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Salvail W, Salvail D, Chagnon F, Lesur O. Apelin-13 administration allows for norepinephrine sparing in a rat model of cecal ligation and puncture-induced septic shock. Intensive Care Med Exp 2024; 12:68. [PMID: 39103658 DOI: 10.1186/s40635-024-00650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 07/21/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Infusion of exogenous catecholamines (i.e., norepinephrine [NE] and dobutamine) is a recommended treatment for septic shock with myocardial dysfunction. However, sustained catecholamine infusion is linked to cardiac toxicity and impaired responsiveness. Several pre-clinical and clinical studies have investigated the use of alternative vasopressors in the treatment of septic shock, with limited benefits and generally no effect on mortality. Apelin-13 (APL-13) is an endogenous positive inotrope and vasoactive peptide and has been demonstrated cardioprotective with vasomodulator and sparing life effects in animal models of septic shock. A primary objective of this study was to evaluate the NE-sparing effect of APL-13 infusion in an experimental sepsis-induced hypotension. METHODS For this goal, sepsis was induced by cecal ligation and puncture (CLP) in male rats and the arterial blood pressure (BP) monitored continuously via a carotid catheter. Monitoring, fluid resuscitation and experimental treatments were performed on conscious animals. Based on pilot assays, normal saline fluid resuscitation (2.5 mL/Kg/h) was initiated 3 h post-CLP and maintained up to the endpoint. Thus, titrated doses of NE, with or without fixed-doses of APL-13 or the apelin receptor antagonist F13A co-infusion were started when 20% decrease of systolic BP (SBP) from baseline was achieved, to restore SBP values ≥ 115 ± 1.5 mmHg (baseline average ± SEM). RESULTS A reduction in mean NE dose was observed with APL-13 but not F13A co-infusion at pre-determined treatment time of 4.5 ± 0.5 h (17.37 ± 1.74 µg/Kg/h [APL-13] vs. 25.64 ± 2.61 µg/Kg/h [Control NE] vs. 28.60 ± 4.79 µg/Kg/min [F13A], P = 0.0491). A 60% decrease in NE infusion rate over time was observed with APL-13 co-infusion, (p = 0.008 vs NE alone), while F13A co-infusion increased the NE infusion rate over time by 218% (p = 0.003 vs NE + APL-13). Associated improvements in cardiac function are likely mediated by (i) enhanced left ventricular end-diastolic volume (0.18 ± 0.02 mL [Control NE] vs. 0.30 ± 0.03 mL [APL-13], P = 0.0051), stroke volume (0.11 ± 0.01 mL [Control NE] vs. 0.21 ± 0.01 mL [APL-13], P < 0.001) and cardiac output (67.57 ± 8.63 mL/min [Control NE] vs. 112.20 ± 8.53 mL/min [APL-13], P = 0.0036), and (ii) a reduced effective arterial elastance (920.6 ± 81.4 mmHg/mL/min [Control NE] vs. 497.633.44 mmHg/mL/min. [APL-13], P = 0.0002). APL-13 administration was also associated with a decrease in lactate levels compared to animals only receiving NE (7.08 ± 0.40 [Control NE] vs. 4.78 ± 0.60 [APL-13], P < 0.01). CONCLUSION APL-13 exhibits NE-sparing benefits in the treatment of sepsis-induced shock, potentially reducing deleterious effects of prolonged exogenous catecholamine administration.
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Affiliation(s)
- William Salvail
- Centre de Recherche Clinique du CHU Sherbrooke (CRCHUS), CHUS, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- IPS Therapeutique Inc., Sherbrooke, QC, Canada
| | | | - Frédéric Chagnon
- Centre de Recherche Clinique du CHU Sherbrooke (CRCHUS), CHUS, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Olivier Lesur
- Centre de Recherche Clinique du CHU Sherbrooke (CRCHUS), CHUS, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Département de Soins Intensifs et Service de PneumologieCHUS, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12th Avenue Nord, SherbrookeSherbrooke, QC, J1H 5N4, Canada.
- Département de Médecine, CHUS, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
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Vuorenpää H, Valtonen J, Penttinen K, Koskimäki S, Hovinen E, Ahola A, Gering C, Parraga J, Kelloniemi M, Hyttinen J, Kellomäki M, Aalto-Setälä K, Miettinen S, Pekkanen-Mattila M. Gellan gum-gelatin based cardiac models support formation of cellular networks and functional cardiomyocytes. Cytotechnology 2024; 76:483-502. [PMID: 38933872 PMCID: PMC11196475 DOI: 10.1007/s10616-024-00630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/06/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiovascular diseases remain as the most common cause of death worldwide. To reveal the underlying mechanisms in varying cardiovascular diseases, in vitro models with cells and supportive biomaterial can be designed to recapitulate the essential components of human heart. In this study, we analyzed whether 3D co-culture of cardiomyocytes (CM) with vascular network and with adipose tissue-derived mesenchymal stem/stromal cells (ASC) can support CM functionality. CM were cultured with either endothelial cells (EC) and ASC or with only ASC in hydrazide-modified gelatin and oxidized gellan gum hybrid hydrogel to form cardiovascular multiculture and myocardial co-culture, respectively. We studied functional characteristics of CM in two different cellular set-ups and analyzed vascular network formation, cellular morphology and orientation. The results showed that gellan gum-gelatin hydrogel supports formation of two different cellular networks and functional CM. We detected formation of a modest vascular network in cardiovascular multiculture and extensive ASC-derived alpha smooth muscle actin -positive cellular network in multi- and co-culture. iPSC-CM showed elongated morphology, partly aligned orientation with the formed networks and presented normal calcium transients, beating rates, and contraction and relaxation behavior in both setups. These 3D cardiac models provide promising platforms to study (patho) physiological mechanisms of cardiovascular diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s10616-024-00630-5.
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Affiliation(s)
- Hanna Vuorenpää
- Adult Stem Cell Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
| | - Joona Valtonen
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kirsi Penttinen
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sanna Koskimäki
- Adult Stem Cell Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Emma Hovinen
- Adult Stem Cell Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Ahola
- Computational Biophysics and Imaging Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Christine Gering
- Biomaterials and Tissue Engineering Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jenny Parraga
- Biomaterials and Tissue Engineering Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Minna Kelloniemi
- Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland
| | - Jari Hyttinen
- Computational Biophysics and Imaging Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Minna Kellomäki
- Biomaterials and Tissue Engineering Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Katriina Aalto-Setälä
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Susanna Miettinen
- Adult Stem Cell Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
| | - Mari Pekkanen-Mattila
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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3
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Sturgess VE, Tune JD, Figueroa CA, Carlson BE, Beard DA. Integrated modeling and simulation of recruitment of myocardial perfusion and oxygen delivery in exercise. J Mol Cell Cardiol 2024; 192:94-108. [PMID: 38754551 DOI: 10.1016/j.yjmcc.2024.05.006] [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: 02/13/2024] [Revised: 04/30/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024]
Abstract
While exercise-mediated vasoregulation in the myocardium is understood to be governed by autonomic, myogenic, and metabolic-mediated mechanisms, we do not yet understand the spatial heterogeneity of vasodilation or its effects on microvascular flow patterns and oxygen delivery. This study uses a simulation and modeling approach to explore the mechanisms underlying the recruitment of myocardial perfusion and oxygen delivery in exercise. The simulation approach integrates model components representing: whole-body cardiovascular hemodynamics, cardiac mechanics and myocardial work; myocardial perfusion; and myocardial oxygen transport. Integrating these systems together, model simulations reveal: (1.) To match expected flow and transmural flow ratios at increasing levels of exercise, a greater degree of vasodilation must occur in the subendocardium compared to the subepicardium. (2.) Oxygen extraction and venous oxygenation are predicted to substantially decrease with increasing exercise level preferentially in the subendocardium, suggesting that an oxygen-dependent error signal driving metabolic mediated recruitment of flow would be operative only in the subendocardium. (3.) Under baseline physiological conditions approximately 4% of the oxygen delivered to the subendocardium may be supplied via retrograde flow from coronary veins.
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Affiliation(s)
- Victoria E Sturgess
- Department of Biomedical Engineering, University of Michigan, United States of America; Section of Vascular Surgery, Department of Surgery, University of Michigan, United States of America
| | - Johnathan D Tune
- Department of Physiology and Anatomy, University of North Texas Health Science Center, United States of America
| | - C Alberto Figueroa
- Department of Biomedical Engineering, University of Michigan, United States of America; Department of Molecular and Integrative Physiology, University of Michigan, United States of America
| | - Brian E Carlson
- Department of Molecular and Integrative Physiology, University of Michigan, United States of America
| | - Daniel A Beard
- Department of Molecular and Integrative Physiology, University of Michigan, United States of America.
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Valtonen J, Prajapati C, Cherian RM, Vanninen S, Ojala M, Leivo K, Heliö T, Koskenvuo J, Aalto-Setälä K. The Junctophilin-2 Mutation p.(Thr161Lys) Is Associated with Hypertrophic Cardiomyopathy Using Patient-Specific iPS Cardiomyocytes and Demonstrates Prolonged Action Potential and Increased Arrhythmogenicity. Biomedicines 2023; 11:1558. [PMID: 37371654 DOI: 10.3390/biomedicines11061558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiac diseases; it is primarily caused by mutations in sarcomeric genes. However, HCM is also associated with mutations in non-sarcomeric proteins and a Finnish founder mutation for HCM in non-sarcomeric protein junctophilin-2 (JPH2) has been identified. This study aimed at assessing the issue of modelling the rare Finnish founder mutation in cardiomyocytes (CMs) differentiated from iPSCs; therefore, presenting the same cardiac abnormalities observed in the patients. To explore the abnormal functions in JPH2-HCM, skin fibroblasts from a Finnish patient with JPH2 p.(Thr161Lys) were reprogrammed into iPSCs and further differentiated into CMs. As a control line, an isogenic counterpart was generated using the CRISPR/Cas9 genome editing method. Finally, iPSC-CMs were evaluated for the morphological and functional characteristics associated with JPH2 mutation. JPH2-hiPSC-CMs displayed key HCM hallmarks (cellular hypertrophy, multi-nucleation, sarcomeric disarray). Moreover, JPH2-hiPSC-CMs exhibit a higher degree of arrhythmia and longer action potential duration associated with slower inactivation of calcium channels. Functional evaluation supported clinical observations, with differences in beating characteristics when compared with isogenic-hiPSC-CMs. Thus, the iPSC-derived, disease-specific cardiomyocytes could serve as a translationally relevant platform to study genetic cardiac diseases.
