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Sample records for 64-slice cardiac computed

  1. Cardiac sarcoidosis evaluated with gadolinium-enhanced magnetic resonance and contrast-enhanced 64-slice computed tomography.

    PubMed

    Smedema, Jan-Peter; Truter, Rene; de Klerk, Petra A; Zaaiman, Leonie; White, Leonie; Doubell, Anton F

    2006-09-20

    Sarcoidosis is a multi-system granulomatous disorder of unknown etiology with symptomatic cardiac involvement in up to 7% of patients. The clinical features of sarcoid heart disease include congestive heart failure, arrhythmias, conduction disturbances, and sudden death. We evaluated the value of contrast-enhanced multi-detector computed tomography in delineating myocardial scar and granulomatous inflammation by comparing our findings with gadolinium magnetic resonance in a patient diagnosed with cardiac sarcoidosis. PMID:16257460

  2. 64 Slice multi-detector row cardiac CT.

    PubMed

    Pannu, Harpreet K; Johnson, Pamela T; Fishman, Elliot K

    2009-01-01

    Cardiac imaging is feasible with multi-detector row (MDCT) scanners. Coronary arterial anatomy and both non-calcified and calcified plaques are depicted at CT coronary angiography. Vessel wall pathology and luminal diameter are depicted, and secondary myocardial changes may also be seen. Diagnostic capacity has increased with technological advancement, and preliminary investigations confirm the utility of 64-MDCT in low- and intermediate-risk patients who present to the emergency department with acute chest pain. The clinical indications, 64-MDCT technique, and MDCT findings in coronary artery disease are reviewed. PMID:18941811

  3. Assessments of Coronary Artery Visibility and Radiation Dose in Infants with Congenital Heart Disease on Cardiac 128-slice CT and on Cardiac 64-slice CT.

    PubMed

    Cui, Y; Huang, M; Zheng, J; Li, J; Liu, H; Liang, C

    2016-01-01

    The aim of this study was to compare the coronary artery visibility and radiation dose in infants with CHD on cardiac 128-slice CT and on cardiac 64-slice CT. The images of 200 patients were analyzed in this study, 100 patients were selected randomly from a group of 789 infants (<1 years old) with CHD undergoing 128-slice CT prospective ECG-triggered axial scan, and 100 were selected randomly from 911 infants with CHD undergoing 64-slice CT retrospective ECG-gated spiral scan. The visibility of coronary artery segments was graded on a four-point scale. The coronary arteries were considered to be detected or visible when grade was 2 or higher. The visibility of the coronary artery segments and the radiation dose was compared between the two groups. Except for the rate of LM (96 vs. 99%), the detection rates of the total, LAD, LCX, RCA, and the proximal segment of the RCA in the 256-slice CT group were significantly higher than those in the 64-slice CT group (51.7, 53.33, 33.67, 53.33, and 99 vs. 34.8, 34.33, 18, 30.67, and 75%, respectively). The counts of visibility score (4/3/2/1) for the LM and the proximal segment of the RCA were 62/22/12/4 and 56/20/17/7, respectively, in the 128-slice CT group and 17/42/30/1 and 9/30/38/25, respectively, in the 64-slice CT group. There were significant differences, especially for score 4 and 3, between the two groups. The radiation dose in the 128-slice CT group was significantly decreased than those in the 64-slice CT group (CTDIvol 1.88 ± 0.51 vs. 5.61 ± 0.63 mGy; SSDE 4.48 ± 1.15 vs. 13.97 ± 1.52 mGy; effective radiation dose 1.36 ± 0.44 vs. 4.06 ± 0.7 mSv). With reduced radiation dose, the visibility of the coronary artery in infants with CHD via prospective ECG-triggered mode on a 128-slice CT is superior to that of the 64-slice CT using retrospective ECG-gated spiral mode. PMID:26271472

  4. The role of 64-slice multi-detector computed tomography in the detection of subclinical atherosclerosis of the coronary artery.

    PubMed

    Jeong, Hae Chang; Ahn, Youngkeun; Ko, Jum Suk; Lee, Min Goo; Sim, Doo Sun; Park, Keun Ho; Yoon, Nam Sik; Youn, Hyun Ju; Hong, Young Joon; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Kim, Yun-Hyeon; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

    2010-12-01

    Multi-detector computed tomography (MDCT) has been used for detecting or excluding coronary atherosclerotic stenosis in symptomatic patients. However, the role of MDCT for routine medical examination in asymptomatic, high-risk patients has not been established. We therefore conducted the present study to test the hypothesis that MDCT could be a valuable method for detecting subclinical coronary artery stenosis in asymptomatic patients. An observational, retrospective, single-centre study was conducted with a cohort of 1,529 patients (mean age, 56.4 ± 8.3 years; 1,353 males) who had undergone MDCT as part of their general medical checkups from November 2005 to April 2008. The patients who had a past history of coronary artery disease, typical chest pain, or evidence of myocardial ischemia were excluded. During clinical follow up of these patients, the incidence of subclinical coronary stenosis and the usefulness of MDCT for routine medical examination in asymptomatic patients were investigated. Of the 1,529 enrolled patients, 42.3% had hypertension, 13.5% had diabetes mellitus, 7.7% had hyperlipidemia, and 40.4% were current smokers. Abnormal MDCT findings were noted in 560 (36.6%) patients, who were classified into two groups. One group had the presence coronary calcium with a luminal diameter stenosis of the coronary artery of <50% (n = 508, 33.2%). These patients were treated with medication or clinical follow-up. The other group had a luminal diameter stenosis of the coronary artery of ≥50% with the presence or absence of coronary calcium (n = 52, 3.4%). These patients underwent a conventional coronary angiogram and intravascular ultrasound. A total of 29 of the 1,529 patients (1.9%) presented with insignificant stenosis or myocardial bridge, and 23 patients (1.5%) presented with significant stenosis. The patients with significant stenosis underwent percutaneous coronary intervention (PCI) with stent implantation. Major adverse cardiac events occurred

  5. 64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: A meta-analysis.

    PubMed

    Barbero, Umberto; Iannaccone, Mario; d'Ascenzo, Fabrizio; Barbero, Cristina; Mohamed, Abdirashid; Annone, Umberto; Benedetto, Sara; Celentani, Dario; Gagliardi, Marco; Moretti, Claudio; Gaita, Fiorenzo

    2016-08-01

    A non-invasive approach to define grafts patency and stenosis in the follow-up of coronary artery bypass graft (CABG) patients may be an interesting alternative to coronary angiography. 64-slice-coronary computed tomography is nowadays a diffused non-invasive method that permits an accurate evaluation of coronary stenosis, due to a high temporal and spatial resolution. However, its sensitivity and specificity in CABG evaluation has to be clearly defined, since published studies used different protocols and scanners. We collected all studies investigating patients with stable symptoms and previous CABG and reporting the comparison between diagnostic performances of invasive coronary angiography and 64-slice-coronary computed tomography. As a result, sensitivity and specificity of 64-slice-coronary computed tomography for CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00) with an area under the curve (AUC) of 0.99. 64-slice-coronary computed tomography sensitivity and specificity for the presence of any CABG stenosis >50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98), while AUC was 0.99. At meta-regression, neither the age nor the time from graft implantation had effect on sensitivity and specificity of 64-slice-coronary computed tomography detection of significant CABG stenosis or occlusion. In conclusion 64-slice-coronary computed tomography confirmed its high sensitivity and specificity in CABG stenosis or occlusion evaluation. PMID:27140337

  6. Coronary calcium mass scores measured by identical 64-slice MDCT scanners are comparable: a cardiac phantom study.

    PubMed

    Dijkstra, Hildebrand; Greuter, Marcel J W; Groen, Jaap M; Vliegenthart-Proença, Rozemarijn; Renema, Klaasjan W K; de Lange, Frank; Oudkerk, Matthijs

    2010-01-01

    To assess whether absolute mass scores are comparable or differ between identical 64-slice MDCT scanners of the same manufacturer and to compare absolute mass scores to the physical mass and between scan modes using a calcified phantom. A non-moving anthropomorphic phantom with nine calcifications of three sizes and three densities was scanned 30 times on three 64-slice MDCT scanners of manufacturer A and on three 64-slice MDCT scanners of manufacturer B in both sequential and spiral scan mode. The mean mass scores and mass score variabilities of seven calcifications were determined for all scanners; two non-detectable calcifications were omitted. It was analyzed whether identical scanners yielded similar or significantly different mass scores. Furthermore mass scores were compared to the physical mass and mass scores were compared between scan modes. The mass score calibration factor was determined for all scanners. Mass scores obtained on identical scanners were similar for almost all calcifications. Overall, mass score differences between the scanners were small ranging from 1.5 to 3.4% for the total mass scores, and most differences between scanners were observed for high density calcifications. Mass scores were significantly different from the physical mass for almost all calcifications and all scanners. In sequential mode the total physical mass (167.8 mg) was significantly overestimated (+2.3%) for 4 out of 6 scanners. In spiral mode a significant overestimation (+2.5%) was found for system B and a significant underestimation (-1.8%) for two scanners of system A. Mass scores were dependent on the scan mode, for manufacturer A scores were higher in sequential mode and for manufacturer B in spiral mode. For system A using spiral scan mode no differences were found between identical scanners, whereas a few differences were found using sequential mode. For system B the scan mode did not affect the number of different mass scores between identical scanners. Mass

  7. Detection of plaque rupture using 64-slice multidetector row computed tomography

    PubMed Central

    Reimann, Anja J; Beck, Torsten; Heuschmid, Martin; Brodoefel, Harald; Burgstahler, Christof; Schröder, Stephen; Kopp, Andreas F

    2008-01-01

    The present case report describes a 37-year-old man who presented to the emergency room with symptoms of a myocardial infarction but no high-grade stenosis on conventional catheter angiography. Consecutive multi-detector row computed tomography of the coronary arteries showed an intimal flap along a fibrous plaque formation in the left anterior descending artery. This finding was found to represent a plaque rupture, and the lesion was treated with an 18 mm stent. Multidetector row computed tomography helped to correctly position the stent by identifying the exact location of the rupture along the long plaque formation. PMID:18340394

  8. 64-Slice spiral computed tomography and three-dimensional reconstruction in the diagnosis of cystic pancreatic tumors

    PubMed Central

    WEN, ZHAOXIA; YAO, FENGQING; WANG, YUXING

    2016-01-01

    The present study aimed to describe the characteristics of cystic pancreatic tumors using computed tomography (CT) and to evaluate the diagnostic accuracy (DA) of post-imaging three-dimensional (3D) reconstruction. Clinical and imaging data, including multi-slice spiral CT scans, enhanced scans and multi-faceted reconstruction, from 30 patients with pathologically confirmed cystic pancreatic tumors diagnosed at the Linyi People's Hospital between August 2008 and June 2014 were retrospectively analyzed. Following the injection of Ultravist® 300 contrast agent, arterial, portal venous and parenchymal phase scans were obtained at 28, 60 and 150 sec, respectively, and 3D reconstructions of the CT images were generated. The average age of the patients was 38.4 years (range, 16–77 years), and the cohort included 5 males and 25 females (ratio, 1:5). The patients included 8 cases of mucinous cystadenoma (DA), 80%]; 9 cases of cystadenocarcinoma (DA, 84%); 6 cases of serous cystadenoma (DA, 100%); 3 cases of solid pseudopapillary tumor (DA, 100%); and 4 cases of intraductal papillary mucinous neoplasm (DA, 100%). 3D reconstructions of CT images were generated and, in the 4 cases of intraductal papillary mucinous neoplasm, the tumor was connected to the main pancreatic duct and multiple mural nodules were detected in one of these cases. The DA of the 3D-reconstructed images of cystic pancreatic tumors was 89.3%. The 64-slice spiral CT and 3D-reconstructed CT images facilitated the visualization of cystic pancreatic tumor characteristics, in particular the connections between the tumor and the main pancreatic duct. In conclusion, the 3D reconstruction of multi-slice CT data may provide an important source of information for the surgical team, in combination with the available clinical data. PMID:27073473

  9. Characterization of Pulmonary Vein Dimensions Using High-Definition 64-Slice Computed Tomography prior to Radiofrequency Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Stähli, Barbara E.; Klaeser, Bernd; Fuchs, Tobias A.; Ghadri, Jelena R.; Lüscher, Thomas F.; Kaufmann, Philipp A.; Duru, Firat

    2014-01-01

    Background. Contrast-enhanced computed tomography is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AFib) to guide the procedure. We analyzed pulmonary vein (PV) ostial diameter and volumes on a high-definition 64-slice CT (HDCT) scanner in patients with AFib prior to RFCA. Methods and Results. This retrospective study included 50 patients (mean age 60.2 ± 11.4 years, 30 males) undergoing cardiac HDCT scanning before RFCA for drug refractory AFib and 50 age-, BMI-, and sex-matched controls with normal sinus rhythm undergoing HDCT. PV ostial diameter and volume were measured and calculated using a semiautomatic calliper tool. Total ostial PV volume was significantly increased in patients with AFib as compared to controls (P < 0.005). Similarly, total ostial PV diameter was significantly increased in AFib compared to controls (P < 0.001). In AFib, the largest PV volume and diameters were measured in right superior PV (P < 0.05 versus controls). The difference in PV volume between patients and controls was most pronounced in right superior PVs (P = 0.015). Right middle PVs were found more often in patients with AFib (16/50; 32%) than in normal subjects (7/50; 14%). Conclusion. Enlargement of PV ostial area and enlargement of volume are frequent findings in patients with drug refractory AFib. These parameters may add to the risk stratification for AFib recurrence following RFCA. PMID:25089213

  10. Infant Cardiac CT Angiography with 64-Slice and 256-Slice CT: Comparison of Radiation Dose and Image Quality Using a Pediatric Phantom

    PubMed Central

    Mok, Greta S. P.; Wu, Tung-Hsin

    2012-01-01

    Background The aims of this study were to investigate the image quality and radiation exposure of pediatric protocols for cardiac CT angiography (CTA) in infants under one year of age. Methodology/Principal Findings Cardiac CTA examinations were performed using an anthropomorphic phantom representing a 1-year-old child scanned with non-electrocardiogram-gated (NG), retrospectively electrocardiogram-gated helical (RGH) and prospectively electrocardiogram-gated axial (PGA) techniques in 64-slice and 256-slice CT scanners. The thermoluminescent dosimeters (TLD) were used for direct organ dose measurement, while dose-length product and effective mAs were also used to estimate the patient dose. For image quality, noise and signal-to-noise-ratio (SNR) were assessed based on regions-of-interest drawn on the reconstructed CT images, and were compared with the proposed cardiac image quantum index (CIQI). Estimated dose results were in accordant to the measured doses. The NG scan showed the best image quality in terms of noise and SNR. The PGA scan had better image quality than the RGH scan with 83.70% dose reduction. Noise and SNR were also corresponded to the proposed CIQI. Conclusions/Significance The PGA scan protocol was a good choice in balancing radiation exposure and image quality for infant cardiac CTA. We also suggested that the effective mAs and the CIQI were suitable in assessing the tradeoffs between radiation dose and image quality for cardiac CTA in infants. These results are useful for future implementation of dose reduction strategies in pediatric cardiac CTA protocols. PMID:23185380

  11. Role of 64 slice multidetector computed tomography and angiography to establish relationship between tumor size, aneurysm formation and spontaneous rupture of renal angiomyolipomas: Single center experience

    PubMed Central

    Gandhi, Shruti P.; Pal, Bipin Chandra; Patel, Kajal N.; Sutariya, Harsh; Trivedi, Hargovind L.

    2016-01-01

    Objective: To evaluate the role of computed tomography (CT) angiography using 64 slice multidetector CT scan to establish relationships among tumor size, aneurysm formation, and spontaneous rupture of renal angiomyolipomas (AML). Materials and Methods: Total 27 patients were diagnosed as having renal angiomyolipoma (AML) at institute of kidney disease and research center from June 2008 to June 2015. All patients with renal AML underwent contrast-enhanced CT (CECT) with CT angiography with 64 slice multidetector CT scan. Results: Total 34 kidneys were found to be affected by AML. Out of which 6 AML were ruptured and remaining 28 were unruptured. If tumor size of 4 cm or larger is used as predictor of rupture; sensitivity 20%, specificity 89%, positive predictive value 83.3%, and negative predictive value 28.5%; and If aneurysm size >5 mm is used as predictor of rupture; sensitivity 75%, specificity 90%, positive predictive value 50%, and negative predictive value 96.4% was found. Conclusion: Tumor size, aneurysm size and tumor multiplicity cannot use as a predictor of spontaneous rupture of the tumor. PMID:27141187

  12. Quantitative parameters to compare image quality of non-invasive coronary angiography with 16-slice, 64-slice and dual-source computed tomography.

    PubMed

    Burgstahler, Christof; Reimann, Anja; Brodoefel, Harald; Daferner, Ulrike; Herberts, Tina; Tsiflikas, Ilias; Thomas, Christoph; Drosch, Tanja; Schroeder, Stephen; Heuschmid, Martin

    2009-03-01

    Multi-slice computed tomography (MSCT) is a non-invasive modality to visualize coronary arteries with an overall good image quality. Improved spatial and temporal resolution of 64-slice and dual-source computed tomography (DSCT) scanners are supposed to have a positive impact on diagnostic accuracy and image quality. However, quantitative parameters to compare image quality of 16-slice, 64-slice MSCT and DSCT are missing. A total of 256 CT examinations were evaluated (Siemens, Sensation 16: n = 90; Siemens Sensation 64: n = 91; Siemens Definition: n = 75). Mean Hounsfield units (HU) were measured in the cavum of the left ventricle (LV), the ascending aorta (Ao), the left ventricular myocardium (My) and the proximal part of the left main (LM), the left anterior descending artery (LAD), the right coronary artery (RCA) and the circumflex artery (CX). Moreover, the ratio of intraluminal attenuation (HU) to myocardial attenuation was assessed for all coronary arteries. Clinical data [body mass index (BMI), gender, heart rate] were accessible for all patients. Mean attenuation (CA) of the coronary arteries was significantly higher for DSCT in comparison to 64- and 16-slice MSCT within the RCA [347 +/- 13 vs. 254 +/- 14 (64-MSCT) vs. 233 +/- 11 (16-MSCT) HU], LM (362 +/- 11/275 +/- 12/262 +/- 9), LAD (332 +/- 17/248 +/- 19/219 +/- 14) and LCX (310 +/- 12/210 +/- 13/221 +/- 10, all p < 0.05), whereas there was no significant difference between DSCT and 64-MSCT for the LV, the Ao and My. Heart rate had a significant impact on CA ratio in 16-slice and 64-slice CT only (p < 0.05). BMI had no impact on the CA ratio in DSCT only (p < 0.001). Improved spatial and temporal resolution of dual-source CT is associated with better opacification of the coronary arteries and a better contrast with the myocardium, which is independent of heart rate. In comparison to MSCT, opacification of the coronary arteries at DSCT is not affected by BMI. The main advantage of DSCT lies with the

  13. Non-invasive Detection of Aortic and Coronary Atherosclerosis in Homozygous Familial Hypercholesterolemia by 64 Slice Multi-detector Row Computed Tomography Angiography

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis, often at the ostia of coronary arteries. In this study we document for the first time that aortic and coronary atherosclerosis can be detected using 64 slice multiple detector-row ...

  14. Non-invasive detection of aortic and coronary atherosclerosis in homozygous familial hypercholesterolemia by 64 slice multi-detector row computed tomography angiography

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by the early onset of atherosclerosis, often at the ostia of coronary arteries. In this study we document for the first time that aortic and coronary atherosclerosis can be detected using 64 slice multiple detector row ...

  15. Evaluation of cardiac function and myocardial viability with 16- and 64-slice multidetector computed tomography.

    PubMed

    Kopp, Andreas F; Heuschmid, Martin; Reimann, Anja; Kuettner, Axel; Beck, Thorsten; Ohmer, Martin; Burgstahler, Christoph; Brodoefel, Harald; Claussen, Claus D; Schroeder, Stephen

    2005-11-01

    Retrospectively ECG-gated MDCT shows a high correlation and acceptable agreement of left-ventricular functional parameters compared to MR imaging. Thus, in addition to the non-invasive evaluation of coronary arteries, further important additional information of left-ventricular functional parameters with clinical and prognostic relevance can be achieved by one single MDCT examination. For assessment of myocardial viability, low-dose CT late enhancement scanning is feasible, and preliminary results look promising. CT late enhancement adds valuable diagnostic information on the haemodynamical significance of coronary stenoses or prior to interventional procedures. PMID:16479639

  16. First in vivo head-to-head comparison of high-definition versus standard-definition stent imaging with 64-slice computed tomography.

