Optical stimulation enables paced electrophysiological studies in embryonic hearts

Cardiac electrophysiology plays a critical role in the development and function of the heart. Studies of early embryonic electrical activity have lacked a viable point stimulation technique to pace in vitro samples. Here, optical pacing by high-precision infrared stimulation is used to pace excised embryonic hearts, allowing electrophysiological parameters to be quantified during pacing at varying rates with optical mapping. Combined optical pacing and optical mapping enables electrophysiological studies in embryos under more physiological conditions and at varying heart rates, allowing detection of abnormal conduction and comparisons between normal and pathological electrical activity during development in various models.

Validation of parameter estimation methods for determining optical properties of atherosclerotic tissues in intravascular OCT

In this paper we present a new process for assessing optical properties of tissues from 3D pullbacks, the standard clinical acquisition method for iOCT data. Our method analyzes a volume of interest (VOI) consisting of about 100 A-lines spread across the angle of rotation (θ) and along the artery, z. The new 3D method uses catheter correction, baseline removal, speckle noise reduction, alignment of A-line sequences, and robust estimation. We compare results to those from a more standard, "gold standard" stationary acquisition where many image frames are averaged to reduce noise. To do these studies in a controlled fashion, we use a realistic optical artery phantom containing of multiple "tissue types." Precision and accuracy for 3D pullback analysis are reported. Our results indicate that when implementing the process on a stationary acquisition dataset, the uncertainty improves at each stage while the uncertainty is reduced. When comparing stationary acquisition dataset to pullback dataset, the values were as follows: calcium: 3.8±1.09mm^-1 in stationary and 3.9±1.2 mm^-1 in a pullback; lipid: 11.025±0.417 mm^-1 in stationary and 11.27±0.25 mm^-1 in pullback; fibrous: 6.08±1.337 mm^-1 in stationary and 5.58±2.0 mm^-1 . These results indicates that the process presented in this paper introduce minimal bias and only a small change in uncertainty when comparing a stationary and pullback dataset, thus paves the way to a highly accurate clinical plaque type discrimination, enabling automatic classification.

Orientation-independent rapid pulsatile flow measurement using dual-angle Doppler OCT

Doppler OCT (DOCT) can provide blood flow velocity information which is valuable for investigation of microvascular structure and function. However, DOCT is only sensitive to motion parallel with the imaging beam, so that knowledge of flow direction is needed for absolute velocity determination. Here, absolute volumetric flow is calculated by integrating velocity components perpendicular to the B-scan plane. These components are acquired using two illumination beams with a predetermined angular separation, produced by a delay encoded technique. This technology enables rapid pulsatile flow measurement from single B-scans without the need for 3-D volumetric data or knowledge of blood vessel orientation.

Three-dimensional correction of conduction velocity in the embryonic heart using integrated optical mapping and optical coherence tomography

Optical mapping (OM) of cardiac electrical activity conventionally collects information from a three-dimensional (3-D) surface as a two-dimensional (2-D) projection map. When applied to measurements of the embryonic heart, this method ignores the substantial and complex curvature of the heart surface, resulting in significant errors when calculating conduction velocity, an important electrophysiological parameter. Optical coherence tomography (OCT) is capable of imaging the 3-D structure of the embryonic heart and accurately characterizing the surface topology. We demonstrate an integrated OCT/OM imaging system capable of simultaneous conduction mapping and 3-D structural imaging. From these multimodal data, we obtained 3-D activation maps and corrected conduction velocity maps of early embryonic quail hearts. 3-D correction eliminates underestimation bias in 2-D conduction velocity measurements, therefore enabling more accurate measurements with less experimental variability. The integrated system will also open the door to correlate the structure and electrophysiology, thereby improving our understanding of heart development.

Ethanol exposure alters early cardiac function in the looping heart: a mechanism for congenital heart defects?