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Affiliation(s)
- Joona Valtonen
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Chandra Prajapati
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Reeja Maria Cherian
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Sari Vanninen
- Tampere University Heart Hospital, 33520 Tampere, Finland
| | - Marisa Ojala
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
| | - Krista Leivo
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
| | | | - Katriina Aalto-Setälä
- Heart Group, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Tampere University Heart Hospital, 33520 Tampere, Finland
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5
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Dias A, de Melo B, dos Santos A, Silva J, Leite G, Bocalini D, Marcolongo A, Serra A. Women pole dance athletes present morphofunctional left ventricular adaptations and greater physical fitness. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION In patients with right ventricular diastolic dysfunction after complete repair of tetralogy of Fallot, some employ the use of beta-blockade. The theoretical benefit of this therapy is felt to be one of the two: 1) reduction in heart rate with subsequent increase in diastolic filling time and stroke volume; 2) halting or reversal of right ventricular remodelling. This study aimed to characterise the use of beta-blockade in paediatric admissions with complete repair of tetralogy of Fallot and characterise the effects of beta-blockade on admission characteristics. METHODS Admissions from 2004 to 2015 in the Pediatric Health Information System database with complete repair of tetralogy of Fallot were identified. Characteristics between admissions with and without beta-blockade were compared by univariate analysis. Next, regression analyses were conducted to determine the independent association of beta-blockade on length of admission, billed charges, cardiac arrest, and inpatient mortality while controlling for demographic variables and comorbidities. RESULTS A total of 3594 admissions were included in the final analyses. Of these, 371 employed beta-blockade. Admissions with beta-blockade were more likely to have heart failure and tachyarrhythmias. These admissions also tended to be longer by univariate analysis. Regression analyses demonstrated that beta-blockade was independently associated with a 2.8-day increase in length of stay and no statistically significant change in billed charges, cardiac arrest, or inpatient mortality. CONCLUSIONS Beta-blockade after complete repair of tetralogy of Fallot is associated with a longer length of stay but did not statistically significantly impact billed charges, cardiac arrest, or inpatient mortality.
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Jezek F, Randall EB, Carlson BE, Beard DA. Systems analysis of the mechanisms governing the cardiovascular response to changes in posture and in peripheral demand during exercise. J Mol Cell Cardiol 2022; 163:33-55. [PMID: 34626617 DOI: 10.1016/j.yjmcc.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/25/2021] [Accepted: 09/29/2021] [Indexed: 12/21/2022]
Abstract
Blood flows and pressures throughout the human cardiovascular system are regulated in response to various dynamic perturbations, such as changes to peripheral demands in exercise, rapid changes in posture, or loss of blood from hemorrhage, via the coordinated action of the heart, the vasculature, and autonomic reflexes. To assess how the systemic and pulmonary arterial and venous circulation, the heart, and the baroreflex work together to effect the whole-body responses to these perturbations, we integrated an anatomically-based large-vessel arterial tree model with the TriSeg heart model, models capturing nonlinear characteristics of the large and small veins, and baroreflex-mediated regulation of vascular tone and cardiac chronotropy and inotropy. The model was identified by matching data from the Valsalva maneuver (VM), exercise, and head-up tilt (HUT). Thirty-one parameters were optimized using a custom parameter-fitting tool chain, resulting in an unique, high-fidelity whole-body human cardiovascular systems model. Because the model captures the effects of exercise and posture changes, it can be used to simulate numerous clinical assessments, such as HUT, the VM, and cardiopulmonary exercise stress testing. The model can also be applied as a framework for representing and simulating individual patients and pathologies. Moreover, it can serve as a framework for integrating multi-scale organ-level models, such as for the heart or the kidneys, into a whole-body model. Here, the model is used to analyze the relative importance of chronotropic, inotropic, and peripheral vascular contributions to the whole-body cardiovascular response to exercise. It is predicted that in normal physiological conditions chronotropy and inotropy make roughly equal contributions to increasing cardiac output and cardiac power output during exercise. Under upright exercise conditions, the nonlinear pressure-volume relationship of the large veins and sympathetic-mediated venous vasoconstriction are both required to maintain preload to achieve physiological exercise levels. The developed modeling framework is built using the open Modelica modeling language and is freely distributed.
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Affiliation(s)
- Filip Jezek
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States; Institute of Pathophysiology, First Faculty of Medicine, Charles University in Prague, Czech Republic.
| | - E Benjamin Randall
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States.
| | - Brian E Carlson
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States.
| | - Daniel A Beard
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States.
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Patient-Specific Fluid-Structure Simulations of Anomalous Aortic Origin of Right Coronary Arteries. JTCVS Tech 2022; 13:144-162. [PMID: 35711199 PMCID: PMC9196314 DOI: 10.1016/j.xjtc.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/16/2022] [Indexed: 01/10/2023] Open
Abstract
Objectives Anomalous aortic origin of the right coronary artery (AAORCA) may cause ischemia and sudden death. However, the specific anatomic indications for surgery are unclear, so dobutamine-stress instantaneous wave-free ratio (iFR) is increasingly used. Meanwhile, advances in fluid–structure interaction (FSI) modeling can simulate the pulsatile hemodynamics and tissue deformation. We sought to evaluate the feasibility of simulating the resting and dobutamine-stress iFR in AAORCA using patient-specific FSI models and to visualize the mechanism of ischemia within the intramural geometry and associated lumen narrowing. Methods We developed 6 patient-specific FSI models of AAORCA using SimVascular software. Three-dimensional geometries were segmented from coronary computed tomography angiography. Vascular outlets were coupled to lumped-parameter networks that included dynamic compression of the coronary microvasculature and were tuned to each patient's vitals and cardiac output. Results All cases were interarterial, and 5 of 6 had an intramural course. Measured iFRs ranged from 0.95 to 0.98 at rest and 0.80 to 0.95 under dobutamine stress. After we tuned the distal coronary resistances to achieve a stress flow rate triple that at rest, the simulations adequately matched the measured iFRs (r = 0.85, root-mean-square error = 0.04). The intramural lumen remained narrowed with simulated stress and resulted in lower iFRs without needing external compression from the pulmonary root. Conclusions Patient-specific FSI modeling of AAORCA is a promising, noninvasive method to assess the iFR reduction caused by intramural geometries and inform surgical intervention. However, the models’ sensitivity to distal coronary resistance suggests that quantitative stress-perfusion imaging may augment virtual and invasive iFR studies.
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Neugebauer F, Noti F, van Gool S, Roten L, Baldinger SH, Seiler J, Madaffari A, Servatius H, Ryser A, Tanner H, Reichlin T, Haeberlin A. Leadless atrio-ventricular synchronous pacing in an outpatient setting - early lessons learned on factors affecting atrio-ventricular synchrony. Heart Rhythm 2021; 19:748-756. [PMID: 34971817 DOI: 10.1016/j.hrthm.2021.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Leadless pacemakers (PMs) capable of atrio-ventricular (AV) synchronous pacing have recently been introduced. Initial feasibility studies were promising, but limited to just a few minutes of AV synchronous pacing. Real-world long-term data on AV synchrony and programming adjustments affecting AV synchrony in outpatients are lacking. OBJECTIVE To investigate AV synchrony and influences of PM programming adjustments in outpatients with leadless VDD PMs. METHODS All patients who received a leadless VDD PM (Micra™ AV, Medtronic, US) between 07/2020 and 05/2021 at our center were included in this observational study. AV synchrony was assessed repeatedly postoperatively and during follow-up using Holter ECG recordings. AV synchrony was defined as a QRS complex preceded by a p-wave within 300ms. The impact of programming changes during follow-up on AV synchrony was studied. RESULTS 816 hours of Holter ECG from 20 outpatients were analyzed. During predominantly paced episodes (≥80% ventricular pacing), median AV synchrony was 91% (IQR 34-100%) when patients had sinus rates 50-80/min. Median AV synchrony was lower when patients had sinus rates >80/min (33%, IQR 29-46%, p<0.001). During a stepwise optimization protocol, AV synchrony could be improved (p<0.038). Multivariate analysis showed that a shorter maximum A3 window end (p<0.001), a lower A3 threshold (p=0.046), and minimum A4 threshold (p<0.001) improved AV synchrony. CONCLUSION Successful VDD pacing in the outpatient setting during higher sinus rates is more difficult to achieve than can be presumed based on the initial feasibility studies. The devices often require multiple reprogramming to maximize AV sequential pacing.
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Affiliation(s)
- Felix Neugebauer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan van Gool
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Ryser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland.
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Kenny JS, Elfarnawany M, Yang Z, Myers M, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD. The Doppler shock index measured by a wearable ultrasound patch accurately detects moderate-to-severe central hypovolemia during lower body negative pressure. J Am Coll Emerg Physicians Open 2021; 2:e12533. [PMID: 34401869 PMCID: PMC8349221 DOI: 10.1002/emp2.12533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Moderate-to-severe hemorrhage is a life-threatening condition, which is challenging to detect in a timely fashion using traditional vital signs because of the human body's robust physiologic compensatory mechanisms. Measuring and trending blood flow could improve diagnosis of clinically significant exsanguination. A lightweight, wireless, wearable Doppler ultrasound patch that captures and trends blood flow velocity could enhance hemorrhage detection. METHODS In 11 healthy volunteers undergoing simulated hemorrhage and resuscitation during graded lower body negative pressure (LBNP) and release, we studied the relationship between stroke volume (SV) and common carotid artery velocity time integral (VTI) and corrected flow time (FTc). We assessed the diagnostic accuracy of 2 variations of a novel metric, the Doppler shock index (ie, the DSIVTI and DSIFTc), at capturing moderate-to-severe central hypovolemia defined as a 30% reduction in SV. The DSIVTI and DSIFTc are calculated as the heart rate divided by either the VTI or FTc, respectively. RESULTS A total of 17,822 cardiac cycles were analyzed across 22 LBNP protocols. The average SV reduction to the lowest tolerated LBNP stage was 40%; there was no clinically significant fall in the mean arterial pressure. Correlations between changing SV and the common carotid artery VTI and FTc were strong (R 2 of 0.87, respectively) and concordant. The DSIVTI and DSIFTc accurately detected moderate-to-severe central hypovolemia with values for the area under the receiver operator curves of 0.96 and 0.97, respectively. CONCLUSION In a human model of hemorrhage and resuscitation, measures from a wearable Doppler ultrasound patch correlated strongly with SV and identified moderate-to-severe central hypovolemia with excellent diagnostic accuracy.