    PubMed

    Fuchs, Tobias A; Stehli, Julia; Fiechter, Michael; Dougoud, Svetlana; Sah, Bert-Ram; Gebhard, Cathérine; Bull, Sacha; Gaemperli, Oliver; Kaufmann, Philipp A

    2013-08-01

    The aim of this study was to compare image quality characteristics from 64-slice high definition (HDCT) versus 64-slice standard definition CT (SDCT) for coronary stent imaging. In twenty-five stents of 14 patients, undergoing contrast-enhanced CCTA both on 64-slice SDCT (LightSpeedVCT, GE Healthcare) and HDCT (Discovery HD750, GE Healthcare), radiation dose, contrast, noise and stent characteristics were assessed. Two blinded observers graded stent image quality (score 1 = no, 2 = mild, 3 = moderate, and 4 = severe artefacts). All scans were reconstructed with increasing contributions of adaptive statistical iterative reconstruction (ASIR) blending (0, 20, 40, 60, 80 and 100 %). Image quality was significantly superior in HDCT versus SDCT (score 1.7 ± 0.5 vs. 2.7 ± 0.7; p < 0.05). Image noise was significantly higher in HDCT compared to SDCT irrespective of ASIR contributions (p < 0.05). Addition of 40 % ASIR or more reduced image noise significantly in both HDCT and SDCT. In HDCT in-stent luminal attenuation was significantly lower and mean measured in-stent luminal diameter was significantly larger (1.2 ± 0.4 mm vs. 0.8 ± 0.4 mm; p < 0.05) compared to SDCT. Radiation dose from HDCT was comparable to SDCT (1.8 ± 0.7 mSv vs. 1.7 ± 0.7 mSv; p = ns). Use of HDCT for coronary stent imaging reduces partial volume artefacts from stents yielding improved image quality versus SDCT at a comparable radiation dose. PMID:23636300

  17. Myocardial bridging of the right coronary artery inside the right atrial myocardium identified by ECG-gated 64-slice multidetector computed tomography angiography.

    PubMed

    Chen, Chien-Cheng; Chen, Huan-Wu; Fu, Chen-Ju; Lin, Fen-Chiung; Wen, Ming-Shien; Liu, Yuan-Chang

    2010-01-01

    A myocardial bridge (MB) is defined as an intramyocardial course of a major epicardial coronary artery, and it is mainly confined to the left ventricle and the left anterior descending coronary artery. There are rare reports of right coronary MB seen during angiographic examination. Herein, we present a 49 year-old man with right coronary artery MB without luminal narrowing in the diastolic and systolic phases of electrocardiography-gated computed tomography images. The value of multi-detector computed tomography for the detection of anatomical variants in the cardiovascular system is further discussed. PMID:20438676

  18. Quantification of coronary artery plaque using 64-slice dual-source CT: comparison of semi-automatic and automatic computer-aided analysis based on intravascular ultrasonography as the gold standard.

    PubMed

    Kim, Young Jun; Jin, Gong Yong; Kim, Eun Young; Han, Young Min; Chae, Jei Keon; Lee, Sang Rok; Kwon, Keun Sang

    2013-12-01

    We evaluated the feasibility of automatic computer-aided analysis (CAA) compared with semi-automatic CAA for differentiating lipid-rich from fibrous plaques based on coronary CT angiography (CCTA) imaging. Seventy-four coronary plaques in 57 patients were evaluated by CCTA using 64-slice dual-source CT. Quantitative analysis of coronary artery plaques was performed by measuring the relative volumes (low, medium, and calcified) of plaque components using automatic CAA and by measuring mean CT density using semi-automatic CAA. We compared the two plaque measurement methods for lipid-rich and fibrous plaques using Pearson's correlation. Intravascular ultrasonography was used as the goal standard for assessment of plaques. Mean CT density of plaques tended to increase in the order of lipid [36 ± 19 Hounsfield unit (HU)], fibrous (106 ± 34 HU), and then calcified plaques (882 ± 296 HU). The mean relative volumes of 'low' components measured by automatic CAA were 13.8 ± 4.6, 7.9 ± 6.7, and 3.5 ± 3.0 % for lipid, fibrous, and calcified plaques, respectively (r = -0.348, P = 0.022). The mean relative volumes of 'medium' components on automatic CAA were 12.9 ± 4.1, 15.7 ± 9.6, and 5.6 ± 4.8 % for lipid, fibrous, and calcified plaques, respectively (r = -0.385, P = 0.011). The mean relative volumes of low and medium components within plaques significantly correlated with the types of plaques. Plaque analysis using automatic CAA has the potential to differentiate lipid from fibrous plaques based on measurement of the relative volume percentages of the low and medium components. PMID:24293043

  19. Usefulness of Cardiac Computed Tomography in the Diagnosis of Prosthetic Coronary Artery Graft with Interposition Procedure

    PubMed Central

    Wake, Ryotaro; Iwata, Shinichi; Nakagawa, Masashi; Doi, Atsushi; Sugioka, Kenichi; Otsuka, Ryo; Hozumi, Takeshi; Takemoto, Yasuhiko; Ehara, Shoichi; Hanatani, Akihisa; Muro, Takashi; Yoshiyama, Minoru

    2010-01-01

    An 80-year-old Japanese man was admitted with orthopnea and pitting edema of both lower legs. We diagnosed congestive heart failure (CHF) on the basis of a chest X-ray and an echocardiogram. An electrocardiogram showed a heart rate of 120 beats/min with atrial fibrillation rhythm (Af). The patient developed aortic valve failure and destruction of the base of right coronary artery (RCA) due to infectious endocarditis at 71 years of age. The patient underwent aortic valve replacement and coronary artery bypass grafting with an interposed graft with polyester vascular graft to RCA. The patient recovered from CHF after the 6 days of treatment with diuretics and verapamil. We confirmed the patency of coronary arteries and bypass grafts using a 64-slice cardiac computed tomography scan (CT) and diagnosed CHF due to Af. Here we describe the estimation of the prosthetic coronary artery graft patency with the interposition procedure using 64-slice cardiac CT. PMID:21079753

  20. Radiation dose evaluation in 64-slice CT examinations with adult and paediatric anthropomorphic phantoms.

    PubMed

    Fujii, K; Aoyama, T; Yamauchi-Kawaura, C; Koyama, S; Yamauchi, M; Ko, S; Akahane, K; Nishizawa, K

    2009-12-01

    The objective of this study was to evaluate the organ dose and effective dose to patients undergoing routine adult and paediatric CT examinations with 64-slice CT scanners and to compare the doses with those from 4-, 8- and 16-multislice CT scanners. Patient doses were measured with small (<7 mm wide) silicon photodiode dosemeters (34 in total), which were implanted at various tissue and organ positions within adult and 6-year-old child anthropomorphic phantoms. Output signals from photodiode dosemeters were read on a personal computer, from which organ and effective doses were computed. For the adult phantom, organ doses (for organs within the scan range) and effective doses were 8-35 mGy and 7-18 mSv, respectively, for chest CT, and 12-33 mGy and 10-21 mSv, respectively, for abdominopelvic CT. For the paediatric phantom, organ and effective doses were 4-17 mGy and 3-7 mSv, respectively, for chest CT, and 5-14 mGy and 3-9 mSv, respectively, for abdominopelvic CT. Doses to organs at the boundaries of the scan length were higher for 64-slice CT scanners using large beam widths and/or a large pitch because of the larger extent of over-ranging. The CT dose index (CTDI(vol)), dose-length product (DLP) and the effective dose values using 64-slice CT for the adult and paediatric phantoms were the same as those obtained using 4-, 8- and 16-slice CT. Conversion factors of DLP to the effective dose by International Commission on Radiological Protection 103 were 0.024 mSvmGy(-1)cm(-1) and 0.019 mSvmGy(-1)cm(-1) for adult chest and abdominopelvic CT scans, respectively. PMID:19934069

  1. Radiation dose evaluation in 64-slice CT examinations with adult and paediatric anthropomorphic phantoms

    PubMed Central

    Fujii, K; Aoyama, T; Yamauchi-Kawaura, C; Koyama, S; Yamauchi, M; Ko, S; Akahane, K; Nishizawa, K

    2009-01-01

    The objective of this study was to evaluate the organ dose and effective dose to patients undergoing routine adult and paediatric CT examinations with 64-slice CT scanners and to compare the doses with those from 4-, 8- and 16-multislice CT scanners. Patient doses were measured with small (<7 mm wide) silicon photodiode dosemeters (34 in total), which were implanted at various tissue and organ positions within adult and 6-year-old child anthropomorphic phantoms. Output signals from photodiode dosemeters were read on a personal computer, from which organ and effective doses were computed. For the adult phantom, organ doses (for organs within the scan range) and effective doses were 8–35 mGy and 7–18 mSv, respectively, for chest CT, and 12–33 mGy and 10–21 mSv, respectively, for abdominopelvic CT. For the paediatric phantom, organ and effective doses were 4–17 mGy and 3–7 mSv, respectively, for chest CT, and 5–14 mGy and 3–9 mSv, respectively, for abdominopelvic CT. Doses to organs at the boundaries of the scan length were higher for 64-slice CT scanners using large beam widths and/or a large pitch because of the larger extent of over-ranging. The CT dose index (CTDIvol), dose–length product (DLP) and the effective dose values using 64-slice CT for the adult and paediatric phantoms were the same as those obtained using 4-, 8- and 16-slice CT. Conversion factors of DLP to the effective dose by International Commission on Radiological Protection 103 were 0.024 mSv⋅mGy−1⋅cm−1 and 0.019 mSv⋅mGy−1⋅cm−1 for adult chest and abdominopelvic CT scans, respectively. PMID:19934069

  2. Coronary artery dissection with rupture of aortic valve commissure following type A aortic dissection: the role of 64-slice MDCT.

    PubMed

    Das, K M; Abdou, Sayed M; El-Menyar, Ayman; Ayman, El Menyar; Khulaifi, A A; Nabti, A L

    2008-01-01

    A rare case of bilateral coronary artery dissection with rupture of aortic valve commissure following type A aortic dissection is described. 64-slice multidetector computed tomography (MDCT) was able to demonstrate both this findings along with involvement of other neck vessels. TEE demonstrated the severity and mechanisms of aortic valve damage and assisted the surgeon in valve repair. MDCT has played an invaluable role in the diagnosis of the abnormal details of such life-threatening vascular complications. PMID:18384568

  3. Performance evaluation of a 64-slice CT system with z-flying focal spot.

    PubMed

    Flohr, T; Stierstorfer, K; Raupach, R; Ulzheimer, S; Bruder, H

    2004-12-01

    The meanwhile established generation of 16-slice CT systems enables routine sub-millimeter imaging at short breath-hold times. Clinical progress in the development of multidetector row CT (MDCT) technology beyond 16 slices can more likely be expected from further improvement in spatial and temporal resolution rather than from a mere increase in the speed of volume coverage. We present an evaluation of a recently introduced 64-slice CT system (SOMATOM Sensation 64, Siemens AG, Forchheim, Germany), which uses a periodic motion of the focal spot in longitudinal direction (z-flying focal spot) to double the number of simultaneously acquired slices. This technique acquires 64 overlapping 0.6 mm slices per rotation. The sampling scheme corresponds to that of a 64 x 0.3 mm detector, with the goal of improved longitudinal resolution and reduced spiral artifacts. After an introduction to the detector design, we discuss the basics of z-flying focal spot technology (z-Sharp). We present phantom and specimen scans for performance evaluation. The measured full width at half maximum (FWHM) of the thinnest spiral slice is 0.65 mm. All spiral slice widths are almost independent of the pitch, with deviations of less than 0.1 mm from the nominal value. Using a high-resolution bar pattern phantom (CATPHAN, Phantom Laboratories, Salem, NY), the longitudinal resolution can be demonstrated to be up to 15 lp/cm at the isocenter independent of the pitch, corresponding to a bar diameter of 0.33 mm. Longitudinal resolution is only slightly degraded for off-center locations. At a distance of 100 mm from the isocenter, 14 lp/cm can be resolved in the z-direction, corresponding to a bar diameter of 0.36 mm. Spiral "windmill" artifacts presenting as hyper- and hypodense structures around osseous edges are effectively reduced by the z-flying focal spot technique. Cardiac scanning benefits from the short gantry rotation time of 0.33 s, providing up to 83 ms temporal resolution with 2-segment ECG

  4. Radiation Exposure of Ovarian Cancer Patients: Contribution of CT Examinations Performed on Different MDCT (16 and 64 Slices) Scanners and Image Quality Evaluation

    PubMed Central

    Rizzo, Stefania; Origgi, Daniela; Brambilla, Sarah; De Maria, Federica; Foà, Riccardo; Raimondi, Sara; Colombo, Nicoletta; Bellomi, Massimo

    2015-01-01

    Abstract The objective of this study is to compare radiation doses given to ovarian cancer patients by different computed tomographies (CTs) and to evaluate association between doses and subjective and objective image quality. CT examinations included were performed either on a 16-slice CT, equipped with automatic z-axis tube current modulation, or on a 64-slice CT, equipped with z-axis, xy-axis modulation, and adaptive statistical iterative algorithm (ASIR). Evaluation of dose included the following dose descriptors: volumetric CT dose index (CTDIvol), dose length product (DLP), and effective dose (E). Objective image noise was evaluated in abdominal aorta and liver. Subjective image quality was evaluated by assessment of image noise, spatial resolution and diagnostic acceptability. Mean and median CTDIvol, DLP, and E; correlation between CTDIvol and DLP and patients’ weight; comparison of objective noise for the 2 scanners; association between dose descriptors and subjective image quality. The 64-slice CT delivered to patients 24.5% lower dose (P < 0.0001) than 16-slice CT. There was a significant correlation between all dose descriptors (CTDIvol, DLP, E) and weight (P < 0.0001). Objective noise was comparable for the 2 CT scanners. There was a significant correlation between dose descriptors and image noise for the 64-slice CT, and between dose descriptors and spatial resolution for the 16-slice CT. Current dose reduction systems may reduce radiation dose without significantly affecting image quality and diagnostic acceptability of CT exams. PMID:25929914

  5. Radiation exposure of ovarian cancer patients: contribution of CT examinations performed on different MDCT (16 and 64 slices) scanners and image quality evaluation: an observational study.

    PubMed

    Rizzo, Stefania; Origgi, Daniela; Brambilla, Sarah; De Maria, Federica; Foà, Riccardo; Raimondi, Sara; Colombo, Nicoletta; Bellomi, Massimo

    2015-05-01

    The objective of this study is to compare radiation doses given to ovarian cancer patients by different computed tomographies (CTs) and to evaluate association between doses and subjective and objective image quality.CT examinations included were performed either on a 16-slice CT, equipped with automatic z-axis tube current modulation, or on a 64-slice CT, equipped with z-axis, xy-axis modulation, and adaptive statistical iterative algorithm (ASIR). Evaluation of dose included the following dose descriptors: volumetric CT dose index (CTDIvol), dose length product (DLP), and effective dose (E). Objective image noise was evaluated in abdominal aorta and liver. Subjective image quality was evaluated by assessment of image noise, spatial resolution and diagnostic acceptability.Mean and median CTDIvol, DLP, and E; correlation between CTDIvol and DLP and patients' weight; comparison of objective noise for the 2 scanners; association between dose descriptors and subjective image quality.The 64-slice CT delivered to patients 24.5% lower dose (P < 0.0001) than 16-slice CT. There was a significant correlation between all dose descriptors (CTDIvol, DLP, E) and weight (P < 0.0001). Objective noise was comparable for the 2 CT scanners. There was a significant correlation between dose descriptors and image noise for the 64-slice CT, and between dose descriptors and spatial resolution for the 16-slice CT.Current dose reduction systems may reduce radiation dose without significantly affecting image quality and diagnostic acceptability of CT exams. PMID:25929914

  6. Computed tomography in patients with cardiac pacemakers: difficulties and solutions.

    PubMed

    Mlynarski, Rafal; Sosnowski, Maciej; Mlynarska, Agnieszka; Tendera, Michał

    2012-05-01

    The presence of cardiac pacemaker systems may significantly limit interpretation of multi-slice computed tomography (MSCT) images. In 80 patients (45 men; aged 69.5 ± 13.4) with previously implanted anti-arrhythmic devices, a 64-slice CT (Aquilion-64) was performed. In 61 patients (76.3%), ECG gating was used (coronaries visualization) and in 19 patients (23.7%) without ECG gating (not coronaries visualization). In all 19 patients without ECG gating MSCT images were diagnostic. In 37 (60.6%) patients of 61, there was no problem with gating process and image quality was diagnostic. In 24 (39.4%) with visible spikes in the ECG-gating group, there were difficulties in differentiating the R spike from an artificial spike (unipolar pacing) by MSCT software. In 15 patients (24.6%) after reprogramming, it was possible to obtain good quality images. In nine (14.7%) patients, it was not possible to reprogram devices due to old unipolar leads, but in two cases (3.3%), ECG gating was corrected manually and good image quality was obtained. In seven (11.5%) patients, it was not possible to perform ECG gating. The ECG gating process was identified as the main cause of the imaging problems. Bipolar leads working as bipolar pacing seem to be necessary to perform MSCT with ECG gating. A unipolar system lead may cause serious problems with reconstructions. PMID:21505855

  7. Impact of the z-flying focal spot on resolution and artifact behavior for a 64-slice spiral CT scanner.

    PubMed

    Kyriakou, Yiannis; Kachelriess, Marc; Knaup, Michael; Krause, Jens U; Kalender, Willi A

    2006-06-01

    The effect of the z-flying focal spot (zFFS) technology was evaluated by simulations and measurements with respect to resolution and artifact behavior for a 64-slice spiral cone-beam computed tomography (CT) scanner. The zFFS alternates between two z-positions of the X-ray focal spot, acquiring two slices per detector row, which results in double sampling in the z-direction. We implemented a modified reconstruction that is able to obtain images as they would be without zFFS. A delta phantom equipped with a thin gold disc was used to measure slice sensitivity profiles (SSP), and a high-contrast bar phantom was used to quantify the resolution in the x/z-plane with and without zFFS. The zFFS decreases the full width at half maximum (FWHM) of the SSPs by a factor of about 1.4. The double z-sampling allows the separation of 0.4 mm bars in the z-direction compared with 0.6 mm in the case without zFFS. The zFFS effectively reduces windmill artifacts in the reconstructed images while maintaining the transverse resolution, even at the largest available pitch value of 1.5. PMID:16541229

  8. A model for quantitative correction of coronary calcium scores on multidetector, dual source, and electron beam computed tomography for influences of linear motion, calcification density, and temporal resolution: A cardiac phantom study

    SciTech Connect

    Greuter, M. J. W.; Groen, J. M.; Nicolai, L. J.; Dijkstra, H.; Oudkerk, M.

