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Steding‐Ehrenborg K, Nelsson A, Hedström E, Engblom H, Ingvarsson A, Nilsson J, Braun O, Arheden H. Diastolic Filling in Patients After Heart Transplantation Is Impaired Due to an Altered Geometrical Relationship Between the Left Atrium and Ventricle. J Am Heart Assoc 2024; 13:e033672. [PMID: 38780152 PMCID: PMC11255639 DOI: 10.1161/jaha.123.033672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/11/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The geometrical relationship between atrial and ventricular short-axis cross-sectional area determines the hydraulic forces acting on intracardiac blood. This is important for diastolic filling. In patients undergoing heart transplantation (HTx), the left atrium is often enlarged as a result of the standard surgical technique. We hypothesized that diastolic filling in HTx patients is affected by the surgery altering the geometrical relationship between atrium and ventricle. METHODS AND RESULTS This retrospective, cross-sectional study included 25 HTx patients (median age, 52 [range, 25-70] years), 15 patients with heart failure with reduced ejection fraction (median age, 63 [range, 52-75] years), 15 patients with heart failure with preserved ejection fraction (median age, 74 [range, 56-82] years), and 15 healthy controls (median age, 64 [range, 58-67] years) who underwent cardiac magnetic resonance imaging. Left ventricular, atrial, and total heart volumes (THV) were obtained. Atrioventricular area difference at end diastole and end systole was calculated as the largest ventricular short-axis area minus the largest atrial short-axis area. Left atrial minimum volume normalized for THV (LAmin/THV) was larger in HTx patients (median, 0.13 [range, 0.07-0.19]) compared with controls (median, 0.05 [range, 0.03-0.08], P <0.001), whereas left ventricular volume normalized for THV (left ventricular end-diastolic volume/THV) was similar between HTx and controls (median, 0.19 [range, 0.12-0.24] and median, 0.22 [range, 0.20-0.25], respectively). At end diastole, when atrioventricular area difference reached its largest positive value in controls, 11 HTx patients (44%) had a negative atrioventricular area difference, indicating impaired diastolic filling. CONCLUSIONS Diastolic filling is impaired in HTx patients due to an altered geometrical relationship between the left atrium and ventricle. When performing cardiac transplantation, a surgical technique that creates a smaller left atrium may improve diastolic filling by aiding hydraulic forces.
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Affiliation(s)
- Katarina Steding‐Ehrenborg
- Clinical Physiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Department of Clinical PhysiologySkåne University HospitalLundSweden
| | - Anders Nelsson
- Clinical Physiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Department of Clinical PhysiologySkåne University HospitalLundSweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Department of Clinical PhysiologySkåne University HospitalLundSweden
- Diagnostic Radiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Department of RadiologySkåne University HospitalLundSweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Department of Clinical PhysiologySkåne University HospitalLundSweden
| | - Annika Ingvarsson
- Cardiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkane University HospitalLundSweden
| | - Johan Nilsson
- Department of Translational Medicine, Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences Research UnitLund UniversityLundSweden
- Department of Thoracic and Vascular SurgerySkảne University HospitalLundSweden
| | - Oscar Braun
- Cardiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkane University HospitalLundSweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences LundLund UniversityLundSweden
- Department of Clinical PhysiologySkåne University HospitalLundSweden
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2
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Szugye NA, Mahalingam N, Somasundaram E, Villa C, Segala J, Segala M, Zafar F, Morales DLS, Moore RA. Deep Learning for Automated Measurement of Total Cardiac Volume for Heart Transplantation Size Matching. Pediatr Cardiol 2024:10.1007/s00246-024-03470-4. [PMID: 38570368 DOI: 10.1007/s00246-024-03470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
Total Cardiac Volume (TCV)-based size matching using Computed Tomography (CT) is a novel technique to compare donor and recipient heart size in pediatric heart transplant that may increase overall utilization of available grafts. TCV requires manual segmentation, which limits its widespread use due to time and specialized software and training needed for segmentation. This study aims to determine the accuracy of a Deep Learning (DL) approach using 3-dimensional Convolutional Neural Networks (3D-CNN) to calculate TCV, with the clinical aim of enabling fast and accurate TCV use at all transplant centers. Ground truth TCV was segmented on CT scans of subjects aged 0-30 years, identified retrospectively. Ground truth segmentation masks were used to train and test a custom 3D-CNN model consisting of a DenseNet architecture in combination with residual blocks of ResNet architecture. The model was trained on a cohort of 270 subjects and a validation cohort of 44 subjects (36 normal, 8 heart disease retained for model testing). The average Dice similarity coefficient of the validation cohort was 0.94 ± 0.03 (range 0.84-0.97). The mean absolute percent error of TCV estimation was 5.5%. There is no significant association between model accuracy and subject age, weight, or height. DL-TCV was on average more accurate for normal hearts than those listed for transplant (mean absolute percent error 4.5 ± 3.9 vs. 10.5 ± 8.5, p = 0.08). A deep learning-based 3D-CNN model can provide accurate automatic measurement of TCV from CT images. This initial study is limited as a single-center study, though future multicenter studies may enable generalizable and more accurate TCV measurement by inclusion of more diverse cardiac pathology and increasing the training data.
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Affiliation(s)
- Nicholas A Szugye
- Cleveland Clinic Foundation, Pediatric Cardiology, Cleveland, OH, USA.
| | - Neeraja Mahalingam
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | | | - Chet Villa
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | | | | | - Farhan Zafar
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - David L S Morales
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Ryan A Moore
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
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3
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Sanjo K, Hebiguchi K, Tang C, Rashed EA, Kodera S, Togo H, Hirata A. Sensitivity of Electrocardiogram on Electrode-Pair Locations for Wearable Devices: Computational Analysis of Amplitude and Waveform Distortion. BIOSENSORS 2024; 14:153. [PMID: 38534260 DOI: 10.3390/bios14030153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
An electrocardiogram (ECG) is used to observe the electrical activity of the heart via electrodes on the body surface. Recently, an ECG with fewer electrodes, such as a bipolar ECG in which two electrodes are attached to the chest, has been employed as wearable devices. However, the effect of different geometrical factors and electrode-pair locations on the amplitude and waveform of ECG signals remains unclear. In this study, we computationally evaluated the effects of body morphology, heart size and orientation, and electrode misalignment on ECG signals for 48 scenarios using 35 bipolar electrode pairs (1680 waveforms) with a dynamic time warping (DTW) algorithm. It was observed that the physique of the human body model predominantly affected the amplitude and waveform of the ECG signals. A multivariate analysis indicated that the heart-electrode distance and the solid angle of the heart from the electrode characterized the amplitude and waveform of the ECG signals, respectively. Furthermore, the electrode locations for less individual variability and less waveform distortion were close to the location of electrodes V2 and V3 in the standard 12-lead. These findings will facilitate the placement of ECG electrodes and interpretation of the measured ECG signals for wearable devices.
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Affiliation(s)
- Kiyoto Sanjo
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
| | - Kazuki Hebiguchi
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
| | - Cheng Tang
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka 819-0395, Japan
| | - Essam A Rashed
- Graduate School of Information Science, University of Hyogo, Kobe 650-0047, Japan
| | - Sachiko Kodera
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
| | - Hiroyoshi Togo
- NTT Device Innovation Center, NTT Corporation, Atsugi 243-0198, Japan
| | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
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4
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Szugye NA, Mahalingam N, Somasundaram E, Villa C, Segala J, Segala M, Zafar F, Morales DLS, Moore RA. Deep Learning for Automated Measurement of Total Cardiac Volume for Heart Transplantation Size Matching. RESEARCH SQUARE 2023:rs.3.rs-3788726. [PMID: 38234758 PMCID: PMC10793494 DOI: 10.21203/rs.3.rs-3788726/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Total Cardiac Volume (TCV) based size matching using Computed Tomography (CT) is a novel technique to compare donor and recipient heart size in pediatric heart transplant that may increase overall utilization of available grafts. TCV requires manual segmentation, which limits its widespread use due to time and specialized software and training needed for segmentation. Objective This study aims to determine the accuracy of a Deep Learning (DL) approach using 3-dimensional Convolutional Neural Networks (3D-CNN) to calculate TCV, with the clinical aim of enabling fast and accurate TCV use at all transplant centers. Materials and Methods Ground truth TCV was segmented on CT scans of subjects aged 0-30 years, identified retrospectively. Ground truth segmentation masks were used to train and test a custom 3D-CNN model consisting of a Dense-Net architecture in combination with residual blocks of ResNet architecture. Results The model was trained on a cohort of 270 subjects and a validation cohort of 44 subjects (36 normal, 8 heart disease retained for model testing). The average Dice similarity coefficient of the validation cohort was 0.94 ± 0.03 (range 0.84-0.97). The mean absolute percent error of TCV estimation was 5.5%. There is no significant association between model accuracy and subject age, weight, or height. DL-TCV was on average more accurate for normal hearts than those listed for transplant (mean absolute percent error 4.5 ± 3.9 vs. 10.5 ± 8.5, p = 0.08). Conclusion A deep learning based 3D-CNN model can provide accurate automatic measurement of TCV from CT images.
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Affiliation(s)
| | | | | | - Chet Villa
- Cincinnati Children's Hospital Medical Center
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5
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Støylen A, Mølmen HE, Dalen H. Regional motion of the AV-plane is related to the cardiac anatomy and deformation of the AV-plane. Data from the HUNT study. Clin Physiol Funct Imaging 2023; 43:453-462. [PMID: 37395325 DOI: 10.1111/cpf.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
The study examines global and regional systolic shortening of the left (LV) and right ventricle (RV) in 1266 individuals without evidence of heart disease in the third wave of the HUNT study. Regional mitral annular systolic displacement (mitral annular plane systolic excursion [MAPSE]) was 1.5 cm in the septum and anterior walls, 1.6 cm in the lateral wall and 1.7 cm in the inferior wall, global mean 1.6 cm. Peak systolic velocity S' was 8.0, 8.3, 8.8 and 8.6 cm/s in the same walls (global mean 8.7 cm/s). All measures of LV longitudinal shortening correlated, mean MAPSE and S' also correlated with stroke volume (SV) and ejection fraction (EF). Global longitudinal strain by either method correlated with MAPSE, S' and EF, but not with SV, reflecting a systematic difference. S' and MAPSE correlated with early annular diastolic velocity (e'), reflecting that e' is the recoil from systole. Mean displacement was 2.8 (0.5) cm in the tricuspid annulus (tricuspid annular plane systolic excursion [TAPSE]). Normal values by age and sex are provided. Both TAPSE and S' were lower in women, where body size explained the sex difference. Normalisation of MAPSE and S' for wall length reduced intra-individual variation of displacement and velocity by 80%-90%, showing regional MAPSE to be related to LV wall length, and that longitudinal wall strain was relatively uniform. Displacement and S' were lowest in the septum and highest in the left and right free walls, shows systolic bending of the AV-plane into a U-shape, relating to the total cardiac volume changes during the heart cycle.