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Affiliation(s)
| | - Mai Elfarnawany
- Health Sciences North Research InstituteSudburyOntarioCanada
- Flosonics MedicalSudburyOntarioCanada
| | - Zhen Yang
- Health Sciences North Research InstituteSudburyOntarioCanada
- Flosonics MedicalSudburyOntarioCanada
| | - Matt Myers
- Health Sciences North Research InstituteSudburyOntarioCanada
- Flosonics MedicalSudburyOntarioCanada
| | - Andrew M. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
| | - Joseph K. Eibl
- Health Sciences North Research InstituteSudburyOntarioCanada
- Northern Ontario School of MedicineSudburyOntarioCanada
| | - Jenna L. Taylor
- Human Integrative and Environmental Physiology LaboratoryDepartment of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
| | - Chul Ho Kim
- Human Integrative and Environmental Physiology LaboratoryDepartment of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
| | - Bruce D. Johnson
- Human Integrative and Environmental Physiology LaboratoryDepartment of Cardiovascular DiseasesMayo ClinicRochesterMinnesotaUSA
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Abstract
BACKGROUND Clinical and experimental evidence regarding the influence of heart rate (HR) on arterial stiffness and its surrogate marker carotid-to-femoral pulse wave velocity (cf-PWV) is conflicting. We aimed to evaluate the effect of HR on cf-PWV measurement under controlled haemodynamic conditions and especially with respect to blood pressure (BP) that is a strong determinant of arterial stiffness. METHOD Fifty-nine simulated cases were created using a previously validated in-silico model. For each case, cf-PWV was measured at five HR values, 60, 70, 80, 90, 100 bpm. With increasing HR, we assessed cf-PWV under two scenarios: with BP free to vary in response to HR increase, and with aortic DBP (aoDBP) fixed to its baseline value at 60 bpm, by modifying total peripheral resistance accordingly. Further, we quantified the importance of arterial compliance (C) on cf-PWV changes caused by increasing HR. RESULTS When BP was left free to vary with HR, a significant HR-effect on cf-PWV (0.66 ± 0.24 m/s per 10 bpm, P < 0.001) was observed. This effect was reduced to 0.21 ± 0.14 m/s per 10 bpm (P = 0.048) when aoDBP was maintained fixed with increasing HR. The HR-effect on the BP-corrected cf-PWV was higher in the case of low C = 0.8 ± 0.3 ml/mmHg (0.26 ± 0.15 m/s per 10 bpm, P = 0.014) than the case of higher C = 1.7 ± 0.5 ml/mmHg (0.16 ± 0.07 m/s per 10 bpm, P = 0.045). CONCLUSION Our findings demonstrated that relatively small HR changes may only slightly affect the cf-PWV. Nevertheless, in cases wherein HR might vary at a greater extent, a more clinically significant impact on cf-PWV should be considered.
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Bombardini T, Cortigiani L, Ciampi Q, Ostojic MC, Kovacevic-Preradovic T, Picano E. The prognostic value of stroke work/end-diastolic volume ratio during stress echocardiography. Acta Cardiol 2021; 76:384-395. [PMID: 32233739 DOI: 10.1080/00015385.2020.1746054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The ventricular stroke work (SW) refers to the work done by the left ventricle to eject the volume of blood during one cardiac cycle. The cath-lab relationship between SW and end-diastolic volume (EDV) is the preload-recruitable SW (PRSW). Recently a non-invasive single-beat PRSW (SBPRSW) has been proposed. However, the single beat formula needs mathematical skillness, and extra software. Aim of this study was to compare the non-invasive SBPRSW with the simpler non-invasive SW/EDVratio in the stress-echo lab. METHODS We studied 692 patients, age 62 ± 12 years, ejection fraction 50 ± 17%, with negative stress echo (SE)(exercise, n = 130, dobutamine, n = 124, dipyridamole, n = 438) and follow-up data. The PRSW was estimated at rest and at peak stress by the SBPRSW technique and compared with the SW/EDV. All patients were followed-up. Event rates were estimated with Kaplan-Meier curves. RESULTS SBPRSW and SW/EDV were linearly correlated at rest (r = 0.842, p < .001) and at peak stress (r = 0.860, p < .001). During a median follow-up of 20 months (first quartile 8, third quartile 40 months), 132 major events were registered: at receiver operating characteristic (ROC) analysis rest SBPRSW vs. SW/EDV (AUC 0.691 vs. 0.722) and peak stress (AUC 0.744 vs. 0.800) demonstrated both a significant prognostic power (all p < .001) with non-inferior survival prediction of the simpler SW/EDV ratio at Kaplan-Meier curves (Chi-square rest = 38, peak = 56) vs. SBPRSW (Chi-square rest = 14, peak = 42). CONCLUSIONS The data obtained with the non-invasive SBPRSW and by the simpler SW/EDV are highly comparable. PRSW with either SB or SW/EDV approach is effective in predicting follow-up events.
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Affiliation(s)
- Tonino Bombardini
- Faculty of Medicine, Clinical Center of The Republic of Srpska, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Miodrag C. Ostojic
- Faculty of Medicine, Clinical Center of The Republic of Srpska, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | - Tamara Kovacevic-Preradovic
- Faculty of Medicine, Clinical Center of The Republic of Srpska, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy
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Computational Modeling of Blood Flow Hemodynamics for Biomechanical Investigation of Cardiac Development and Disease. J Cardiovasc Dev Dis 2021; 8:jcdd8020014. [PMID: 33572675 PMCID: PMC7912127 DOI: 10.3390/jcdd8020014] [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] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
The heart is the first functional organ in a developing embryo. Cardiac development continues throughout developmental stages while the heart goes through a serious of drastic morphological changes. Previous animal experiments as well as clinical observations showed that disturbed hemodynamics interfere with the development of the heart and leads to the formation of a variety of defects in heart valves, heart chambers, and blood vessels, suggesting that hemodynamics is a governing factor for cardiogenesis, and disturbed hemodynamics is an important source of congenital heart defects. Therefore, there is an interest to image and quantify the flowing blood through a developing heart. Flow measurement in embryonic fetal heart can be performed using advanced techniques such as magnetic resonance imaging (MRI) or echocardiography. Computational fluid dynamics (CFD) modeling is another approach especially useful when the other imaging modalities are not available and in-depth flow assessment is needed. The approach is based on numerically solving relevant physical equations to approximate the flow hemodynamics and tissue behavior. This approach is becoming widely adapted to simulate cardiac flows during the embryonic development. While there are few studies for human fetal cardiac flows, many groups used zebrafish and chicken embryos as useful models for elucidating normal and diseased cardiogenesis. In this paper, we explain the major steps to generate CFD models for simulating cardiac hemodynamics in vivo and summarize the latest findings on chicken and zebrafish embryos as well as human fetal hearts.
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14
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Bombardini T. The venous contribution to cardiovascular performance: From systemic veins to left ventricular function: A review. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-35083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The venous system contains ≈ 70 % of the total blood volume and is responsible in heart failure for key symptoms of congestion. It is active: it can increase or relax its tone with physiologic or pharmacologic stimuli. It is heterogeneous, behaves as a two-compartment model, compliant (splanchnic veins) and noncompliant (nonsplanchnic veins). It is dynamic in health and disease: in heart failure the vascular capacitance (storage space) is decreased and can result in volume redistribution from the abdominal compartment to the thoracic compartment (heart and lungs), which increases pulmonary pressures and precipitates pulmonary congestion. A noninvasive assessment of venous function, at rest and dynamically during stress, is warranted. The systemic haemodynamic congestion is assessed with inferior vena cava diameter and collapsibility. The pulmonary congestion is assessed with B-lines and pleural effusion. The contribution of left ventricular filling is assessed with end-diastolic volume, integrated with left ventricular function.
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Single breath-hold saturation recovery 3D cardiac T1 mapping via compressed SENSE at 3T. MAGNETIC RESONANCE MATERIALS IN PHYSICS, BIOLOGY AND MEDICINE 2020; 33:865-876. [PMID: 32410103 PMCID: PMC7669807 DOI: 10.1007/s10334-020-00848-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 11/06/2022]
Abstract
Objectives To propose and validate a novel imaging sequence that uses a single breath-hold whole-heart 3D T1 saturation recovery compressed SENSE rapid acquisition (SACORA) at 3T. Methods The proposed sequence combines flexible saturation time sampling, compressed SENSE, and sharing of saturation pulses between two readouts acquired at different RR intervals. The sequence was compared with a 3D saturation recovery single-shot acquisition (SASHA) implementation with phantom and in vivo experiments (pre and post contrast; 7 pigs) and was validated against the reference inversion recovery spin echo (IR-SE) sequence in phantom experiments. Results Phantom experiments showed that the T1 maps acquired by 3D SACORA and 3D SASHA agree well with IR-SE. In vivo experiments showed that the pre-contrast and post-contrast T1 maps acquired by 3D SACORA are comparable to the corresponding 3D SASHA maps, despite the shorter acquisition time (15s vs. 188s, for a heart rate of 60 bpm). Mean septal pre-contrast T1 was 1453 ± 44 ms with 3D SACORA and 1460 ± 60 ms with 3D SASHA. Mean septal post-contrast T1 was 824 ± 66 ms and 824 ± 60 ms. Conclusion 3D SACORA acquires 3D T1 maps in 15 heart beats (heart rate, 60 bpm) at 3T. In addition to its short acquisition time, the sequence achieves good T1 estimation precision and accuracy. Electronic supplementary material The online version of this article (10.1007/s10334-020-00848-2) contains supplementary material, which is available to authorized users.
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Vikhorev PG, Vikhoreva NN, Yeung W, Li A, Lal S, dos Remedios CG, Blair CA, Guglin M, Campbell KS, Yacoub MH, de Tombe P, Marston SB. Titin-truncating mutations associated with dilated cardiomyopathy alter length-dependent activation and its modulation via phosphorylation. Cardiovasc Res 2020; 118:241-253. [PMID: 33135063 PMCID: PMC8752363 DOI: 10.1093/cvr/cvaa316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
Abstract
Aims
Dilated cardiomyopathy (DCM) is associated with mutations in many genes encoding sarcomere proteins. Truncating mutations in the titin gene TTN are the most frequent. Proteomic and functional characterizations are required to elucidate the origin of the disease and the pathogenic mechanisms of TTN-truncating variants.
Methods and results
We isolated myofibrils from DCM hearts carrying truncating TTN mutations and measured the Ca2+ sensitivity of force and its length dependence. Simultaneous measurement of force and adenosine triphosphate (ATP) consumption in skinned cardiomyocytes was also performed. Phosphorylation levels of troponin I (TnI) and myosin binding protein-C (MyBP-C) were manipulated using protein kinase A and λ phosphatase. mRNA sequencing was employed to overview gene expression profiles. We found that Ca2+ sensitivity of myofibrils carrying TTN mutations was significantly higher than in myofibrils from donor hearts. The length dependence of the Ca2+ sensitivity was absent in DCM myofibrils with TTN-truncating variants. No significant difference was found in the expression level of TTN mRNA between the DCM and donor groups. TTN exon usage and splicing were also similar. However, we identified down-regulation of genes encoding Z-disk proteins, while the atrial-specific regulatory myosin light chain gene, MYL7, was up-regulated in DCM patients with TTN-truncating variants.
Conclusion
Titin-truncating mutations lead to decreased length-dependent activation and increased elasticity of myofibrils. Phosphorylation levels of TnI and MyBP-C seen in the left ventricles are essential for the length-dependent changes in Ca2+ sensitivity in healthy donors, but they are reduced in DCM patients with TTN-truncating variants. A decrease in expression of Z-disk proteins may explain the observed decrease in myofibril passive stiffness and length-dependent activation.