Alcohol-induced congenital heart defects are frequently among the most life threatening and require surgical correction in newborns. The etiology of these defects, collectively known as fetal alcohol syndrome, has been the focus of much study, particularly involving cellular and molecular mechanisms. Few studies have addressed the influential role of altered cardiac function in early embryogenesis because of a lack of tools with the capability to assay tiny beating hearts. To overcome this gap in our understanding, we used optical coherence tomography (OCT), a nondestructive imaging modality capable of micrometer-scale resolution imaging, to rapidly and accurately map cardiovascular structure and hemodynamics in real time under physiological conditions. In this study, we exposed avian embryos to a single dose of alcohol/ethanol at gastrulation when the embryo is sensitive to the induction of birth defects. Late-stage hearts were analyzed using standard histological analysis with a focus on the atrio-ventricular valves. Early cardiac function was assayed using Doppler OCT, and structural analysis of the cardiac cushions was performed using OCT imaging. Our results indicated that ethanol-exposed embryos developed late-stage valvuloseptal defects. At early stages, they exhibited increased regurgitant flow and developed smaller atrio-ventricular cardiac cushions, compared with controls (uninjected and saline-injected embryos). The embryos also exhibited abnormal flexion/torsion of the body. Our evidence suggests that ethanol-induced alterations in early cardiac function have the potential to contribute to late-stage valve and septal defects, thus demonstrating that functional parameters may serve as early and sensitive gauges of cardiac normalcy and abnormalities.

Altering embryonic cardiac dynamics with optical pacing

Several studies have shown that altering blood flow early in development leads to congenital heart defects. In these studies the perturbations to hemodynamics were very gross manipulations (vessel ligation, conotruncal banding, etc.) that would be inappropriate for probing the delicate mechanisms responsible for mechanically-transduced signaling. Also, these perturbations lacked feedback from a monitoring system to determine the exact degree of alteration and the location of its effect. Here, we employed optical pacing (OP) to alter the heart rate in quail embryos and optical coherence tomography (OCT) to measure the resultant shear forces on the endocardium. OP is a new technique utilizing pulsed 1.851 µm infrared laser light to noninvasively capture the heart rate to the pulse frequency of the laser without the use of exogenous agents. To measure shear stress on the endocardium, we extended our previous OCT algorithms to enable the production of 4-D shear maps. 4-D shear maps allowed observation of the spatial and temporal distribution of shear stress. Employing both OCT and OP, we were able to develop perturbation protocols that increase regurgitant flow and greatly modify the oscillatory shear index (OSI) in a region of the heart tube where future valves will develop. Regurgitant flow has been linked with valve development and precise perturbations may allow one to determine the role of hemodynamics in valvulogenesis.

4D shear stress maps of the developing heart using Doppler optical coherence tomography

Accurate imaging and measurement of hemodynamic forces is vital for investigating how physical forces acting on the embryonic heart are transduced and influence developmental pathways. Of particular importance is blood flow-induced shear stress, which influences gene expression by endothelial cells and potentially leads to congenital heart defects through abnormal heart looping, septation, and valvulogenesis. However no imaging tool has been available to measure shear stress on the endocardium volumetrically and dynamically. Using 4D structural and Doppler OCT imaging, we are able to accurately measure the blood flow in the heart tube in vivo and to map endocardial shear stress throughout the heart cycle under physiological conditions for the first time. These measurements of the shear stress patterns will enable precise titration of experimental perturbations and accurate correlation of shear with the expression of molecules critical to heart development.

Automatic stent detection in intravascular OCT images using bagged decision trees

Intravascular optical coherence tomography (iOCT) is being used to assess viability of new coronary artery stent designs. We developed a highly automated method for detecting stent struts and measuring tissue coverage. We trained a bagged decision trees classifier to classify candidate struts using features extracted from the images. With 12 best features identified by forward selection, recall (precision) were 90%-94% (85%-90%). Including struts deemed insufficiently bright for manual analysis, precision improved to 94%. Strut detection statistics approached variability of manual analysis. Differences between manual and automatic area measurements were 0.12 ± 0.20 mm(2) and 0.11 ± 0.20 mm(2) for stent and tissue areas, respectively. With proposed algorithms, analyst time per stent should significantly reduce from the 6-16 hours now required.