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Affiliation(s)
- Asbjørn Støylen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Harald E Mølmen
- Division of Medicine, Department of Endocrinology, Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
- Department of general practice, Asgardstrand GP, Horten, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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6
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Won D, Bang J, Choi SH, Pyun KR, Jeong S, Lee Y, Ko SH. Transparent Electronics for Wearable Electronics Application. Chem Rev 2023; 123:9982-10078. [PMID: 37542724 PMCID: PMC10452793 DOI: 10.1021/acs.chemrev.3c00139] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Indexed: 08/07/2023]
Abstract
Recent advancements in wearable electronics offer seamless integration with the human body for extracting various biophysical and biochemical information for real-time health monitoring, clinical diagnostics, and augmented reality. Enormous efforts have been dedicated to imparting stretchability/flexibility and softness to electronic devices through materials science and structural modifications that enable stable and comfortable integration of these devices with the curvilinear and soft human body. However, the optical properties of these devices are still in the early stages of consideration. By incorporating transparency, visual information from interfacing biological systems can be preserved and utilized for comprehensive clinical diagnosis with image analysis techniques. Additionally, transparency provides optical imperceptibility, alleviating reluctance to wear the device on exposed skin. This review discusses the recent advancement of transparent wearable electronics in a comprehensive way that includes materials, processing, devices, and applications. Materials for transparent wearable electronics are discussed regarding their characteristics, synthesis, and engineering strategies for property enhancements. We also examine bridging techniques for stable integration with the soft human body. Building blocks for wearable electronic systems, including sensors, energy devices, actuators, and displays, are discussed with their mechanisms and performances. Lastly, we summarize the potential applications and conclude with the remaining challenges and prospects.
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Affiliation(s)
- Daeyeon Won
- Applied
Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea
| | - Junhyuk Bang
- Applied
Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea
| | - Seok Hwan Choi
- Applied
Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea
| | - Kyung Rok Pyun
- Applied
Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea
| | - Seongmin Jeong
- Applied
Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea
| | - Youngseok Lee
- Applied
Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea
| | - Seung Hwan Ko
- Applied
Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, Seoul 08826, Korea
- Institute
of Engineering Research/Institute of Advanced Machinery and Design
(SNU-IAMD), Seoul National University, Seoul 08826, South Korea
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7
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Szugye NA, Shuler JM, Pradhan S, Plasencia JD, Villa C, Taylor M, Lorts A, Zafar F, Morales DLS, Moore RA. Echocardiography Provides a Reliable Estimate of Total Cardiac Volume for Pediatric Heart Transplantation. J Am Soc Echocardiogr 2023; 36:224-232. [PMID: 36087887 DOI: 10.1016/j.echo.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Donor-to-recipient size matching for heart transplantation typically involves comparing donor and recipient body weight; however, weight is not linearly related to cardiac size. Attention has shifted toward the use of computed tomography- (CT-) derived total cardiac volume (TCV), that is, CT-TCV, to compare donor and recipient heart organ size. At this time, TCV size matching is near impossible for most centers due to logistical limitations. To overcome this impediment, echocardiogram-derived TCV (ECHO-TCV) is an attractive, alternative option to estimate CT-TCV. The goal of this study is to test whether ECHO-TCV is an accurate and reliable surrogate for TCV measurement compared with the gold standard CT-TCV. METHODS ECHO-TCV and CT-TCV were measured in a cohort spanning the neonatal to young adult age range with the intention to simulate the pediatric heart transplant donor pool. ECHO-TCV was measured using a modified Simpson's summation-of-discs method from the apical 4-chamber (A4C) view. The gold standard of CT-TCV was measured from CT scans using three-dimensional reconstruction software. The relationship between ECHO-TCV and CT-TCV was evaluated and compared with other anthropometric and image-based markers that may predict CT-TCV. Inter-rater reliability of ECHO-TCV was tested among 4 independent observers. Subanalyses were performed to identify imaging views and timing that enable greater accuracy of ECHO-TCV. RESULTS Banked imaging data of 136 subjects with both echocardiogram and CT were identified. ECHO-TCV demonstrated a linear relationship to CT-TCV with a Pearson correlation coefficient of r = 0.96 (95% CI, 0.95-0.97; P < .0001) and mean absolute percent error of 8.6%. ECHO-TCV correlated most strongly with CT-TCV in the subset of subjects <4 years of age (n = 33; r = 0.98; 95% CI, 0.96-0.99; P < .0001). The single-score intraclass correlation coefficient across all 4 raters is 0.96 (interquartile range, 0.93-0.98). ECHO-TCV measured from a standard A4C view at end diastole with the atria in the plane of view had the strongest correlation to CT-TCV. CONCLUSIONS ECHO-TCV by the A4C view was found to be both an accurate and reliable alternative measurement of CT-TCV and is derived from readily available donor ECHO images. The ECHO-TCV findings in this study make the ECHO method an attractive means of direct donor-to-recipient TCV size matching in pediatric heart transplantation.
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Affiliation(s)
- Nicholas A Szugye
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jeffrey M Shuler
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sarah Pradhan
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan D Plasencia
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chet Villa
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael Taylor
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Angela Lorts
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Farhan Zafar
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan A Moore
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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8
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Kim Y, Thangam R, Yoo J, Heo J, Park JY, Kang N, Lee S, Yoon J, Mun KR, Kang M, Min S, Kim SY, Son S, Kim J, Hong H, Bae G, Kim K, Lee S, Yang L, Lee JY, Kim J, Park S, Kim DH, Lee KB, Jang WY, Kim BH, Paulmurugan R, Cho SW, Song HC, Kang SJ, Sun W, Zhu Y, Lee J, Kim HJ, Jang HS, Kim JS, Khademhosseini A, Kim Y, Kim S, Kang H. Photoswitchable Microgels for Dynamic Macrophage Modulation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2205498. [PMID: 36268986 DOI: 10.1002/adma.202205498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Dynamic manipulation of supramolecular self-assembled structures is achieved irreversibly or under non-physiological conditions, thereby limiting their biomedical, environmental, and catalysis applicability. In this study, microgels composed of azobenzene derivatives stacked via π-cation and π-π interactions are developed that are electrostatically stabilized with Arg-Gly-Asp (RGD)-bearing anionic polymers. Lateral swelling of RGD-bearing microgels occurs via cis-azobenzene formation mediated by near-infrared-light-upconverted ultraviolet light, which disrupts intermolecular interactions on the visible-light-absorbing upconversion-nanoparticle-coated materials. Real-time imaging and molecular dynamics simulations demonstrate the deswelling of RGD-bearing microgels via visible-light-mediated trans-azobenzene formation. Near-infrared light can induce in situ swelling of RGD-bearing microgels to increase RGD availability and trigger release of loaded interleukin-4, which facilitates the adhesion structure assembly linked with pro-regenerative polarization of host macrophages. In contrast, visible light can induce deswelling of RGD-bearing microgels to decrease RGD availability that suppresses macrophage adhesion that yields pro-inflammatory polarization. These microgels exhibit high stability and non-toxicity. Versatile use of ligands and protein delivery can offer cytocompatible and photoswitchable manipulability of diverse host cells.
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Affiliation(s)
- Yuri Kim
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Ramar Thangam
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
- Institute for High Technology Materials and Devices, Korea University, Seoul, 02841, Republic of Korea
| | - Jounghyun Yoo
- Chemical and Biological Integrative Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Jeongyun Heo
- Chemical and Biological Integrative Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Jung Yeon Park
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Nayeon Kang
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Sungkyu Lee
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Jiwon Yoon
- Chemical and Biological Integrative Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Kwang Rok Mun
- Materials Architecturing Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Misun Kang
- Materials Architecturing Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Sunhong Min
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Seong Yeol Kim
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Subin Son
- Department of Chemistry, Korea University, Seoul, 02841, Republic of Korea
| | - Jihwan Kim
- Chemical and Biological Integrative Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Hyunsik Hong
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Gunhyu Bae
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Kanghyeon Kim
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Sanghyeok Lee
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
| | - Letao Yang
- Department of Chemistry and Chemical Biology, Rutgers University, Piscataway, NJ, 08854, USA
| | - Ja Yeon Lee
- Materials Architecturing Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Jinjoo Kim
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, 90024, USA
| | - Steve Park
- Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Ki-Bum Lee
- Department of Chemistry and Chemical Biology, Rutgers University, Piscataway, NJ, 08854, USA
| | - Woo Young Jang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, 02841, Republic of Korea
| | - Bong Hoon Kim
- Daegu Gyeongbuk Institute of Science and Technology (DGIST), Department of Robotics and Mechatronics Engineering, Daegu, 42988, Republic of Korea
| | - Ramasamy Paulmurugan
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford University, Palo Alto, CA, 94304, USA
- Department of Radiology, Canary Center at Stanford for Cancer Early Detection, Stanford University School of Medicine, Stanford University, Palo Alto, CA, 94304, USA
| | - Seung-Woo Cho
- Department of Biotechnology, Yonsei University, Seoul, 03722, Republic of Korea
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, Republic of Korea
| | - Hyun-Cheol Song
- Electronic Materials Research Center, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
- KIST-SKKU Carbon-Neutral Research Center, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Seok Ju Kang
- School of Energy and Chemical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea
| | - Wujin Sun
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Yangzhi Zhu
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, 90024, USA
| | - Junmin Lee
- Department of Materials Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang, 37673, Republic of Korea
| | - Han-Jun Kim
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, 90024, USA
| | - Ho Seong Jang
- Materials Architecturing Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- Division of Nano & Information Technology, KIST School, Korea University of Science and Technology (UST), Seoul, 02792, Republic of Korea
| | - Jong Seung Kim
- Department of Chemistry, Korea University, Seoul, 02841, Republic of Korea
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, 90024, USA
| | - Yongju Kim
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Sehoon Kim
- Chemical and Biological Integrative Research Center, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Heemin Kang
- Department of Materials Science and Engineering, Korea University, Seoul, 02841, Republic of Korea
- College of Medicine, Korea University, Seoul, 02841, Republic of Korea
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Omidi A, Weiss E, Wilson JS, Rosu-Bubulac M. Quantitative assessment of intra- and inter-modality deformable image registration of the heart, left ventricle, and thoracic aorta on longitudinal 4D-CT and MR images. J Appl Clin Med Phys 2021; 23:e13500. [PMID: 34962065 PMCID: PMC8833287 DOI: 10.1002/acm2.13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Accepted: 11/29/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Magnetic resonance imaging (MRI)‐based investigations into radiotherapy (RT)‐induced cardiotoxicity require reliable registrations of magnetic resonance (MR) imaging to planning computed tomography (CT) for correlation to regional dose. In this study, the accuracy of intra‐ and inter‐modality deformable image registration (DIR) of longitudinal four‐dimensional CT (4D‐CT) and MR images were evaluated for heart, left ventricle (LV), and thoracic aorta (TA). Methods and materials Non‐cardiac‐gated 4D‐CT and T1 volumetric interpolated breath‐hold examination (T1‐VIBE) MRI datasets from five lung cancer patients were obtained at two breathing phases (inspiration/expiration) and two time points (before treatment and 5 weeks after initiating RT). Heart, LV, and TA were manually contoured. Each organ underwent three intramodal DIRs ((A) CT modality over time, (B) MR modality over time, and (C) MR contrast effect at the same time) and two intermodal DIRs ((D) CT/MR multimodality at same time and (E) CT/MR multimodality over time). Hausdorff distance (HD), mean distance to agreement (MDA), and Dice were evaluated and assessed for compliance with American Association of Physicists in Medicine (AAPM) Task Group (TG)‐132 recommendations. Results Mean values of HD, MDA, and Dice under all registration scenarios for each region of interest ranged between 8.7 and 16.8 mm, 1.0 and 2.6 mm, and 0.85 and 0.95, respectively, and were within the TG‐132 recommended range (MDA < 3 mm, Dice > 0.8). Intramodal DIR showed slightly better results compared to intermodal DIR. Heart and TA demonstrated higher registration accuracy compared to LV for all scenarios except for HD and Dice values in Group A. Significant differences for each metric and tissue of interest were noted between Groups B and D and between Groups B and E. MDA and Dice significantly differed between LV and heart in all registrations except for MDA in Group E. Conclusions DIR of the heart, LV, and TA between non‐cardiac‐gated longitudinal 4D‐CT and MRI across two modalities, breathing phases, and pre/post‐contrast is acceptably accurate per AAPM TG‐132 guidelines. This study paves the way for future evaluation of RT‐induced cardiotoxicity and its related factors using multimodality DIR.