    2009-11-15

    Purpose: The objective of this study is to quantify the influence of linear motion, calcification density, and temporal resolution on coronary calcium determination using multidetector computed tomography (MDCT), dual source CT (DSCT), and electron beam tomography (EBT) and to find a quantitative method which corrects for the influences of these parameters using a linear moving cardiac phantom. Methods: On a robotic arm with artificial arteries with four calcifications of increasing density, a linear movement was applied between 0 and 120 mm/s (step of 10 mm/s). The phantom was scanned five times on 64-slice MDCT, DSCT, and EBT using a standard acquisition protocol. The average Agatston, volume, and mass scores were determined for each velocity, calcification, and scanner. Susceptibility to motion was quantified using a cardiac motion susceptibility (CMS) index. Resemblance to EBT and physical volume and mass was quantified using a {Delta} index. Results: Increasing motion artifacts were observed at increasing velocities on all scanners, with increasing severity from EBT to DSCT to 64-slice MDCT. The calcium score showed a linear dependency on motion from which a correction factor could be derived. This correction factor showed a linear dependency on the mean calcification density with a good fit for all three scoring methods and all three scanners (0.73{<=}R{sup 2}{<=}0.95). The slope and offset of this correction factor showed a linear dependency on temporal resolution with a good fit for all three scoring methods and all three scanners (0.83{<=}R{sup 2}{<=}0.98). CMS was minimal for EBT and increasing values were observed for DSCT and highest values for 64-slice MDCT. CMS was minimal for mass score and increasing values were observed for volume score and highest values for Agatston score. For all densities and scoring methods DSCT showed on average the closest resemblance to EBT calcium scores. When using the correction factor, CMS index decreased on average by

  9. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    PubMed Central

    Yi, Ji Sook; Han, Jong Kyu; Kim, Hyun-Joo

    2015-01-01

    Objective To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Materials and Methods Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. Results The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Conclusion Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI. PMID:26175589

  10. Quantitative analysis of myocardial perfusion SPECT anatomically guided by co-registered 64-slice coronary CT angiography

    PubMed Central

    Slomka, Piotr J.; Cheng, Victor Y.; Dey, Damini; Woo, Jonghye; Ramesh, Amit; Kriekinge, Serge Van; Suzuki, Yasuzuki; Elad, Yaron; Karlsberg, Ronald; Berman, Daniel S.; Germano, Guido

    2012-01-01

    Aim Sequential testing by coronary computed tomography angiography (CTA) and myocardial perfusion SPECT (MPS) obtained on standalone scanners may be needed to diagnose coronary artery disease (CAD) in equivocal cases. We have developed an automated technique for MPS-CTA registration and demonstrate its utility for improved MPS quantification by guiding the co-registered physiological (MPS) with anatomical CTA information. Methods Automated registration of MPS left ventricular (LV) surfaces with CTA coronary trees was accomplished by iterative minimization of voxel differences between pre-segmented CTA volumes and “motion-frozen” MPS data. Studies of 35 sequential patients (26 males), mean age 67±12 years with 64-slice coronary CTA, MPS and with available results of the invasive coronary angiography performed within 3 months were retrospectively analyzed. 3D coronary vessels and CTA slices were extracted and fused with quantitative MPS results mapped on LV surfaces and MPS coronary regions. Automatically co-registered CTA images and extracted trees were used to correct the MPS contours and to adjust the standard vascular region definitions for MPS quantification. Results Automated co-registration of MPS and coronary CTA had the success rate of 96% as assessed visually; the average errors were 4.3±3.3 mm in translation and 1.5±2.6 deg in rotation on stress and 4.2±3.1 mm in translation and 1.7±3.2 deg in rotation on rest. MPS vascular region definition was adjusted in 17 studies and LV contours were adjusted in 11 studies using co-registered CTA images as a guide. CTA-guided MP analysis resulted in improved area under the receiver operator characteristics (ROC) curves for the detection of RCA and LCX lesions as compared to standard MPS analysis 0.84±0.08 vs. 0.70±0.11 for LCX (p = 0.03) and 0.92±0.05 vs. 0.75±0.09 (p=0.02) for RCA. Conclusions Software image co-registration of standalone coronary CTA and MPS obtained on separate scanners can be performed

  11. Computed tomography of cardiac pseudotumors and neoplasms.

    PubMed

    Anavekar, Nandan S; Bonnichsen, Crystal R; Foley, Thomas A; Morris, Michael F; Martinez, Matthew W; Williamson, Eric E; Glockner, James F; Miller, Dylan V; Breen, Jerome F; Araoz, Philip A

    2010-07-01

    Important features of cardiac masses can be clearly delineated on cardiac computed tomography (CT) imaging. This modality is useful in identifying the presence of a mass, its relationship with cardiac and extracardiac structures, and the features that distinguish one type of mass from another. A multimodality approach to the evaluation of cardiac tumors is advocated, with the use of echocardiography, CT imaging and magnetic resonance imaging as appropriately indicated. In this article, various cardiac masses are described, including pseudotumors and true cardiac neoplasms, and the CT imaging findings that may be useful in distinguishing these rare entities are presented. PMID:20705174

  12. Computer simulations to estimate organ doses from clinically validated cardiac, neuro, and pediatric protocols for multiple detector computed tomography scanners

    NASA Astrophysics Data System (ADS)

    Ghita, Monica

    Recent advances in Computed Tomography (CT) technology, particularly that of multiple detector CT (MDCT) scanning, have provided increased utilization and more diverse clinical applications including more advanced vascular and cardiac exams, perfusion imaging, and screening exams. Notwithstanding the benefits to the patient undergoing a CT study, the fundamental concern in radiation protection is the minimization of the radiation exposure delivered as well as the implementation of structures to prevent inappropriate ordering and clinical use of these advanced studies. This research work developed a computational methodology for routine clinical use to assess patient organ doses from MDCT scanners. To support the methodology, a computer code (DXS-Diagnostic X-ray Spectra) was developed to accurately and conveniently generate x-ray spectra in the diagnostic energy range (45-140 keV). The two accepted standard radiation transport calculation methods namely, deterministic and Monte Carlo, have been preliminarily investigated for their capability and readiness to support the proposed goal of the work. Thorough tests demonstrated that the lack of appropriate discrete photon interaction coefficients in the aforementioned diagnostic energy range impedes the applicability of the deterministic approach to routine clinical use; improvements in the multigroup treatment may make it more viable. Thus, the open source Monte Carlo code, MCNP5, was adapted to appropriately model an MDCT scan. For this, a new method, entirely based on routine clinical CT measurements, was developed and validated to generate an "equivalent source and filtration" model that obviates the need of proprietary information for a given CT scanner. Computer simulations employing the Monte Carlo methodology and UF's tomographic human phantoms were performed to assess, compare, and optimize pediatric, cardiac and neuro-imaging protocols for the new 320-slice scanner at Shands/UF based on dose considerations

  13. Cardiac Computed Tomography (Multidetector CT, or MDCT)

    MedlinePlus

    ... High Blood Pressure Tools & Resources Stroke More Cardiac Computed Tomography (Multidetector CT, or MDCT) Updated:Sep 3,2015 ... facts MDCT is a very fast type of computed tomography (CT) scan. MDCT creates pictures of the healthy ...

  14. Applications of Computational Modeling in Cardiac Surgery

    PubMed Central

    Lee, Lik Chuan; Genet, Martin; Dang, Alan B.; Ge, Liang; Guccione, Julius M.; Ratcliffe, Mark B.

    2014-01-01

    Although computational modeling is common in many areas of science and engineering, only recently have advances in experimental techniques and medical imaging allowed this tool to be applied in cardiac surgery. Despite its infancy in cardiac surgery, computational modeling has been useful in calculating the effects of clinical devices and surgical procedures. In this review, we present several examples that demonstrate the capabilities of computational cardiac modeling in cardiac surgery. Specifically, we demonstrate its ability to simulate surgery, predict myofiber stress and pump function, and quantify changes to regional myocardial material properties. In addition, issues that would need to be resolved in order for computational modeling to play a greater role in cardiac surgery are discussed. PMID:24708036

  15. Clinically applicable gated cardiac computed tomography

    SciTech Connect

    Cipriano, P.R.; Nassi, M.; Brody, W.R.

    1983-03-01

    Several attempts have been made to improve cardiac images obtained with x-ray transmission computed tomography (CT) by stopping cardiac motion through electrocardiographic gating. These methods reconstruct images that correspond to time intervals of the cardiac cycle identified by electrocardiography using either a pulsed x-ray beam at a selected time in the cardiac cycle or selected measurements in retrospect from regularly pulsed measurements made over several cardiac cycles. Missing CT angles of view (line integrals) have been a major problem contributing to degradation of such gated cardiac CT images. A new method for CT reconstruction from an incomplete set of projection data is presented that can be used clinically with a standard fan-beam reconstruction algorithm to improve gated cardiac CT images.

  16. Computing effective dose in cardiac CT

    NASA Astrophysics Data System (ADS)

    Huda, Walter; Tipnis, Sameer; Sterzik, Alexander; Schoepf, U. Joseph

    2010-07-01

    We present a method of estimating effective doses in cardiac CT that accounts for selected techniques (kV mAs-1), anatomical location of the scan and patient size. A CT dosimetry spreadsheet (ImPACT CT Patient Dosimetry Calculator) was used to estimate effective doses (E) using ICRP 103 weighting factors for a 70 kg patient undergoing cardiac CT examinations. Using dose length product (DLP) for the same scans, we obtained values of E/DLP for three CT scanners used in cardiac imaging from two vendors. E/DLP ratios were obtained as a function of the anatomical location in the chest and for x-ray tube voltages ranging from 80 to 140 kV. We also computed the ratio of the average absorbed dose in a water cylinder modeling a patient weighing W kg to the corresponding average absorbed dose in a water cylinder equivalent to a 70 kg patient. The average E/DLP for a 16 cm cardiac heart CT scan was 26 µSv (mGy cm)-1, which is about 70% higher than the current E/DLP values used for chest CT scans (i.e. 14-17 µSv (mGy cm)-1). Our cardiac E/DLP ratios are higher because the cardiac region is ~30% more radiosensitive than the chest, and use of the ICRP 103 tissue weighting factors increases cardiac CT effective doses by ~30%. Increasing the x-ray tube voltage from 80 to 140 kV increases the E/DLP conversion factor for cardiac CT by 17%. For the same incident radiation at 120 kV, doses in 45 kg adults were ~22% higher than those in 70 kg adults, whereas doses in 120 kg adults were ~28% lower. Accurate estimates of the patient effective dose in cardiac CT should use ICRP 103 tissue weighting factors, and account for a choice of scan techniques (kV mAs-1), exposed scan region, as well as patient size.

  17. Three-dimensional cardiac computational modelling: methods, features and applications.

    PubMed

    Lopez-Perez, Alejandro; Sebastian, Rafael; Ferrero, Jose M

    2015-01-01

    The combination of computational models and biophysical simulations can help to interpret an array of experimental data and contribute to the understanding, diagnosis and treatment of complex diseases such as cardiac arrhythmias. For this reason, three-dimensional (3D) cardiac computational modelling is currently a rising field of research. The advance of medical imaging technology over the last decades has allowed the evolution from generic to patient-specific 3D cardiac models that faithfully represent the anatomy and different cardiac features of a given alive subject. Here we analyse sixty representative 3D cardiac computational models developed and published during the last fifty years, describing their information sources, features, development methods and online availability. This paper also reviews the necessary components to build a 3D computational model of the heart aimed at biophysical simulation, paying especial attention to cardiac electrophysiology (EP), and the existing approaches to incorporate those components. We assess the challenges associated to the different steps of the building process, from the processing of raw clinical or biological data to the final application, including image segmentation, inclusion of substructures and meshing among others. We briefly outline the personalisation approaches that are currently available in 3D cardiac computational modelling. Finally, we present examples of several specific applications, mainly related to cardiac EP simulation and model-based image analysis, showing the potential usefulness of 3D cardiac computational modelling into clinical environments as a tool to aid in the prevention, diagnosis and treatment of cardiac diseases. PMID:25928297

  18. Cardiac Injuries: A Review of Multidetector Computed Tomography Findings

    PubMed Central

    Baxi, Ameya Jagdish; Restrepo, Carlos; Mumbower, Amy; McCarthy, Michael; Rashmi, Katre

    2015-01-01

    Trauma is the leading cause of death in United States in the younger population. Cardiac trauma is common following blunt chest injuries and is associated with high morbidity and mortality. This study discusses various multidetector computed tomography (MDCT) findings of cardiac trauma. Cardiac injuries are broadly categorized into the most commonly occurring blunt cardiac injury and the less commonly occurring penetrating injury. Signs and symptoms of cardiac injury can be masked by the associated injuries. Each imaging modality including chest radiographs, echocardiography, magnetic resonance imaging and MDCT has role in evaluating these patients. However, MDCT is noninvasive; universally available and has a high spatial, contrast, and temporal resolution. It is a one stop shop to diagnose and evaluate complications of cardiac injury. MDCT is an imaging modality of choice to evaluate patients with cardiac injuries especially the injuries capable of causing hemodynamic instability. PMID:26839855

  19. [Cardiac magnetic resonance imaging and cardiac computed tomography in clinical practice].

    PubMed

    Barone-Rochette, G; Jankowski, A; Rodiere, M

    2014-11-01

    Technological advances have enabled the rapid development of cardiovascular imaging techniques. Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have become diagnostic and prognostic tools for the management of patients in routine clinical practice. This review gives the main indications and describes the performance of both techniques. PMID:25023720

  20. Advances in imaging protocols for cardiac MDCT: from 16- to 64-row multidetector computed tomography.

    PubMed

    Kopp, Andreas F; Heuschmid, Martin; Reimann, Anja; Kuettner, Axel; Beck, Thorsten; Burgstahler, Christoph; Brodoefel, Harald; Claussen, Claus D; Schroeder, Stephen

    2005-12-01

    Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the Western world. Since the majority of all invasive diagnostic coronary angiography procedures are not followed by therapeutic interventions, interest is growing in noninvasive technologies to diagnose and visualize CAD. The most promising of these is multislice spiral computed tomography (MSCT), which can visualize human coronary arteries in vivo noninvasively. Since 1999, this technique has improved rapidly, offering faster gantry rotation times and smaller voxel sizes. The image quality has become significantly more stable and MSCT has become a robust imaging modality. Beginning with 4-slice scanners in 1999, the latest scanner generation employs 64 slices. The present article summarizes the technical principles, image protocols and possible clinical applications of the current 64-row scanners. PMID:18637233

  1. Evaluation of organ doses and specific k effective dose of 64-slice CT thorax examination using an adult anthropomorphic phantom

    NASA Astrophysics Data System (ADS)

    Hashim, S.; Karim, M. K. A.; Bakar, K. A.; Sabarudin, A.; Chin, A. W.; Saripan, M. I.; Bradley, D. A.

    2016-09-01

    The magnitude of radiation dose in computed tomography (CT) depends on the scan acquisition parameters, investigated herein using an anthropomorphic phantom (RANDO®) and thermoluminescence dosimeters (TLD). Specific interest was in the organ doses resulting from CT thorax examination, the specific k coefficient for effective dose estimation for particular protocols also being determined. For measurement of doses representing five main organs (thyroid, lung, liver, esophagus and skin), TLD-100 (LiF:Mg, Ti) were inserted into selected holes in a phantom slab. Five CT thorax protocols were investigated, one routine (R1) and four that were modified protocols (R2 to R5). Organ doses were ranked from greatest to least, found to lie in the order: thyroid>skin>lung>liver>breast. The greatest dose, for thyroid at 25 mGy, was that in use of R1 while the lowest, at 8.8 mGy, was in breast tissue using R3. Effective dose (E) was estimated using three standard methods: the International Commission on Radiological Protection (ICRP)-103 recommendation (E103), the computational phantom CT-EXPO (E(CTEXPO)) method, and the dose-length product (DLP) based approach. E103 k factors were constant for all protocols, ~8% less than that of the universal k factor. Due to inconsistency in tube potential and pitch factor the k factors from CTEXPO were found to vary between 0.015 and 0.010 for protocols R3 and R5. With considerable variation between scan acquisition parameters and organ doses, optimization of practice is necessary in order to reduce patient organ dose.

  2. Imaging study on the optic canal using sixty four-slice spiral computed tomography

    PubMed Central

    Jiang, Peng-Fei; Dai, Xiu-Yu; Lv, Yongbin; Liu, Shaoyi; Mu, Xiao-Yan

    2015-01-01

    Background: Rapid advances in multislice computed tomography (MSCT) technology facilitate accurate clinical imaging. The newly developed 64-slice CT increases temporal and spatial resolution efficiently. Purpose: The purpose of this study is to evaluate the application of 64 slice spiral computed tomography (CT) on the imaging of the normal optics canal. Methods and materials: 100 healthy adults were investigated using 64 slice spiral CT. The optics canal was scanned, reconstructed and examined. Results: Among the four walls of the optic canal, the medial wall is the longest one. The upper wall and outer wall are inferior to the medial wall while the inferior wall is the shortest one. All the data accomplished by the 64 slice CT was consistent with the results of previous reports using other methods. Conclusion: The results suggested that the 64 slice spiral CT could be a valuable and accurate method for measuring the length of optics canal walls. PMID:26885062

  3. Computational modeling of cardiac hemodynamics: Current status and future outlook

    NASA Astrophysics Data System (ADS)

    Mittal, Rajat; Seo, Jung Hee; Vedula, Vijay; Choi, Young J.; Liu, Hang; Huang, H. Howie; Jain, Saurabh; Younes, Laurent; Abraham, Theodore; George, Richard T.

    2016-01-01

    The proliferation of four-dimensional imaging technologies, increasing computational speeds, improved simulation algorithms, and the widespread availability of powerful computing platforms is enabling simulations of cardiac hemodynamics with unprecedented speed and fidelity. Since cardiovascular disease is intimately linked to cardiovascular hemodynamics, accurate assessment of the patient's hemodynamic state is critical for the diagnosis and treatment of heart disease. Unfortunately, while a variety of invasive and non-invasive approaches for measuring cardiac hemodynamics are in widespread use, they still only provide an incomplete picture of the hemodynamic state of a patient. In this context, computational modeling of cardiac hemodynamics presents as a powerful non-invasive modality that can fill this information gap, and significantly impact the diagnosis as well as the treatment of cardiac disease. This article reviews the current status of this field as well as the emerging trends and challenges in cardiovascular health, computing, modeling and simulation and that are expected to play a key role in its future development. Some recent advances in modeling and simulations of cardiac flow are described by using examples from our own work as well as the research of other groups.

  4. The feasibility of a 64-slice MDCT for detection of the Adamkiewicz artery: comparison of the detection rate of intravenous injection CT angiography using a 64-slice MDCT versus intra-arterial and intravenous injection CT angiography using a 16-slice MDCT.

    PubMed

    Nishii, Tatsuya; Kono, Atsushi K; Negi, Noriyuki; Hashimura, Hiromi; Uotani, Kensuke; Okita, Yutaka; Sugimura, Kazuro

    2013-12-01

    Identification of the Adamkiewicz artery (AKA) using CT angiography (CTA) is crucial in patients with thoracic aortic aneurysm (TAA) or aortic dissection (AD). The purpose of this study was to compare the AKA detection rate of intravenous injection with a 64-slice MDCT (IV64) versus a 16-slice MDCT (IV16) as well as by CTA using intra-arterial injection with a 16-slice MDCT (IA16). A retrospective review of 160 consecutive patients who underwent CTA was performed. There were 108 TAA and 52 AD cases, 105 of whom were examined with IV64, 15 with IV16, and 40 with IA16. The AKA detectability for each imaging method was assessed, and the factors influencing the detectability were analyzed by multivariate analysis. The detection rates for IV64, IV16, and IA16 were 85.7, 60.0, and 80.0 %, respectively, with IV64 being more sensitive than IV16 (P = 0.025). The detection rate for AD patients was 66.7 % with IV64, which was similar to IV16 (57.1 %) and IA16 (66.8 %). On the other hand, the detection rate for TAA patients was 93.3 % with IV64, which was higher than IV16 (62.5 %, P = 0.021) and similar to IA16 (88.0 %). Multivariate analysis demonstrated the independent factors for AKA detectability were TAA versus AD (P = 0.005, Odds ratio = 3.98) and IV64 versus IV16 (P = 0.037, Odds ratio = 4.03). The detection rate was higher for IV64 than for IV16, especially for TAA patients, while the rate was similar between IV64 and invasive IA16. A 64-slice MDCT thus provides a less invasive visualization of the AKA. PMID:24081485

  5. Influence of computer work under time pressure on cardiac activity.

    PubMed

    Shi, Ping; Hu, Sijung; Yu, Hongliu

    2015-03-01

    Computer users are often under stress when required to complete computer work within a required time. Work stress has repeatedly been associated with an increased risk for cardiovascular disease. The present study examined the effects of time pressure workload during computer tasks on cardiac activity in 20 healthy subjects. Heart rate, time domain and frequency domain indices of heart rate variability (HRV) and Poincaré plot parameters were compared among five computer tasks and two rest periods. Faster heart rate and decreased standard deviation of R-R interval were noted in response to computer tasks under time pressure. The Poincaré plot parameters showed significant differences between different levels of time pressure workload during computer tasks, and between computer tasks and the rest periods. In contrast, no significant differences were identified for the frequency domain indices of HRV. The results suggest that the quantitative Poincaré plot analysis used in this study was able to reveal the intrinsic nonlinear nature of the autonomically regulated cardiac rhythm. Specifically, heightened vagal tone occurred during the relaxation computer tasks without time pressure. In contrast, the stressful computer tasks with added time pressure stimulated cardiac sympathetic activity. PMID:25614130

  6. Computer-aided assessment of cardiac computed tomographic images

    NASA Astrophysics Data System (ADS)

    King, Martin; Giger, Maryellen; Suzuki, Kenji; Pan, Xiaochuan

    2007-03-01

    The accurate interpretation of cardiac CT images is commonly hindered by the presence of motion artifacts. Since motion artifacts commonly can obscure the presence of coronary lesions, physicians must spend much effort analyzing images at multiple cardiac phases in order to determine which coronary structures are assessable for potential lesions. In this study, an artificial neural network (ANN) classifier was designed to assign assessability indices to calcified plaques in individual region-of-interest (ROI) images reconstructed at multiple cardiac phases from two cardiac scans obtained at heart rates of 66 bpm and 90 bpm. Six individual features (volume, circularity, mean intensity, margin gradient, velocity, and acceleration) were used for analyzing images. Visually-assigned assessability indices were used as a continuous truth, and jack-knife analysis with four testing sets was used to evaluate the performance of the ANN classifier. In a study in which all six features were inputted into the ANN classifier, correlation coefficients of 0.962 +/- 0.006 and 0.935 +/- 0.023 between true and ANN-assigned assessability indices were obtained for databases corresponding to 66 bpm and 90 bpm, respectively.