Quantification of fiber orientation in the canine atrial pacemaker complex using optical coherence tomography

The atrial pacemaker complex is responsible for the initiation and early propagation of cardiac impulses. Optical coherence tomography (OCT), a nondestructive imaging modality with spatial resolutions of ∼1 to 15 μm, can be used to identify unique fiber orientation patterns in this region of the heart. Functionally characterized canine sinoatrial nodes (SAN) (n=7) were imaged using OCT up to ∼1  mm below the endocardial tissue surface. OCT images were directly compared to their corresponding histological sections. Fiber orientation patterns unique to the crista terminalis (CT), SAN, and surrounding atrial myocardium were identified with dominant average fiber angles of 89 ± 12 deg, 110 ± 16 deg, and 95 ± 35 deg, respectively. Both the CT and surrounding atrial myocardium displayed predominantly unidirectionally based fiber orientation patterns within each specimen, whereas the SAN displayed an increased amount of fiber disarray manifested quantitatively as a significantly greater standard deviation in fiber angle distribution within specimens [33 ± 7 deg versus 23 ± 5 deg, atrium (p=0.02); 18 ± 3 deg, CT (p=0.0003)]. We also identified unique, local patterns of fiber orientation specific to the functionally characterized block zone. We demonstrate the ability of OCT in detecting components of the atrial pacemaker complex which are intimately involved in both normal and abnormal cardiac conduction.

Volumetric quantification of fibrous caps using intravascular optical coherence tomography

The rupture of thin-cap fibroatheroma accounts for most acute coronary events. Optical Coherence Tomography (OCT) allows quantification of fibrous cap (FC) thickness in vivo. Conventional manual analysis, by visually determining the thinnest part of the FC is subject to inter-observer variability and does not capture the 3-D morphology of the FC. We propose and validate a computer-aided method that allows volumetric analysis of FC. The radial FC boundary is semi-automatically segmented using a dynamic programming algorithm. The thickness at every point of the FC boundary, along with 3-D morphology of the FC, can be quantified. The method was validated against three experienced OCT image analysts in 14 lipid-rich lesions. The proposed method may advance our understanding of the mechanisms behind plaque rupture and improve disease management.

Longitudinal Imaging of Heart Development With Optical Coherence Tomography

Optical coherence tomography (OCT) has great potential for deciphering the role of mechanics in normal and abnormal heart development. OCT images tissue microstructure and blood flow deep into the tissue (1-2mm) at high spatiotemporal resolutions allowing unprecedented images of the developing heart. Here, we review the advancement of OCT technology to image heart development and report some of our recent findings utilizing OCT imaging under environmental control for longitudinal imaging. Precise control of the environment is absolutely required in longitudinal studies that follow the growth of the embryo or studies comparing normal versus perturbed heart development to obtain meaningful in vivo results. These types of studies are essential to tease out the influence of cardiac dynamics on molecular expression and their role in the progression of congenital heart defects.

Intravascular optical coherence tomography detection of atherosclerosis and inflammation in murine aorta

OBJECTIVE

The goal of this study was to evaluate the feasibility of imaging the aorta of apolipoprotein E-deficient (ApoE(-/-)) mice for the detection of atherosclerosis and macrophages using optical coherence tomography (OCT) compared with histology.

METHODS AND RESULTS

Atherosclerosis was induced by high-fat diet in 7-week-old ApoE(-/-) mice for 10 (n=7) and 22 (n=7) weeks. Nine-week-old ApoE(-/-) mice (n=7) fed a standard chow diet were used as controls. OCT images of a 10-mm descending aorta in situ were performed in 4 mice for each, and plaque and macrophages were determined at 0.5-mm intervals. Automated detection and quantification of macrophages were performed independently using a customized algorithm. Coregistered histological cross-sections were stained with hematoxylin-eosin, Mac-3, and von Kossa. Three mice in each group had en face OCT imaging to detect macrophages, which were compared with lipid-positive area with Sudan IV. OCT images were successfully acquired in all mice. OCT and histology were able to discriminate macrophages and plaque among the 3 groups and showed excellent correlation for (1) visual detection of plaque (r=0.98) and macrophages (r=0.93), (2) automated detection and quantification of macrophages by OCT versus Mac-3-positive area (r=0.92), and (3) en face OCT detection of macrophages versus Sudan IV-positive area (r=0.92).