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Affiliation(s)
- Alireza Omidi
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - John S Wilson
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA.,Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Mihaela Rosu-Bubulac
- Department of Radiation Oncology, Virginia Commonwealth University Health, Richmond, Virginia, USA
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10
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Nelsson A, Kanski M, Engblom H, Ugander M, Carlsson M, Arheden H. Pulmonary blood volume measured by cardiovascular magnetic resonance: influence of pulmonary transit time methods and left atrial volume. J Cardiovasc Magn Reson 2021; 23:123. [PMID: 34706735 PMCID: PMC8554972 DOI: 10.1186/s12968-021-00809-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased pulmonary blood volume (PBV) is a measure of congestion and is associated with an increased risk of cardiovascular events. PBV can be quantified using cardiovascular magnetic resonance (CMR) imaging as the product of cardiac output and pulmonary transit time (PTT), the latter measured from the contrast time-intensity curves in the right and left side of the heart from first-pass perfusion (FPP). Several methods of estimating PTT exist, including pulmonary transit beats (PTB), peak-to-peak, and center of gravity (CoG). The aim of this study was to determine the accuracy and precision for these methods of quantifying the PBV, taking the left atrium volume (LAV) into consideration. METHODS Fifty-eight participants (64 ± 11 years, 24 women) underwent 1.5 T CMR. PTT was quantified from (1) a basal left ventricular short-axis image (FPP), and (2) the reference method with a separate contrast administration using an image intersecting the pulmonary artery (PA) and the LA (CoG(PA-LA)). RESULTS Compared to the reference, PBV for (a) PTB(FPP) was 14 ± 17% larger, (b) peak-peak(FPP) was 17 ± 16% larger, and (c) CoG(FPP) was 18 ± 10% larger. Subtraction of the LAV (available for n = 50) decreased overall differences to - 1 ± 19%, 2 ± 18%, and 3 ± 12% for PTB(FPP), peak-peak(FPP), and CoG(FPP), respectively. Lowest interobserver variability was seen for CoG(FPP) (- 2 ± 7%). CONCLUSIONS CoG(PA-LA) and FPP methods measured the same PBV only when adjusting for the LAV, since FPP inherently quantifies a volume consisting of PBV + LAV. CoG(FPP) had the best precision and lowest interobserver variability among the FPP methods of measuring PBV.
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Affiliation(s)
- Anders Nelsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mikael Kanski
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Kolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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11
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Hou K, Yang C, Shi J, Kuang B, Tian B. Nano- and Microscale Optical and Electrical Biointerfaces and Their Relevance to Energy Research. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2100165. [PMID: 34142435 DOI: 10.1002/smll.202100165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/13/2021] [Indexed: 06/12/2023]
Abstract
Different research fields in energy sciences, such as photovoltaics for solar energy conversion, supercapacitors for energy storage, electrocatalysis for clean energy conversion technologies, and materials-bacterial hybrid for CO2 fixation have been under intense investigations over the past decade. In recent years, new platforms for biointerface designs have emerged from the energy conversion and storage principles. This paper reviews recent advances in nano- and microscale materials/devices for optical and electrical biointerfaces. First, a connection is drawn between biointerfaces and energy science, and how these two distinct research fields can be connected is summarized. Then, a brief overview of current available tools for biointerface studies is presented. Third, three representative biointerfaces are reviewed, including neural, cardiac, and bacterial biointerfaces, to show how to apply these tools and principles to biointerface design and research. Finally, two possible future research directions for nano- and microscale biointerfaces are proposed.
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Affiliation(s)
- Kun Hou
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
| | - Chuanwang Yang
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
| | - Jiuyun Shi
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
| | - Boya Kuang
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
| | - Bozhi Tian
- Department of Chemistry, The University of Chicago, Chicago, IL, 60637, USA
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12
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Ricci F, Aung N, Thomson R, Boubertakh R, Camaioni C, Doimo S, Sanghvi MM, Fung K, Khanji MY, Lee A, Malcolmson J, Mantini C, Paiva J, Gallina S, Fedorowski A, Mohiddin SA, Aquaro GD, Petersen SE. Pulmonary blood volume index as a quantitative biomarker of haemodynamic congestion in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 20:1368-1376. [PMID: 31504370 PMCID: PMC6868494 DOI: 10.1093/ehjci/jez213] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/01/2019] [Accepted: 08/21/2019] [Indexed: 12/24/2022] Open
Abstract
Aims The non-invasive assessment of left ventricular (LV) diastolic function and filling pressure in hypertrophic cardiomyopathy (HCM) is still an open issue. Pulmonary blood volume index (PBVI) by cardiovascular magnetic resonance (CMR) has been proposed as a quantitative biomarker of haemodynamic congestion. We aimed to assess the diagnostic accuracy of PBVI for left atrial pressure (LAP) estimation in patients with HCM. Methods and results We retrospectively identified 69 consecutive HCM outpatients (age 58 ± 11 years; 83% men) who underwent both transthoracic echocardiography (TTE) and CMR. Guideline-based detection of LV diastolic dysfunction was assessed by TTE, blinded to CMR results. PBVI was calculated as the product of right ventricular stroke volume index and the number of cardiac cycles for a bolus of gadolinium to pass through the pulmonary circulation as assessed by first-pass perfusion imaging. Compared to patients with normal LAP, patients with increased LAP showed significantly larger PBVI (463 ± 127 vs. 310 ± 86 mL/m2, P < 0.001). PBVI increased progressively with worsening New York Heart Association functional class and echocardiographic stages of diastolic dysfunction (P < 0.001 for both). At the best cut-off point of 413 mL/m2, PBVI yielded good diagnostic accuracy for the diagnosis of LV diastolic dysfunction with increased LAP [C-statistic = 0.83; 95% confidence interval (CI): 0.73–0.94]. At multivariable logistic regression analysis, PBVI was an independent predictor of increased LAP (odds ratio per 10% increase: 1.97, 95% CI: 1.06–3.68; P = 0.03). Conclusion PBVI is a promising CMR application for assessment of diastolic function and LAP in patients with HCM and may serve as a quantitative marker for detection, grading, and monitoring of haemodynamic congestion.
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Affiliation(s)
- Fabrizio Ricci
- Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Via Luigi Polacchi, 11 - 66100 Chieti, Italy.,William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.,Fondazione Villa Serena per la Ricerca, Viale Leonardo Petruzzi, 42 - 65013 Città Sant'Angelo, Italy
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ross Thomson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Redha Boubertakh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Claudia Camaioni
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Sara Doimo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK.,Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, via Pietro Valdoni, 7 - 34149 Trieste, Italy
| | - Mihir M Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Aaron Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - James Malcolmson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Cesare Mantini
- Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Via Luigi Polacchi, 11 - 66100 Chieti, Italy
| | - José Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Sabina Gallina
- Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University, Via Luigi Polacchi, 11 - 66100 Chieti, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Saidi A Mohiddin
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | | | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
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13
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Nakano Y, Rashed EA, Nakane T, Laakso I, Hirata A. ECG Localization Method Based on Volume Conductor Model and Kalman Filtering. SENSORS (BASEL, SWITZERLAND) 2021; 21:4275. [PMID: 34206512 PMCID: PMC8271910 DOI: 10.3390/s21134275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
The 12-lead electrocardiogram was invented more than 100 years ago and is still used as an essential tool in the early detection of heart disease. By estimating the time-varying source of the electrical activity from the potential changes, several types of heart disease can be noninvasively identified. However, most previous studies are based on signal processing, and thus an approach that includes physics modeling would be helpful for source localization problems. This study proposes a localization method for cardiac sources by combining an electrical analysis with a volume conductor model of the human body as a forward problem and a sparse reconstruction method as an inverse problem. Our formulation estimates not only the current source location but also the current direction. For a 12-lead electrocardiogram system, a sensitivity analysis of the localization to cardiac volume, tilted angle, and model inhomogeneity was evaluated. Finally, the estimated source location is corrected by Kalman filter, considering the estimated electrocardiogram source as time-sequence data. For a high signal-to-noise ratio (greater than 20 dB), the dominant error sources were the model inhomogeneity, which is mainly attributable to the high conductivity of the blood in the heart. The average localization error of the electric dipole sources in the heart was 12.6 mm, which is comparable to that in previous studies, where a less detailed anatomical structure was considered. A time-series source localization with Kalman filtering indicated that source mislocalization could be compensated, suggesting the effectiveness of the source estimation using the current direction and location simultaneously. For the electrocardiogram R-wave, the mean distance error was reduced to less than 7.3 mm using the proposed method. Considering the physical properties of the human body with Kalman filtering enables highly accurate estimation of the cardiac electric signal source location and direction. This proposal is also applicable to electrode configuration, such as ECG sensing systems.
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Affiliation(s)
- Yuki Nakano
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan; (Y.N.); (E.A.R.); (T.N.)
| | - Essam A. Rashed
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan; (Y.N.); (E.A.R.); (T.N.)
- Department of Mathematics, Faculty of Science, Suez Canal University, Ismailia 41522, Egypt
| | - Tatsuhito Nakane
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan; (Y.N.); (E.A.R.); (T.N.)
| | - Ilkka Laakso
- Department of Electrical Engineering and Automation, Aalto University, 02150 Espoo, Finland;
| | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan; (Y.N.); (E.A.R.); (T.N.)
- Center of Biomedical Physics and Information Technology, Nagoya Institute of Technology, Nagoya 466-8555, Japan
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14
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Asulin M, Michael I, Shapira A, Dvir T. One-Step 3D Printing of Heart Patches with Built-In Electronics for Performance Regulation. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2004205. [PMID: 33977062 PMCID: PMC8097332 DOI: 10.1002/advs.202004205] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/23/2020] [Indexed: 06/12/2023]
Abstract
Three dimensional (3D) printing of heart patches usually provides the ability to precisely control cell location in 3D space. Here, one-step 3D printing of cardiac patches with built-in soft and stretchable electronics is reported. The tissue is simultaneously printed using three distinct bioinks for the cells, for the conducting parts of the electronics and for the dielectric components. It is shown that the hybrid system can withstand continuous physical deformations as those taking place in the contracting myocardium. The electronic patch is flexible, stretchable, and soft, and the electrodes within the printed patch are able to monitor the function of the engineered tissue by providing extracellular potentials. Furthermore, the system allowed controlling tissue function by providing electrical stimulation for pacing. It is envisioned that such transplantable patches may regain heart contractility and allow the physician to monitor the implant function as well as to efficiently intervene from afar when needed.