  7. New applications for noninvasive cardiac imaging: dual-source computed tomography.

    PubMed

    Rist, Carsten; Johnson, Thorsten R; Becker, Christoph R; Reiser, Maximilian F; Nikolaou, Konstantin

    2007-12-01

    Coronary catheter angiography is considered to be the standard of reference for the diagnosis of coronary artery disease (CAD) and the grading of coronary artery stenoses. Even with the established generation of 16- and 64-multislice CT (MSCT) systems, with remarkable results reported for diagnostic accuracy, a substantial number of limitations remain, hindering full acceptance of the method as a standard technique in the clinical cascade for CAD patients. Recently, dual-source CT (DSCT) with improved temporal resolution has been introduced into clinical routine, raising the hope that some of the earlier problems might be overcome. MSCTA with 64-slice CT scanners has successfully been validated for the evaluation of clinically relevant lumen reduction of the coronary arteries with high negative predictive values and for the simultaneous assessment of pulmonary embolism, coronary artery stenoses, and aortic dissection and aneurysm in patients with chest pain ("triple rule out"). However, certain limitations continue to exist including partial volume effects due to heavy calcium deposits in the coronary artery wall, impaired assessability of coronary artery branches smaller than 2 mm in diameter, and impaired assessability of patients with a high heart rate and/or arrhythmia. While MSCT has mainly been tested to detect obstructive CAD, an accurate assessment of regional and global ventricular function, as well as of the aortic and mitral valves, might be feasible using DSCT, since image reconstruction is possible in virtually any phase of the cardiac cycle with a sufficiently high temporal resolution. DSCT is a robust method for the evaluation of patients with higher heart rates and arrhythmias and, in most cases, obviates the need for beta-blocker premedication. While the evaluation of coronary artery stenoses will remain the primary clinical indication for cardiac DSCT, a simultaneous and sufficiently accurate assessment of global left ventricular functional

  8. Verification of computational models of cardiac electro-physiology.

    PubMed

    Pathmanathan, Pras; Gray, Richard A

    2014-05-01

    For computational models of cardiac activity to be used in safety-critical clinical decision-making, thorough and rigorous testing of the accuracy of predictions is required. The field of 'verification, validation and uncertainty quantification' has been developed to evaluate the credibility of computational predictions. The first stage, verification, is the evaluation of how well computational software correctly solves the underlying mathematical equations. The aim of this paper is to introduce novel methods for verifying multi-cellular electro-physiological solvers, a crucial first stage for solvers to be used with confidence in clinical applications. We define 1D-3D model problems with exact solutions for each of the monodomain, bidomain, and bidomain-with-perfusing-bath formulations of cardiac electro-physiology, which allow for the first time the testing of cardiac solvers against exact errors on fully coupled problems in all dimensions. These problems are carefully constructed so that they can be easily run using a general solver and can be used to greatly increase confidence that an implementation is correct, which we illustrate by testing one major solver, 'Chaste', on the problems. We then perform case studies on calculation verification (also known as solution verification) for two specific applications. We conclude by making several recommendations regarding verification in cardiac modelling. PMID:24259465

  9. Computational tools to investigate genetic cardiac channelopathies

    PubMed Central

    Abriel, Hugues; de Lange, Enno; Kucera, Jan P.; Loussouarn, Gildas; Tarek, Mounir

    2013-01-01

    The aim of this perspective article is to share with the community of ion channel scientists our thoughts and expectations regarding the increasing role that computational tools will play in the future of our field. The opinions and comments detailed here are the result of a 3-day long international exploratory workshop that took place in October 2013 and that was supported by the Swiss National Science Foundation. PMID:24421770

  10. Extracellular volume quantification by dynamic equilibrium cardiac computed tomography in cardiac amyloidosis

    PubMed Central

    Treibel, Thomas A.; Bandula, Steve; Fontana, Marianna; White, Steven K.; Gilbertson, Janet A.; Herrey, Anna S.; Gillmore, Julian D.; Punwani, Shonit; Hawkins, Philip N.; Taylor, Stuart A.; Moon, James C.

    2015-01-01

    Background Cardiac involvement determines outcome in patients with systemic amyloidosis. There is major unmet need for quantification of cardiac amyloid burden, which is currently only met in part through semi-quantitative bone scintigraphy or Cardiovascular Magnetic Resonance (CMR), which measures ECVCMR. Other accessible tests are needed. Objectives To develop cardiac computed tomography to diagnose and quantify cardiac amyloidosis by measuring the myocardial Extracellular Volume, ECVCT. Methods Twenty-six patients (21 male, 64 ± 14 years) with a biopsy-proven systemic amyloidosis (ATTR n = 18; AL n = 8) were compared with twenty-seven patients (19 male, 68 ± 8 years) with severe aortic stenosis (AS). All patients had undergone echocardiography, bone scintigraphy, NT-pro-BNP measurement and EQ-CMR. Dynamic Equilibrium CT (DynEQ-CT) was performed using a prospectively gated cardiac scan prior to and after (5 and 15 minutes) a standard Iodixanol (1 ml/kg) bolus to measure ECVCT. ECVCT was compared to the reference ECVCMR and conventional amyloid measures: bone scintigraphy and clinical markers of cardiac amyloid severity (NT-pro-BNP, Troponin, LVEF, LV mass, LA and RA area). Results ECVCT and ECVCMR results were well correlated (r2 = 0.85 vs r2 = 0.74 for 5 and 15 minutes post bolus respectively). ECVCT was higher in amyloidosis than AS (0.54 ± 0.11 vs 0.28 ± 0.04, p<0.001) with no overlap. ECVCT tracked clinical markers of cardiac amyloid severity (NT-pro-BNP, Troponin, LVEF, LV mass, LA and RA area), and bone scintigraphy amyloid burden (p<0.001). Conclusion Dynamic Equilibrium CT, a 5 minute contrast-enhanced gated cardiac CT, has potential for non-invasive diagnosis and quantification of cardiac amyloidosis. PMID:26209459

  11. Calcium Scoring and Cardiac Computed Tomography.

    PubMed

    Parikh, Swapnesh; Budoff, Matthew J

    2016-01-01

    Although recent advances in noninvasive imaging technologies have potentially improved diagnostic efficiency and clinical outcomes of patients with acute chest pain, controversy remains regarding much of the accumulated evidence. This article reviews the role of coronary computed tomography (CT) angiography in the assessment of coronary risk, and its usefulness in the emergency department in facilitating appropriate disposition decisions. Also discussed is coronary artery calcification incidentally found on CT scans when done for indications such as evaluation of pulmonary embolism or lung cancer. The evidence base and clinical applications for both techniques are described, together with cost-effectiveness and radiation exposure considerations. PMID:26567977

  12. Images as drivers of progress in cardiac computational modelling

    PubMed Central

    Lamata, Pablo; Casero, Ramón; Carapella, Valentina; Niederer, Steve A.; Bishop, Martin J.; Schneider, Jürgen E.; Kohl, Peter; Grau, Vicente

    2014-01-01

    Computational models have become a fundamental tool in cardiac research. Models are evolving to cover multiple scales and physical mechanisms. They are moving towards mechanistic descriptions of personalised structure and function, including effects of natural variability. These developments are underpinned to a large extent by advances in imaging technologies. This article reviews how novel imaging technologies, or the innovative use and extension of established ones, integrate with computational models and drive novel insights into cardiac biophysics. In terms of structural characterization, we discuss how imaging is allowing a wide range of scales to be considered, from cellular levels to whole organs. We analyse how the evolution from structural to functional imaging is opening new avenues for computational models, and in this respect we review methods for measurement of electrical activity, mechanics and flow. Finally, we consider ways in which combined imaging and modelling research is likely to continue advancing cardiac research, and identify some of the main challenges that remain to be solved. PMID:25117497

  13. Cardiac PET/Computed Tomography Applications and Cardiovascular Outcome.

    PubMed

    Schindler, Thomas Hellmut

    2015-07-01

    Cardiac PET/computed tomography (CT) in conjunction with different blood flow tracers is increasingly applied for the assessment of myocardial perfusion and myocardial flow reserve (MFR) in the detection of coronary artery disease (CAD). The ability of PET/CT to noninvasively determine regional myocardial blood flow at rest and during vasomotor stress allows the calculation of the MFR, which carries important prognostic information in patients with subclinical forms of cardiomyopathy. The measured MFR optimizes the identification and characterization of the extent and severity of CAD burden, and contributes to the flow-limiting effect of single lesions in multivessel CAD. PMID:26099678

  14. Cardiac Computed Tomography Angiography for Left Atrial Appendage Closure.

    PubMed

    Saw, Jacqueline; Lopes, Joao Pedro; Reisman, Mark; McLaughlin, Patrick; Nicolau, Savvas; Bezerra, Hiram G

    2016-08-01

    Atrial fibrillation is prevalent and percutaneous left atrial appendage (LAA) closure is increasingly performed worldwide. This procedure is technically challenging and the success and procedural complexities depend on anatomy of the LAA and surrounding structures. These are readily depicted on cardiac computed tomography angiography (CCTA), which offers unique imaging planes. CCTA allows not only preplanning anatomic LAA assessment, but can also be used to evaluate for pre-existing LAA thrombus, and done postprocedure for surveillance for device-related thrombus, residual leak, and complications. In this article, we review the practical utility of CCTA for LAA closure. PMID:26907169

  15. Cardiac computed tomography in patients with acute chest pain.

    PubMed

    Nieman, Koen; Hoffmann, Udo

    2015-04-14

    The efficient and reliable evaluation of patients with acute chest pain is one of the most challenging tasks in the emergency department. Coronary computed tomography (CT) angiography may play a major role, since it permits ruling out coronary artery disease with high accuracy if performed with expertise in properly selected and prepared patients. Several randomized trials have established early cardiac CT as a viable safe and potentially more efficient alternative to functional testing in the evaluation of acute chest pain. Ongoing investigations explore whether advanced anatomic and functional assessments such as high-risk coronary plaque, resting myocardial perfusion, and left ventricular function, or the simulation of the fractional coronary flow reserve will add information to the anatomic assessment for stenosis, which would allow expanding the benefits of cardiac CT from triage to treatment decisions. Especially, the combination of high-sensitive troponins and coronary computed tomography angiography may play a valuable role in future strategies for the management of patients presenting with acute chest pain. PMID:25687351

  16. Computed tomographic coronary angiography: experience at Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital

    PubMed Central

    2005-01-01

    Noninvasive cardiac computed tomographic imaging using multislice or electron beam technology has been shown to be highly specific and sensitive in diagnosing coronary heart disease. It is about a fifth of the cost of coronary angiography and is particularly well suited for evaluating patients with a low or low to moderate probability of having obstructive coronary atherosclerosis. In addition, it offers more information than calcium scoring: because of the intravenous contrast used, it temporarily increases the density of the lumen and allows differentiation of soft plaque from calcified plaque. The Baylor Hamilton Heart and Vascular Hospital now uses this modality to define coronary atherosclerosis in patients who would otherwise have needed invasive coronary angiography; several research protocols with the technique are also under way. Baylor has recently upgraded to the 64-slice scanner. It is expected that computed tomographic coronary angiography will replace a significant percentage of invasive cardiac catheterizations. PMID:16200178

  17. Computational modeling of muscular thin films for cardiac repair

    NASA Astrophysics Data System (ADS)

    Böl, Markus; Reese, Stefanie; Parker, Kevin Kit; Kuhl, Ellen

    2009-03-01

    Motivated by recent success in growing biohybrid material from engineered tissues on synthetic polymer films, we derive a computational simulation tool for muscular thin films in cardiac repair. In this model, the polydimethylsiloxane base layer is simulated in terms of microscopically motivated tetrahedral elements. Their behavior is characterized through a volumetric contribution and a chain contribution that explicitly accounts for the polymeric microstructure of networks of long chain molecules. Neonatal rat ventricular cardiomyocytes cultured on these polymeric films are modeled with actively contracting truss elements located on top of the sheet. The force stretch response of these trusses is motivated by the cardiomyocyte force generated during active contraction as suggested by the filament sliding theory. In contrast to existing phenomenological models, all material parameters of this novel model have a clear biophyisical interpretation. The predictive features of the model will be demonstrated through the simulation of muscular thin films. First, the set of parameters will be fitted for one particular experiment documented in the literature. This parameter set is then used to validate the model for various different experiments. Last, we give an outlook of how the proposed simulation tool could be used to virtually predict the response of multi-layered muscular thin films. These three-dimensional constructs show a tremendous regenerative potential in repair of damaged cardiac tissue. The ability to understand, tune and optimize their structural response is thus of great interest in cardiovascular tissue engineering.

  18. Design of a specialized computer for on-line monitoring of cardiac stroke volume

    NASA Technical Reports Server (NTRS)

    Webb, J. A., Jr.; Gebben, V. D.

    1972-01-01

    The design of a specialized analog computer for on-line determination of cardiac stroke volume by means of a modified version of the pressure pulse contour method is presented. The design consists of an analog circuit for computation and a timing circuit for detecting necessary events on the pressure waveform. Readouts of arterial pressures, systolic duration, heart rate, percent change in stroke volume, and percent change in cardiac output are provided for monitoring cardiac patients. Laboratory results showed that computational accuracy was within 3 percent, while animal experiments verified the operational capability of the computer. Patient safety considerations are also discussed.

  19. Human cardiac systems electrophysiology and arrhythmogenesis: iteration of experiment and computation

    PubMed Central

    Holzem, Katherine M.; Madden, Eli J.; Efimov, Igor R.

    2014-01-01

    Human cardiac electrophysiology (EP) is a unique system for computational modelling at multiple scales. Due to the complexity of the cardiac excitation sequence, coordinated activity must occur from the single channel to the entire myocardial syncytium. Thus, sophisticated computational algorithms have been developed to investigate cardiac EP at the level of ion channels, cardiomyocytes, multicellular tissues, and the whole heart. Although understanding of each functional level will ultimately be important to thoroughly understand mechanisms of physiology and disease, cardiac arrhythmias are expressly the product of cardiac tissue—containing enough cardiomyocytes to sustain a reentrant loop of activation. In addition, several properties of cardiac cellular EP, that are critical for arrhythmogenesis, are significantly altered by cell-to-cell coupling. However, relevant human cardiac EP data, upon which to develop or validate models at all scales, has been lacking. Thus, over several years, we have developed a paradigm for multiscale human heart physiology investigation and have recovered and studied over 300 human hearts. We have generated a rich experimental dataset, from which we better understand mechanisms of arrhythmia in human and can improve models of human cardiac EP. In addition, in collaboration with computational physiologists, we are developing a database for the deposition of human heart experimental data, including thorough experimental documentation. We anticipate that accessibility to this human heart dataset will further human EP computational investigations, as well as encourage greater data transparency within the field of cardiac EP. PMID:25362174

  20. Analysis of left atrial respiratory and cardiac motion for cardiac ablation therapy

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Holmes, D. R.; Johnson, S. B.; Lehmann, H. I.; Robb, R. A.; Packer, D. L.

    2015-03-01

    Cardiac ablation therapy is often guided by models built from preoperative computed tomography (CT) or magnetic resonance imaging (MRI) scans. One of the challenges in guiding a procedure from a preoperative model is properly synching the preoperative models with cardiac and respiratory motion through computational motion models. In this paper, we describe a methodology for evaluating cardiac and respiratory motion in the left atrium and pulmonary veins of a beating canine heart. Cardiac catheters were used to place metal clips within and near the pulmonary veins and left atrial appendage under fluoroscopic and ultrasound guidance and a contrast-enhanced, 64-slice multidetector CT scan was collected with the clips in place. Each clip was segmented from the CT scan at each of the five phases of the cardiac cycle at both end-inspiration and end-expiration. The centroid of each segmented clip was computed and used to evaluate both cardiac and respiratory motion of the left atrium. A total of three canine studies were completed, with 4 clips analyzed in the first study, 5 clips in the second study, and 2 clips in the third study. Mean respiratory displacement was 0.2+/-1.8 mm in the medial/lateral direction, 4.7+/-4.4 mm in the anterior/posterior direction (moving anterior on inspiration), and 9.0+/-5.0 mm superior/inferior (moving inferior with inspiration). At end inspiration, the mean left atrial cardiac motion at the clip locations was 1.5+/-1.3 mm in the medial/lateral direction, and 2.1+/-2.0 mm in the anterior/posterior and 1.3+/-1.2 mm superior/inferior directions. At end expiration, the mean left atrial cardiac motion at the clip locations was 2.0+/-1.5mm in the medial/lateral direction, 3.0+/-1.8mm in the anterior/posterior direction, and 1.5+/-1.5 mm in the superior/inferior directions.

  1. Established and emerging dose reduction methods in cardiac computed tomography.

    PubMed

    Small, Gary R; Kazmi, Mustapha; Dekemp, Robert A; Chow, Benjamin J W

    2011-08-01

    Cardiac computed tomography (CT) is a non-invasive modality that is commonly used as an alternative to invasive coronary angiography for the investigation of coronary artery disease. The enthusiasm for this technology has been tempered by a growing appreciation of the potential risks of malignancy associated with the use of ionising radiation. In the spirit of minimizing patient risk, the medical profession and industry have worked hard to developed methods and protocols to reduce patient radiation exposure while maintaining excellent diagnostic accuracy. A complete understanding of radiation reduction techniques will allow clinicians to reduce patient risk while providing an important diagnostic service. This review will consider the established and emerging techniques that may be adopted to reduce patient absorbed doses from x-ray CT. By modifying (1) x-ray tube output, (2) imaging time (scan duration), (3) imaging distance (scan length) and (4) the appropriate use of shielding, clinicians will be able to adhere to the 'as low as reasonably achievable (ALARA)' principle. PMID:21630110

  2. Imaging pitfalls, normal anatomy, and anatomical variants that can simulate disease on cardiac imaging as demonstrated on multidetector computed tomography

    PubMed Central

    White, Charles S

    2015-01-01

    Advances in computed tomography have led to continuous improvement in cardiac imaging. Dedicated postprocessing capabilities, faster scan times, and cardiac gating methods reveal details of normal cardiac anatomy and anatomic variants that can mimic pathologic conditions. This article will review normal cardiac anatomy and variants that can mimic disease. Radiologists should be familiar with normal cardiac anatomy and anatomic variants to avoid misinterpretation of normal findings for pathologic processes. PMID:25610617

  3. Evolution of Cardiac Biomodels from Computational to Therapeutics.

    PubMed

    Rathinam, Alwin Kumar; Mokhtar, Raja Amin Raja

    2016-01-01

    Biomodeling the human anatomy in exact structure and size is an exciting field of medical science. Utilizing medical data from various medical imaging topography, the data of an anatomical structure can be extracted and converted into a three-dimensional virtual biomodel; thereafter a physical biomodel can be generated utilizing rapid prototyping machines. Here, we have reviewed the utilization of this technology and have provided some guidelines to develop biomodels of cardiac structures. Cardiac biomodels provide insights for cardiothoracic surgeons, cardiologists, and patients alike. Additionally, the technology may have future usability for tissue engineering, robotic surgery, or routine hospital usage as a diagnostic and therapeutic tool for cardiovascular diseases (CVD). Given the broad areas of application of cardiac biomodels, attention should be given to further research and development of their potential. PMID:27585205

  4. Preliminary Experimental Results on Controlled Cardiac Computed Tomography: A Phantom Study

    PubMed Central

    Lu, Yang; Cai, Zhijun; Wang, Ge; Zhao, Jun; Bai, Er-Wei

    2010-01-01

    In this paper, we present the preliminary experimental results on controlled cardiac computed tomography (CT), which aims to reduce the motion artifacts by means of controlling the x-ray source rotation speed. An innovative cardiac phantom enables us to perform this experiment without modifying the scanner. It is the first experiment on the cardiac CT with speed controlled x-ray source. Experimental results demonstrate that the proposed method successfully separates the phantom images at different phases (improve the temporal resolution) though controlling the x-ray speed. PMID:19696470

  5. Ghost in the left ventricle on electrocardiogram-gated cardiac computed tomography by turbulent flow.

    PubMed

    Byun, Sung Su; Sung, Yon Mi; Lee, Kyounghoon; Kim, Yoon Kyung; Park, Jae Hyung

    2015-01-01

    We report on an extremely rare case of a fake lesion in the left ventricle on electrocardiogram-gated cardiac computed tomography simulating thrombus or tumor by turbulent flow in a 14-year-old boy. Cardiac magnetic resonance imaging with contrast-enhanced myocardial perfusion and delayed enhancement images were helpful in excluding true thrombus or tumor. Awareness of this potential pitfall is critical in order to avoid unnecessary anticoagulation or surgery. PMID:25229204

  6. Evaluating the Effectiveness of an Interactive Multimedia Computer-based Patient Education Program in Cardiac Rehabilitation.