CONCLUSIONS

Murine intra-aortic OCT is feasible and shows excellent correlation with histology for detection of atherosclerotic plaque and macrophages.

Optical coherence tomography captures rapid hemodynamic responses to acute hypoxia in the cardiovascular system of early embryos

BACKGROUND

The trajectory to heart defects may start in tubular and looping heart stages when detailed analysis of form and function is difficult by currently available methods. We used a novel method, Doppler optical coherence tomography (OCT), to follow changes in cardiovascular function in quail embryos during acute hypoxic stress. Chronic fetal hypoxia is a known risk factor for congenital heart diseases (CHDs). Decreased fetal heart rates during maternal obstructive sleep apnea suggest that studying fetal heart responses under acute hypoxia is warranted.

RESULTS

We captured responses to hypoxia at the critical looping heart stages. Doppler OCT revealed detailed vitelline arterial pulsed Doppler waveforms. Embryos tolerated 1 hr of hypoxia (5%, 10%, or 15% O(2) ), but exhibited changes including decreased systolic and increased diastolic duration in 5 min. After 5 min, slower heart rates, arrhythmic events and an increase in retrograde blood flow were observed. These changes suggested slower filling of the heart, which was confirmed by four-dimensional Doppler imaging of the heart itself.

CONCLUSIONS

Doppler OCT is well suited for rapid noninvasive screening for functional changes in avian embryos under near physiological conditions. Analysis of the accessible vitelline artery sensitively reflected changes in heart function and can be used for rapid screening. Acute hypoxia caused rapid hemodynamic changes in looping hearts and may be a concern for increased CHD risk.

In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation

Complete catheter-tissue contact and permanent tissue destruction are essential for efficient radio-frequency ablation (RFA) during cardiac arrhythmia treatment. Current methods of monitoring lesion formation are indirect and unreliable. The purpose of this study is to evaluate the feasibility of using optical coherence tomography (OCT) catheter to image endocardial wall in actively beating hearts through percutaneous access. We reported the first in vivo intracardiac OCT imaging through percutaneous access with a thin and flexible OCT catheter. This is a critical step toward image-guided RFA in a clinical setting. A cone-scanning forward-viewing OCT catheter was advanced into beating hearts through percutaneous access in four swine. The OCT catheter was steered by an introducer to touch the endocardial wall. We are able to acquire high quality OCT images in beating hearts, observe the polarization-related artifacts induced by the birefringence of myocardium, and readily evaluate catheter-tissue contact. The observations indicate that OCT could be a promising technique for in vivo guidance of RFA.

Motion artifacts associated with in vivo endoscopic OCT images of the esophagus

3-D optical coherence tomography (OCT) has been extensively investigated as a potential screening and/or surveillance tool for Barrett's esophagus (BE). Understanding and correcting motion artifact may improve image interpretation. In this work, the motion trace was analyzed to show the physiological origin (respiration and heart beat) of the artifacts. Results showed that increasing balloon pressure did not sufficiently suppress the physiological motion artifact. An automated registration algorithm was designed to correct such artifacts. The performance of the algorithm was evaluated in images of normal porcine esophagus and demonstrated in images of BE in human patients.

Using optical coherence tomography for the longitudinal non-invasive evaluation of epidermal thickness in a murine model of chronic skin inflammation

BACKGROUND

Non-invasive methods are desirable for longitudinal studies examining drug efficacy and disease resolution defined as decreases in epidermal thickness in mouse models of psoriasiform skin disease. This would eliminate the need for either sacrificing animals or collecting serial skin biopsies to evaluate changes in disease progression during an individual study. The quantitation of epidermal thickness using optical coherence tomography (OCT) provides an alternative to traditional histology techniques.

METHODS

Using the KC-Tie2 doxycycline-repressible psoriasiform skin disease mouse model, OCT imaging was completed on diseased back skin of adult KC-Tie2 (n = 3-4) and control (n = 3-4) mice, followed immediately by the surgical excision of the same region for histologic analyses. Animals were then treated with doxycycline to suppress transgene expression and to reverse the skin disease and additional OCT images and tissues were collected 2 and 4 weeks following. Epidermal thickness was measured using OCT and histology.