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Affiliation(s)
- Masha Asulin
- The Shmunis School of Biomedicine and Cancer ResearchFaculty of Life SciencesTel Aviv UniversityTel Aviv6997801Israel
- Department of Materials Science and EngineeringFaculty of EngineeringTel Aviv UniversityTel Aviv6997801Israel
| | - Idan Michael
- The Shmunis School of Biomedicine and Cancer ResearchFaculty of Life SciencesTel Aviv UniversityTel Aviv6997801Israel
| | - Assaf Shapira
- The Shmunis School of Biomedicine and Cancer ResearchFaculty of Life SciencesTel Aviv UniversityTel Aviv6997801Israel
| | - Tal Dvir
- The Shmunis School of Biomedicine and Cancer ResearchFaculty of Life SciencesTel Aviv UniversityTel Aviv6997801Israel
- Department of Materials Science and EngineeringFaculty of EngineeringTel Aviv UniversityTel Aviv6997801Israel
- The Center for Nanoscience and NanotechnologyTel Aviv UniversityTel Aviv6997801Israel
- Sagol Center for Regenerative BiotechnologyTel Aviv UniversityTel Aviv6997801Israel
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15
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Støylen A, Dalen H, Molmen HE. Left ventricular longitudinal shortening: relation to stroke volume and ejection fraction in ageing, blood pressure, body size and gender in the HUNT3 study. Open Heart 2020; 7:openhrt-2020-001243. [PMID: 32978265 PMCID: PMC7520903 DOI: 10.1136/openhrt-2020-001243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/04/2020] [Accepted: 08/07/2020] [Indexed: 01/22/2023] Open
Abstract
Background Aims of this cross-sectional study were to assess: the relative contribution of left ventricular (LV) systolic long-axis shortening (mean mitral annular plane systolic excursion, MAPSE) to stroke volume (SV), the mechanisms for preserved ejection fraction (EF) despite reduced MAPSE, the age dependency of myocardial volume and myocardial systolic compression. Methods Linear dimensions and longitudinal and cross-sectional M-modes were acquired in 1266 individuals without history of heart disease, diabetes or known hypertension from the third wave of the Nord-Trøndelag Health Study. Measurements were entered into a half-ellipsoid LV model for volume calculations, and volumes were related to age, body size (body surface area, BSA), sex and blood pressure (BP). Results Mean BP and proportion with hypertensive values increased with increasing age. MAPSE contributed to 75% of SV, with no relation to age or BSA as both MAPSE and SV decreased with increasing age. LV end-diastolic volume (LVEDV) and SV increased with BSA and decreased with higher age; EF was not related to age or BSA. Myocardial volume increased with higher age and BSA, with an additional gender dependency. The association of age with myocardial volume was not significant when corrected for BP, while both systolic and diastolic BP were significant associated with myocardial volume. Myocardial compression was less than 3%. Conclusions MAPSE contributes approximately 75% and short axis shortening 25% to SV. Both decline with age, but their percentage contributions to SV are unchanged. EF is preserved by the simultaneous decrease in LVEDV and SV. Myocardial volume is positively associated with age, but this is only related to higher BP, which may have implications for BP treatment in ageing. The myocardium is near incompressible.
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Affiliation(s)
- Asbjørn Støylen
- Faculty of Medicine, Dept of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway .,Cardiology, St. Olav University Hospital, Trondheim, Norway
| | - Håvard Dalen
- Faculty of Medicine, Dept of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Cardiology, St. Olav University Hospital, Trondheim, Norway.,MI Lab and Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.,Cardiology, Levanger Hospital, Levanger, Norway
| | - Harald Edvard Molmen
- Asgardstrand General Practice, Horten, Norway.,Division of Medicine, Department of Endocrinology, Morbid Obesity Centre, Vestfold Hospital Trust, Tonsberg, Norway
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16
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Csecs I, Pashakhanloo F, Paskavitz A, Jang J, Al-Otaibi T, Neisius U, Manning WJ, Nezafat R. Association Between Left Ventricular Mechanical Deformation and Myocardial Fibrosis in Nonischemic Cardiomyopathy. J Am Heart Assoc 2020; 9:e016797. [PMID: 33006296 PMCID: PMC7792406 DOI: 10.1161/jaha.120.016797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In patients with nonischemic cardiomyopathy, nonischemic fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is related to adverse cardiovascular outcomes. However, its relationship with left ventricular (LV) mechanical deformation parameters remains unclear. We sought to investigate the association between LV mechanics and the presence, location, and extent of fibrosis in patients with nonischemic cardiomyopathy. Methods and Results We retrospectively identified 239 patients with nonischemic cardiomyopathy (67% male; 55±14 years) referred for a clinical cardiovascular magnetic resonance. LGE was present in 109 patients (46%), most commonly (n=52; 22%) in the septum. LV deformation parameters did not differentiate between LGE‐positive and LGE‐negative groups. Global longitudinal, radial, and circumferential strains, twist and torsion showed no association with extent of fibrosis. Patients with septal fibrosis had a more depressed LV ejection fraction (30±12% versus 35±14%; P=0.032) and more impaired global circumferential strain (−7.9±3.5% versus −9.7±4.4%; P=0.045) and global radial strain (10.7±5.2% versus 13.3±7.7%; P=0.023) than patients without septal LGE. Global longitudinal strain was similar in both groups. While patients with septal‐only LGE (n=28) and free wall–only LGE (n=32) had similar fibrosis burden, the septal‐only LGE group had more impaired LV ejection fraction and global circumferential, longitudinal, and radial strains (all P<0.05). Conclusions There is no association between LV mechanical deformation parameters and presence or extent of fibrosis in patients with nonischemic cardiomyopathy. Septal LGE was associated with poor global LV function, more impaired global circumferential and radial strains, and more impaired global strain rates.
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Affiliation(s)
- Ibolya Csecs
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Farhad Pashakhanloo
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Amanda Paskavitz
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Jihye Jang
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Talal Al-Otaibi
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Ulf Neisius
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Warren J Manning
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
| | - Reza Nezafat
- Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA
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17
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Schiavone G, Lacour SP. Conformable bioelectronic interfaces: Mapping the road ahead. Sci Transl Med 2020; 11:11/503/eaaw5858. [PMID: 31366582 DOI: 10.1126/scitranslmed.aaw5858] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022]
Abstract
Translating conformable bioelectronic interface research into clinical reality foretells a promising future for an aging society.
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Affiliation(s)
- Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202 Geneva, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202 Geneva, Switzerland
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18
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Fallegger F, Schiavone G, Lacour SP. Conformable Hybrid Systems for Implantable Bioelectronic Interfaces. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1903904. [PMID: 31608508 DOI: 10.1002/adma.201903904] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/20/2019] [Indexed: 05/27/2023]
Abstract
Conformable bioelectronic systems are promising tools that may aid the understanding of diseases, alleviate pathological symptoms such as chronic pain, heart arrhythmia, and dysfunctions, and assist in reversing conditions such as deafness, blindness, and paralysis. Combining reduced invasiveness with advanced electronic functions, hybrid bioelectronic systems have evolved tremendously in the last decade, pushed by progress in materials science, micro- and nanofabrication, system assembly and packaging, and biomedical engineering. Hybrid integration refers here to a technological approach to embed within mechanically compliant carrier substrates electronic components and circuits prepared with traditional electronic materials. This combination leverages mechanical and electronic performance of polymer substrates and device materials, respectively, and offers many opportunities for man-made systems to communicate with the body with unmet precision. However, trade-offs between materials selection, manufacturing processes, resolution, electrical function, mechanical integrity, biointegration, and reliability should be considered. Herein, prominent trends in manufacturing conformable hybrid systems are analyzed and key design, function, and validation principles are outlined together with the remaining challenges to produce reliable conformable, hybrid bioelectronic systems.
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Affiliation(s)
- Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
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19
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Sjöberg P, Ostenfeld E, Hedström E, Arheden H, Gustafsson R, Nozohoor S, Carlsson M. Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot. Am J Physiol Heart Circ Physiol 2020; 318:H345-H353. [PMID: 31886724 DOI: 10.1152/ajpheart.00417.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance was performed in patients (n = 12) with rToF and PR > 35% before and after PVR and in healthy controls (n = 15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes, and caval blood flows were analyzed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared with controls (P < 0.0001; P < 0.01) and decreased after PVR (P < 0.0001 for both). Left ventricular AVPD was lower in patients before PVR compared with controls (P < 0.05) and decreased after PVR (P < 0.01). Left ventricular GLS did not differ between patients and controls (P > 0.05). Right atrial reservoir volume and RV stroke volume generated by AVPD correlated in controls (r = 0.93; P < 0.0001) and patients before PVR (r = 0.88; P < 0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly because of loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavorable, and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF.NEW & NOTEWORTHY There is a clear atrioventricular coupling in patients with Tetralogy of Fallot (ToF) and pulmonary regurgitation before surgical pulmonary valve replacement (PVR) that is lost after operation, possibly because of loss of pericardial integrity. The impaired atrioventricular coupling complicates assessment of ventricular function after surgery when using measurements of longitudinal function. Left ventricular atrioventricular plane displacement (AVPD) found differences between patients and controls and changes after PVR that longitudinal strain could not detect. This indicates that AVPD and strain cannot be used interchangeably to assess longitudinal function in repaired ToF.
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Affiliation(s)
- Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.,Diagnostic Radiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Cardiothoracic Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Shahab Nozohoor
- Cardiothoracic Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
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20
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Carlsson M, Heiberg E, Ostenfeld E, Steding-Ehrenborg K, Kovács SJ, Flachskampf F, Arheden H. Functional Contribution of Circumferential Versus Longitudinal Strain: Different Concepts Suggest Conflicting Results. J Am Coll Cardiol 2019; 71:254-255. [PMID: 29325646 DOI: 10.1016/j.jacc.2017.09.1156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 11/24/2022]
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21
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Feiner R, Wertheim L, Gazit D, Kalish O, Mishal G, Shapira A, Dvir T. A Stretchable and Flexible Cardiac Tissue-Electronics Hybrid Enabling Multiple Drug Release, Sensing, and Stimulation. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1805526. [PMID: 30838769 PMCID: PMC7100044 DOI: 10.1002/smll.201805526] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/17/2019] [Indexed: 04/14/2023]
Abstract
Replacement of the damaged scar tissue created by a myocardial infarction is the goal of cardiac tissue engineering. However, once the implanted tissue is in place, monitoring its function is difficult and involves indirect methods, while intervention necessarily requires an invasive procedure and available medical attention. To overcome this, methods of integrating electronic components into engineered tissues have been recently presented. These allow for remote monitoring of tissue function as well as intervention through stimulation and controlled drug release. Here, an improved hybrid microelectronic tissue construct capable of withstanding the dynamic environment of the beating heart without compromising electronic or mechanical functionality is reported. While the reported system is enabled to sense the function of the engineered tissue and provide stimulation for pacing, an electroactive polymer on the electronics enables it to release multiple drugs in parallel. It is envisioned that the integration of microelectronic devices into engineered tissues will provide a better way to monitor patient health from afar, as well as provide facile, more exact methods to control the healing process.