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Affiliation(s)
- Petr G Vikhorev
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Natalia N Vikhoreva
- Heart Science Centre, Magdi Yacoub Institute, Harefield Hospital, London UB9 6JH, UK
| | - WaiChun Yeung
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Amy Li
- Department of Pharmacy and Biomedical Sciences, La Trobe University, Bendigo, VIC 3550, Australia
| | - Sean Lal
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia
| | - Cristobal G dos Remedios
- Division of Molecular Cardiology and Biophysics, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Cheavar A Blair
- Division of Cardiovascular Medicine, Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Maya Guglin
- Division of Cardiovascular Medicine, Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Kenneth S Campbell
- Division of Cardiovascular Medicine, Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Magdi H Yacoub
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Pieter de Tombe
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
- Heart Science Centre, Magdi Yacoub Institute, Harefield Hospital, London UB9 6JH, UK
- Department of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL, USA
| | - Steven B Marston
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0NN, UK
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Sarıkaya Y, Arslan S, Taydaş O, Erarslan Y, Arıyürek OM. Axial pulmonary trunk diameter variations during the cardiac cycle. Surg Radiol Anat 2020; 42:1279-1285. [PMID: 32405785 DOI: 10.1007/s00276-020-02493-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies have shown a correlation between axial pulmonary trunk diameter (PTD) on chest computed tomography (CT) and pulmonary artery pressure. However, it is not known whether the PTD slices measured on chest CT have been recorded during the systolic or diastolic phase. The aim of this study was to demonstrate the variations in PTD during the cardiac cycle by measuring coronary CT angiography (CCTA) images. METHODS A retrospective analysis was made of 101 patients who underwent CCTA for coronary artery disease assessment. CCTA images were reconstructed during a full cardiac cycle and measurements were taken of the systolic and diastolic PTD and ascending aorta diameter (AAD) from the same slice by two independent observers. RESULTS Inter-observer agreement was excellent (intraclass correlation coefficient = 0.99) for all CT measurements. The mean systolic PTD of all patients was 26.3 ± 3.6 mm and the mean diastolic PTD was 22.8 ± 3.2 mm (p < 0.001). The mean difference between systole and diastole was found to be 3.5 ± 1.2 mm for PTD, 1.2 ± 0.7 mm for AAD, and 0.1 ± 0.04 for the PTD/AAD ratio (p values < 0.001). There was no statistical significance of PTD variations according to gender, age, height, weight, body mass index, and body surface area. CONCLUSION When an increased PTD is detected in a chest CT compared to normal limits or a previous CT scan, this may be the result of the variation in PTD due to the cardiac cycle.
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Affiliation(s)
- Yasin Sarıkaya
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| | - Sevtap Arslan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Onur Taydaş
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Yasin Erarslan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Orhan Macit Arıyürek
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
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Roeh A, Schuster T, Jung P, Schneider J, Halle M, Scherr J. Two dimensional and real-time three dimensional ultrasound measurements of left ventricular diastolic function after marathon running: results from a substudy of the BeMaGIC trial. Int J Cardiovasc Imaging 2019; 35:1861-1869. [PMID: 31154595 DOI: 10.1007/s10554-019-01634-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/24/2019] [Indexed: 01/13/2023]
Abstract
Strenuous exercise results in transient but minor alterations in left ventricular diastolic function (LVDF). The aim of this study is to describe and interpret the kinetics of the well-established 2D parameters of diastolic function and the novel and very sensitive 3D parameters before/after a marathon race. LVDF was evaluated by transthoracic echocardiography (TEE) in 212 healthy male [aged 42 (36-49) years)] marathon runners (all Be-MaGIC-study) in the week prior to (V1), immediately after (V2), 24 h after (V3) and 72 h after (V4) a marathon race. Real time three-dimensional echocardiography (RT3DE) included maximal and minimal left atrium (LA) volume, total LA ejection fraction (Total-EF), total LA stroke volume (Total-SV), true ejection fraction (True-EF) and atrial stroke volume (ASV). After adjustment for possible confounders (heart rate and systolic blood pressure), 2D Parameters of left ventricular inflow (E/A-ratio) decreased from pre- to immediately post-race (- 0.3 ± 0.06, p < 0.001) and returned to baseline within 24 h. [Formula: see text]-ratio remained unchanged directly post-race, but was significantly increased during follow-up of 24 and 72 h. 3D LA Vmin was increased immediately postrace and in the 24 h follow-up, LA Vmax was increased immediately post-race and in the follow-up of 24 and 72 h. During follow-up of 72 h, but not immediately postrace, TrueEF and ASV were significantly increased. Both techniques revealed acute and prolonged alterations of diastolic LV function. Considering all parameters, the recovery of diastolic LV after a marathon seems to take longer than previously assumed.Trial registration ClinicalTrials.gov ID: NCT00933218.
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Affiliation(s)
- Astrid Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany.
| | - Tibor Schuster
- Department for Medical Statistics and Epidemiology, Klinikum Rechts Der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Philip Jung
- Medizinische Klinik und Poliklinik I, Klinikum der Universitaet Muenchen, Munich, Germany
| | - Jens Schneider
- Universitäts Herz-Zentrum Freiburg - Bad Krozingen, Klinik für Kardiologie Und Angiologie II, Bad Krozingen, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, 80802, Munich, Germany
| | - Johannes Scherr
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany
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Lo Muzio FP, Rozzi G, Rossi S, Gerbolés AG, Fassina L, Pelà G, Luciani GB, Miragoli M. In-situ optical assessment of rat epicardial kinematic parameters reveals frequency-dependent mechanic heterogeneity related to gender. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2019; 154:94-101. [PMID: 31126627 DOI: 10.1016/j.pbiomolbio.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gender-related cardiac mechanics following the electrical activity has been investigated from basic to clinical research, but results are still controversial. The aim of this work is to study the gender related cardiac mechanics and to focus on its heart rate dependency. METHODS We employed 12 Sprague Dawley rats (5 males and 7 females) of the same age and, through a novel high resolution artificial vision contactless approach, we evaluated in-situ cardiac kinematic. The hearts were paced on the right atria appendage via cathodal stimuli at rising frequency. RESULTS Kinematic data obtained at rising pacing rates are different between male and female rat hearts: male tended to maintain the same level of cardiac force, energy and contractility, while female responded with an increment of such parameters at increasing heart rate. Female hearts preserved their pattern of contraction and epicardial torsion (vorticity) at rising pacing rates compared to male. Furthermore, we observed a difference in the mechanical restitution: systolic time vs. diastolic time, as an index of cardiac performance, reached higher value in male compared to female hearts. CONCLUSION Our innovative technology was capable to evaluate in-situ rat epicardial kinematic at high stimulation frequency, revealing that male preserved kinematic parameters but varying the pattern of contraction/relaxation. On the contrary, female preserved the pattern of contraction/relaxation increasing kinematic parameters.
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Affiliation(s)
- Francesco Paolo Lo Muzio
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona Via S. Francesco 22, 37129, Verona, Italy; Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | - Giacomo Rozzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona Via S. Francesco 22, 37129, Verona, Italy; Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | - Stefano Rossi
- Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | | | - Lorenzo Fassina
- Department of Industrial Engineering and Informatics, University of Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona Via S. Francesco 22, 37129, Verona, Italy
| | - Michele Miragoli
- Department of Medicine and Surgery, University di Parma, via Gramsci 14, 43126, Parma, Italy; Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Italy.
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Esmolol Compared with Amiodarone in the Treatment of Recent-Onset Atrial Fibrillation (RAF): An Emergency Medicine External Validity Study. J Emerg Med 2019; 56:308-318. [PMID: 30711368 DOI: 10.1016/j.jemermed.2018.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/18/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Recent-onset atrial fibrillation (RAF) is the most frequent supraventricular dysrhythmia in emergency medicine. Severely compromised patients require acute treatment with injectable drugs OBJECTIVE: The main purpose of this external validity study was to compare the short-term efficacy of esmolol with that of amiodarone to treat severe RAF in an emergency setting. METHODS This retrospective survey was conducted in mobile intensive care units by analyzing patient records between 2002 and 2013. We included RAF with (one or more) severity factors including: clinical shock, angina pectoris, ST shift, and very rapid ventricular rate. A blind matching procedure was used to constitute esmolol group (n = 100) and amiodarone group (n = 200), with similar profiles for age, gender, initial blood pressure, heart rate, severity factors, and treatment delay. The main outcome measure was the percentage of patients with a ventricular rate control defined as heart frequency ≤ 100 beats/min. More stringent (rhythm control) and more humble indicators (20% heart rate reduction) were analyzed at from 10 to 120 min after treatment initiation. RESULTS Patient characteristics were comparable for both groups: age 66 ± 16 years, male 71%, treatment delay < 1 h 36%, 1-2 h 29%, > 2 h 35%, chest pain 61%, ST shift 62%, ventricular rate 154 ± 26 beats/min, and blood pressure 126/73 mm Hg. The superiority of esmolol was significant at 40 min (64% rate control with esmolol vs. 25% with amiodarone) and for all indicators from 10 to 120 min after treatment onset. CONCLUSION In "real life emergency medicine," esmolol is better than amiodarone in the treatment of RAF.
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Lloyd RA, Fletcher DF, Clarke EC, Bilston LE. Chiari malformation may increase perivascular cerebrospinal fluid flow into the spinal cord: A subject-specific computational modelling study. J Biomech 2017; 65:185-193. [DOI: 10.1016/j.jbiomech.2017.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/07/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022]
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Pant S, Corsini C, Baker C, Hsia TY, Pennati G, Vignon-Clementel IE. Inverse problems in reduced order models of cardiovascular haemodynamics: aspects of data assimilation and heart rate variability. J R Soc Interface 2017; 14:rsif.2016.0513. [PMID: 28077762 DOI: 10.1098/rsif.2016.0513] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/05/2016] [Indexed: 11/12/2022] Open
Abstract
Inverse problems in cardiovascular modelling have become increasingly important to assess each patient individually. These problems entail estimation of patient-specific model parameters from uncertain measurements acquired in the clinic. In recent years, the method of data assimilation, especially the unscented Kalman filter, has gained popularity to address computational efficiency and uncertainty consideration in such problems. This work highlights and presents solutions to several challenges of this method pertinent to models of cardiovascular haemodynamics. These include methods to (i) avoid ill-conditioning of the covariance matrix, (ii) handle a variety of measurement types, (iii) include a variety of prior knowledge in the method, and (iv) incorporate measurements acquired at different heart rates, a common situation in the clinic where the patient state differs according to the clinical situation. Results are presented for two patient-specific cases of congenital heart disease. To illustrate and validate data assimilation with measurements at different heart rates, the results are presented on a synthetic dataset and on a patient-specific case with heart valve regurgitation. It is shown that the new method significantly improves the agreement between model predictions and measurements. The developed methods can be readily applied to other pathophysiologies and extended to dynamical systems which exhibit different responses under different sets of known parameters or different sets of inputs (such as forcing/excitation frequencies).
