflects longitudinal changes in arterial compliance in normal pregnancy but individual variance of DPA changes were greater than the influence of GA. Normal distributions of AI, b/a and d/a at 14–24 weeks are presented, but it remains to show whether these can be used to detect pathological hemodynamic alterations in pregnancy

Arterial stiffness during controlled ovarian hyperstimulation and early pregnancy in women exposed to assisted reproduction

INTRODUCTION: Female sex hormones have vasorelaxing effects in non-pregnant and pregnant women. We aimed to investigate the effect of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF), and early pregnancy, on arterial stiffness as assessed by digital pulse wave analysis (DPA), hypothesizing reduced arterial stiffness as an effect of increased estrogen levels.MATERIAL AND METHODS: A total of 68 women undergoing IVF were examined with DPA before conception and during IVF treatment with COH and embryo transfer (ET), and in gestational week seven in 19 women who became pregnant. Heart rate (HR), mean arterial pressure (MAP) and the DPA variables cardiac ejection elasticity index (EEI), b/a, dicrotic index (DI), d/a and aging index (AI) were measured.RESULTS: HR was significantly increased at all measuring points (p ≤ 0.003) but MAP only at ET (p 0.007). DPA variables representing large arteries (EEI, b/a) and peripheral arteries (DI, but not d/a), and the global variable AI, indicated increased arterial stiffness at ET compared with baseline (p ≤ 0.035). No DPA variable was significantly changed at pregnancy measurements compared to baseline.CONCLUSION: During COH for IVF treatment, DPA showed no changes in arterial stiffness during the follicular phase or in early pregnancy, but increased arterial stiffness in central and peripheral arteries in the early luteal phase. The result suggests a hormonal hemodynamic activation counteracting the effects of estrogen

Digital Photoplethysmography for Assessment of Arterial Stiffness: Repeatability and Comparison with Applanation Tonometry.

Arterial stiffness is an independent risk factor for cardiovascular morbidity and can be assessed by applanation tonometry by measuring pulse wave velocity (PWV) and augmentation index (AIX) by pressure pulse wave analysis (PWA). As an inexpensive and operator independent alternative, photoelectric plethysmography (PPG) has been introduced with analysis of the digital volume pulse wave (DPA) and its second derivatives of wave reflections

Association between uterine artery Doppler blood flow changes and arterial wall elasticity in pregnant women

Introduction: Uterine artery (UtA) Doppler velocimetry changes and increased arterial stiffness are associated with preeclampsia. We aimed to investigate the relation between UtA velocimetry changes and arterial stiffness in pregnant women. Methods: Doppler velocimetry and photoplethysmographic digital pulse wave analysis (DPA) were performed in 173 pregnant women in the second or the third trimester, where UtA Doppler pulsatility index (PI), diastolic notching, and UtA score (UAS) combining notching and high PI were calculated. DPA stiffness parameters representing large arteries were ejection elasticity index (EEI) and b/a, small arteries dicrotic index (DI) and d/a, and global stiffness the aging index (AI). Results: One hundred and thirty women had normal Doppler and 43 had diastolic notching, of whom nine had high PI. DI indicated increased stiffness in small arteries when notching was present (p = 0.044) and showed a significant but weak correlation to UAS (p = 0.025, tau 0.12). EEI and b/a indicated increased large artery stiffness (p ≤0.014), d/a small artery stiffness (p = 0.023), and AI a systemic stiffness (p = 0.040) when high PI. Conclusion: High UtA PI was associated with increased systemic arterial stiffness, whereas notching was related to increased stiffness in small arteries only. This indicates pathophysiological differences between the two Doppler parameters

Association between ETc and LVET@60.

<p>Simple linear regression analysis of ejection time compensated (ETc) measured by photoplethysmography, and left ventricular ejection time adjusted to a heart rate of 60 bpm (LVET@60) measured by tonometry (r 0.46). The solid line represents the regression line and the interrupted line the line of identity.</p

Agreement between ETc and LVET@60.

<p>Bland-Altman plot of left ventricular ejection time adjusted to a heart rate of 60 bpm (LVET@60) by tonometry and left ventricular ejection time compensated (ETc) by photoplethysmography, depicting the relationship of difference of measurements (Delta LVET@60 –ETc) and mean value of measurements.</p

Correlation between DPA variables and heart rate and body height, respectively, in 112 individuals.

<p>^a) Second order polynomial regression analysis, <i>p</i> = 0.044.</p><p>DPA@75 denotes adjustment of the variable to a heart rate of 75 bpm.</p

Measures of agreement and reliability between two repeated measurements of digital pulse analysis (DPA) variables in 112 individuals.

<p>ΔDPA, difference between measurements; CoR, coefficient of repeatability; ICC, intraclass correlation coefficient</p><p>^a) 95% lower limit of agreement (-1.96 × SD of ΔDPA).</p><p>^b) 95% upper limit of agreement (+1.96 × SD of ΔDPA).</p><p>^c) After exclusion of three outliers with ΔDPA values ≥ ± 4SD of mean ΔDPA (old age in two, low heart rate in two, and low pulse height in one).</p><p>For explanation of DPA variables, see text.</p