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Affiliation(s)
- Ron Feiner
- School for Molecular Cell Biology and Biotechnology, Tel Aviv University, Tel Aviv 69978, Israel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Wertheim
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Danielle Gazit
- School for Molecular Cell Biology and Biotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Or Kalish
- School for Molecular Cell Biology and Biotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Gal Mishal
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Assaf Shapira
- School for Molecular Cell Biology and Biotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tal Dvir
- School for Molecular Cell Biology and Biotechnology, Tel Aviv University, Tel Aviv 69978, Israel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- Sagol Center for Regenerative Biotechnology, Tel Aviv University, Tel Aviv 69978, Israel
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22
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Myziuk N, Guerrero T, Sakthivel G, Solis D, Nair G, Guerra R, Castillo E. Pulmonary blood mass dynamics on 4DCT during tidal breathing. ACTA ACUST UNITED AC 2019; 64:045014. [DOI: 10.1088/1361-6560/aaff7b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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23
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Carlsson M, Ugander M, Kanski M, Borgquist R, Ekelund U, Arheden H. Heart filling exceeds emptying during late ventricular systole in patients with systolic heart failure and healthy subjects - a cardiac MRI study. Clin Physiol Funct Imaging 2018; 39:192-200. [PMID: 30506862 PMCID: PMC7380006 DOI: 10.1111/cpf.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/30/2018] [Indexed: 11/28/2022]
Abstract
Background Total heart volume (THV) within the pericardium is not constant throughout the cardiac cycle and THV would intuitively be lowest at end systole. We have, however, observed a phase shift between ventricular outflow and atrial inflow which causes the minimum THV to occur before end systole. The aims were to explain the mechanism of the late‐systolic net inflow to the heart and determine whether this net inflow is affected by increased cardiac output or systolic heart failure. Methods and Results Healthy controls (n = 21) and patients with EF<35% (n = 14) underwent magnetic resonance imaging with flow measurements in vessels to and from the heart, and this was repeated in nine controls during 140 μgram kg−1 min−1 adenosine infusion. Minimum THV occurred 78 ± 6 ms before end of systolic ejection (8 ± 1% of the cardiac cycle) in controls. The late‐systolic net inflow was 12·3 ± 1·1 ml or 6·0 ± 0·5% of total stroke volume (TSV). Cardiac output increased 66 ± 8% during adenosine but late‐systolic net inflow to the heart did not change (P = 0·73). In patients with heart failure, late‐systolic net inflow of the heart′s left side was lower (3·4 ± 0·5%) compared to healthy subjects (5·3 ± 0·6%, P = 0·03). Conclusions Heart size increases before end systole due to a late‐systolic net inflow which is unaffected by increased cardiac output. This may be explained by inertia of blood that flows into the atria generated by ventricular systole. The lower late‐systolic net inflow in patients with systolic heart failure may be a measure of decreased ventricular filling due to decreased systolic function, thus linking systolic to diastolic dysfunction.
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Affiliation(s)
- Marcus Carlsson
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Martin Ugander
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Rasmus Borgquist
- Department of Clinical Sciences, Cardiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Ulf Ekelund
- Department of Clinical Sciences, Emergency Medicine, Skane University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
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24
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Feiner R, Fleischer S, Shapira A, Kalish O, Dvir T. Multifunctional degradable electronic scaffolds for cardiac tissue engineering. J Control Release 2018; 281:189-195. [PMID: 29782947 PMCID: PMC6018619 DOI: 10.1016/j.jconrel.2018.05.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
Abstract
The capability to on-line sense tissue function, provide stimulation to control contractility and efficiently release drugs within an engineered tissue microenvironment may enhance tissue assembly and improve the therapeutic outcome of implanted engineered tissues. To endow cardiac patches with such capabilities we developed elastic, biodegradable, electronic scaffolds. The scaffolds were composed of electrospun albumin fibers that served as both a substrate and a passivation layer for evaporated gold electrodes. Cardiomyocytes seeded onto the electronic scaffolds organized into a functional cardiac tissue and their function was recorded on-line. Furthermore, the electronic scaffolds enabled to actuate the engineered tissue to control its function and trigger the release of drugs. Post implantation, these electronic scaffolds degraded, leading to the dissociation of the inorganic material from within the scaffold. Such technology can be built upon to create a variety of degradable devices for tissue engineering of various tissues, as well as pristine cell-free devices with electronic components for short-term in vivo use.
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Affiliation(s)
- Ron Feiner
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel; The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Sharon Fleischer
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel; The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Assaf Shapira
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel; The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Or Kalish
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tal Dvir
- The School for Molecular Cell Biology and Biotechnology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel; The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel; Department of Materials Science and Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel; Sagol Center for Regenerative Biotechnology, Tel Aviv University, Tel Aviv 69978, Israel.
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25
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Resolving the True Ventricular Mural Architecture. J Cardiovasc Dev Dis 2018; 5:jcdd5020034. [PMID: 29925810 PMCID: PMC6023305 DOI: 10.3390/jcdd5020034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/10/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023] Open
Abstract
The precise nature of packing together of the cardiomyocytes within the ventricular walls has still to be determined. The spiraling nature of the chains of interconnected cardiomyocytes has long been recognized. As long ago as the end of the nineteenth century, Pettigrew had emphasized that the ventricular cone was not arranged on the basis of skeletal muscle. Despite this guidance, subsequent anatomists described entities such as “bulbo-spiral muscles”, with this notion of subunits culminating in the suggestion that the ventricular cone could be unwrapped so as to produce a “ventricular myocardial band”. Others, in contrast, had suggested that the ventricular walls were arranged on the basis of “sheets”, or more recently “sheetlets”, with investigators seeking to establishing the angulation of these entities using techniques such as magnetic resonance imaging. Our own investigations, in contrast, have shown that the cardiomyocytes are aggregated together within the supporting fibrous matrix so as to produce a three-dimensional myocardial mesh. In this review, we summarize the previous accounts, and provide the anatomical evidence we have thus far accumulated to support the model of the myocardial mesh. We show how these anatomic findings underscore the concept of the myocardial mesh functioning in antagonistic fashion. They lend evidence to support the notion that the ventricular myocardium works as a muscular hydrostat.
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26
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Stephensen SS, Ostenfeld E, Steding-Ehrenborg K, Thilén U, Heiberg E, Arheden H, Carlsson M. Alterations in ventricular pumping in patients with atrial septal defect at rest, during dobutamine stress and after defect closure. Clin Physiol Funct Imaging 2017; 38:830-839. [PMID: 29235722 DOI: 10.1111/cpf.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Regional ventricular pumping mechanisms in patients with volume-loaded right ventricles (RV) are altered, but the cause is unknown. The aim was to determine whether these changes in ventricular pumping mechanisms are influenced by the RV dilatation itself or the aetiology behind it. METHODS Seventeen patients with atrial septal defects (ASD) and 10 healthy controls underwent cardiovascular magnetic resonance (CMR) at rest and during dobutamine/atropine stress. Sixteen patients underwent transcutaneous ASD closure. Follow-up CMR at rest was performed the following day. Thirty patients with RV overload due to pulmonary regurgitation (PR) underwent CMR at rest. Cine images were used to measure left ventricular (LV) and RV volumes as well as septal, longitudinal and lateral contributions to LV and RV stroke volume (SV). RESULTS At rest, septal contribution to LVSV was lower in ASD patients than controls (-1% versus 7%, P<0·05), but there was no difference in longitudinal or lateral contribution to SV. Patients with PR had lower longitudinal contribution to RV with increased lateral and septal contribution. During dobutamine stress, longitudinal contribution to LV and RVSV decreased and lateral contribution increased for ASD patients and controls. The day after ASD closure, septal contribution to LVSV was 6%, longitudinal contribution had increased for RVSV (P<0·05) and decreased for LVSV (P<0·01). CONCLUSION Pumping mechanisms in patients with RV volume overload depend on the aetiology for the RV dilation and not the size of the RV.
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Affiliation(s)
- Sigurdur S Stephensen
- Department of Clinical Sciences, Clinical Physiology, Lund University, Lund, Sweden.,Department of Pediatric Cardiology, Lund University Hospital, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences, Clinical Physiology, Lund University, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Sciences, Clinical Physiology, Lund University, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Ulf Thilén
- Department of Cardiology, Lund University Hospital, Lund University, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Sciences, Clinical Physiology, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Hakan Arheden
- Department of Clinical Sciences, Clinical Physiology, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences, Clinical Physiology, Lund University, Lund, Sweden
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27
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Hydraulic forces contribute to left ventricular diastolic filling. Sci Rep 2017; 7:43505. [PMID: 28256604 PMCID: PMC5334655 DOI: 10.1038/srep43505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 01/27/2017] [Indexed: 01/20/2023] Open
Abstract
Myocardial active relaxation and restoring forces are known determinants of left ventricular (LV) diastolic function. We hypothesize the existence of an additional mechanism involved in LV filling, namely, a hydraulic force contributing to the longitudinal motion of the atrioventricular (AV) plane. A prerequisite for the presence of a net hydraulic force during diastole is that the atrial short-axis area (ASA) is smaller than the ventricular short-axis area (VSA). We aimed (a) to illustrate this mechanism in an analogous physical model, (b) to measure the ASA and VSA throughout the cardiac cycle in healthy volunteers using cardiovascular magnetic resonance imaging, and (c) to calculate the magnitude of the hydraulic force. The physical model illustrated that the anatomical difference between ASA and VSA provides the basis for generating a hydraulic force during diastole. In volunteers, VSA was greater than ASA during 75-100% of diastole. The hydraulic force was estimated to be 10-60% of the peak driving force of LV filling (1-3 N vs 5-10 N). Hydraulic forces are a consequence of left heart anatomy and aid LV diastolic filling. These findings suggest that the relationship between ASA and VSA, and the associated hydraulic force, should be considered when characterizing diastolic function and dysfunction.
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28
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Seemann F, Pahlm U, Steding-Ehrenborg K, Ostenfeld E, Erlinge D, Dubois-Rande JL, Jensen SE, Atar D, Arheden H, Carlsson M, Heiberg E. Time-resolved tracking of the atrioventricular plane displacement in Cardiovascular Magnetic Resonance (CMR) images. BMC Med Imaging 2017; 17:19. [PMID: 28241751 PMCID: PMC5330030 DOI: 10.1186/s12880-017-0189-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background Atrioventricular plane displacement (AVPD) is an indicator for systolic and diastolic function and accounts for 60% of the left ventricular, and 80% of the right ventricular stroke volume. AVPD is commonly measured clinically in echocardiography as mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE), but has not been applied widely in cardiovascular magnetic resonance (CMR). To date, there is no robust automatic algorithm available that allows the AVPD to be measured clinically in CMR with input in a single timeframe. This study aimed to develop, validate and provide a method that automatically tracks the left and right ventricular AVPD in CMR images, which can be used in the clinical setting or in applied cardiovascular research in multi-center studies. Methods The proposed algorithm is based on template tracking by normalized cross-correlation combined with a priori information by principal component analysis. The AVPD in each timeframe is calculated for the left and right ventricle separately using CMR long-axis cine images of the 2, 3, and 4-chamber views. The algorithm was developed using a training set (n = 40), and validated in a test set (n = 113) of healthy subjects, athletes, and patients after ST-elevation myocardial infarction from 10 centers. Validation was done using manual measurements in end diastole and end systole as reference standard. Additionally, AVPD, peak emptying velocity, peak filling velocity, and atrial contraction was validated in 20 subjects, where time-resolved manual measurements were used as reference standard. Inter-observer variability was analyzed in 20 subjects. Results In end systole, the difference between the algorithm and the reference standard in the left ventricle was (mean ± SD) -0.6 ± 1.9 mm (R = 0.79), and −0.8 ± 2.1 mm (R = 0.88) in the right ventricle. Inter-observer variability in end systole was −0.6 ± 0.7 mm (R = 0.95), and −0.5 ± 1.4 mm (R = 0.95) for the left and right ventricle, respectively. Validation of peak emptying velocity, peak filling velocity, and atrial contraction yielded lower accuracy than the displacement measures. Conclusions The proposed algorithm show good agreement and low bias with the reference standard, and with an agreement in parity with inter-observer variability. Thus, it can be used as an automatic method of tracking and measuring AVPD in CMR. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0189-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felicia Seemann
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Numerical Analysis, Faculty of Engineering, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Ulrika Pahlm
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden.,Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden. .,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.