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Affiliation(s)
- Sanjay Pant
- Inria Paris & Sorbonne Universités UPMC Paris 6, Laboratoire Jacques-Louis Lions, Paris, France
| | - Chiara Corsini
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Catriona Baker
- Cardiac Unit, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, London, UK
| | - Tain-Yen Hsia
- Cardiac Unit, UCL Institute of Cardiovascular Science, and Great Ormond Street Hospital for Children, London, UK
| | - Giancarlo Pennati
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
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Tekkeşin Aİ, Velibey Y, Türkkan C, Alper AT, Çakıllı Y, Güvenç TS, Tanık O, Kaya A, Yıldırımtürk Ö, Özbilgin N, Güzelburç Ö, Öz A, Zehir R, Gürkan K. Diastolic Electrocardiographic Parameters Predict Implantable Device Detected Asymptomatic Atrial Fibrillation. Balkan Med J 2017; 34:417-424. [PMID: 28443594 PMCID: PMC5635628 DOI: 10.4274/balkanmedj.2016.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Atrial fibrillation is the most common clinically significant arrhythmia. It is now established that atrial high-rate episodes are highly correlated with atrial fibrillation. Aims: To investigate the relation between diastolic electrocardiographic parameters and subclinical atrial fibrillation detected by cardiac implantable electronic devices. Study Design: Ccross-sectional study. Methods: A total of 203 patients who had a dual-chamber, rate-modulated pacing pacemaker implanted due to sinus node dysfunction were prospectively enrolled in this study. Atrial high-rate episodes were defined as any lasting more than 5 min with an atrial rate of ≥220 beats per minute during the previous year. Patient groups were categorized on the basis of pacemaker interrogation as the absence of atrial high-rate episodes [atrial high-rate episodes (-)] and the presence of atrial high-rate episodes [atrial high-rate episodes (+)]. Episodes related to atrial over sensing were excluded. Twelve-lead surface electrocardiography was independently analyzed by two experienced readers for the measurement of diastolic electrocardiography parameters. Results: Among 203 patients (mean age: 67.5±9.1, 60.1% male), 51 (25.1%) with atrial high-rate episodes were defined as group 1 and 152 (74.9%) without atrial high-rate episodes were defined as group 2. Both groups were similar in terms of demographic characteristics and cardiovascular risk factors. Tend-Q and Tend-P were significantly longer in group 2. PQ interval was statistically longer in group 1. Corrected QT interval was significantly longer in group 1. Diastolic electrocardiography index, heart rate and PQ and QT intervals were the only independent predictors of atrial high-rate episodes in patients with dual pacemakers in multivariate analysis. Conclusion: Abnormal diastolic electrocardiography parameters are powerful predisposing factors for the initiation of incident atrial fibrillation. Diastolic electrocardiography parameters and a novel diastolic index predict atrial high-rate episodes. Evaluating these parameters enables clinicians to identify patients who are at high risk and who may benefit from prophylactic treatment.
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Affiliation(s)
- Ahmet İlker Tekkeşin
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Yalçın Velibey
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ceyhan Türkkan
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Taha Alper
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Yasin Çakıllı
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Tolga Sinan Güvenç
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ozan Tanık
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Adnan Kaya
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Özlem Yıldırımtürk
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nazmiye Özbilgin
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Özge Güzelburç
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Öz
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Regayip Zehir
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Kadir Gürkan
- Department of Cardiology, University of Healty Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Bazan O, Ortiz JP. Duration of Systole and Diastole for Hydrodynamic Testing of Prosthetic Heart Valves: Comparison Between ISO 5840 Standards and in vivo Studies. Braz J Cardiovasc Surg 2016; 31:171-3. [PMID: 27556318 PMCID: PMC5062727 DOI: 10.5935/1678-9741.20160036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/25/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To complement the ISO 5840 standards concerning the duration of left
ventricular systole and diastole as a function of changes in heart rates
according to in vivo studies from the physiologic literature review. Methods The systolic and diastolic durations from three in vivo
studies were compared with the durations of systole proposed by the ISO
5840:2010 and ISO 5840-2:2015 for hydrodynamic performance assessment of
prosthetic heart valves. Results Based on the in vivo studies analyzed, the systolic
durations proposed by the ISO 5840 standard seemed consistent for 45 and 120
beats per minute (bpm), and showed diverse results for the 70 bpm
condition. Conclusion Information on the realistic validation of the operation of left ventricular
models for different heart rates were obtained.
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Affiliation(s)
- Ovandir Bazan
- Department of Mechanical Engineering, Escola Politécnica, University of São Paulo, Brazil
| | - Jayme Pinto Ortiz
- Department of Mechanical Engineering, Escola Politécnica, University of São Paulo, Brazil
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Coolbaugh CL, Bush EC, Caskey CF, Damon BM, Towse TF. FloWave.US: validated, open-source, and flexible software for ultrasound blood flow analysis. J Appl Physiol (1985) 2016; 121:849-857. [PMID: 27516540 DOI: 10.1152/japplphysiol.00819.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 08/10/2016] [Indexed: 11/22/2022] Open
Abstract
Automated software improves the accuracy and reliability of blood velocity, vessel diameter, blood flow, and shear rate ultrasound measurements, but existing software offers limited flexibility to customize and validate analyses. We developed FloWave.US-open-source software to automate ultrasound blood flow analysis-and demonstrated the validity of its blood velocity (aggregate relative error, 4.32%) and vessel diameter (0.31%) measures with a skeletal muscle ultrasound flow phantom. Compared with a commercial, manual analysis software program, FloWave.US produced equivalent in vivo cardiac cycle time-averaged mean (TAMean) velocities at rest and following a 10-s muscle contraction (mean bias <1 pixel for both conditions). Automated analysis of ultrasound blood flow data was 9.8 times faster than the manual method. Finally, a case study of a lower extremity muscle contraction experiment highlighted the ability of FloWave.US to measure small fluctuations in TAMean velocity, vessel diameter, and mean blood flow at specific time points in the cardiac cycle. In summary, the collective features of our newly designed software-accuracy, reliability, reduced processing time, cost-effectiveness, and flexibility-offer advantages over existing proprietary options. Further, public distribution of FloWave.US allows researchers to easily access and customize code to adapt ultrasound blood flow analysis to a variety of vascular physiology applications.
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Affiliation(s)
- Crystal L Coolbaugh
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee;
| | - Emily C Bush
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee
| | - Charles F Caskey
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Bruce M Damon
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee; Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee; and
| | - Theodore F Towse
- Vanderbilt University Institute of Imaging Science, Nashville, Tennessee; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee; Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee
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26
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van Ockenburg SL, Rosmalen JGM, Bakker SJL, de Jonge P, Gans ROB. Effects of urinary cortisol levels and resting heart rate on the risk for fatal and nonfatal cardiovascular events. Atherosclerosis 2016; 248:44-50. [PMID: 26987065 DOI: 10.1016/j.atherosclerosis.2016.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/10/2016] [Accepted: 02/25/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Higher cortisol levels are associated with cardiovascular mortality in the elderly. It is unclear whether this association also exists in a general population of younger adults and for non-fatal cardiovascular events. Likewise, resting heart rate is associated with cardiovascular mortality, but fewer studies have also considered non-fatal events. The goal of this study was to investigate whether twenty-four-hour urinary cortisol (24-h UFC) levels and resting heart rate (RHR) predict major adverse fatal and non-fatal cardiovascular events (MACE) in the general population. METHODS We used data from a subcohort of the PREVEND study, a prospective general population based cohort study with a follow-up of 6.4 years for 24-h UFC and 10.6 years for RHR. Participants were 3432 adults (mean age 49 years, range 28-75). 24-h UFC was collected and measured by liquid chromatography-tandem mass spectrometry. RHR was measured at baseline in a supine position for 10 min with the Dinamap XL Model 9300. Information about cardiovascular events and mortality was obtained from the Dutch national registry of hospital discharge diagnoses and the municipal register respectively. RESULTS 24-h UFC did not significantly increase the hazard of MACE (hazard ratio = 0.999, 95% confidence interval = 0.993-1.006, p = 0.814). RHR increased the risk for MACE with 17% per 10 extra heart beats per minute (hazard ratio = 1.016, 95% confidence interval = 1.001-1.031, p = 0.036) after adjustment for conventional risk factors. CONCLUSIONS In contrast to 24-h UFC, RHR is a risk marker for MACE in the general population.
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Affiliation(s)
- Sonja L van Ockenburg
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Judith G M Rosmalen
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Reinold O B Gans
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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27
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Lai CQ, Lim GL, Jamil M, Mattar CNZ, Biswas A, Yap CH. Fluid mechanics of blood flow in human fetal left ventricles based on patient-specific 4D ultrasound scans. Biomech Model Mechanobiol 2015; 15:1159-72. [DOI: 10.1007/s10237-015-0750-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
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28
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Dao AT. Wireless laptop-based phonocardiograph and diagnosis. PeerJ 2015; 3:e1178. [PMID: 26339555 PMCID: PMC4558084 DOI: 10.7717/peerj.1178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/21/2015] [Indexed: 11/20/2022] Open
Abstract
Auscultation is used to evaluate heart health, and can indicate when it’s needed to refer a patient to a cardiologist. Advanced phonocardiograph (PCG) signal processing algorithms are developed to assist the physician in the initial diagnosis but they are primarily designed and demonstrated with research quality equipment. Therefore, there is a need to demonstrate the applicability of those techniques with consumer grade instrument. Furthermore, routine monitoring would benefit from a wireless PCG sensor that allows continuous monitoring of cardiac signals of patients in physical activity, e.g., treadmill or weight exercise. In this work, a low-cost portable and wireless healthcare monitoring system based on PCG signal is implemented to validate and evaluate the most advanced algorithms. Off-the-shelf electronics and a notebook PC are used with MATLAB codes to record and analyze PCG signals which are collected with a notebook computer in tethered and wireless mode. Physiological parameters based on the S1 and S2 signals and MATLAB codes are demonstrated. While the prototype is based on MATLAB, the later is not an absolute requirement.
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Affiliation(s)
- Amy T Dao
- University of New Mexico , Albuquerque, NM , USA
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29
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Kiviaho AL, Ahola A, Larsson K, Penttinen K, Swan H, Pekkanen-Mattila M, Venäläinen H, Paavola K, Hyttinen J, Aalto-Setälä K. Distinct electrophysiological and mechanical beating phenotypes of long QT syndrome type 1-specific cardiomyocytes carrying different mutations. IJC HEART & VASCULATURE 2015; 8:19-31. [PMID: 28785673 PMCID: PMC5497295 DOI: 10.1016/j.ijcha.2015.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/16/2015] [Indexed: 01/27/2023]
Abstract
Background Long QT syndrome (LQTS) is associated with increased risk of ventricular arrhythmias and cardiac arrest. LQTS type 1 (LQT1), the most prevalent subtype of LQTS, is caused by defects of slow delayed rectifier potassium current (IKs) that lead to abnormal cardiac repolarization. Here we used pluripotent stem cell (iPSC)-technology to investigate both the electrophysiological and also for the first time the mechanical beating behavior of genetically defined, LQT1 specific cardiomyocytes (CMs) carrying different mutations. Methods We established in vitro models for LQT1 caused by two mutations (G589D or ivs7-2A>G). LQT1 specific CMs were derived from patient specific iPSCs and characterized for their electrophysiology using a current clamp and Ca2 +-imaging. Their mechanical beating characteristics were analyzed with video-image analysis method. Results and conclusions Both LQT1-CM-types showed prolonged repolarization, but only those with G589D presented early after-depolarizations at baseline. Increased amounts of abnormal Ca2 + transients were detected in both types of LQT1-CMs. Surprisingly, also the mechanical beating behavior demonstrated clear abnormalities and additionally the abnormalities were different with the two mutations: prolonged contraction was seen in G589D-CMs while impaired relaxation was observed in ivs7-2A>G-CMs. The CMs carrying two different LQT1 specific mutations (G589D or ivs7-2A>G) presented clear differences in their electrical properties as well as in their mechanical beating behavior. Results from different methods correlated well with each other suggesting that simply mechanical beating behavior of CMs could be used for screening of diseased CMs and possibly for diagnostic purposes in the future.