    ERIC Educational Resources Information Center

    Jenny, Ng Yuen Yee; Fai, Tam Sing

    2001-01-01

    A study compared 48 cardiac patients who used an interactive multimedia computer-assisted patient education program and 48 taught by tutorial. The computer-assisted instructional method resulted in significantly better knowledge about exercise and self-management of chronic diseases. (Contains 29 references.) (JOW)

  7. Characterization of cardiac quiescence from retrospective cardiac computed tomography using a correlation-based phase-to-phase deviation measure

    SciTech Connect

    Wick, Carson A.; McClellan, James H.; Arepalli, Chesnal D.; Auffermann, William F.; Henry, Travis S.; Khosa, Faisal; Coy, Adam M.; Tridandapani, Srini

    2015-02-15

    Purpose: Accurate knowledge of cardiac quiescence is crucial to the performance of many cardiac imaging modalities, including computed tomography coronary angiography (CTCA). To accurately quantify quiescence, a method for detecting the quiescent periods of the heart from retrospective cardiac computed tomography (CT) using a correlation-based, phase-to-phase deviation measure was developed. Methods: Retrospective cardiac CT data were obtained from 20 patients (11 male, 9 female, 33–74 yr) and the left main, left anterior descending, left circumflex, right coronary artery (RCA), and interventricular septum (IVS) were segmented for each phase using a semiautomated technique. Cardiac motion of individual coronary vessels as well as the IVS was calculated using phase-to-phase deviation. As an easily identifiable feature, the IVS was analyzed to assess how well it predicts vessel quiescence. Finally, the diagnostic quality of the reconstructed volumes from the quiescent phases determined using the deviation measure from the vessels in aggregate and the IVS was compared to that from quiescent phases calculated by the CT scanner. Three board-certified radiologists, fellowship-trained in cardiothoracic imaging, graded the diagnostic quality of the reconstructions using a Likert response format: 1 = excellent, 2 = good, 3 = adequate, 4 = nondiagnostic. Results: Systolic and diastolic quiescent periods were identified for each subject from the vessel motion calculated using the phase-to-phase deviation measure. The motion of the IVS was found to be similar to the aggregate vessel (AGG) motion. The diagnostic quality of the coronary vessels for the quiescent phases calculated from the aggregate vessel (P{sub AGG}) and IVS (P{sub IV} {sub S}) deviation signal using the proposed methods was comparable to the quiescent phases calculated by the CT scanner (P{sub CT}). The one exception was the RCA, which improved for P{sub AGG} for 18 of the 20 subjects when compared to P

  8. Computer simulation of cardiac cryoablation: comparison with in vivo data.

    PubMed

    Handler, Michael; Fischer, Gerald; Seger, Michael; Kienast, Roland; Nowak, Claudia-Nike; Pehböck, Daniel; Hintringer, Florian; Baumgartner, Christian

    2013-12-01

    Simulation of cardiac cryoablation by the finite element method can contribute to optimizing ablation results and understanding the effects of modifications prior to time-consuming and expensive experiments. In this work an intervention scenario using a 9 Fr 8 mm tip applicator applied to ventricular tissue was simulated using the effective heat capacity model based on Pennes' bioheat equation. Using experimentally obtained refrigerant flow rates and temperature profiles recorded by a thermocouple located at the tip of the applicator the cooling performance of the refrigerant was estimated and integrated by time and temperature dependent boundary conditions based on distinct phases of a freeze-thaw cycle. Our simulations exhibited a mean difference of approximately 6°C at the applicator tip compared to temperature profiles obtained during in vivo experiments. The presented model is a useful tool for simulation and validation of new developments in clinical cardiac cryoablation. PMID:23972331

  9. Characterization of mitral valve prolapse with cardiac computed tomography: comparison to echocardiographic and intraoperative findings.

    PubMed

    Ghosh, Nina; Al-Shehri, Haliah; Chan, Kwan; Mesana, Thierry; Chan, Vincent; Chen, Li; Yam, Yeung; Chow, Benjamin J W

    2012-04-01

    A single imaging modality that can accurately assess both coronary anatomy and mitral valve (MV) anatomy prior to surgery may be desirable. We sought to determine the diagnostic accuracy of cardiac computed tomography (CT) to detect and characterize mitral valve prolapse (MVP) compared to echocardiography. Consecutive patients referred for 'single-source' cardiac CT for investigation prior to non-coronary cardiac sugery were identified. MV anatomy was assessed for MVP and results were compared to echocardiography and to intra-operative visual assessment of the MV. Comparison between the three modalities was performed at the per-patient, per-leaflet and per-scallop levels. A total of 67 consecutive patients that were referred for Cardiac CT prior to non-coronary cardiac surgery and were prospectively recruited into a Cardiac CT registry. Of these, 65 patients underwent cardiac surgery. 63 patients had echocardiography and 32 patients had intra-operative visual assessment of the mitral valve. Compared to echocardiography, cardiac CT had excellent sensitivity (92.6%) and specificity (97.1%) for the detection of any MVP, but had poor sensitivity (68.5%) for the detection of individual prolapsing scallop. Compared to intra-operative visual assessment of the prolapsing scallop, both cardiac CT and echocardiography had low sensitivity (58.1 and 78.1%, respectively). Cardiac CT was able to identify patients with MVP but had difficulty identifying the prolapsed scallops compared to echocardiography. Single-source CT may not be ready for characterization of individual mitral valve scallops. PMID:21604082

  10. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    PubMed Central

    Andreini, Daniele; Bertella, Erika; Mushtaq, Saima; Guaricci, Andrea Igoren; Pepi, Mauro

    2015-01-01

    Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR) has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT) has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT), functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach. PMID:25692133

  11. Computational Models for Predictive Cardiac Ion Channel Pharmacology

    PubMed Central

    Yarov-Yarovoy, Vladimir; Allen, Toby W.; Clancy, Colleen E.

    2014-01-01

    A wealth of experimental data exists describing the elementary building blocks of complex physiological systems. However, it is increasingly apparent in the biomedical sciences that mechanisms of biological function cannot be observed or readily predicted via study of constituent elements alone. This is especially clear in the longstanding failures in prediction of effects of drug treatment for heart rhythm disturbances. These failures stem in part from classical assumptions that have been made in cardiac antiarrhythmic drug development – that a drug operates by one mechanism via one target receptor that arises from one gene. PMID:26635886

  12. Ubiquitous Computing for Remote Cardiac Patient Monitoring: A Survey

    PubMed Central

    Kumar, Sunil; Kambhatla, Kashyap; Hu, Fei; Lifson, Mark; Xiao, Yang

    2008-01-01

    New wireless technologies, such as wireless LAN and sensor networks, for telecardiology purposes give new possibilities for monitoring vital parameters with wearable biomedical sensors, and give patients the freedom to be mobile and still be under continuous monitoring and thereby better quality of patient care. This paper will detail the architecture and quality-of-service (QoS) characteristics in integrated wireless telecardiology platforms. It will also discuss the current promising hardware/software platforms for wireless cardiac monitoring. The design methodology and challenges are provided for realistic implementation. PMID:18604301

  13. Conversion of cardiac performance data in analog form for digital computer entry

    NASA Technical Reports Server (NTRS)

    Miller, R. L.

    1972-01-01

    A system is presented which will reduce analog cardiac performance data and convert the results to digital form for direct entry into a commercial time-shared computer. Circuits are discussed which perform the measurement and digital conversion of instantaneous systolic and diastolic parameters from the analog blood pressure waveform. Digital averaging over a selected number of heart cycles is performed on these measurements, as well as those of flow and heart rate. The determination of average cardiac output and peripheral resistance, including trends, is the end result after processing by digital computer.

  14. Ensuring reliability of safety-critical clinical applications of computational cardiac models

    PubMed Central

    Pathmanathan, Pras; Gray, Richard A.

    2013-01-01

    Computational models of cardiac electrophysiology have been used for over half a century to investigate physiological mechanisms and generate hypotheses for experimental testing, and are now starting to play a role in clinical applications. There is currently a great deal of interest in using models as diagnostic or therapeutic aids, for example using patient-specific whole-heart simulations to optimize cardiac resynchronization therapy, ablation therapy, and defibrillation. However, if models are to be used in safety-critical clinical decision making, the reliability of their predictions needs to be thoroughly investigated. In engineering and the physical sciences, the field of “verification, validation and uncertainty quantification” (VVUQ) [also known as “verification and validation” (V&V)] has been developed for rigorously evaluating the credibility of computational model predictions. In this article we first discuss why it is vital that cardiac models be developed and evaluated within a VVUQ framework, and then consider cardiac models in the context of each of the stages in VVUQ. We identify some of the major difficulties which may need to be overcome for cardiac models to be used in safely-critical clinical applications. PMID:24376423

  15. Ensuring reliability of safety-critical clinical applications of computational cardiac models.

    PubMed

    Pathmanathan, Pras; Gray, Richard A

    2013-01-01

    Computational models of cardiac electrophysiology have been used for over half a century to investigate physiological mechanisms and generate hypotheses for experimental testing, and are now starting to play a role in clinical applications. There is currently a great deal of interest in using models as diagnostic or therapeutic aids, for example using patient-specific whole-heart simulations to optimize cardiac resynchronization therapy, ablation therapy, and defibrillation. However, if models are to be used in safety-critical clinical decision making, the reliability of their predictions needs to be thoroughly investigated. In engineering and the physical sciences, the field of "verification, validation and uncertainty quantification" (VVUQ) [also known as "verification and validation" (V&V)] has been developed for rigorously evaluating the credibility of computational model predictions. In this article we first discuss why it is vital that cardiac models be developed and evaluated within a VVUQ framework, and then consider cardiac models in the context of each of the stages in VVUQ. We identify some of the major difficulties which may need to be overcome for cardiac models to be used in safely-critical clinical applications. PMID:24376423

  16. Advanced computer techniques for inverse modeling of electric current in cardiac tissue

    SciTech Connect

    Hutchinson, S.A.; Romero, L.A.; Diegert, C.F.

    1996-08-01

    For many years, ECG`s and vector cardiograms have been the tools of choice for non-invasive diagnosis of cardiac conduction problems, such as found in reentrant tachycardia or Wolff-Parkinson-White (WPW) syndrome. Through skillful analysis of these skin-surface measurements of cardiac generated electric currents, a physician can deduce the general location of heart conduction irregularities. Using a combination of high-fidelity geometry modeling, advanced mathematical algorithms and massively parallel computing, Sandia`s approach would provide much more accurate information and thus allow the physician to pinpoint the source of an arrhythmia or abnormal conduction pathway.

  17. Tetralogy of Fallot Cardiac Function Evaluation and Intelligent Diagnosis Based on Dual-Source Computed Tomography Cardiac Images.

    PubMed

    Cai, Ken; Rongqian, Yang; Li, Lihua; Xie, Zi; Ou, Shanxing; Chen, Yuke; Dou, Jianhong

    2016-05-01

    Tetralogy of Fallot (TOF) is the most common complex congenital heart disease (CHD) of the cyanotic type. Studies on ventricular functions have received an increasing amount of attention as the development of diagnosis and treatment technology for CHD continues to advance. Reasonable options for imaging examination and accurate assessment of preoperative and postoperative left ventricular functions of TOF patients are important in improving the cure rate of TOF radical operation, therapeutic evaluation, and judgment prognosis. Therefore, with the aid of dual-source computed tomography (DSCT), cardiac images with high temporal resolution and high definition, we measured the left ventricular time-volume curve using image data and calculating the left ventricular function parameters to conduct the preliminary evaluation on TOF patients. To comprehensively evaluate the cardiac function, the segmental ventricular wall function parameters were measured, and the measurement results were mapped to a bull's eye diagram to realize the standardization of segmental ventricular wall function evaluation. Finally, we introduced a new clustering method based on auto-regression model parameters and combined this method with Euclidean distance measurements to establish an intelligent diagnosis of TOF. The results of this experiment show that the TOF evaluation and the intelligent diagnostic methods proposed in this article are feasible. PMID:26496001

  18. Combining high-performance computing and networking for advanced 3-D cardiac imaging.

    PubMed

    Santarelli, M F; Positano, V; Landini, L

    2000-03-01

    This paper deals with the integration of a powerful parallel computer-based image analysis and visualization system for cardiology into a hospital information system. Further services are remote access to the hospital Web server through an internet network. The visualization system includes dynamic three-dimensional representation of two types of medical images (e.g., magnetic resonance and nuclear medicine) as well as two images in the same modality (e.g., basal versus stress images). A series of software tools for quantitative image analysis developed for supporting diagnosis of cardiac disease are also available, including automated image segmentation and quantitative time evaluation of left ventricular volumes and related indices during cardiac cycle, myocardial mass, and myocardial perfusion indices. The system has been tested both at a specialized cardiologic center and for remote consultation in diagnosis of cardiac disease by using anatomical and perfusion magnetic resonance images. PMID:10761775

  19. Knowledge-Based Dynamic Volumetric Cardiac Computed Tomography With Saddle Curve Trajectory

    PubMed Central

    Bharkhada, Deepak; Yu, Hengyong; Wang, Ge

    2010-01-01

    Motion artifact is still a major issue in cardiac computed tomography because the current motion correction and electrocardiogram gating techniques have not fully addressed this problem. The image quality can be significantly improved by using information about the actual state of the heart and an exact reconstruction algorithm. We propose to extend a cardiac computed tomographic technique, using the knowledge of the volume and the relation between the state and the phase of the heart, to a saddle curve trajectory. This will optimize the image quality by reducing the artifacts resulting from approximate reconstruction and solve the long-object problem. Necessary background is provided, and the effectiveness of the algorithms is demonstrated in numerical simulations with the dynamic thorax phantom. PMID:19204459

  20. Computational Chemical Imaging for Cardiovascular Pathology: Chemical Microscopic Imaging Accurately Determines Cardiac Transplant Rejection

    PubMed Central

    Tiwari, Saumya; Reddy, Vijaya B.; Bhargava, Rohit; Raman, Jaishankar

    2015-01-01

    Rejection is a common problem after cardiac transplants leading to significant number of adverse events and deaths, particularly in the first year of transplantation. The gold standard to identify rejection is endomyocardial biopsy. This technique is complex, cumbersome and requires a lot of expertise in the correct interpretation of stained biopsy sections. Traditional histopathology cannot be used actively or quickly during cardiac interventions or surgery. Our objective was to develop a stain-less approach using an emerging technology, Fourier transform infrared (FT-IR) spectroscopic imaging to identify different components of cardiac tissue by their chemical and molecular basis aided by computer recognition, rather than by visual examination using optical microscopy. We studied this technique in assessment of cardiac transplant rejection to evaluate efficacy in an example of complex cardiovascular pathology. We recorded data from human cardiac transplant patients’ biopsies, used a Bayesian classification protocol and developed a visualization scheme to observe chemical differences without the need of stains or human supervision. Using receiver operating characteristic curves, we observed probabilities of detection greater than 95% for four out of five histological classes at 10% probability of false alarm at the cellular level while correctly identifying samples with the hallmarks of the immune response in all cases. The efficacy of manual examination can be significantly increased by observing the inherent biochemical changes in tissues, which enables us to achieve greater diagnostic confidence in an automated, label-free manner. We developed a computational pathology system that gives high contrast images and seems superior to traditional staining procedures. This study is a prelude to the development of real time in situ imaging systems, which can assist interventionists and surgeons actively during procedures. PMID:25932912

  1. Analysis of Pulmonary Vein Antrums Motion with Cardiac Contraction Using Dual-Source Computed Tomography

    PubMed Central

    de Guise, Jacques; Vu, Toni; Chartrand-Lefebvre, Carl; Blais, Danis; Lebeau, Martin; Nguyen, Nhu-Tram; Roberge, David

    2016-01-01

    Purpose: The purpose of the study was to determine the extent of displacement of the pulmonary vein antrums resulting from the intrinsic motion of the heart using 4D cardiac dual-source computed tomography (DSCT). Methods: Ten consecutive female patients were enrolled in this prospective planning study. In breath-hold, a contrast-injected cardiac 4-dimensional (4D) computed tomography (CT) synchronized to the electrocardiogram was obtained using a prospective sequential acquisition method including the extreme phases of systole and diastole. Right and left atrial fibrillation target volumes (CTVR and CTVL) were defined, with each target volume containing the antral regions of the superior and inferior pulmonary veins. Four points of interest were used as surrogates for the right superior and inferior pulmonary vein antrum (RSPVA and RIPVA) and the left superior and inferior pulmonary vein antrum (LSPVA and LIPVA). On our 4D post-processing workstation (MIM Maestro™, MIM Software Inc.), maximum displacement of each point of interest from diastole to systole was measured in the mediolateral (ML), anteroposterior (AP), and superoinferior (SI) directions. Results: Median age of the enrolled patients was 60 years (range, 56-71 years). Within the CTVR, the mean displacements of the superior and inferior surrogates were 3 mm vs. 1 mm (p=0.002), 2 mm vs. 0 mm (p= 0.001), and 3 mm vs. 0 mm (p=0.00001), in the ML, AP, and SI directions, respectively. On the left, mean absolute displacements of the LSPVA vs. LIPVA were similar at 4 mm vs. 1 mm (p=0.0008), 2 mm vs. 0 mm (p= 0.001), and 3 mm vs. 1 mm (p=0.00001) in the ML, AP, and SI directions. Conclusion: When isolated from breathing, cardiac contraction is associated with minimal inferior pulmonary veins motion and modest (1-6 mm) motion of the superior veins. Target deformation was thus of a magnitude similar or greater than target motion, limiting the potential gains of cardiac tracking. Optimal strategies for cardiac

  2. Petascale computation performance of lightweight multiscale cardiac models using hybrid programming models.

    PubMed

    Pope, Bernard J; Fitch, Blake G; Pitman, Michael C; Rice, John J; Reumann, Matthias

    2011-01-01

    Future multiscale and multiphysics models must use the power of high performance computing (HPC) systems to enable research into human disease, translational medical science, and treatment. Previously we showed that computationally efficient multiscale models will require the use of sophisticated hybrid programming models, mixing distributed message passing processes (e.g. the message passing interface (MPI)) with multithreading (e.g. OpenMP, POSIX pthreads). The objective of this work is to compare the performance of such hybrid programming models when applied to the simulation of a lightweight multiscale cardiac model. Our results show that the hybrid models do not perform favourably when compared to an implementation using only MPI which is in contrast to our results using complex physiological models. Thus, with regards to lightweight multiscale cardiac models, the user may not need to increase programming complexity by using a hybrid programming approach. However, considering that model complexity will increase as well as the HPC system size in both node count and number of cores per node, it is still foreseeable that we will achieve faster than real time multiscale cardiac simulations on these systems using hybrid programming models. PMID:22254341

  3. Aborted sudden cardiac death associated with an anomalous right coronary artery.

    PubMed

    Diaz, Rienzi A; Valdés, Julio

    2015-01-01

    Coronary artery anomalies arising from the opposite sinus of Valsalva and having an interarterial course between the aorta (AO) and pulmonary artery (PA) are the second most common cause of sudden cardiac death among young athletes, after hypertrophic cardiomyopathy. The right coronary artery (RCA) originating from the AO above the left sinus of Valsalva (LSV) is an extremely rare anomaly. We report the first case of a RCA arising from the AO above the LSV that subsequently runs between the AO and the PA, discovered by a 64-slice multidetector coronary CT, in a patient who was successfully resuscitated from ventricular fibrillation (VF) cardiac arrest while running in a marathon race. PMID:26153291

  4. Cardiac magnetic resonance imaging and computed tomography in ischemic cardiomyopathy: an update*

    PubMed Central

    Assunção, Fernanda Boldrini; de Oliveira, Diogo Costa Leandro; Souza, Vitor Frauches; Nacif, Marcelo Souto

    2016-01-01

    Ischemic cardiomyopathy is one of the major health problems worldwide, representing a significant part of mortality in the general population nowadays. Cardiac magnetic resonance imaging (CMRI) and cardiac computed tomography (CCT) are noninvasive imaging methods that serve as useful tools in the diagnosis of coronary artery disease and may also help in screening individuals with risk factors for developing this illness. Technological developments of CMRI and CCT have contributed to the rise of several clinical indications of these imaging methods complementarily to other investigation methods, particularly in cases where they are inconclusive. In terms of accuracy, CMRI and CCT are similar to the other imaging methods, with few absolute contraindications and minimal risks of adverse side-effects. This fact strengthens these methods as powerful and safe tools in the management of patients. The present study is aimed at describing the role played by CMRI and CCT in the diagnosis of ischemic cardiomyopathies. PMID:26929458