RESULTS

Optical coherence tomography and histology both demonstrated that KC-Tie2 mice had significantly thicker epidermis (~4-fold; P < 0.0001) than control animals. By 2 weeks following gene repression, decreases in epidermal thickness were observed using both OCT and histology, and were sustained through 4 weeks. Correlation analyses between histology and OCT values at all time points and in all animals revealed high significance (R(2) = 0.78); with correlation being highest in KC-Tie2 mice (R(2) = 0.92) compared to control animals (R(2) = 0.16).

CONCLUSION

Non-invasive OCT imaging provided similar values as those collected using standard histologic measures in thick skin of KC-Tie2 mice but became less reliable in thinner control mouse skin, possibly reflecting limitations in resolution of OCT. Future advances in resolution of OCT may improve and allow greater accuracy of epidermal thickness measurements.

Optical Coherence Tomography and Fibrous Cap Characterization

The pathophysiology of acute coronary syndromes has long been associated with atherosclerotic plaque rupture. Inflammation, thinning, and disruption of the fibrous cap have been implicated with the final processes leading to plaque rupture, but confirmation of these mechanisms of coronary thrombosis in humans has been hampered by the lack of imaging methods with sufficient resolution to resolve fibrous cap characterization and thickness in vivo. Intravascular optical coherence tomography (OCT) provides images with micron-level axial and lateral resolution, enabling detailed visualization of micro-structural changes of the arterial wall. The present article provides an overview of the potential role of OCT in identifying and characterizing fibrous cap morphology, thickness, and inflammation in human coronary plaques.

Diagnostic efficacy of computer extracted image features in optical coherence tomography of the precancerous cervix

PURPOSE

To determine the diagnostic efficacy of optical coherence tomography (OCT) to identify cervical intraepithelial neoplasia (CIN) grade 2 or higher by computer-aided diagnosis (CADx).

METHODS

OCT has been investigated as a screening/diagnostic tool in the management of preinvasive and early invasive cancers of the uterine cervix. In this study, an automated algorithm was developed to extract OCT image features and identify CIN 2 or higher. First, the cervical epithelium was detected by a combined watershed and active contour method. Second, four features were calculated: The thickness of the epithelium and its standard deviation and the contrast between the epithelium and the stroma and its standard deviation. Finally, linear discriminant analysis was applied to classify images into two categories: Normal/inflammation/CIN 1 and CIN 2/CIN 3. The algorithm was applied to 152 images (74 patients) obtained from an international study.

RESULTS

The numbers of normal/inflammatory/CIN 1/CIN 2/CIN 3 images are 74, 29, 14, 24, and 11, respectively. Tenfold cross-validation predicted the algorithm achieved a sensitivity of 51% (95% CI: 36%-67%) and a specificity of 92% (95% CI: 86%-96%) with an empirical two-category prior probability estimated from the data set. Receiver operating characteristic analysis yielded an area under the curve of 0.86.

CONCLUSIONS

The diagnostic efficacy of CADx in OCT imaging to differentiate high-grade CIN from normal/low grade CIN is demonstrated. The high specificity of OCT with CADx suggests further investigation as an effective secondary screening tool when combined with a highly sensitive primary screening tool.

Blood flow dynamics of one cardiac cycle and relationship to mechanotransduction and trabeculation during heart looping

Analyses of form-function relationships during heart looping are directly related to technological advances. Recent advances in four-dimensional optical coherence tomography (OCT) permit observations of cardiac dynamics at high-speed acquisition rates and high resolution. Real-time observation of the avian stage 13 looping heart reveals that interactions between the endocardial and myocardial compartments are more complex than previously depicted. Here we applied four-dimensional OCT to elucidate the relationships of the endocardium, myocardium, and cardiac jelly compartments in a single cardiac cycle during looping. Six cardiac levels along the longitudinal heart tube were each analyzed at 15 time points from diastole to systole. Using image analyses, the organization of mechanotransducing molecules, fibronectin, tenascin C, α-tubulin, and nonmuscle myosin II was correlated with specific cardiac regions defined by OCT data. Optical coherence microscopy helped to visualize details of cardiac architectural development in the embryonic mouse heart. Throughout the cardiac cycle, the endocardium was consistently oriented between the midline of the ventral floor of the foregut and the outer curvature of the myocardial wall, with multiple endocardial folds allowing high-volume capacities during filling. The cardiac area fractional shortening is much higher than previously published. The in vivo profile captured by OCT revealed an interaction of the looping heart with the extra-embryonic splanchnopleural membrane providing outside-in information. In summary, the combined dynamic and imaging data show the developing structural capacity to accommodate increasing flow and the mechanotransducing networks that organize to effectively facilitate formation of the trabeculated four-chambered heart.