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Affiliation(s)
- Anna L Kiviaho
- University of Tampere, BioMediTech, School of Medicine, Tampere, Finland
| | - Antti Ahola
- Tampere University of Technology, Department of Electronics and Communications Engineering, BioMediTech, Tampere, Finland
| | - Kim Larsson
- University of Tampere, BioMediTech, School of Medicine, Tampere, Finland
| | - Kirsi Penttinen
- University of Tampere, BioMediTech, School of Medicine, Tampere, Finland
| | - Heikki Swan
- Heart and Lung Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | - Henna Venäläinen
- University of Tampere, BioMediTech, School of Medicine, Tampere, Finland
| | - Kiti Paavola
- University of Tampere, BioMediTech, School of Medicine, Tampere, Finland
| | - Jari Hyttinen
- Tampere University of Technology, Department of Electronics and Communications Engineering, BioMediTech, Tampere, Finland
| | - Katriina Aalto-Setälä
- University of Tampere, BioMediTech, School of Medicine, Tampere, Finland.,Heart Center, Tampere University Hospital, Tampere, Finland
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30
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Bartoli CR, Rogers BD, Ionan CE, Pantalos GM. End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation. J Thorac Cardiovasc Surg 2014; 147:1660-7. [PMID: 24139614 PMCID: PMC3988268 DOI: 10.1016/j.jtcvs.2013.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/06/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Counterpulsation with an intra-aortic balloon pump (IABP) has not achieved the same success or clinical use in pediatric patients as in adults. In a pediatric animal model, IABP efficacy was investigated to determine whether IABP timing with a high-fidelity blood pressure signal may improve counterpulsation therapy versus a low-fidelity signal. METHODS In Yorkshire piglets (n = 19; weight, 13.0 ± 0.5 kg) with coronary ligation-induced acute ischemic left ventricular failure, pediatric IABPs (5 or 7 mL) were placed in the descending thoracic aorta. Inflation and deflation were timed with traditional criteria from low-fidelity (fluid-filled) and high-fidelity (micromanometer) blood pressure signals during 1:1 support. Aortic, carotid, and coronary hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption was calculated from coronary sinus and arterial blood samples. Left ventricular myocardial blood flow and end-organ blood flow were measured with microspheres. RESULTS Despite significant suprasystolic diastolic augmentation and afterload reduction at heart rates of 105 ± 3 beats per minute, left ventricular myocardial blood flow, myocardial oxygen consumption, the myocardial oxygen supply/demand relationship, cardiac output, and end-organ blood flow did not change. Statistically significant end-diastolic coronary, carotid, and aortic flow reversal occurred with IABP deflation. Inflation and deflation timed with a high-fidelity versus low-fidelity signal did not attenuate systemic flow reversal or improve the myocardial oxygen supply/demand relationship. CONCLUSIONS Systemic end-diastolic flow reversal limited counterpulsation efficacy in a pediatric model of acute left ventricular failure. Adjustment of IABP inflation and deflation timing with traditional criteria and a high-fidelity blood pressure waveform did not improve IABP efficacy or attenuate flow reversal. End-diastolic flow reversal may limit the efficacy of IABP counterpulsation therapy in pediatric patients with traditional timing criteria. Investigation of alternative deflation timing strategies is warranted.
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Affiliation(s)
- Carlo R Bartoli
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa; MD/PhD Program, University of Louisville School of Medicine, Louisville, Ky
| | | | - Constantine E Ionan
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Ky
| | - George M Pantalos
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Ky; Department of Bioengineering, University of Louisville, Louisville, Ky; Department of Surgery, University of Louisville, Louisville, Ky.
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Persico N, Fabietti I, Baffero GM, Fedele L, Nicolaides KH. Fetal right ventricular contraction and relaxation times at 11-13 weeks' gestation on speckle tracking imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:284-290. [PMID: 23939754 DOI: 10.1002/uog.13192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/14/2013] [Accepted: 08/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the contraction time and relaxation time of the right ventricle at 11-13 weeks' gestation in trisomy 21 and euploid fetuses by speckle tracking ultrasound imaging. METHODS Measurement of fetal nuchal translucency (NT) thickness, Doppler assessment for tricuspid regurgitation and reversed A-wave in the ductus venosus (DV) and fetal echocardiography were performed immediately before chorionic villus sampling for fetal karyotyping at 11-13 weeks' gestation. Digital videoclips of the four-chamber view of the fetal heart were recorded and analyzed offline using speckle tracking imaging software. The contraction time, which is the time between the highest and lowest peaks in the right ventricular area, and relaxation time, which is the time between the lowest and the subsequent highest area peak, were measured and expressed as a percentage of the duration of the cardiac cycle. Values in trisomy 21 and euploid fetuses were compared. RESULTS Mean contraction time and relaxation time in 119 euploid fetuses were 52.1% (95% CI, 51.6-52.8%) and 47.8% (95% CI, 47.2-48.4%), respectively. In 21 trisomy 21 fetuses, mean contraction time was significantly higher (57.0% (95% CI, 55.2-58.9%); P<0.01) and relaxation time lower (42.9% (95% CI, 41.1-44.8%); P<0.01) than in euploid fetuses. Multiple regression analysis showed that significant contributions to contraction time and relaxation time were provided by fetal karyotype, NT and tricuspid regurgitation, but not by reversed A-wave in the DV or the presence of a cardiac defect. CONCLUSION In first-trimester fetuses with trisomy 21 and in euploid fetuses with increased NT and tricuspid regurgitation there is evidence of increased right ventricular contraction time and shortening of the relaxation time.
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Affiliation(s)
- N Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Prospective ECG-Gated Coronary 320-MDCT Angiography With Absolute Acquisition Delay Strategy for Patients With Persistent Atrial Fibrillation. AJR Am J Roentgenol 2013; 201:1197-203. [DOI: 10.2214/ajr.12.10140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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33
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Namdar M, Biaggi P, Stähli B, Bütler B, Casado-Arroyo R, Ricciardi D, Rodríguez-Mañero M, Steffel J, Hürlimann D, Schmied C, de Asmundis C, Chierchia GB, Sarkozy A, Lüscher TF, Jenni R, Duru F, Paulus WJ, Brugada P. A novel electrocardiographic index for the diagnosis of diastolic dysfunction. PLoS One 2013; 8:e79152. [PMID: 24223898 PMCID: PMC3818461 DOI: 10.1371/journal.pone.0079152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/28/2013] [Indexed: 11/28/2022] Open
Abstract
Background Although the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD. Methods and Results ECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422±24ms and 434±32ms vs. 409±25ms, p<0.0005) and shorter Tend–P and Tend–Q intervals, reflecting the electrical and mechanical diastole (240±78ms and 276±108ms vs. 373±110ms, p<0.0001; 409±85ms and 447±115ms vs. 526±119ms, p<0.0001). The PQ–interval was significantly longer in the patient group (169±28ms and 171±38ms vs. 153±22ms, p<0.005). After adjusting for possible confounders, a novel index (Tend–P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%). Conclusions A novel electrocardiographic index Tend–P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI.
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Affiliation(s)
- Mehdi Namdar
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- * E-mail:
| | - Patric Biaggi
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Barbara Stähli
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Bernhard Bütler
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Rubén Casado-Arroyo
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Danilo Ricciardi
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Moisés Rodríguez-Mañero
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Jan Steffel
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - David Hürlimann
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Christian Schmied
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Thomas F. Lüscher
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Rolf Jenni
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Walter J. Paulus
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pedro Brugada
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
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Schultz CJ, van Mieghem NM, van der Boon RM, Dharampal AS, Lauritsch G, Rossi A, Moelker A, Krestin G, van Geuns R, de Feijter P, Serruys PW, de Jaegere P. Effect of body mass index on the image quality of rotational angiography without rapid pacing for planning of transcatheter aortic valve implantation: a comparison with multislice computed tomography. Eur Heart J Cardiovasc Imaging 2013; 15:133-41. [PMID: 23530030 DOI: 10.1093/ehjci/jet037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the feasibility of procedural planning for transcatheter aortic valve implantation (TAVI) using rotational angiography (R-angio) by comparison with multislice computed tomography (MSCT) and to investigate determinants of the image quality of R-angio. METHODS AND RESULTS Patients who underwent R-angio of the left ventricle and cardiac MSCT were eligible. R-angio acquisition was performed during contrast injection through a 6F pigtail catheter positioned in the left ventricle. On 3D R-angio and MSCT data sets, diameter measurements were made on short-axis images at the level of the aortic annulus (D(perimeter), D(area)), ascending aorta, sino-tubular junction (ST-junction), and the sinus of Valsalva. At the level of the aortic annulus, diagnostic image quality was obtained in 49 of 56 patients. In all patients with a body mass index (BMI) < 29 kg/m(2), image quality was acceptable whether or not rapid pacing was used. In patients with BMI ≥ 29 kg/m(2), the image quality was poor in 1 of 9 (11%) who were rapidly paced compared with 6 of 12 (50%) who were not. The correlation between R-angio and MSCT measurements was high for aortic annulus D(perimeter), D(area), ST-junction, Valsalva sinus, and ascending aorta (respectively, R = 0.90, 0.90, 0.91, 0.92, and 0.89). The correlations improved further when the analysis was limited to patients with a BMI < 29 kg/m(2) (respectively, 0.92, 0.92, 0.92, 0.92, and 0.93). CONCLUSION R-angio of the left ventricle allows precise measurement of the aortic root and annulus and was feasible for sizing at the time of TAVI. Diagnostic image quality was obtained without rapid pacing in all patients with a BMI < 29 kg/m(2).