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Rashid A, Kim S, Liu D, Kim KY. A dynamic oppositional biogeography-based optimization approach for time-varying electrical impedance tomography. Physiol Meas 2016; 37:820-42. [PMID: 27203482 DOI: 10.1088/0967-3334/37/6/820] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Dynamic electrical impedance tomography-based image reconstruction using conventional algorithms such as the extended Kalman filter often exhibits inferior performance due to the presence of measurement noise, the inherent ill-posed nature of the problem and its critical dependence on the selection of the initial guess as well as the state evolution model. Moreover, many of these conventional algorithms require the calculation of a Jacobian matrix. This paper proposes a dynamic oppositional biogeography-based optimization (OBBO) technique to estimate the shape, size and location of the non-stationary region boundaries, expressed as coefficients of truncated Fourier series, inside an object domain using electrical impedance tomography. The conductivity of the object domain is assumed to be known a priori. Dynamic OBBO is a novel addition to the family of dynamic evolutionary algorithms. Moreover, it is the first such study on the application of dynamic evolutionary algorithms for dynamic electrical impedance tomography-based image reconstruction. The performance of the algorithm is tested through numerical simulations and experimental study and is compared with state-of-the-art gradient-based extended Kalman filter. The dynamic OBBO is shown to be far superior compared to the extended Kalman filter. It is found to be robust to measurement noise as well as the initial guess, and does not rely on a priori knowledge of the state evolution model.
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Affiliation(s)
- A Rashid
- Faculty of Computer Sciences and Engineering, GIK Institute of Engineering Science and Technology, Topi, Swabi, Pakistan
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30
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Seguin M, Bourqui J, Fear E, Okoniewski M. Monitoring the heart with ultra-wideband microwave signals: evaluation with a semi-dynamic heart model. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/3/035011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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31
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Quantitative criteria for the diagnosis of the congenital absence of pericardium by cardiac magnetic resonance. Eur J Radiol 2016; 85:616-24. [DOI: 10.1016/j.ejrad.2015.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 12/01/2015] [Accepted: 12/24/2015] [Indexed: 01/19/2023]
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32
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Wittek A, Karatolios K, Fritzen CP, Bereiter-Hahn J, Schieffer B, Moosdorf R, Vogt S, Blase C. Cyclic three-dimensional wall motion of the human ascending and abdominal aorta characterized by time-resolved three-dimensional ultrasound speckle tracking. Biomech Model Mechanobiol 2016; 15:1375-88. [PMID: 26897533 DOI: 10.1007/s10237-016-0769-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/03/2016] [Indexed: 01/22/2023]
Abstract
The aim of this study was to measure, characterize, and compare the time-resolved three-dimensional wall kinematics of the ascending and the abdominal aorta. Comprehensive description of aortic wall kinematics is an important issue for understanding its physiological functioning and early detection of adverse changes. Data on the three-dimensional, dynamic cyclic deformation of the aorta in vivo are scarce. Either most imaging techniques available are too slow to capture aortic wall motion (CT, MRI) or they do not provide three-dimensional geometry data. Three-dimensional volume data sets of ascending and abdominal aortae of male healthy subjects (25.5 [24.5, 27.5] years) were acquired by use of a commercial echocardiography system with a temporal resolution of 11-25 Hz. Longitudinal and circumferential strain, twist, and relative volume change were determined by use of a commercial speckle tracking algorithm and in-house software. The kinematics of the abdominal aorta is characterized by diameter change, almost constant length and unidirectional, either clockwise or counter clockwise twist. In contrast, the ascending aorta undergoes a complex deformation with alternating clockwise and counterclockwise twist. Length and diameter changes were in the same order of magnitude with a phase shift between both. Longitudinal strain and its phase shift to circumferential strain contribute to the proximal aorta's Windkessel function. Complex cyclic deformations are known to be highly fatiguing. This may account for increased degradation of components of the aortic wall and therefore promote aortic dissection or aneurysm formation.
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Affiliation(s)
- Andreas Wittek
- Department of Biological Sciences, Goethe University, Max-von-Laue-Str. 13, 60438, Frankfurt am Main, Germany
- Department of Mechanical Engineering, University Siegen, Siegen, Germany
| | | | | | - Jürgen Bereiter-Hahn
- Department of Biological Sciences, Goethe University, Max-von-Laue-Str. 13, 60438, Frankfurt am Main, Germany
| | | | - Rainer Moosdorf
- University Heart Center, Philipps University Marburg, Marburg, Germany
| | - Sebastian Vogt
- University Heart Center, Philipps University Marburg, Marburg, Germany
| | - Christopher Blase
- Department of Biological Sciences, Goethe University, Max-von-Laue-Str. 13, 60438, Frankfurt am Main, Germany.
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Steding-Ehrenborg K, Arvidsson PM, Töger J, Rydberg M, Heiberg E, Carlsson M, Arheden H. Determinants of kinetic energy of blood flow in the four-chambered heart in athletes and sedentary controls. Am J Physiol Heart Circ Physiol 2016; 310:H113-22. [DOI: 10.1152/ajpheart.00544.2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 11/22/2022]
Abstract
The kinetic energy (KE) of intracardiac blood may play an important role in cardiac function. The aims of the present study were to 1) quantify and investigate the determinants of KE, 2) compare the KE expenditure of intracardiac blood between athletes and control subjects, and 3) quantify the amount of KE inside and outside the diastolic vortex. Fourteen athletes and fourteen volunteers underwent cardiac MRI, including four-dimensional phase-contrast sequences. KE was quantified in four chambers, and energy expenditure was calculated by determining the mean KE/cardiac index. Left ventricular (LV) mass was an independent predictor of diastolic LVKE ( R2= 0.66, P < 0.001), whereas right ventricular (RV) end-diastolic volume was important for diastolic RVKE ( R2= 0.76, P < 0.001). The mean KE/cardiac index did not differ between groups (control subjects: 0.53 ± 0.14 mJ·l−1·min·m2and athletes: 0.56 ± 0.21 mJ·l−1·min·m2, P = 0.98). Mean LV diastolic vortex KE made up 70 ± 1% and 73 ± 2% of total LV diastolic KE in athletes and control subjects ( P = 0.18). In conclusion, the characteristics of the LV as a pressure pump and the RV as a volume pump are demonstrated as an association between LVKE and LV mass and between RVKE and end-diastolic volume. This also suggests different filling mechanisms where the LV is dependent on diastolic suction, whereas the RV fills with a basal movement of the atrioventricular plane over “stationary” blood. Both groups had similar energy expenditure for intracardiac blood flow, indicating similar pumping efficiency, likely explained by the lower heart rate that cancels the higher KE per heart beat in athletes. The majority of LVKE is found within the LV diastolic vortex, in contrast to earlier findings.
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Affiliation(s)
- K. Steding-Ehrenborg
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - P. M. Arvidsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - J. Töger
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - M. Rydberg
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - E. Heiberg
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - M. Carlsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - H. Arheden
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
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Stephenson RS, Agger P, Lunkenheimer PP, Zhao J, Smerup M, Niederer P, Anderson RH, Jarvis JC. The functional architecture of skeletal compared to cardiac musculature: Myocyte orientation, lamellar unit morphology, and the helical ventricular myocardial band. Clin Anat 2015; 29:316-32. [PMID: 26478993 DOI: 10.1002/ca.22661] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 11/06/2022]
Abstract
How the cardiomyocytes are aggregated within the heart walls remains contentious. We still do not fully understand how the end-to-end longitudinal myocytic chains are arranged, nor the true extent and shape of the lamellar units they aggregate to form. In this article, we show that an understanding of the complex arrangement of cardiac musculature requires knowledge of three-dimensional myocyte orientation (helical and intrusion angle), and appreciation of myocyte packing within the connective tissue matrix. We show how visualization and segmentation of high-resolution three-dimensional image data can accurately identify the morphology and orientation of the myocytic chains, and the lamellar units. Some maintain that the ventricles can be unwrapped in the form of a "helical ventricular myocardial band," that is, as a compartmentalized band with selective regional innervation and deformation, and a defined origin and insertion like most skeletal muscles. In contrast to the simpler interpretation of the helical ventricular myocardial band, we provide insight as to how the complex myocytic chains, the heterogeneous lamellar units, and connective tissue matrix form an interconnected meshwork, which facilitates the complex internal deformations of the ventricular wall. We highlight the dangers of disregarding the intruding cardiomyocytes. Preparation of the band destroys intruding myocytic chains, and thus disregards the functional implications of the antagonistic auxotonic forces they produce. We conclude that the ventricular myocardium is not analogous to skeletal muscle, but is a complex three-dimensional meshwork, with a heterogeneous branching lamellar architecture.
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Affiliation(s)
- Robert S Stephenson
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Peter Agger
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Paul P Lunkenheimer
- Department of Experimental Thoracic and Cardiovascular Surgery, University Hospital Munster, Munster, DE, Germany
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Morten Smerup
- Department of Cardiothoracic & Vascular Surgery, Aarhus University, Aarhus, Denmark
| | - Peter Niederer
- Institute for Biomedical Engineering, University of Zurich, Zurich, CH, Switzerland
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Division of Biomedical Sciences, University College London, London, United Kingdom
| | - Jonathan C Jarvis
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
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Steding-Ehrenborg K, Boushel RC, Calbet JA, Åkeson P, Mortensen SP. Left ventricular atrioventricular plane displacement is preserved with lifelong endurance training and is the main determinant of maximal cardiac output. J Physiol 2015; 593:5157-66. [PMID: 26496146 DOI: 10.1113/jp271621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/14/2015] [Indexed: 11/08/2022] Open
Abstract
Age-related decline in cardiac function can be prevented or postponed by lifelong endurance training. However, effects of normal ageing as well as of lifelong endurance exercise on longitudinal and radial contribution to stroke volume are unknown. The aim of this study was to determine resting longitudinal and radial pumping in elderly athletes, sedentary elderly and young sedentary subjects. Furthermore, we aimed to investigate determinants of maximal cardiac output in elderly. Eight elderly athletes (63 ± 4 years), seven elderly sedentary (66 ± 4 years) and ten young sedentary subjects (29 ± 4 years) underwent cardiac magnetic resonance imaging. All subjects underwent maximal exercise testing and for elderly subjects maximal cardiac output during cycling was determined using a dye dilution technique. Longitudinal and radial contribution to stroke volume did not differ between groups (longitudinal left ventricle (LV) 52-65%, P = 0.12, right ventricle (RV) 77-87%, P = 0.16, radial 7.9-8.6%, P = 1.0). Left ventricular atrioventricular plane displacement (LVAVPD) was higher in elderly athletes and young sedentary compared with elderly sedentary subjects (14 ± 3, 15 ± 2 and 11 ± 1 mm, respectively, P < 0.05). There was no difference between groups for RVAVPD (P = 0.2). LVAVPD was an independent predictor of maximal cardiac output (R(2) = 0.61, P < 0.01, β = 0.78). Longitudinal and radial contributions to stroke volume did not differ between groups. However, how longitudinal pumping was achieved differed; elderly athletes and young sedentary subjects showed similar AVPD whereas this was significantly lower in elderly sedentary subjects. Elderly sedentary subjects achieved longitudinal pumping through increased short-axis area of the ventricle. Large AVPD was a determinant of maximal cardiac output and exercise capacity.