Intracoronary optical coherence tomography, basic theory and image acquisition techniques

Optical coherence tomography (OCT) imaging is showing great potential as an alternative or complementary tool to intravascular ultrasound (IVUS) for aiding in stent procedures and future diagnosis/treatment of atherosclerosis. Here, we describe the basic theory behind OCT imaging and explain important parameters such as axial resolution, lateral resolution and sensitivity. Also, we describe several image acquisition techniques that have been adopted for OCT imaging.

Optical coherence tomography imaging of early quail embryos

Congenital heart defects (CHDs) affect thousands of newborns each year in the United States. Recent research using animal model systems indicates that the abnormal function of the early tubular heart precedes structural defects such as septal defects. Optical coherence tomography (OCT) is an imaging modality that can provide high spatial and temporal resolution to study both the structure and the function of the tubular heart. With technical advances in OCT imaging speed, especially with frequency domain OCT and image-based retrospective gating, it is now possible to image a beating avian embryonic heart in three dimensions under physiological conditions and follow morphogenesis over critical periods of developmental time. These technological advances have already revealed novel aspects of heart development. By expanding our understanding of heart development, research using OCT technology combined with other imaging modalities may eventually lead to strategies to predict, treat, and even prevent CHDs. This protocol provides some practical details for obtaining four-dimensional (4D) OCT images from beating embryonic quail hearts, with the necessary temporal and spatial resolution.

High-speed optical coherence tomography imaging of the beating avian embryonic heart

Congenital heart defects (CHDs) affect thousands of newborns each year in the United States. Recent research using animal model systems indicates that the abnormal function of the early tubular heart precedes structural defects such as septal defects. Optical coherence tomography (OCT) is an imaging modality that can provide high spatial and temporal resolution to study both the structure and the function of the tubular heart. With technical advances in OCT imaging speed, especially with frequency domain OCT and image-based retrospective gating, it is now possible to image a beating avian embryonic heart in three dimensions under physiological conditions and follow morphogenesis over critical periods of developmental time. These technological advances have already revealed novel aspects of heart development. By expanding our understanding of heart development, research using OCT technology combined with other imaging modalities may eventually lead to strategies to predict, treat, and even prevent CHDs.

Three-dimensional imaging of ureter with endoscopic optical coherence tomography

OBJECTIVES

To verify the ability to identify the layered structures of the ureteral wall and to image a segment of the ureter in 3 dimensions with high-speed, endoscopic optical coherence tomography (EOCT).

METHODS

We imaged a porcine ureter ex vivo using a spectral-domain EOCT with a specially designed circumferential scanning fiber catheter. The images were correlated with the histologic findings to identify the corresponding structures. Three-dimensional images and en face images at different depths from the luminal surface were reconstructed from the multiple cross-sectional images to visualize the layered structure of a segment of the ureter from different perspectives.

RESULTS

The EOCT images clearly revealed all layers of the ureteral wall as shown in the histologic images. In particular, with the specially designed fiber catheter, the light beam was well centered during the rotation and pull back, allowing constant acquisition of high-fidelity images and unambiguous identification of the smooth muscle layers in all images. With high-speed EOCT, a segment of ureter (20 mm) can be imaged in <90 seconds at a high resolution.

CONCLUSIONS

With its ability to visualize all layers of the ureteral wall, EOCT offers the potential to stage urothelial cancers that have infiltrated the muscular wall (Stage T2). This information will be complimentary to the diagnostic information obtained through ureteroscopic biopsy and computed tomography urogram.