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Affiliation(s)
- Carl J Schultz
- Department of Cardiology, Erasmus MC, PB 412, Rotterdam 3000 CA, the Netherlands
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Tavakolian K, Khosrow-Khavar F, Kajbafzadeh B, Marzencki M, Blaber AP, Kaminska B, Menon C. Precordial acceleration signals improve the performance of diastolic timed vibrations. Med Eng Phys 2013; 35:1133-40. [PMID: 23291107 DOI: 10.1016/j.medengphy.2012.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 11/09/2012] [Accepted: 12/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE This paper introduces a seismocardiography based methodology of predicting the start and the end of diastole to be used in diastolic timed vibrations (DTV), which provides non-invasive emergency treatment of acute coronary thrombosis by applying direct mechanical vibrations to the patient chest during diastole of heart cycles. It is proposed that seismocardiogram (SCG), in combination with electrocardiogram (ECG), provides a new means of diastole prediction. METHODS An accelerometer was placed on the sternum of 120 healthy participants and 22 ischemic heart patients to record precordial accelerations created by the heart. The accelerometer signal was used to extract SCG and phonocardiogram (PCG). Two independent trained experts annotated the extracted signals based on the timings of the start and end of diastole. RESULTS In the ischemic heart disease population by using 15 consecutive SCG cycles, the start and end of diastole was predicted in the upcoming cycles with 95 percentile error margin of 10.7 ms and 5.8 ms, respectively. These error margins were 7.4 ms and 3.5 ms, respectively, for normal participants. CONCLUSION The results provide that prediction of the aortic valve closure point in the SCG signal helps start the vibrator in time to cover most of the isovolumic relaxation period. Also, through prediction of the mitral valve closure point in the SCG signal, safety of the technique can be assessed through prediction of the amount of unwanted vibrations applied during the isovolumic contraction period.
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Affiliation(s)
- K Tavakolian
- School of Engineering Science, Simon Fraser University, British Columbia, Canada.
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Ramos JP, Carvalho P, Coimbra M. Towards a time-feature independent phonocardiogram segmentation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:2116-2119. [PMID: 24110138 DOI: 10.1109/embc.2013.6609951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Delimitation and classification of each heart sound is a rather difficult task. Elevated heart rates, as found in pediatrics and in some adults as well, influence some of the most reliable features used by existing methods. Furthermore, in real life scenarios, cardiologists will not have the time to acquire the signal's length required by some of the existing algorithms, which make us think that different approaches ought to be pursued. This paper presents the work on heart sound segmentation using structural and energy based features. It is an attempt to not rely on features considered crucial to most existing approaches. Yet, it achieves a high sensitivity and specificity comparable to some literature.
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Vogt E, MacQuarrie D, Neary JP. Using ballistocardiography to measure cardiac performance: a brief review of its history and future significance. Clin Physiol Funct Imaging 2012; 32:415-20. [PMID: 23031061 DOI: 10.1111/j.1475-097x.2012.01150.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 06/06/2012] [Indexed: 11/28/2022]
Abstract
Ballistocardiography (BCG) is a non-invasive technology that has been used to record ultra-low-frequency vibrations of the heart allowing for the measurement of cardiac cycle events including timing and amplitudes of contraction. Recent developments in BCG have made this technology simple to use, as well as time- and cost-efficient in comparison with other more complicated and invasive techniques used to evaluate cardiac performance. Recent technological advances are considerably greater since the advent of microprocessors and laptop computers. Along with the history of BCG, this paper reviews the present and future potential benefits of using BCG to measure cardiac cycle events and its application to clinical and applied research.
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Affiliation(s)
- Emelie Vogt
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
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Schmid Daners M, Knobloch V, Soellinger M, Boesiger P, Seifert B, Guzzella L, Kurtcuoglu V. Age-specific characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid dynamics. PLoS One 2012; 7:e37502. [PMID: 22666360 PMCID: PMC3364266 DOI: 10.1371/journal.pone.0037502] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/20/2012] [Indexed: 11/25/2022] Open
Abstract
The objective of this work is to quantify age-related differences in the characteristics and coupling of cerebral arterial inflow and cerebrospinal fluid (CSF) dynamics. To this end, 3T phase-contrast magnetic resonance imaging blood and CSF flow data of eleven young ( years) and eleven elderly subjects ( years) with a comparable sex-ratio were acquired. Flow waveforms and their frequency composition, transfer functions from blood to CSF flows and cross-correlations were analyzed. The magnitudes of the frequency components of CSF flow in the aqueduct differ significantly between the two age groups, as do the frequency components of the cervical spinal CSF and the arterial flows. The males' aqueductal CSF stroke volumes and average flow rates are significantly higher than those of the females. Transfer functions and cross-correlations between arterial blood and CSF flow reveal significant age-dependence of phase-shift between these, as do the waveforms of arterial blood, as well as cervical-spinal and aqueductal CSF flows. These findings accentuate the need for age- and sex-matched control groups for the evaluation of cerebral pathologies such as hydrocephalus.
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Affiliation(s)
- Marianne Schmid Daners
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Verena Knobloch
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Michaela Soellinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Neuroimaging Research Unit, Department of Neurology, Medical University Graz, Graz, Austria
| | - Peter Boesiger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Lino Guzzella
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Vartan Kurtcuoglu
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
- * E-mail:
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Coronary perfusion: Impact of flow dynamics and geometric design of 2 different aortic prostheses of similar size. J Thorac Cardiovasc Surg 2012; 143:1030-5. [DOI: 10.1016/j.jtcvs.2011.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/12/2011] [Accepted: 06/07/2011] [Indexed: 11/19/2022]
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Rosic M, Ilic V, Obradovic Z, Pantovic S, Rosic G. The mathematical analysis of the heart rate and blood lactate curves during incremental exercise testing. ACTA PHYSIOLOGICA HUNGARICA 2011; 98:456-464. [PMID: 22173027 DOI: 10.1556/aphysiol.98.2011.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper describes a new mathematical approach for the analysis of HR (heart rate) and BL (blood lactate) curves during incremental exercise testing using a HR/BL curve and its derivatives, taking into account the native shape of all curves, without any linear approximation. Using this approach the results indicate the appearance of three characteristic points (A, B and C) on the HR/BL curve. The point A on the HR/BL curve which is the value that corresponds to the load (12.73 ± 0.46 km h-1) at which BL starts to increase above the resting levels (0.9 ± 0.06 mM), and is analogous to Lactate Turn Point 1 (LTP1). The point C on the HR/BL curve which corresponds to a BL of approximately 4mM, and is analogous to LTP2. The point B on the HR/BL curve, which corresponds to the load (16.32 ± 0.49 km h-1) at which the moderate increase turns into a more pronounced increase in BL. This point has not been previously recognized in literature. We speculate this point represents attenuation of left ventricular ejection fraction (LVEF) increase, accompanied by the decrease in diastolic time duration during incremental exercise testing. Proposed mathematical approach allows precise determination of lactate turnpoints during incremental exercise testing.
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Affiliation(s)
- Mirko Rosic
- University of Kragujevac, Department of Physiology, Novi Sad, Serbia.
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Bombardini T, Sicari R, Bianchini E, Picano E. Abnormal shortened diastolic time length at increasing heart rates in patients with abnormal exercise-induced increase in pulmonary artery pressure. Cardiovasc Ultrasound 2011; 9:36. [PMID: 22104611 PMCID: PMC3268730 DOI: 10.1186/1476-7120-9-36] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/21/2011] [Indexed: 12/03/2022] Open
Abstract
Background The degree of pulmonary hypertension is not independently related to the severity of left ventricular systolic dysfunction but is frequently associated with diastolic filling abnormalities. The aim of this study was to assess diastolic times at increasing heart rates in normal and in patients with and without abnormal exercise-induced increase in pulmonary artery pressure (PASP). Methods. We enrolled 109 patients (78 males, age 62 ± 13 years) referred for exercise stress echocardiography and 16 controls. The PASP was derived from the tricuspid Doppler tracing. A cut-off value of PASP ≥ 50 mmHg at peak stress was considered as indicative of abnormal increase in PASP. Diastolic times and the diastolic/systolic time ratio were recorded by a precordial cutaneous force sensor based on a linear accelerometer. Results At baseline, PASP was 30 ± 5 mmHg in patients and 25 ± 4 in controls. At peak stress the PASP was normal in 95 patients (Group 1); 14 patients (Group 2) showed an abnormal increase in PASP (from 35 ± 4 to 62 ± 12 mmHg; P < 0.01). At 100 bpm, an abnormal (< 1) diastolic/systolic time ratio was found in 0/16 (0%) controls, in 12/93 (13%) Group 1 and 7/14 (50%) Group 2 patients (p < 0.05 between groups). Conclusion The first and second heart sound vibrations non-invasively monitored by a force sensor are useful for continuously assessing diastolic time during exercise. Exercise-induced abnormal PASP was associated with reduced diastolic time at heart rates beyond 100 beats per minute.
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Affiliation(s)
- Tonino Bombardini
- National Research Council, Institute of Clinical Physiology, Pisa, Italy.
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Abstract
A considerable body of evidence indicates that elevated resting heart rate is an independent, modifiable risk factor for cardiovascular events and mortality in patients with coronary artery disease. Elevated heart rate can produce adverse effects in several ways. Firstly, myocardial oxygen consumption is increased at high heart rates, but the time available for myocardial perfusion is reduced, increasing the likelihood of myocardial ischemia. Secondly, exposure of the large elastic arteries to cyclical stretch is increased at high heart rates. This effect can increase the rate at which components of the arterial wall deteriorate. Elastin fibers, which have an extremely slow rate of turnover in adult life, might be particularly vulnerable. Thirdly, elevated heart rate can predispose the myocardium to arrhythmias, and favor the development and progression of coronary atherosclerosis, by adversely affecting the balance between systolic and diastolic flow. Comparisons of the effects of the specific heart-rate-lowering drug ivabradine with those of β-blockers could help clarify the pathophysiological effects of elevated heart rate. Effective heart rate control among patients with coronary artery disease is uncommon in clinical practice, representing a missed therapeutic opportunity.
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Affiliation(s)
- Kim M Fox
- Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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Kamran H, Salciccioli L, Pushilin S, Kumar P, Carter J, Kuo J, Novotney C, Lazar JM. Characterization of cardiac time intervals in healthy bonnet macaques (Macaca radiata) by using an electronic stethoscope. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2011; 50:238-243. [PMID: 21439218 PMCID: PMC3061425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 08/13/2010] [Accepted: 10/19/2010] [Indexed: 05/30/2023]
Abstract
Nonhuman primates are used frequently in cardiovascular research. Cardiac time intervals derived by phonocardiography have long been used to assess left ventricular function. Electronic stethoscopes are simple low-cost systems that display heart sound signals. We assessed the use of an electronic stethoscope to measure cardiac time intervals in 48 healthy bonnet macaques (age, 8±5 y) based on recorded heart sounds. Technically adequate recordings were obtained from all animals and required 1.5±1.3 min. The following cardiac time intervals were determined by simultaneously recording acoustic and single-lead electrocardiographic data: electromechanical activation time (QS1), electromechanical systole (QS2), the time interval between the first and second heart sounds (S1S2), and the time interval between the second and first sounds (S2S1). QS2 was correlated with heart rate, mean arterial pressure, diastolic blood pressure, and left ventricular ejection time determined by using echocardiography. S1S2 correlated with heart rate, mean arterial pressure, diastolic blood pressure, left ventricular ejection time, and age. S2S1 correlated with heart rate, mean arterial pressure, diastolic blood pressure, systolic blood pressure, and left ventricular ejection time. QS1 did not correlate with any anthropometric or echocardiographic parameter. The relation S1S2/S2S1 correlated with systolic blood pressure. On multivariate analyses, heart rate was the only independent predictor of QS2, S1S2, and S2S1. In conclusion, determination of cardiac time intervals is feasible and reproducible by using an electrical stethoscope in nonhuman primates. Heart rate is a major determinant of QS2, S1S2, and S2S1 but not QS1; regression equations for reference values for cardiac time intervals in bonnet macaques are provided.