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Affiliation(s)
- Katarina Steding-Ehrenborg
- Danish Research Centre for Magnetic Resonance, Hvidovre Hospital, Denmark.,Copenhagen Muscle Research Centre, Rigshospitalet, Denmark.,Department of Clinical Physiology, Skåne University Hospital Lund, Lund University, Lund, Sweden
| | | | - José A Calbet
- Copenhagen Muscle Research Centre, Rigshospitalet, Denmark.,Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Per Åkeson
- Danish Research Centre for Magnetic Resonance, Hvidovre Hospital, Denmark
| | - Stefan P Mortensen
- Copenhagen Muscle Research Centre, Rigshospitalet, Denmark.,Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Denmark
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Seguin M, Bourqui J, Fear E, Okoniewski M. A semi-dynamic heart model for UWB microwave transmission simulations and hardware evaluation. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/4/045005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Arvidsson PM, Carlsson M, Kovács SJ, Arheden H. Letter to the Editor: Atrioventricular plane displacement is not the sole mechanism of atrial and ventricular refill. Am J Physiol Heart Circ Physiol 2015; 309:H1094-6. [PMID: 26374902 DOI: 10.1152/ajpheart.00483.2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Per M Arvidsson
- Department of Clinical Physiology, Lund University, and Lund University Hospital, Lund, Sweden; and
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, and Lund University Hospital, Lund, Sweden; and
| | - Sándor J Kovács
- Cardiovascular Biophysics Laboratory, Cardiovascular Division, Washington University School of Medicine, Saint Louis, Missouri
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, and Lund University Hospital, Lund, Sweden; and
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38
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Chen C, Copley JT, Linse K, Rogers AD, Sigwart JD. The heart of a dragon: 3D anatomical reconstruction of the 'scaly-foot gastropod' (Mollusca: Gastropoda: Neomphalina) reveals its extraordinary circulatory system. Front Zool 2015; 12:13. [PMID: 26085836 PMCID: PMC4470333 DOI: 10.1186/s12983-015-0105-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/15/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The 'scaly-foot gastropod' (Chrysomallon squamiferum Chen et al., 2015) from deep-sea hydrothermal vent ecosystems of the Indian Ocean is an active mobile gastropod occurring in locally high densities, and it is distinctive for the dermal scales covering the exterior surface of its foot. These iron-sulfide coated sclerites, and its nutritional dependence on endosymbiotic bacteria, are both noted as adaptations to the extreme environment in the flow of hydrogen sulfide. We present evidence for other adaptations of the 'scaly-foot gastropod' to life in an extreme environment, investigated through dissection and 3D tomographic reconstruction of the internal anatomy. RESULTS Our anatomical investigations of juvenile and adult specimens reveal a large unganglionated nervous system, a simple and reduced digestive system, and that the animal is a simultaneous hermaphrodite. We show that Chrysomallon squamiferum relies on endosymbiotic bacteria throughout post-larval life. Of particular interest is the circulatory system: Chrysomallon has a very large ctenidium supported by extensive blood sinuses filled with haemocoel. The ctenidium provides oxygen for the host but the circulatory system is enlarged beyond the scope of other similar vent gastropods. At the posterior of the ctenidium is a remarkably large and well-developed heart. Based on the volume of the auricle and ventricle, the heart complex represents approximately 4 % of the body volume. This proportionally giant heart primarily sucks blood through the ctenidium and supplies the highly vascularised oesophageal gland. Thus we infer the elaborate cardiovascular system most likely evolved to oxygenate the endosymbionts in an oxygen poor environment and/or to supply hydrogen sulfide to the endosymbionts. CONCLUSIONS This study exemplifies how understanding the autecology of an organism can be enhanced by detailed investigation of internal anatomy. This gastropod is a large and active species that is abundant in its hydrothermal vent field ecosystem. Yet all of its remarkable features-protective dermal sclerites, circulatory system, high fecundity-can be viewed as adaptations beneficial to its endosymbiont microbes. We interpret these results to show that, as a result of specialisation to resolve energetic needs in an extreme chemosynthetic environment, this dramatic dragon-like species has become a carrying vessel for its bacteria.
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Affiliation(s)
- Chong Chen
- Department of Zoology, University of Oxford, The Tinbergen Building, South Parks Road, Oxford, OX1 3PS UK
| | - Jonathan T Copley
- Ocean and Earth Science, University of Southampton, European Way, Southampton, SO14 3ZH UK
| | - Katrin Linse
- British Antarctic Survey, High Cross, Cambridge, CB3 0ET UK
| | - Alex D Rogers
- Department of Zoology, University of Oxford, The Tinbergen Building, South Parks Road, Oxford, OX1 3PS UK
| | - Julia D Sigwart
- Queen's University Belfast, Marine Laboratory, Portaferry, BT22 1PF Northern Ireland
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Braun F, Proença M, Rapin M, Lemay M, Adler A, Grychtol B, Solà J, Thiran JP. Aortic blood pressure measured via EIT: investigation of different measurement settings. Physiol Meas 2015; 36:1147-59. [DOI: 10.1088/0967-3334/36/6/1147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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40
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Proença M, Braun F, Rapin M, Solà J, Adler A, Grychtol B, Bohm SH, Lemay M, Thiran JP. Influence of heart motion on cardiac output estimation by means of electrical impedance tomography: a case study. Physiol Meas 2015; 36:1075-91. [PMID: 26006113 DOI: 10.1088/0967-3334/36/6/1075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Electrical impedance tomography (EIT) is a non-invasive imaging technique that can measure cardiac-related intra-thoracic impedance changes. EIT-based cardiac output estimation relies on the assumption that the amplitude of the impedance change in the ventricular region is representative of stroke volume (SV). However, other factors such as heart motion can significantly affect this ventricular impedance change. In the present case study, a magnetic resonance imaging-based dynamic bio-impedance model fitting the morphology of a single male subject was built. Simulations were performed to evaluate the contribution of heart motion and its influence on EIT-based SV estimation. Myocardial deformation was found to be the main contributor to the ventricular impedance change (56%). However, motion-induced impedance changes showed a strong correlation (r = 0.978) with left ventricular volume. We explained this by the quasi-incompressibility of blood and myocardium. As a result, EIT achieved excellent accuracy in estimating a wide range of simulated SV values (error distribution of 0.57 ± 2.19 ml (1.02 ± 2.62%) and correlation of r = 0.996 after a two-point calibration was applied to convert impedance values to millilitres). As the model was based on one single subject, the strong correlation found between motion-induced changes and ventricular volume remains to be verified in larger datasets.
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Affiliation(s)
- Martin Proença
- Systems Division, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland. Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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41
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Xu L, Gutbrod SR, Ma Y, Petrossians A, Liu Y, Chad Webb R, Fan JA, Yang Z, Xu R, Whalen JJ, Weiland JD, Huang Y, Efimov IR, Rogers JA. Materials and fractal designs for 3D multifunctional integumentary membranes with capabilities in cardiac electrotherapy. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2015; 27:1731-7. [PMID: 25641076 PMCID: PMC4527319 DOI: 10.1002/adma.201405017] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 11/26/2014] [Indexed: 05/20/2023]
Abstract
Advanced materials and fractal design concepts form the basis of a 3D conformal electronic platform with unique capabilities in cardiac electrotherapies. Fractal geometries, advanced electrode materials, and thin, elastomeric membranes yield a class of device capable of integration with the entire 3D surface of the heart, with unique operational capabilities in low power defibrillation. Co-integrated collections of sensors allow simultaneous monitoring of physiological responses. Animal experiments on Langendorff-perfused rabbit hearts demonstrate the key features of these systems.
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Affiliation(s)
- Lizhi Xu
- Department of Materials Science and Engineering and Frederick Seitz Materials Research Laboratory. University of Illinois at Urbana-Champaign, 1304 W. Green St., Urbana, Illinois, 61801, USA
| | - Sarah R. Gutbrod
- Department of Biomedical Engineering, Washington University in Saint Louis, 360 Whitaker Hall, 1 Brookings Dr., Saint Louis, MO 63130, USA
| | - Yinji Ma
- Center for Mechanics and Materials, Tsinghua University, Beijing, 100084, China. Department of Civil and Environmental Engineering, Department of Mechanical Engineering, Center for Engineering and Health and Skin Disease Research Center, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - Artin Petrossians
- Department of Chemical Engineering and Materials Science, Department of Ophthalmology, Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90033
| | - Yuhao Liu
- Department of Materials Science and Engineering and Frederick Seitz Materials Research Laboratory. University of Illinois at Urbana-Champaign, 1304 W. Green St., Urbana, Illinois, 61801, USA
| | - R. Chad Webb
- Department of Materials Science and Engineering and Frederick Seitz Materials Research Laboratory. University of Illinois at Urbana-Champaign, 1304 W. Green St., Urbana, Illinois, 61801, USA
| | - Jonathan A. Fan
- Department of Electrical Engineering, Stanford University, 307 Spilker Building, 348 Via Pueblo, Stanford, CA 94305-4088, USA
| | - Zijian Yang
- Department of Materials Science and Engineering and Frederick Seitz Materials Research Laboratory. University of Illinois at Urbana-Champaign, 1304 W. Green St., Urbana, Illinois, 61801, USA
| | - Renxiao Xu
- Department of Civil and Environmental Engineering, Department of Mechanical Engineering, Center for Engineering and Health and Skin Disease Research Center, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - John J. Whalen
- Department of Chemical Engineering and Materials Science, Department of Ophthalmology, Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90033
| | - James D. Weiland
- Department of Chemical Engineering and Materials Science, Department of Ophthalmology, Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90033
| | - Yonggang Huang
- Department of Civil and Environmental Engineering, Department of Mechanical Engineering, Center for Engineering and Health and Skin Disease Research Center, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - Igor R. Efimov
- Department of Biomedical Engineering, Washington University in Saint Louis, 360 Whitaker Hall, 1 Brookings Dr., Saint Louis, MO 63130, USA
| | - John A. Rogers
- Department of Materials Science and Engineering, Beckman Institute for Advanced Science and Technology and Frederick Seitz Materials Research Laboratory, University of Illinois at Urbana-Champaign, 1304 W. Green St., Urbana, Illinois, 61801, USA
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Maksuti E, Bjällmark A, Broomé M. Modelling the heart with the atrioventricular plane as a piston unit. Med Eng Phys 2015; 37:87-92. [DOI: 10.1016/j.medengphy.2014.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 10/02/2014] [Accepted: 11/05/2014] [Indexed: 11/25/2022]
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43
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Pikkemaat R, Lundin S, Stenqvist O, Hilgers RD, Leonhardt S. Recent Advances in and Limitations of Cardiac Output Monitoring by Means of Electrical Impedance Tomography. Anesth Analg 2014; 119:76-83. [DOI: 10.1213/ane.0000000000000241] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Stephensen S, Steding-Ehrenborg K, Munkhammar P, Heiberg E, Arheden H, Carlsson M. The relationship between longitudinal, lateral, and septal contribution to stroke volume in patients with pulmonary regurgitation and healthy volunteers. Am J Physiol Heart Circ Physiol 2014; 306:H895-903. [PMID: 24441546 DOI: 10.1152/ajpheart.00483.2013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Septal systolic motion is towards the left ventricle (LV) in healthy hearts. Patients with pulmonary regurgitation (PR) and right ventricular (RV) volume overload have systolic septal motion toward the RV. This may affect the longitudinal contribution from atrioventricular plane displacement (AVPD) and septal and lateral contribution to stroke volume (SV). The study aimed to quantify these contributions to SV in patients with PR. Cardiac magnetic resonance imaging was used for assessment of cardiac volumes. Patients (n = 30; age 9-59 yr) with PR due to surgically corrected tetralogy of Fallot and 54 healthy controls (age 10-66 yr) were studied. Longitudinal contribution to RVSV was 47 ± 2% (means ± SE) in patients with PR and 79 ± 1% in controls (P < 0.001). Lateral contribution to RVSV and LVSV was 40 ± 1 and 62 ± 2% in patients and 31 ± 1 and 36 ± 1% in controls (P < 0.001 for both). Septal motion contributed to RVSV by 8 ± 1% in patients and by 7 ± 1% to LVSV in controls (P < 0.001). PR patients have decreased longitudinal contribution to RVSV and increased lateral pumping, resulting in larger outer volume changes and septal motion towards the RV. The changes in RV pumping physiology may be explained by RV remodeling resulting in lower systolic inflow of blood into the right atrium in relation to SV. This avoids the development of pendulum volume between the caval veins and right atrium, which would occur in PR patients if longitudinal contribution to SV was preserved. Decreased AVPD suggests that tricuspid annular excursion, a marker of RV function, is less valid in these patients.