  5. Cardiac findings on non-gated chest computed tomography: A clinical and pictorial review.

    PubMed

    Kanza, Rene Epunza; Allard, Christian; Berube, Michel

    2016-02-01

    The use of chest computed tomography (CT) as an imaging test for the evaluation of thoracic pathology has significantly increased during the last four decades. Although cardiopulmonary diseases often overlap in their clinical manifestation, radiologists tend to overlook the heart while interpreting routine chest CT. Recent advances in CT technology have led to significant reduction of heart motion artefacts and now allow for the identification of several cardiac findings on chest CT even without electrocardiogram (ECG) gating. These observations range from simple curiosity to both benign and malignant discoveries, to life-threatening discoveries. We here present a clinical and radiologic review of common and less common cardiac findings discovered on non-gated chest CT in order to draw the attention of radiologists and referring physicians to these possibilities. PMID:26781150

  6. Cardiac magnetic resonance imaging and computed tomography in ischemic cardiomyopathy: an update.

    PubMed

    Assunção, Fernanda Boldrini; de Oliveira, Diogo Costa Leandro; Souza, Vitor Frauches; Nacif, Marcelo Souto

    2016-01-01

    Ischemic cardiomyopathy is one of the major health problems worldwide, representing a significant part of mortality in the general population nowadays. Cardiac magnetic resonance imaging (CMRI) and cardiac computed tomography (CCT) are noninvasive imaging methods that serve as useful tools in the diagnosis of coronary artery disease and may also help in screening individuals with risk factors for developing this illness. Technological developments of CMRI and CCT have contributed to the rise of several clinical indications of these imaging methods complementarily to other investigation methods, particularly in cases where they are inconclusive. In terms of accuracy, CMRI and CCT are similar to the other imaging methods, with few absolute contraindications and minimal risks of adverse side-effects. This fact strengthens these methods as powerful and safe tools in the management of patients. The present study is aimed at describing the role played by CMRI and CCT in the diagnosis of ischemic cardiomyopathies. PMID:26929458

  7. Primary cardiac fibroma in an infant: computed tomography and magnetic resonance imaging findings.

    PubMed

    Liu, Hsien-Tzu; Tiu, Chui-Mei; Weng, Zen-Chung; Chou, Yi-Hong; Hsueh, Huai-Cheng; Lee, Ming-Hsun; Tseng, Tse-Kai; Chang, Cheng-Yen

    2013-09-01

    Cardiac fibromas (CFs) are benign primary tumors that typically occur during childhood and may be asymptomatic. However, due to the proximity of CFs to the cardiac structure, significant morbidity and mortality may also be anticipated. CFs do not show spontaneous regression and surgical resection generally remains the treatment of choice for these tumors in children. Thus, it is important to take aggressive steps to obtain accurate pretreatment image diagnosis. A full-term male infant was presented to our facility suffering from shortness of breath, after an episode of upper respiratory tract infection at age 1.5 months. Subsequent chest X-ray revealed widening of the mediastinum and trachea deviation. Cardiogenic pathology was suspected. Computed tomography and magnetic resonance imaging were performed, and we confirmed a diagnosis of benign CF. Thoracotomy biopsy of the tumor confirmed the pathological diagnosis. PMID:23880575

  8. Multi-Detector Computed Tomography Angiography for Coronary Artery Disease

    PubMed Central

    2005-01-01

    groups: Group 1 included 9 studies that focused on the detection of CAD in symptomatic patients, and Group 2 included 4 studies that examined the use of 16-slice CT angiography to detect disease progression after cardiac interventions. The 2 abstracts on 64-slice CT angiography were presented separately, but were not critically appraised due to the lack of information provided in the abstracts. 16-Slice Computed Tomography Angiography The STARD initiative to evaluate the reporting quality of studies that focus on diagnostic tests was used. Overall the studies were relatively small (fewer than 100 people), and only about one-half recruited consecutive patients. Most studies reported inclusion criteria, but 5 did not report exclusion criteria. In these 5, the patients were highly selected; therefore, how representative they are of the general population of people with suspicion if CAD or those with disease progression after cardiac intervention is questionable. In most studies, patients were either already taking, or were given, β-blockers to reduce their heart rates to improve image quality sufficiently. Only 6 of the 13 studies reported interobserver reliability quantitatively. The studies typically assessed the quality of the images obtained from 16-slice CT angiography, excluded those of poor quality, and compared the rest with the gold standard, coronary angiography. This practice necessarily inflated the diagnostic accuracy measures. Only 3 studies reported confidence intervals around their measures. Evaluation of the studies in Group 1 reported variable sensitivity, from just over 60% to 96%, but a more stable specificity, at more than 95%. The false positive rate ranged from 5% to 8%, but the false negative rate was at best under 10% and at worst about 30%. This means that up to one-third of patients who have disease may be missed. These patients may therefore progress to a more severe level of disease and require more invasive procedures. The calculated positive

  9. Radiation Dose to the Thyroid and Gonads in Patients Undergoing Cardiac CT Angiography

    PubMed Central

    Behroozi, Hamid; Davoodi, Mohammad; Aghasi, Shahriar

    2015-01-01

    Background: The present data show a global increase in the rate of cardiovascular disease. Cardiac CT angiography has developed as a fast and non-invasive cardiac imaging modality following the introduction of multi-slice computed tomogaraphy. Objectives: The aim of this study was to measure the radiation dose to the thyroid and pelvis regions in patients undergoing cardiac CT angiography using the Care Dose 4D method of 64-slice scanner. Patients and Methods: Eighty-one patients (41 males and 40 females) who were diagnosed with suspected coronary artery disease and were referred to Golestan Hospital, Imaging Department were recruited. Inclusion criteria were based on the protocol of multi-slice CT coronary angiography. The radiation dose to the thyroid and pelvis regions was measured using thermo luminescent dosimeters (TLDs). Results: The mean radiation dose to the thyroid in male and female subjects was 0.32 mSv and 0.41 mSv, respectively (P = 0.032) (total mean, 0.36 mSv). The mean radiation dose to the pelvis in male and female subjects was 81 μSv and 112 μSv, respectively (P = 0.026) (total mean, 96.5 μSv), Conclusions: The total mean radiation dose to the thyroid and gonads was 0.36 mSv, and 96.5 μSv, respectively for the subjects. These values were high for one organ in a single study. Gender can affect the radiation dose to the thyroid and gonads. This can be attributed to the anatomical characteristic differences of the male and female subjects. PMID:26060556

  10. Threshold adjusted calcium scoring using CT is less susceptible to cardiac motion and more accurate.

    PubMed

    Groen, J M; Dijkstra, H; Greuter, M J W; Oudkerk, M

    2009-02-01

    The purpose of this paper is to investigate calcium scoring on computed tomography (CT) using an adjusted threshold depending on the maximum Hounsfield value within the calcification (HU(peak)). The volume of 19 calcifications was retrospectively determined on 64-slice multidetector CT and dual source CT (DSCT) at different thresholds and the threshold associated with the physical volume was determined. In addition, approximately 10 000 computer simulations were done simulating the same process for calcifications with mixed density. Using these data a relation between the HU(peak) and the threshold could be established. Hereafter, this relation was assessed by scanning six calcifications in a phantom at 40-110 beats per minute using DSCT. The influence of motion was determined and the measured calcium scores were compared to the physical volumes and mass. A positive linear correlation was found between the scoring threshold and the HU(peak) of the calcifications both for the phantom measurements as for the computer simulations. Using this relation the individual threshold for each calcification could be calculated. Calcium scores of the moving calcifications determined with an adjusted threshold were approximately 30% less susceptible to cardiac motion compared to standard calcium scoring. Furthermore, these scores approximated the physical volume and mass at least 10% better than the standard calcium scores. The threshold in calcium scoring should be adjusted for each individual calcification based on the HU(peak) of the calcification. Calcium scoring using an adjusted threshold is less susceptible to cardiac motion and more accurate compared to the physical values. PMID:19291982

  11. Segmentation of 4D cardiac computer tomography images using active shape models

    NASA Astrophysics Data System (ADS)

    Leiner, Barba-J.; Olveres, Jimena; Escalante-Ramírez, Boris; Arámbula, Fernando; Vallejo, Enrique

    2012-06-01

    This paper describes a segmentation method for time series of 3D cardiac images based on deformable models. The goal of this work is to extend active shape models (ASM) of tree-dimensional objects to the problem of 4D (3D + time) cardiac CT image modeling. The segmentation is achieved by constructing a point distribution model (PDM) that encodes the spatio-temporal variability of a training set, i.e., the principal modes of variation of the temporal shapes are computed using some statistical parameters. An active search is used in the segmentation process where an initial approximation of the spatio-temporal shape is given and the gray level information in the neighborhood of the landmarks is analyzed. The starting shape is able to deform so as to better fit the data, but in the range allowed by the point distribution model. Several time series consisting of eleven 3D images of cardiac CT are employed for the method validation. Results are compared with manual segmentation made by an expert. The proposed application can be used for clinical evaluation of the left ventricle mechanical function. Likewise, the results can be taken as the first step of processing for optic flow estimation algorithms.

  12. Cardiac single-photon emission-computed tomography using combinedcone-beam/fan-beam collimation

    SciTech Connect

    Gullberg, Grant T.; Zeng, Gengsheng L.

    2004-12-03

    The objective of this work is to increase system sensitivity in cardiac single-photon emission-computed tomography (SPECT) studies without increasing patient imaging time. For imaging the heart, convergent collimation offers the potential of increased sensitivity over that of parallel-hole collimation. However, if a cone-beam collimated gamma camera is rotated in a planar orbit, the projection data obtained are not complete. Two cone-beam collimators and one fan-beam collimator are used with a three-detector SPECT system. The combined cone-beam/fan-beam collimation provides a complete set of data for image reconstruction. The imaging geometry is evaluated using data acquired from phantom and patient studies. For the Jaszazck cardiac torso phantom experiment, the combined cone-beam/fan-beam collimation provided 1.7 times greater sensitivity than standard parallel-hole collimation (low-energy high-resolution collimators). Also, phantom and patient comparison studies showed improved image quality. The combined cone-beam/fan-beam imaging geometry with appropriate weighting of the two data sets provides improved system sensitivity while measuring sufficient data for artifact free cardiac images.

  13. ECG-gated emission computed tomography of the cardiac blood pool

    SciTech Connect

    Moore, M.L.; Murphy, P.H.; Burdine, J.A.

    1980-01-01

    ECG-gated cross-sectional images of the cardiac blood pool were produced using a specially constructed emission computed tomographic scanner. A pair of large-field-of-view cameras were mounted in opposition in a gantry that rotates 360/sup 0/ about the patient. The coordinates of each detected event, the output of a physiological synchronizer, and the position of the camera heads were input to a dedicated minicomputer which was used to produce the images. Display as a movie permitted evaluation of regional and global wall motion in cross section without the disadvantages of superimposed blood pools as obtained in nontomographic views.

  14. Moving Domain Computational Fluid Dynamics to Interface with an Embryonic Model of Cardiac Morphogenesis

    PubMed Central

    Lee, Juhyun; Moghadam, Mahdi Esmaily; Kung, Ethan; Cao, Hung; Beebe, Tyler; Miller, Yury; Roman, Beth L.; Lien, Ching-Ling; Chi, Neil C.; Marsden, Alison L.; Hsiai, Tzung K.

    2013-01-01

    Peristaltic contraction of the embryonic heart tube produces time- and spatial-varying wall shear stress (WSS) and pressure gradients (∇P) across the atrioventricular (AV) canal. Zebrafish (Danio rerio) are a genetically tractable system to investigate cardiac morphogenesis. The use of Tg(fli1a:EGFP)y1 transgenic embryos allowed for delineation and two-dimensional reconstruction of the endocardium. This time-varying wall motion was then prescribed in a two-dimensional moving domain computational fluid dynamics (CFD) model, providing new insights into spatial and temporal variations in WSS and ∇P during cardiac development. The CFD simulations were validated with particle image velocimetry (PIV) across the atrioventricular (AV) canal, revealing an increase in both velocities and heart rates, but a decrease in the duration of atrial systole from early to later stages. At 20-30 hours post fertilization (hpf), simulation results revealed bidirectional WSS across the AV canal in the heart tube in response to peristaltic motion of the wall. At 40-50 hpf, the tube structure undergoes cardiac looping, accompanied by a nearly 3-fold increase in WSS magnitude. At 110-120 hpf, distinct AV valve, atrium, ventricle, and bulbus arteriosus form, accompanied by incremental increases in both WSS magnitude and ∇P, but a decrease in bi-directional flow. Laminar flow develops across the AV canal at 20-30 hpf, and persists at 110-120 hpf. Reynolds numbers at the AV canal increase from 0.07±0.03 at 20-30 hpf to 0.23±0.07 at 110-120 hpf (p< 0.05, n=6), whereas Womersley numbers remain relatively unchanged from 0.11 to 0.13. Our moving domain simulations highlights hemodynamic changes in relation to cardiac morphogenesis; thereby, providing a 2-D quantitative approach to complement imaging analysis. PMID:24009714

  15. ASCI 2010 contrast media guideline for cardiac imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

    PubMed Central

    Kitagawa, Kakuya; Tsai, I-Chen; Chan, Carmen; Yu, Wei; Yong, Hwan Seok; Choi, Byoung Wook

    2010-01-01

    The use of contrast media for cardiac imaging becomes increasing as the widespread of cardiac CT and cardiac MR. A radiologist needs to carefully consider the indication and the injection protocol of contrast media to be used as well as the possibility of adverse effect. There are several guidelines for contrast media in western countries. However, these are focusing the adverse effect of contrast media. The Asian Society of Cardiovascular Imaging, the only society dedicated to cardiovascular imaging in Asia, formed a Working Group and created a guideline, which summarizes the integrated knowledge of contrast media for cardiac imaging. In cardiac imaging, coronary artery evaluation is feasible by non-contrast MR angiography, which can be an alternative examination in high risk patients for the use of iodine contrast media. Furthermore, the body habitus of Asian patients is usually smaller than that of their western counterparts. This necessitates modifications in the injection protocol and in the formula for calculation of estimated glomerular filtration rate. This guideline provided fundamental information for the use of contrast media for Asian patients in cardiac imaging. PMID:20931289

  16. Morphological and Functional Evaluation of Quadricuspid Aortic Valves Using Cardiac Computed Tomography

    PubMed Central

    Song, Inyoung; Park, Jung Ah; Choi, Bo Hwa; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok

    2016-01-01

    Objective The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). Materials and Methods We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. Results All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). Conclusion Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV. PMID:27390538

  17. Development and clinical study of mobile 12-lead electrocardiography based on cloud computing for cardiac emergency.

    PubMed

    Fujita, Hideo; Uchimura, Yuji; Waki, Kayo; Omae, Koji; Takeuchi, Ichiro; Ohe, Kazuhiko

    2013-01-01

    To improve emergency services for accurate diagnosis of cardiac emergency, we developed a low-cost new mobile electrocardiography system "Cloud Cardiology®" based upon cloud computing for prehospital diagnosis. This comprises a compact 12-lead ECG unit equipped with Bluetooth and Android Smartphone with an application for transmission. Cloud server enables us to share ECG simultaneously inside and outside the hospital. We evaluated the clinical effectiveness by conducting a clinical trial with historical comparison to evaluate this system in a rapid response car in the real emergency service settings. We found that this system has an ability to shorten the onset to balloon time of patients with acute myocardial infarction, resulting in better clinical outcome. Here we propose that cloud-computing based simultaneous data sharing could be powerful solution for emergency service for cardiology, along with its significant clinical outcome. PMID:23920851

  18. Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve.

    PubMed

    Suh, Young Joo; Kim, Young Jin; Lee, Sak; Hong, Yoo Jin; Lee, Hye-Jeong; Hur, Jin; Choi, Byoung Wook; Chang, Byung-Chul

    2015-08-01

    The clinical significance of pannus detected on computed tomography (CT) has not yet been investigated. The purposes of this study were to investigate the clinical significance of pannus detected on cardiac CT in patients who underwent aortic valve replacement (AVR) with mechanical valves, and to determine predictors for pannus severity. A total of 92 patients who underwent cardiac CT and TTE and who had undergone mechanical AVR were included. The geometric orifice area (GOA), the presence of limitation of motion (LOM) and pannus were evaluated on CT. The GOA, presence of LOM, and presence and severity of pannus were compared with echocardiographic parameters. Logistic regression analysis was performed to determine the predictors for pannus severity. The GOA on CT positively correlated with effective orifice area on TTE (r = 0.733, P < 0.0001). Pannus was found in 77.2% and LOM in 14.0%. With increasing pannus severity, mean transvalvular pressure gradient (PG) was significantly higher (P < 0.0001). Patients with elevated PG showed a smaller GOA, a higher incidence of pannus, more severe pannus and LOM than patients with normal PG (P < 0.05). Small valve size (≤19 mm), Carbomedics valve, rheumatic etiology, and young age at AVR (<48.8 years) were independent predictors of moderate to severe pannus (P < 0.05). Cardiac CT is helpful in the evaluation of pannus formation in patients with mechanical aortic valves. Moderate to severe pannus formation frequently occurred in patients with small mechanical valve size, Carbomedics valves, rheumatic heart disease and young age at AVR. PMID:25990093

  19. Application of Micro-Computed Tomography with Iodine Staining to Cardiac Imaging, Segmentation and Computational Model Development

    PubMed Central

    Aslanidi, OV; Nikolaidou, T; Zhao, J; Smaill, BH; Gilbert, SH; Holden, AV; Lowe, T; Withers, PJ; Jarvis, JC; Stephenson, RS; Hart, G; Hancox, JC; Boyett, MR; Zhang, H

    2012-01-01

    Micro-computed tomography (micro-CT) has been widely used to generate high-resolution 3D tissue images from small animals non-destructively, especially for mineralized skeletal tissues. However, its application to the analysis of soft cardiovascular tissues has been limited by poor inter-tissue contrast. Recent ex vivo studies have shown that contrast between muscular and connective tissue in micro-CT images can be enhanced by staining with iodine. In the present study, we apply this novel technique for imaging of cardiovascular structures in canine hearts. We optimize the method to obtain high resolution X-ray micro-CT images of the canine atria and its distinctive regions - including the Bachmann’s bundle, atrioventricular node, pulmonary arteries and veins - with clear inter-tissue contrast. The imaging results are used to reconstruct and segment the detailed 3D geometry of the atria. Structure tensor analysis shows that the arrangement of atrial fibres can also be characterised using the enhanced micro-CT images, as iodine preferentially accumulates within the muscular fibres rather than in connective tissues. This novel technique can be particularly useful in non-destructive imaging of 3D cardiac architectures from large animals and humans, due to the combination of relatively high speed (~1 hour/scan of a large canine heart) and high voxel resolution (36 μm) provided. In summary, contrast micro-CT facilitates fast and non-destructive imaging and segmenting of detailed 3D cardiovascular geometries, as well as measuring fibre orientation, which are crucial in constructing biophysically detailed computational cardiac models. PMID:22829390

  20. Epicardial Adipose Tissue Is Associated with Plaque Burden and Composition and Provides Incremental Value for the Prediction of Cardiac Outcome. A Clinical Cardiac Computed Tomography Angiography Study

    PubMed Central

    Gitsioudis, Gitsios; Schmahl, Christina; Missiou, Anna; Voss, Andreas; Schüssler, Alena; Abdel-Aty, Hassan; Buss, Sebastian J.; Mueller, Dirk; Vembar, Mani; Bryant, Mark; Kauczor, Hans-Ulrich; Giannitsis, Evangelos; Katus, Hugo A.; Korosoglou, Grigorios

    2016-01-01

    Objectives We sought to investigate the association of epicardial adipose tissue (eCAT) volume with plaque burden, circulating biomarkers and cardiac outcomes in patients with intermediate risk for coronary artery disease (CAD). Methods and Results 177 consecutive outpatients at intermediate risk for CAD and completed biomarker analysis including high-sensitive Troponin T (hs-TnT) and hs-CRP underwent 256-slice cardiac computed tomography angiography (CCTA) between June 2008 and October 2011. Patients with lumen narrowing ≥50% exhibited significantly higher eCAT volume than patients without any CAD or lumen narrowing <50% (median (interquartile range, IQR): 108 (73–167) cm3 vs. 119 (82–196) cm3, p = 0.04). Multivariate regression analysis demonstrated an independent association eCAT volume with plaque burden by number of lesions (R2 = 0.22, rpartial = 0.29, p = 0.026) and CAD severity by lumen narrowing (R2 = 0.22, rpartial = 0.23, p = 0.038) after adjustment for age, diabetes mellitus, hyperlidipemia, body-mass-index (BMI), hs-CRP and hs-TnT. Univariate Cox proportional hazards regression analysis identified a significant association for both increased eCAT volume and maximal lumen narrowing with all cardiac events. Multivariate Cox proportional hazards regression analysis revealed an independent association of increased eCAT volume with all cardiac events after adjustment for age, >3 risk factors, presence of CAD, hs-CRP and hs-TnT. Conclusion Epicardial adipose tissue volume is independently associated with plaque burden and maximum luminal narrowing by CCTA and may serve as an independent predictor for cardiac outcomes in patients at intermediate risk for CAD. PMID:27187590

  1. New Applications of Cardiac Computed Tomography: Dual-Energy, Spectral, and Molecular CT Imaging.

    PubMed

    Danad, Ibrahim; Fayad, Zahi A; Willemink, Martin J; Min, James K

    2015-06-01

    Computed tomography (CT) has evolved into a powerful diagnostic tool, and it is impossible to imagine current clinical practice without CT imaging. Because of its widespread availability, ease of clinical application, superb sensitivity for the detection of coronary artery disease, and noninvasive nature, CT has become a valuable tool within the armamentarium of cardiologists. In the past few years, numerous technological advances in CT have occurred, including dual-energy CT, spectral CT, and CT-based molecular imaging. By harnessing the advances in technology, cardiac CT has advanced beyond the mere evaluation of coronary stenosis to an imaging tool that permits accurate plaque characterization, assessment of myocardial perfusion, and even probing of molecular processes that are involved in coronary atherosclerosis. Novel innovations in CT contrast agents and pre-clinical spectral CT devices have paved the way for CT-based molecular imaging. PMID:26068288

  2. Recent Advances in Cardiac Computed Tomography: Dual Energy, Spectral and Molecular CT Imaging

    PubMed Central

    Danad, Ibrahim; Fayad, Zahi A.; Willemink, Martin J.; Min, James K.