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Affiliation(s)
- Haroon Kamran
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Louis Salciccioli
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Sergei Pushilin
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Paraag Kumar
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - John Carter
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - John Kuo
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
| | - Carol Novotney
- Primate Behavior Laboratory, Department of Psychiatry, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jason M Lazar
- Division of Cardiovascular Medicine University of New York Downstate Medical Center, Brooklyn, New York
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Gill H, Hoffmann A. The Timing of Onset of Mechanical Systole and Diastole in Reference to the QRS-T Complex: a Study to Determine Performance Criteria for a Non-Invasive Diastolic Timed Vibration Massage System in Treatment of Potentially Unstable Cardiac Disorders. ACTA ACUST UNITED AC 2010; 10:235-45. [PMID: 21113800 DOI: 10.1007/s10558-010-9108-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Harjit Gill
- Division of Research and Development, Ahof Biophysical Systems Inc., Burnaby V5C4G8, Canada
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Bombardini T, Cini D, Arpesella G, Picano E. WEB downloadable software for training in cardiovascular hemodynamics in the (3-D) stress echo lab. Cardiovasc Ultrasound 2010; 8:48. [PMID: 21073738 PMCID: PMC2997766 DOI: 10.1186/1476-7120-8-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 11/13/2010] [Indexed: 12/15/2022] Open
Abstract
When a physiological (exercise) stress echo is scheduled, interest focuses on wall motion segmental contraction abnormalities to diagnose ischemic response to stress, and on left ventricular ejection fraction to assess contractile reserve. Echocardiographic evaluation of volumes (plus standard assessment of heart rate and blood pressure) is ideally suited for the quantitative and accurate calculation of a set of parameters allowing a complete characterization of cardiovascular hemodynamics (including cardiac output and systemic vascular resistance), left ventricular elastance (mirroring left ventricular contractility, theoretically independent of preload and afterload changes heavily affecting the ejection fraction), arterial elastance, ventricular arterial coupling (a central determinant of net cardiovascular performance in normal and pathological conditions), and diastolic function (through the diastolic mean filling rate). All these parameters were previously inaccessible, inaccurate or labor-intensive and now become, at least in principle, available in the stress echocardiography laboratory since all of them need an accurate estimation of left ventricular volumes and stroke volume, easily derived from 3 D echo. Aims of this paper are: 1) to propose a simple method to assess a set of parameters allowing a complete characterization of cardiovascular hemodynamics in the stress echo lab, from basic measurements to calculations 2) to propose a simple, web-based software program, to learn and training calculations as a phantom of the everyday activity in the busy stress echo lab 3) to show examples of software testing in a way that proves its value. The informatics infrastructure is available on the web, linking to http://cctrainer.ifc.cnr.it
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GEMIGNANI VINCENZO, BIANCHINI ELISABETTA, FAITA FRANCESCO, LIONETTI VINCENZO, CAMPAN MANUELA, RECCHIA FABIOANASTASIO, PICANO EUGENIO, BOMBARDINI TONINO. Transthoracic Sensor for Noninvasive Assessment of Left Ventricular Contractility: Validation in A Minipig Model of Chronic Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:795-803. [DOI: 10.1111/j.1540-8159.2009.02684.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Optimal phase for coronary interpretations and correlation of ejection fraction using late-diastole and end-diastole imaging in cardiac computed tomography angiography: implications for prospective triggering. Int J Cardiovasc Imaging 2009; 25:739-49. [PMID: 19633922 PMCID: PMC2729417 DOI: 10.1007/s10554-009-9481-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 07/09/2009] [Indexed: 01/15/2023]
Abstract
A typical acquisition protocol for multi-row detector computed tomography (MDCT) angiography is to obtain all phases of the cardiac cycle, allowing calculation of ejection fraction (EF) simultaneously with plaque burden. New MDCT protocols scanner, designed to reduce radiation, use prospectively acquired ECG gated image acquisition to obtain images at certain specific phases of the cardiac cycle with least coronary artery motion. These protocols do not we allow acquisition of functional data which involves measurement of ejection fraction requiring end-systolic and end-diastolic phases. We aimed to quantitatively identify the cardiac cycle phase that produced the optimal images as well as aimed to evaluate, if obtaining only 35% (end-systole) and 75% (as a surrogate for end-diastole) would be similar to obtaining the full cardiac cycle and calculating end diastolic volumes (EDV) and EF from the 35th and 95th percentile images. 1,085 patients with no history of coronary artery disease were included; 10 images separated by 10% of R–R interval were retrospectively constructed. Images with motion in the mid portion of RCA were graded from 1 to 3; with ‘1’ being no motion, ‘2’ if 0 to <1 mm motion, and ‘3’ if there is >1 mm motion and/or non-interpretable study. In a subgroup of 216 patients with EF > 50%, we measured left ventricular (LV) volumes in the 10 phases, and used those obtained during 25, 35, 75 and 95% phase to calculate the EF for each patient. The average heart rate (HR) for our patient group was 56.5 ± 8.4 (range 33–140). The distribution of image quality at all heart rates was 958 (88.3%) in Grade 1, 113 (10.42%) in Grade 2 and 14 (1.29%) in Grade 3 images. The area under the curve for optimum image quality (Grade 1 or 2) in patients with HR > 60 bpm for phase 75% was 0.77 ± 0.04 [95% CI: 0.61–0.87], while for similar heart rates the area under the curve for phases 75 + 65 + 55 + 45% combined was 0.92 ± 0.02. LV volume at 75% phase was strongly correlated with EDV (LV volume at 95% phase) (r = 0.970, P < 0.001). There was also a strong correlation between LVEF (75_35) and LVEF (95_35) (r = 0.93, P < 0.001). Subsequently, we developed a formula to correct for the decrement in LVEF using 35–75% phase: LVEF (95_35) = 0.783 × LVEF (75_35) + 20.68; adjusted R2 = 0.874, P < 0.001. Using 64 MDCT scanners, in order to acquire >90% interpretable studies, if HR < 60 bpm 75% phase of RR interval provides optimal images; while for HR > 60 analysis of images in 4 phases (75, 35, 45 and 55%) is needed. Our data demonstrates that LVEF can be predicted with reasonable accuracy by using data acquired in phases 35 and 75% of the R–R interval. Future prospective acquisition that obtains two phases (35 and 75%) will allow for motion free images of the coronary arteries and EF estimates in over 90% of patients.
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Ishikawa T, Tanaka R, Suzuki S, Saida Y, Soda A, Fukushima R, Yamane Y. Daily Rhythms of Left Atrial Pressure in Beagle Dogs with Mitral Valve Regurgitation. J Vet Intern Med 2009; 23:824-31. [PMID: 19496915 DOI: 10.1111/j.1939-1676.2009.0322.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- T Ishikawa
- Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo, Japan
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Bombardini T, Gemignani V, Bianchini E, Pasanisi E, Pratali L, Pianelli M, Faita F, Giannoni M, Arpesella G, Sicari R, Picano E. Post-exercise contractility, diastolic function, and pressure: operator-independent sensor-based intelligent monitoring for heart failure telemedicine. Cardiovasc Ultrasound 2009; 7:21. [PMID: 19442285 PMCID: PMC2689191 DOI: 10.1186/1476-7120-7-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 05/14/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New sensors for intelligent remote monitoring of the heart should be developed. Recently, a cutaneous force-frequency relation recording system has been validated based on heart sound amplitude and timing variations at increasing heart rates. AIM To assess sensor-based post-exercise contractility, diastolic function and pressure in normal and diseased hearts as a model of a wireless telemedicine system. METHODS We enrolled 150 patients and 22 controls referred for exercise-stress echocardiography, age 55 +/- 18 years. The sensor was attached in the precordial region by an ECG electrode. Stress and recovery contractility were derived by first heart sound amplitude vibration changes; diastolic times were acquired continuously. Systemic pressure changes were quantitatively documented by second heart sound recording. RESULTS Interpretable sensor recordings were obtained in all patients (feasibility = 100%). Post-exercise contractility overshoot (defined as increase > 10% of recovery contractility vs exercise value) was more frequent in patients than controls (27% vs 8%, p < 0.05). At 100 bpm stress heart rate, systolic/diastolic time ratio (normal, < 1) was > 1 in 20 patients and in none of the controls (p < 0.01); at recovery systolic/diastolic ratio was > 1 in only 3 patients (p < 0.01 vs stress). Post-exercise reduced arterial pressure was sensed. CONCLUSION Post-exercise contractility, diastolic time and pressure changes can be continuously measured by a cutaneous sensor. Heart disease affects not only exercise systolic performance, but also post-exercise recovery, diastolic time intervals and blood pressure changes--in our study, all of these were monitored by a non-invasive wearable sensor.
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Affiliation(s)
- Tonino Bombardini
- Department of Echocardiography Lab, Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
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Hogers B, van der Weerd L, Olofsen H, van der Graaf LM, DeRuiter MC, Gittenberger-de Groot AC, Poelmann RE. Non-invasive tracking of avian development in vivo by MRI. NMR IN BIOMEDICINE 2009; 22:365-373. [PMID: 19003815 DOI: 10.1002/nbm.1346] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Conventional microscopic techniques, to study embryonic development, require large numbers of embryos and are invasive, making follow-up impossible. We explored the use of in vivo MRI to study embryonic development, in general, and cardiovascular development in particular, over time. Wild-type quail embryos (n = 11) were imaged at embryonic days 3, 5, 7, 9, and 11, covering the main time course of embryonic heart development. On each imaging day cardiac morphology was evaluated and embryonic length was measured. MRI-embryos as well as control embryos (n = 11) were sacrificed at day 11 and scored for external malformations, while embryonic wet weight and stage were determined. In addition, venous clipped embryos (n = 4), known to develop cardiovascular malformations, were scanned at regular intervals and sacrificed at day 9 for histological analysis ex vivo. We were able to follow heart development of individual quail embryos inside their shell non-invasively over time, with sufficient detail to study cardiac morphology in vivo. We did not find any adverse effect of the repeated MRI examinations on morphology, length, or weight. Prenatally diagnosed malformations, like ventricular septal defects and aortic arch interruptions were confirmed by histology. In conclusion, micro-MRI can be used to evaluate in vivo early embryonic development and to diagnose cardiovascular malformations prenatally.
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Affiliation(s)
- Bianca Hogers
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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