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Affiliation(s)
- Sigurdur Stephensen
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Lund University Hospital, Lund, Sweden
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45
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Abstract
When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. Confounding factors such as use of therapeutic hypothermia, high-dose metabolic suppression, and movements associated with complex spinal reflexes, fasciculations, or cardiogenic ventilator autotriggering may delay initiation or completion of brain death protocols. Neurodiagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies.
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Affiliation(s)
- Richard B. Arbour
- Richard B. Arbour is a liver transplant coordinator at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania
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Mosén H, Steding-Ehrenborg K. Atrial remodelling is less pronounced in female endurance-trained athletes compared with that in male athletes. SCAND CARDIOVASC J 2013; 48:20-6. [DOI: 10.3109/14017431.2013.860234] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Steding-Ehrenborg K, Jablonowski R, Arvidsson PM, Carlsson M, Saltin B, Arheden H. Moderate intensity supine exercise causes decreased cardiac volumes and increased outer volume variations: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2013; 15:96. [PMID: 24156367 PMCID: PMC4015552 DOI: 10.1186/1532-429x-15-96] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/01/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effects on left and right ventricular (LV, RV) volumes during physical exercise remains controversial. Furthermore, no previous study has investigated the effects of exercise on longitudinal contribution to stroke volume (SV) and the outer volume variation of the heart. The aim of this study was to determine if LV, RV and total heart volumes (THV) as well as cardiac pumping mechanisms change during physical exercise compared to rest using cardiovascular magnetic resonance (CMR). METHODS 26 healthy volunteers (6 women) underwent CMR at rest and exercise. Exercise was performed using a custom built ergometer for one-legged exercise in the supine position during breath hold imaging. Cardiac volumes and atrio-ventricular plane displacement were determined. Heart rate (HR) was obtained from ECG. RESULTS HR increased during exercise from 60±2 to 94±2 bpm, (p<0.001). LVEDV remained unchanged (p=0.81) and LVESV decreased with -9±18% (p<0.05) causing LVSV to increase with 8±3% (p<0.05). RVEDV and RVESV decreased by -7±10% and -24±14% respectively, (p<0.001) and RVSV increased 5±17% during exercise although not statistically significant (p=0.18). Longitudinal contribution to RVSV decreased during exercise by -6±15% (p<0.05) but was unchanged for LVSV (p=0.74). THV decreased during exercise by -4±1%, (p<0.01) and total heart volume variation (THVV) increased during exercise from 5.9±0.5% to 9.7±0.6% (p<0.001). CONCLUSIONS Cardiac volumes and function are significantly altered during supine physical exercise. THV becomes significantly smaller due to decreases in RVEDV whilst LVEDV remains unchanged. THVV and consequently radial pumping increases during exercise which may improve diastolic suction during the rapid filling phase.
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Affiliation(s)
- Katarina Steding-Ehrenborg
- Copenhagen Muscle Research Centre, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Hvidovre Hospital, Copenhagen, Denmark
| | - Robert Jablonowski
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - Per M Arvidsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - Bengt Saltin
- Copenhagen Muscle Research Centre, Copenhagen, Denmark
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
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48
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Kanski M, Arheden H, Wuttge DM, Bozovic G, Hesselstrand R, Ugander M. Pulmonary blood volume indexed to lung volume is reduced in newly diagnosed systemic sclerosis compared to normals--a prospective clinical cardiovascular magnetic resonance study addressing pulmonary vascular changes. J Cardiovasc Magn Reson 2013; 15:86. [PMID: 24066703 PMCID: PMC3850930 DOI: 10.1186/1532-429x-15-86] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/11/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pulmonary involvement, manifested as pulmonary arterial hypertension or pulmonary fibrosis, is the most common cause of death in systemic sclerosis (SSc). We aimed to explore the feasibility of detecting early pulmonary involvement in SSc using recently developed non-invasive quantitative measures of pulmonary physiology using cardiovascular magnetic resonance (CMR). METHODS Twenty-seven SSc patients (9 men, 57 ± 13 years) and 10 healthy controls (3 men, 54 ± 9 years) underwent CMR to determine the pulmonary blood volume (PBV) and the PBV variation (PBVV) throughout the cardiac cycle. Patients underwent Doppler echocardiography, high-resolution computed tomography (HRCT), and pulmonary function testing by spirometry. Comparisons were performed using the unpaired t-test and linear regression analysis was performed with Pearson's correlation coefficient (r). RESULTS Compared to healthy controls, the PBV indexed to lung volume (PBVI) was lower in patients (16 ± 4 vs 20 ± 5%, p < 0.05). There was no difference in PBV (466 ± 87 vs 471 ± 122 mL, p = 0.91) or PBVV/stroke volume (45 ± 10 vs 40 ± 6%, p = 0.09). There were no significant correlations between PBVI and pulmonary artery pressure estimated by Doppler (p = 0.08) the lung's diffusion capacity for carbon monoxide (DLCO) (p = 0.09), vital capacity (p = 0.45), or pulmonary fibrosis by HRCT (p = 0.74). CONCLUSIONS This study is the first to measure the PBV in humans using CMR. Compared to healthy controls, newly diagnosed SSc patients have a reduced amount of blood in the pulmonary vasculature (PBVI) but unchanged pulmonary vascular distensibility (PBVV/stroke volume). PBVI is unrelated to DLCO, pulmonary artery pressure, vital capacity, and the presence of pulmonary fibrosis. PBVI may be a novel parameter reflecting vascular lung involvement in early-stage SSc, and these findings may be consistent with pathophysiological changes of the pulmonary vasculature.
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Affiliation(s)
- Mikael Kanski
- Department of Clinical Physiology, Lund University and Lund University Hospital, Lund, SE-221 85 Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University and Lund University Hospital, Lund, SE-221 85 Lund, Sweden
| | - Dirk M Wuttge
- Department of Rheumatology, Lund University and Lund University Hospital, Lund, SE-221 85 Lund, Sweden
| | - Gracijela Bozovic
- Department of Radiology, Lund University and Lund University Hospital, Lund, SE-221 85 Lund, Sweden
| | - Roger Hesselstrand
- Department of Rheumatology, Lund University and Lund University Hospital, Lund, SE-221 85 Lund, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Lund University and Lund University Hospital, Lund, SE-221 85 Lund, Sweden
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49
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Riesenkampff E, Al-Wakeel N, Kropf S, Stamm C, Alexi-Meskishvili V, Berger F, Kuehne T. Surgery impacts right atrial function in tetralogy of Fallot. J Thorac Cardiovasc Surg 2013; 147:1306-11. [PMID: 23896323 DOI: 10.1016/j.jtcvs.2013.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/29/2013] [Accepted: 06/14/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the impact of surgery and pericardial integrity on right atrial function and total heart volume variation in the setting of pulmonary valve insufficiency. METHODS Right atrial function and total heart volume variation were analyzed in 2 subgroups of patients with pulmonary valve insufficiency compared with healthy controls: group 1 with surgically repaired tetralogy of Fallot (n = 20 patients) and group 2 after balloon angioplasty of pulmonary valve stenosis in patients with isolated valve disease without surgery (n = 7 patients). Volumetric analysis of magnetic resonance imaging data revealed parameters of atrial function (reservoir, conduit, and pump functions and cyclic volume change) and of total heart volume (end-diastolic and end-systolic total heart volume and the variation). Statistical analysis included uncorrected and corrected pairwise comparisons and the calculation of groupwise Pearson correlation coefficients. RESULTS In group 1 with a pulmonary regurgitation fraction of 31.0% ± 14.9%, right atrial function was clearly impaired, with reduced reservoir and elevated conduit function, and total heart volume variation was elevated to 13.9% ± 3.4%. In group 2 with a pulmonary regurgitation fraction of 22.8% ± 6.9%, the values were close to normal, with unaffected atrial function and a total heart volume variation of 9.9% ± 3.3%. CONCLUSIONS The hydrodynamic effect of pulmonary valve insufficiency alone is likely not the only reason for impaired right atrial function and elevated total heart volume variation in patients with tetralogy of Fallot; it is rather the scar in the right atrium, the injured pericardium, and the disease itself that are responsible for the energetically unfavorable alterations.
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Affiliation(s)
- Eugenie Riesenkampff
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Nadya Al-Wakeel
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Siegfried Kropf
- Institute of Biometry and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Felix Berger
- Department of Pediatric Cardiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Department of Pediatric Cardiology, Charité Universitaetsmedizin Berlin, Berlin, Germany.
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50
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Arvidsson PM, Töger J, Heiberg E, Carlsson M, Arheden H. Quantification of left and right atrial kinetic energy using four-dimensional intracardiac magnetic resonance imaging flow measurements. J Appl Physiol (1985) 2013; 114:1472-81. [DOI: 10.1152/japplphysiol.00932.2012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Kinetic energy (KE) of atrial blood has been postulated as a possible contributor to ventricular filling. Therefore, we aimed to quantify the left (LA) and right (RA) atrial blood KE using cardiac magnetic resonance (CMR). Fifteen healthy volunteers underwent CMR at 3 T, including a four-dimensional phase-contrast flow sequence. Mean LA KE was lower than RA KE (1.1 ± 0.1 vs. 1.7 ± 0.1 mJ, P < 0.01). Three KE peaks were seen in both atria: one in ventricular systole, one during early ventricular diastole, and one during atrial contraction. The systolic LA peak was significantly smaller than the RA peak ( P < 0.001), and the early diastolic LA peak was larger than the RA peak ( P < 0.05). Rotational flow contained 46 ± 7% of total KE and conserved energy better than nonrotational flow did. The KE increase in early diastole was higher in the LA ( P < 0.001). Systolic KE correlated with the combination of atrial volume and systolic velocity of the atrioventricular plane displacement ( r2 = 0.57 for LA and r2 = 0.64 for RA). Early diastolic KE of the LA correlated with left ventricle (LV) mass ( r2 = 0.28), however, no such correlation was found in the right heart. This suggests that LA KE increases during early ventricular diastole due to LV elastic recoil, indicating that LV filling is dependent on diastolic suction. Right ventricle (RV) relaxation does not seem to contribute to atrial KE. Instead, RA KE generated during ventricular systole may be conserved in a hydraulic “flywheel” and transferred to the RV through helical flow, which may contribute to RV filling.
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Affiliation(s)
- Per M. Arvidsson
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden; and
| | - Johannes Töger
- Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Einar Heiberg
- Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden; and
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skane University Hospital, Lund, Sweden; and
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