    2015-01-01

    Computed tomography (CT) evolved into a powerful diagnostic tool and it is impossible to imagine current clinical practice without CT imaging. Due to its widespread availability, ease of clinical application, superb sensitivity for detection of CAD, and non-invasive nature, CT has become a valuable tool within the armamentarium of the cardiologist. In the last few years, numerous technological advances in CT have occurred—including dual energy CT (DECT), spectral CT and CT-based molecular imaging. By harnessing the advances in technology, cardiac CT has advanced beyond the mere evaluation of coronary stenosis to an imaging modality tool that permits accurate plaque characterization, assessment of myocardial perfusion and even probing of molecular processes that are involved in coronary atherosclerosis. Novel innovations in CT contrast agents and pre-clinical spectral CT devices have paved the way for CT-based molecular imaging. PMID:26068288

  3. Clinical Diagnostic Biomarkers from the Personalization of Computational Models of Cardiac Physiology.

    PubMed

    Lamata, Pablo; Cookson, Andrew; Smith, Nic

    2016-01-01

    Computational modelling of the heart is rapidly advancing to the point of clinical utility. However, the difficulty of parameterizing and validating models from clinical data indicates that the routine application of truly predictive models remains a significant challenge. We argue there is significant value in an intermediate step towards prediction. This step is the use of biophysically based models to extract clinically useful information from existing patient data. Specifically in this paper we review methodologies for applying modelling frameworks for this goal in the areas of quantifying cardiac anatomy, estimating myocardial stiffness and optimizing measurements of coronary perfusion. Using these indicative examples of the general overarching approach, we finally discuss the value, ongoing challenges and future potential for applying biophysically based modelling in the clinical context. PMID:26399986

  4. Demonstrating the origin of cardiac air embolism using post-mortem computed tomography; an illustrated case.

    PubMed

    Saunders, Sarah; Kotecha, Deepjay; Morgan, Bruno; Raj, Vimal; Rutty, Guy

    2011-03-01

    An 83 year old female was found dead in her home. The deceased had been struck repeatedly to the head with at least one weapon, one of which was a hammer. The deceased had suffered both penetrating and non-penetrating blunt trauma to the head as a result of the assault. A multi-detector computed tomography (MDCT) scan was undertaken approximately 12h after death prior to the autopsy examination. This demonstrated the presence of a cardiac air embolus and continuity between the air embolus and the penetrating head injury. Air within the heart is a recognised post-mortem artefact frequently seen on MDCT scans and a common pitfall for inexperienced cadaveric MDCT reporters. This case builds upon a previous report by Kauczor, illustrating how MDCT can be used to demonstrate the origin and route of ingress of a genuine air embolism to the heart. PMID:21131225

  5. Assessment of cardiac single-photon emission computed tomography performance using a scanning linear observer

    SciTech Connect

    Lee, Chih-Jie; Kupinski, Matthew A.; Volokh, Lana

    2013-01-15

    Purpose: Single-photon emission computed tomography (SPECT) is widely used to detect myocardial ischemia and myocardial infarction. It is important to assess and compare different SPECT system designs in order to achieve the highest detectability of cardiac defects. Methods: Whitaker et al.'s study ['Estimating random signal parameters from noisy images with nuisance parameters: linear and scanning-linear methods,' Opt. Express 16(11), 8150-8173 (2008)] on the scanning linear observer (SLO) shows that the SLO can be used to estimate the location and size of signals. One major advantage of the SLO is that it can be used with projection data rather than with reconstruction data. Thus, this observer model assesses the overall hardware performance independent of any reconstruction algorithm. In addition, the computation time of image quality studies is significantly reduced. In this study, three systems based on the design of the GE cadmium zinc telluride-based dedicated cardiac SPECT camera Discovery 530c were assessed. This design, which is officially named the Alcyone Technology: Discovery NM 530c, was commercialized in August, 2009. The three systems, GE27, GE19, and GE13, contain 27, 19, and 13 detectors, respectively. Clinically, a human heart can be virtually segmented into three coronary artery territories: the left-anterior descending artery, left-circumflex artery, and right coronary artery. One of the most important functions of a cardiac SPECT system is to produce images from which a radiologist can accurately predict in which territory the defect exists [http://www.asnc.org/media/PDFs/PPReporting081511.pdf, Guideline from American Society of Nuclear Cardiology]. A good estimation of the extent of the defect from the projection images is also very helpful for determining the seriousness of the myocardial ischemia. In this study, both the location and extent of defects were estimated by the SLO, and the system performance was assessed by localization

  6. Assessment of cardiac single-photon emission computed tomography performance using a scanning linear observer

    PubMed Central

    Lee, Chih-Jie; Kupinski, Matthew A.; Volokh, Lana

    2013-01-01

    Purpose: Single-photon emission computed tomography (SPECT) is widely used to detect myocardial ischemia and myocardial infarction. It is important to assess and compare different SPECT system designs in order to achieve the highest detectability of cardiac defects. Methods:Whitaker ’s study [“Estimating random signal parameters from noisy images with nuisance parameters: linear and scanning-linear methods,” Opt. Express 16(11), 8150–8173 (2008)]10.1364/OE.16.008150 on the scanning linear observer (SLO) shows that the SLO can be used to estimate the location and size of signals. One major advantage of the SLO is that it can be used with projection data rather than with reconstruction data. Thus, this observer model assesses the overall hardware performance independent of any reconstruction algorithm. In addition, the computation time of image quality studies is significantly reduced. In this study, three systems based on the design of the GE cadmium zinc telluride-based dedicated cardiac SPECT camera Discovery 530c were assessed. This design, which is officially named the Alcyone Technology: Discovery NM 530c, was commercialized in August, 2009. The three systems, GE27, GE19, and GE13, contain 27, 19, and 13 detectors, respectively. Clinically, a human heart can be virtually segmented into three coronary artery territories: the left-anterior descending artery, left-circumflex artery, and right coronary artery. One of the most important functions of a cardiac SPECT system is to produce images from which a radiologist can accurately predict in which territory the defect exists [http://www.asnc.org/media/PDFs/PPReporting081511.pdf, Guideline from American Society of Nuclear Cardiology]. A good estimation of the extent of the defect from the projection images is also very helpful for determining the seriousness of the myocardial ischemia. In this study, both the location and extent of defects were estimated by the SLO, and the system performance was assessed by

  7. Assessment of the Radiation Effects of Cardiac Computed Tomographic Angiography Using Protein and Genetic Biomarkers

    PubMed Central

    Nguyen, Patricia K.; Lee, Won Hee; Li, Yong Fuga; Hong, Wan Xing; Hu, Shijun; Chan, Charles; Liang, Grace; Nguyen, Ivy; Ong, Sang-Ging; Churko, Jared; Wang, Jia; Altman, Russ B.; Fleischmann, Dominik; Wu, Joseph C.

    2016-01-01

    Objectives To evaluate whether radiation exposure from cardiac computed tomographic angiography is associated with DNA damage and whether damage leads to programmed cell death and activation of genes involved in apoptosis and DNA repair. Background Exposure to radiation from medical imaging has become a public health concern, but whether it causes significant cell damage remains unclear. Methods We conducted a prospective cohort study in 67 patients undergoing cardiac computed tomographic angiography (CTA) between January 2012 and December 2013 in two US medical centers. Median blood radiation exposure was estimated using phantom dosimetry. Biomarkers of DNA damage and apoptosis were measured by flow cytometry, whole genome sequencing, and single cell polymerase chain reaction. Results The median DLP was 1535.3 mGy·cm (969.7 – 2674.0 mGy·cm). The median radiation dose to the blood was 29.8 milliSieverts (18.8 – 48.8 mSv). Median DNA damage increased 3.39% (1.29 – 8.04%, P<0.0001) post-radiation. Median apoptosis increased 3.1-fold (1.4 – 5.1-fold, P<0.0001) post-radiation. Whole genome sequencing revealed changes in the expression of 39 transcription factors involved in the regulation of apoptosis, cell cycle, and DNA repair. Genes involved in mediating apoptosis and DNA repair were significantly changed post-radiation, including DDB2 [1.9-fold (1.5 – 3.0-fold), P<0.001], XRCC4 [3.0-fold (1.1 – 5.4-fold), P=0.005], and BAX [1.6-fold (0.9 – 2.6-fold), P<0.001]. Exposure to radiation was associated with DNA damage [OR: 1.8 (1.2 – 2.6), P=0.003]. DNA damage was associated with apoptosis [OR: 1.9 (1.2 – 5.1), P<0.0001] and gene activation [OR: 2.8 (1.2 – 6.2), P=0.002]. Conclusions Patients exposed to radiation from cardiac CTA had evidence of DNA damage, which was associated with programmed cell death and activation of genes involved in apoptosis and DNA repair. PMID:26210695

  8. Performance of hybrid programming models for multiscale cardiac simulations: preparing for petascale computation.

    PubMed

    Pope, Bernard J; Fitch, Blake G; Pitman, Michael C; Rice, John J; Reumann, Matthias

    2011-10-01

    Future multiscale and multiphysics models that support research into human disease, translational medical science, and treatment can utilize the power of high-performance computing (HPC) systems. We anticipate that computationally efficient multiscale models will require the use of sophisticated hybrid programming models, mixing distributed message-passing processes [e.g., the message-passing interface (MPI)] with multithreading (e.g., OpenMP, Pthreads). The objective of this study is to compare the performance of such hybrid programming models when applied to the simulation of a realistic physiological multiscale model of the heart. Our results show that the hybrid models perform favorably when compared to an implementation using only the MPI and, furthermore, that OpenMP in combination with the MPI provides a satisfactory compromise between performance and code complexity. Having the ability to use threads within MPI processes enables the sophisticated use of all processor cores for both computation and communication phases. Considering that HPC systems in 2012 will have two orders of magnitude more cores than what was used in this study, we believe that faster than real-time multiscale cardiac simulations can be achieved on these systems. PMID:21768044

  9. Simulation study of respiratory-induced errors in cardiac positron emission tomography/computed tomography

    SciTech Connect

    Fitzpatrick, Gianna M.; Wells, R. Glenn

    2006-08-15

    Heart disease is a leading killer in Canada and positron emission tomography (PET) provides clinicians with in vivo metabolic information for diagnosing heart disease. Transmission data are usually acquired with {sup 68}Ge, although the advent of PET/CT scanners has made computed tomography (CT) an alternative option. The fast data acquisition of CT compared to PET may cause potential misregistration problems, leading to inaccurate attenuation correction (AC). Using Monte Carlo simulations and an anthropomorphic dynamic computer phantom, this study determines the magnitude and location of respiratory-induced errors in radioactivity uptake measured in cardiac PET/CT. A homogeneous tracer distribution in the heart was considered. The AC was based on (1) a time-averaged attenuation map (2) CT maps from a single phase of the respiratory cycle, and (3) CT maps phase matched to the emission data. Circumferential profiles of the heart uptake were compared and differences of up to 24% were found between the single-phase CT-AC method and the true phantom values. Simulation results were supported by a PET/CT canine study which showed differences of up to 10% in the heart uptake in the lung-heart boundary region when comparing {sup 68}Ge- to CT-based AC with the CT map acquired at end inhalation.

  10. Decoding Hemodynamics of Large Vessels via Dispersion of Contrast Agent in Cardiac Computed Tomography

    NASA Astrophysics Data System (ADS)

    Eslami, Parastou; Seo, Jung-Hee; Abd, Thura T.; George, Richard; Lardo, Albert C.; Chen, Marcus Y.; Mittal, Rajat

    2015-11-01

    Computed tomography angiography (CTA) has emerged as a powerful tool for the assessment of coronary artery disease and other cardiac conditions. Continuous improvements in the spatial and temporal resolution of CT scanners are revealing details regarding the spatially and temporally varying contrast concentration in the vasculature, that were not evident before. These contrast dispersion patterns offer the possibility of extracting useful information about the hemodynamics from the scans. In the current presentation, we will describe experimental studies carried out with CT compatible phantoms of coronary vessels that provide insights into the effect of imaging artifacts on the observed intracoronary contrast gradients. In addition, we will describe a series of computational fluid dynamics studies that explore the dispersion of contrast through the ascending-descending aorta with particular focus on the effect of the aortic curvature on the dispersion patterns. PE is supported by the NIH Graduate Partnership Program. RM and ACL pending patents in CTA based flow diagnostics and have other significant financial interests in these technologies.

  11. The Impact of Cardiac Motion on Aortic Valve Flow Used in Computational Simulations of the Thoracic Aorta.

    PubMed

    Wendell, David C; Samyn, Margaret M; Cava, Joseph R; Krolikowski, Mary M; LaDisa, John F

    2016-09-01

    Advancements in image-based computational modeling are producing increasingly more realistic representations of vasculature and hemodynamics, but so far have not compensated for cardiac motion when imposing inflow boundary conditions. The effect of cardiac motion on aortic flow is important when assessing sequelae in this region including coarctation of the aorta (CoA) or regurgitant fraction. The objective of this investigation was to develop a method to assess and correct for the influence of cardiac motion on blood flow measurements through the aortic valve (AoV) and to determine its impact on patient-specific local hemodynamics quantified by computational fluid dynamics (CFD). A motion-compensated inflow waveform was imposed into the CFD model of a patient with repaired CoA that accounted for the distance traveled by the basal plane during the cardiac cycle. Time-averaged wall shear stress (TAWSS) and turbulent kinetic energy (TKE) values were compared with CFD results of the same patient using the original waveform. Cardiac motion resulted in underestimation of flow during systole and overestimation during diastole. Influences of inflow waveforms on TAWSS were greatest along the outer wall of the ascending aorta (AscAo) (∼30 dyn/cm2). Differences in TAWSS were more pronounced than those from the model creation or mesh dependence aspects of CFD. TKE was slightly higher for the motion-compensated waveform throughout the aortic arch. These results suggest that accounting for cardiac motion when quantifying blood flow through the AoV can lead to different conclusions for hemodynamic indices, which may be important if these results are ultimately used to predict patient outcomes. PMID:27367143

  12. Computational modeling of inhibition of voltage-gated Ca channels: identification of different effects on uterine and cardiac action potentials

    PubMed Central

    Tong, Wing-Chiu; Ghouri, Iffath; Taggart, Michael J.

    2014-01-01

    The uterus and heart share the important physiological feature whereby contractile activation of the muscle tissue is regulated by the generation of periodic, spontaneous electrical action potentials (APs). Preterm birth arising from premature uterine contractions is a major complication of pregnancy and there remains a need to pursue avenues of research that facilitate the use of drugs, tocolytics, to limit these inappropriate contractions without deleterious actions on cardiac electrical excitation. A novel approach is to make use of mathematical models of uterine and cardiac APs, which incorporate many ionic currents contributing to the AP forms, and test the cell-specific responses to interventions. We have used three such models—of uterine smooth muscle cells (USMC), cardiac sinoatrial node cells (SAN), and ventricular cells—to investigate the relative effects of reducing two important voltage-gated Ca currents—the L-type (ICaL) and T-type (ICaT) Ca currents. Reduction of ICaL (10%) alone, or ICaT (40%) alone, blunted USMC APs with little effect on ventricular APs and only mild effects on SAN activity. Larger reductions in either current further attenuated the USMC APs but with also greater effects on SAN APs. Encouragingly, a combination of ICaL and ICaT reduction did blunt USMC APs as intended with little detriment to APs of either cardiac cell type. Subsequent overlapping maps of ICaL and ICaT inhibition profiles from each model revealed a range of combined reductions of ICaL and ICaT over which an appreciable diminution of USMC APs could be achieved with no deleterious action on cardiac SAN or ventricular APs. This novel approach illustrates the potential for computational biology to inform us of possible uterine and cardiac cell-specific mechanisms. Incorporating such computational approaches in future studies directed at designing new, or repurposing existing, tocolytics will be beneficial for establishing a desired uterine specificity of action

  13. Mouse and computational models link Mlc2v dephosphorylation to altered myosin kinetics in early cardiac disease

    PubMed Central

    Sheikh, Farah; Ouyang, Kunfu; Campbell, Stuart G.; Lyon, Robert C.; Chuang, Joyce; Fitzsimons, Dan; Tangney, Jared; Hidalgo, Carlos G.; Chung, Charles S.; Cheng, Hongqiang; Dalton, Nancy D.; Gu, Yusu; Kasahara, Hideko; Ghassemian, Majid; Omens, Jeffrey H.; Peterson, Kirk L.; Granzier, Henk L.; Moss, Richard L.; McCulloch, Andrew D.; Chen, Ju

    2012-01-01

    Actin-myosin interactions provide the driving force underlying each heartbeat. The current view is that actin-bound regulatory proteins play a dominant role in the activation of calcium-dependent cardiac muscle contraction. In contrast, the relevance and nature of regulation by myosin regulatory proteins (for example, myosin light chain-2 [MLC2]) in cardiac muscle remain poorly understood. By integrating gene-targeted mouse and computational models, we have identified an indispensable role for ventricular Mlc2 (Mlc2v) phosphorylation in regulating cardiac muscle contraction. Cardiac myosin cycling kinetics, which directly control actin-myosin interactions, were directly affected, but surprisingly, Mlc2v phosphorylation also fed back to cooperatively influence calcium-dependent activation of the thin filament. Loss of these mechanisms produced early defects in the rate of cardiac muscle twitch relaxation and ventricular torsion. Strikingly, these defects preceded the left ventricular dysfunction of heart disease and failure in a mouse model with nonphosphorylatable Mlc2v. Thus, there is a direct and early role for Mlc2 phosphorylation in regulating actin-myosin interactions in striated muscle contraction, and dephosphorylation of Mlc2 or loss of these mechanisms can play a critical role in heart failure. PMID:22426213

  14. Simulation of cardiac electrophysiology on next-generation high-performance computers.

    PubMed

    Bordas, Rafel; Carpentieri, Bruno; Fotia, Giorgio; Maggio, Fabio; Nobes, Ross; Pitt-Francis, Joe; Southern, James

    2009-05-28

    Models of cardiac electrophysiology consist of a system of partial differential equations (PDEs) coupled with a system of ordinary differential equations representing cell membrane dynamics. Current software to solve such models does not provide the required computational speed for practical applications. One reason for this is that little use is made of recent developments in adaptive numerical algorithms for solving systems of PDEs. Studies have suggested that a speedup of up to two orders of magnitude is possible by using adaptive methods. The challenge lies in the efficient implementation of adaptive algorithms on massively parallel computers. The finite-element (FE) method is often used in heart simulators as it can encapsulate the complex geometry and small-scale details of the human heart. An alternative is the spectral element (SE) method, a high-order technique that provides the flexibility and accuracy of FE, but with a reduced number of degrees of freedom. The feasibility of implementing a parallel SE algorithm based on fully unstructured all-hexahedra meshes is discussed. A major computational task is solution of the large algebraic system resulting from FE or SE discretization. Choice of linear solver and preconditioner has a substantial effect on efficiency. A fully parallel implementation based on dynamic partitioning that accounts for load balance, communication and data movement costs is required. Each of these methods must be implemented on next-generation supercomputers in order to realize the necessary speedup. The problems that this may cause, and some of the techniques that are beginning to be developed to overcome these issues, are described. PMID:19380320

  15. Clinical Structural Anatomy of the Inferior Pyramidal Space Reconstructed Within the Cardiac Contour Using Multidetector-Row Computed Tomography.

    PubMed

    Mori, Shumpei; Fukuzawa, Koji; Takaya, Tomofumi; Takamine, Sachiko; Ito, Tatsuro; Fujiwara, Sei; Nishii, Tatsuya; Kono, Atsushi K; Yoshida, Akihiro; Hirata, Ken-Ichi

    2015-07-01

    Although many studies have described the detailed anatomy of the inferior pyramidal space, it may not be easy for cardiologists who have few chances to study cadaveric hearts to understand the correct morphology of the structure. The inferior pyramidal space is the part of extracardiac fibro-adipose tissue wedging between the 4 cardiac chambers from the diaphragmatic surface of the heart. Many cardiologists have interests in pericardial adipose tissue, but the inferior pyramidal space seems to have been neglected. A number of important structures, including the coronary sinus, atrioventricular node, atrioventricular nodal artery, membranous septum, muscular atrioventricular sandwich (previously called the "muscular atrioventricular septum"), atrial septum, ventricular septum, aortic valvar complex, mitral valvar attachment, and tricuspid valvar attachment are associated with the inferior pyramidal space. We previously revealed its 3-dimensional live anatomy using multidetector-row computed tomography. Moreover, the 3-dimensional understanding of the anatomy in association with the cardiac contour is important from the viewpoints of clinical cardiac electrophysiology. The purpose of this article is to demonstrate extended findings regarding the clinical structural anatomy of the inferior pyramidal space, which was reconstructed in combination with the cardiac contour using multidetector-row computed tomography, and discuss the clinical implications of the findings. PMID:25884276

  16. Early computed tomography in victims of non-traumatic out-of-hospital cardiac arrest.

    PubMed

    Christ, Martin; von Auenmueller, Katharina Isabel; Noelke, Jan Peter; Sasko, Benjamin; Amirie, Scharbanu; Trappe, Hans-Joachim

    2016-03-01

    Although early cranial and thoracic computed tomography (CT) is recommended in the early in-hospital treatment of victims of out-of-hospital cardiac arrest (OHCA), hardly anything is known regarding the proportions of therapy-relevant findings with this method. Victims of OHCA who were admitted to our hospital between January 1, 2008 and December 31, 2014 were studied. CT was classified as early if performed within the first 4 h following hospital admission. There were 32 (12.7 %) cranial, 31 (12.3 %) thoracic and 15 (6.0 %) abdominal CT. The major findings and associated number of patients were: intracranial bleeding in two patients (0.8 %), acute cerebral ischemia in two (0.8 %), cerebral oedema in four (1.6 %), pulmonary emboli in three (1.2 %), hemothorax in two (0.8 %), tracheal rupture in one (0.4 %), pneumonia in 11 (4.4 %), paralytic ileus in one (0.4 %), ascites in three (1.2 %), pneumoperitoneum in one (0.4 %), acute cholecystitis in two (0.8 %), mesenteric vascular occlusion in one (0.4 %) and ruptured abdominal aortic aneurysm in one (0.4 %). In victims of OHCA, early diagnostic CT provides therapy-relevant findings in a high proportion (42.3 %) of patients examined. PMID:26597877

  17. A computational model-based validation of Guyton's analysis of cardiac output and venous return curves

    NASA Technical Reports Server (NTRS)

    Mukkamala, R.; Cohen, R. J.; Mark, R. G.

    2002-01-01

    Guyton developed a popular approach for understanding the factors responsible for cardiac output (CO) regulation in which 1) the heart-lung unit and systemic circulation are independently characterized via CO and venous return (VR) curves, and 2) average CO and right atrial pressure (RAP) of the intact circulation are predicted by graphically intersecting the curves. However, this approach is virtually impossible to verify experimentally. We theoretically evaluated the approach with respect to a nonlinear, computational model of the pulsatile heart and circulation. We developed two sets of open circulation models to generate CO and VR curves, differing by the manner in which average RAP was varied. One set applied constant RAPs, while the other set applied pulsatile RAPs. Accurate prediction of intact, average CO and RAP was achieved only by intersecting the CO and VR curves generated with pulsatile RAPs because of the pulsatility and nonlinearity (e.g., systemic venous collapse) of the intact model. The CO and VR curves generated with pulsatile RAPs were also practically independent. This theoretical study therefore supports the validity of Guyton's graphical analysis.

  18. Thermal dilution measurement of cardiac output in dogs using an analog computer.

    PubMed

    Hendriks, F F; Schipperheyn, J J; Quanjer, P H

    1978-01-01

    Thermal dilution cardiac output determinations in dogs were compared to simultaneously performed Fick oxygen measurements. The purpose of this study was to validate in dog experiments a method for thermal dilution measurement which employs a double-thermistor catheter combined with an automatic computer as described by Olsson et al. Dilution and injectate temperature are entered directly into the calculation. The method does not employ logarithmic extrapolation, integration of the dilution signal being terminated when a preset cut-off level is reached. Errors due to recirculation, thermal capacitance of the right heart and heat exchange with the catheter's dead space require the use of an empirically derived correction factor, which in dogs was found to be significantly different from the factor used for human thermal dilution curves. With the appropriate cut-off level and correction factor a good agreement was found between the results of the thermal dilution and the Fick method. The regression equation for 47 experiments was found to be COtd = 0.95 COFick + 0.08; the correlation coefficient was 0.94. PMID:728031

  19. A computer simulation study of isometric contraction of latissimus dorsi muscle used for cardiac assistance.

    PubMed

    Minoura, T; Mizuhara, H; Tsutsumi, S; Nishimura, K; Ban, T

    1997-01-01

    This study was designed to investigate the feasibility of a skeletal muscle pump employing latissimus dorsi muscle (LDM) for cardiac assistance. We developed and used a 2-dimensional mathematical model for LDM to investigate how the size of pneumatic balloons (30, 38, and 45 ml) and the three different locations (proximal, center, and distal) affect the pressure applied to the balloon by LDM. The computer simulation was performed by coding a visco-elastic and nonlinear 2-dimensional program that employed the finite element method (FEM). The muscle specific parameters of LDM were obtained from animal experiment results. The model is based on Hill's characteristic equation and composed of a contractile component and a passive element. The simulation results indicated that the intermediate and largest sized balloon lead to the highest and the lowest power (volume reduction per unit time interval), respectively. On the other hand, when the balloon is inserted in the distal LDM, the power is lower than in the other two positions, regardless of the balloon size. The above results suggest that the optimal size of the balloon should be selected depending on the muscle specific parameters of the actuator, and that the balloon should be inserted either in the proximal portion or center of the actuator. PMID:9360153

  20. Anatomical reconstructions of the human cardiac venous system using contrast-computed tomography of perfusion-fixed specimens.

    PubMed

    Spencer, Julianne; Fitch, Emily; Iaizzo, Paul A

    2013-01-01

    A detailed understanding of the complexity and relative variability within the human cardiac venous system is crucial for the development of cardiac devices that require access to these vessels. For example, cardiac venous anatomy is known to be one of the key limitations for the proper delivery of cardiac resynchronization therapy (CRT)(1) Therefore, the development of a database of anatomical parameters for human cardiac venous systems can aid in the design of CRT delivery devices to overcome such a limitation. In this research project, the anatomical parameters were obtained from 3D reconstructions of the venous system using contrast-computed tomography (CT) imaging and modeling software (Materialise, Leuven, Belgium). The following parameters were assessed for each vein: arc length, tortuousity, branching angle, distance to the coronary sinus ostium, and vessel diameter. CRT is a potential treatment for patients with electromechanical dyssynchrony. Approximately 10-20% of heart failure patients may benefit from CRT(2). Electromechanical dyssynchrony implies that parts of the myocardium activate and contract earlier or later than the normal conduction pathway of the heart. In CRT, dyssynchronous areas of the myocardium are treated with electrical stimulation. CRT pacing typically involves pacing leads that stimulate the right atrium (RA), right ventricle (RV), and left ventricle (LV) to produce more resynchronized rhythms. The LV lead is typically implanted within a cardiac vein, with the aim to overlay it within the site of latest myocardial activation. We believe that the models obtained and the analyses thereof will promote the anatomical education for patients, students, clinicians, and medical device designers. The methodologies employed here can also be utilized to study other anatomical features of our human heart specimens, such as the coronary arteries. To further encourage the educational value of this research, we have shared the venous models on our

  1. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence.

    PubMed

    Gimeno-Blanes, Francisco J; Blanco-Velasco, Manuel; Barquero-Pérez, Óscar; García-Alberola, Arcadi; Rojo-Álvarez, José L

    2016-01-01

    Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future. PMID:27014083

  2. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence

    PubMed Central

    Gimeno-Blanes, Francisco J.; Blanco-Velasco, Manuel; Barquero-Pérez, Óscar; García-Alberola, Arcadi; Rojo-Álvarez, José L.

    2016-01-01

    Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future. PMID:27014083

  3. The relative role of patient physiology and device optimisation in cardiac resynchronisation therapy: A computational modelling study.

    PubMed

    Crozier, Andrew; Blazevic, Bojan; Lamata, Pablo; Plank, Gernot; Ginks, Matthew; Duckett, Simon; Sohal, Manav; Shetty, Anoop; Rinaldi, Christopher A; Razavi, Reza; Smith, Nicolas P; Niederer, Steven A

    2016-07-01

    Cardiac resynchronisation therapy (CRT) is an established treatment for heart failure, however the effective selection of patients and optimisation of therapy remain controversial. While extensive research is ongoing, it remains unclear whether improvements in patient selection or therapy planning offers a greater opportunity for the improvement of clinical outcomes. This computational study investigates the impact of both physiological conditions that guide patient selection and the optimisation of pacing lead placement on CRT outcomes. A multi-scale biophysical model of cardiac electromechanics was developed and personalised to patient data in three patients. These models were separated into components representing cardiac anatomy, pacing lead location, myocardial conductivity and stiffness, afterload, active contraction and conduction block for each individual, and recombined to generate a cohort of 648 virtual patients. The effect of these components on the change in total activation time of the ventricles (ΔTAT) and acute haemodynamic response (AHR) was analysed. The pacing site location was found to have the largest effect on ΔTAT and AHR. Secondary effects on ΔTAT and AHR were found for functional conduction block and cardiac anatomy. The simulation results highlight a need for a greater emphasis on therapy optimisation in order to achieve the best outcomes for patients. PMID:26546827

  4. TOPICAL REVIEW: Dynamic single photon emission computed tomography—basic principles and cardiac applications

    NASA Astrophysics Data System (ADS)

    Gullberg, Grant T.; Reutter, Bryan W.; Sitek, Arkadiusz; Maltz, Jonathan S.; Budinger, Thomas F.

    2010-10-01

    The very nature of nuclear medicine, the visual representation of injected radiopharmaceuticals, implies imaging of dynamic processes such as the uptake and wash-out of radiotracers from body organs. For years, nuclear medicine has been touted as the modality of choice for evaluating function in health and disease. This evaluation is greatly enhanced using single photon emission computed tomography (SPECT), which permits three-dimensional (3D) visualization of tracer distributions in the body. However, to fully realize the potential of the technique requires the imaging of in vivo dynamic processes of flow and metabolism. Tissue motion and deformation must also be addressed. Absolute quantification of these dynamic processes in the body has the potential to improve diagnosis. This paper presents a review of advancements toward the realization of the potential of dynamic SPECT imaging and a brief history of the development of the instrumentation. A major portion of the paper is devoted to the review of special data processing methods that have been developed for extracting kinetics from dynamic cardiac SPECT data acquired using rotating detector heads that move as radiopharmaceuticals exchange between biological compartments. Recent developments in multi-resolution spatiotemporal methods enable one to estimate kinetic parameters of compartment models of dynamic processes using data acquired from a single camera head with slow gantry rotation. The estimation of kinetic parameters directly from projection measurements improves bias and variance over the conventional method of first reconstructing 3D dynamic images, generating time-activity curves from selected regions of interest and then estimating the kinetic parameters from the generated time-activity curves. Although the potential applications of SPECT for imaging dynamic processes have not been fully realized in the clinic, it is hoped that this review illuminates the potential of SPECT for dynamic imaging

  5. Dynamic single photon emission computed tomography—basic principles and cardiac applications

    PubMed Central

    Gullberg, Grant T; Reutter, Bryan W; Sitek, Arkadiusz; Maltz, Jonathan S; Budinger, Thomas F

    2011-01-01

    The very nature of nuclear medicine, the visual representation of injected radiopharmaceuticals, implies imaging of dynamic processes such as the uptake and wash-out of radiotracers from body organs. For years, nuclear medicine has been touted as the modality of choice for evaluating function in health and disease. This evaluation is greatly enhanced using single photon emission computed tomography (SPECT), which permits three-dimensional (3D) visualization of tracer distributions in the body. However, to fully realize the potential of the technique requires the imaging of in vivo dynamic processes of flow and metabolism. Tissue motion and deformation must also be addressed. Absolute quantification of these dynamic processes in the body has the potential to improve diagnosis. This paper presents a review of advancements toward the realization of the potential of dynamic SPECT imaging and a brief history of the development of the instrumentation. A major portion of the paper is devoted to the review of special data processing methods that have been developed for extracting kinetics from dynamic cardiac SPECT data acquired using rotating detector heads that move as radiopharmaceuticals exchange between biological compartments. Recent developments in multi-resolution spatiotemporal methods enable one to estimate kinetic parameters of compartment models of dynamic processes using data acquired from a single camera head with slow gantry rotation. The estimation of kinetic parameters directly from projection measurements improves bias and variance over the conventional method of first reconstructing 3D dynamic images, generating time–activity curves from selected regions of interest and then estimating the kinetic parameters from the generated time–activity curves. Although the potential applications of SPECT for imaging dynamic processes have not been fully realized in the clinic, it is hoped that this review illuminates the potential of SPECT for dynamic imaging

  6. Computational Modeling of Open-Irrigated Electrodes for Radiofrequency Cardiac Ablation Including Blood Motion-Saline Flow Interaction.

    PubMed

    González-Suárez, Ana; Berjano, Enrique; Guerra, Jose M; Gerardo-Giorda, Luca

    2016-01-01

    Radiofrequency catheter ablation (RFCA) is a routine treatment for cardiac arrhythmias. During RFCA, the electrode-tissue interface temperature should be kept below 80 °C to avoid thrombus formation. Open-irrigated electrodes facilitate power delivery while keeping low temperatures around the catheter. No computational model of an open-irrigated electrode in endocardial RFCA accounting for both the saline irrigation flow and the blood motion in the cardiac chamber has been proposed yet. We present the first computational model including both effects at once. The model has been validated against existing experimental results. Computational results showed that the surface lesion width and blood temperature are affected by both the electrode design and the irrigation flow rate. Smaller surface lesion widths and blood temperatures are obtained with higher irrigation flow rate, while the lesion depth is not affected by changing the irrigation flow rate. Larger lesions are obtained with increasing power and the electrode-tissue contact. Also, larger lesions are obtained when electrode is placed horizontally. Overall, the computational findings are in close agreement with previous experimental results providing an excellent tool for future catheter research. PMID:26938638

  7. Computational Modeling of Open-Irrigated Electrodes for Radiofrequency Cardiac Ablation Including Blood Motion-Saline Flow Interaction

    PubMed Central

    González-Suárez, Ana; Berjano, Enrique; Guerra, Jose M.; Gerardo-Giorda, Luca

    2016-01-01

    Radiofrequency catheter ablation (RFCA) is a routine treatment for cardiac arrhythmias. During RFCA, the electrode-tissue interface temperature should be kept below 80°C to avoid thrombus formation. Open-irrigated electrodes facilitate power delivery while keeping low temperatures around the catheter. No computational model of an open-irrigated electrode in endocardial RFCA accounting for both the saline irrigation flow and the blood motion in the cardiac chamber has been proposed yet. We present the first computational model including both effects at once. The model has been validated against existing experimental results. Computational results showed that the surface lesion width and blood temperature are affected by both the electrode design and the irrigation flow rate. Smaller surface lesion widths and blood temperatures are obtained with higher irrigation flow rate, while the lesion depth is not affected by changing the irrigation flow rate. Larger lesions are obtained with increasing power and the electrode-tissue contact. Also, larger lesions are obtained when electrode is placed horizontally. Overall, the computational findings are in close agreement with previous experimental results providing an excellent tool for future catheter research. PMID:26938638

  8. Cardiac magnetic resonance imaging and computed tomography: state of the art in clinical practice.

    PubMed

    Lang, Christopher; Atalay, Michael K

    2014-02-01

    Recent technological innovations in CT and MR imaging of the heart have vastly expanded the clinical utility of these modalities allowing them to complement and in some ways surpass the capabilities of more traditional methods. Cardiac MR (CMR) has an unrivaled ability to assess contractile function, characterize tissue, and detect minute areas of scar. In turn, CMR can reliably risk stratify ischemic heart disease and has emerged as a non-invasive gold standard technique for imaging non-ischemic cardiomyopathies.1 Cardiac CT (CCT) by comparison reveals cardiac structure and, in particular, coronary anatomy with remarkable sub-millimeter detail. For the first time, coronary stenoses can be directly and reliably visualized non-invasively. Owing to its very high negative predictive value for the detection of significant coronary obstruction, CCT can accurately exclude coronary disease as a cause of chest pain in low- to intermediate-risk populations. This article describes these modalities and their recent clinical advances. PMID:24494211

  9. Myocardial perfusion analysis in cardiac computed tomography angiographic images at rest.

    PubMed

    Xiong, Guanglei; Kola, Deeksha; Heo, Ran; Elmore, Kimberly; Cho, Iksung; Min, James K

    2015-08-01

    Cardiac computed tomography angiography (CTA) is a non-invasive method for anatomic evaluation of coronary artery stenoses. However, CTA is prone to artifacts that reduce the diagnostic accuracy to identify stenoses. Further, CTA does not allow for determination of the physiologic significance of the visualized stenoses. In this paper, we propose a new system to determine the physiologic manifestation of coronary stenoses by assessment of myocardial perfusion from typically acquired CTA images at rest. As a first step, we develop an automated segmentation method to delineate the left ventricle. Both endocardium and epicardium are compactly modeled with subdivision surfaces and coupled by explicit thickness representation. After initialization with five anatomical landmarks, the model is adapted to a target image by deformation increments including control vertex displacements and thickness variations guided by trained AdaBoost classifiers, and regularized by a prior of deformation increments from principal component analysis (PCA). The evaluation using a 5-fold cross-validation demonstrates the overall segmentation error to be 1.00 ± 0.39 mm for endocardium and 1.06 ± 0.43 mm for epicardium, with a boundary contour alignment error of 2.79 ± 0.52. Based on our LV model, two types of myocardial perfusion analyzes have been performed. One is a perfusion network analysis, which explores the correlation (as network edges) pattern of perfusion between all pairs of myocardial segments (as network nodes) defined in AHA 17-segment model. We find perfusion network display different patterns in the normal and disease groups, as divided by whether significant coronary stenosis is present in quantitative coronary angiography (QCA). The other analysis is a clinical validation assessment of the ability of the developed algorithm to predict whether a patient has significant coronary stenosis when referenced to an invasive QCA ground truth standard. By training three machine

  10. A comparison of bolus injection of landiolol versus oral administration of propranolol before cardiac computed tomography.

    PubMed

    Nakamura, Yoshitaka; Yamaji, Kyohei; Saho, Tatsunori; Matsuzaki, Zyousin; Yuda, Itsuo; Soga, Yoshimitsu; Shirai, Shinichi; Ando, Kenji; Nobuyoshi, Masakiyo

    2014-01-01

    Heart rate (HR) reduction is essential to achieve good image quality for cardiac computed tomography (CCT). We evaluated the efficacy of a bolus injection of landiolol, an ultra-short acting β-blocker, without the administration of oral β-blocker to reduce HR prior to CCT. We enrolled 678 consecutive patients who underwent CCT from December 2011 to March 2012 and divided them into three groups, which were a propranolol group (n = 277), a low-dose landiolol group (n = 188), and a high-dose landiolol group (n = 213). Patients in the propranolol group received oral propranolol (10-20 mg) prior to CCT. Patients in the low-dose and high-dose landiolol groups were administered a bolus injection of landiolol (0.125 mg/kg), while the high-dose group received an additional 3.75 mg of landiolol if the baseline HR was ≥75/min. Although the average HR was significantly lower in the propranolol group (61.6 ± 8.0/min) than in the low-dose landiolol group (64.1 ± 7.4/min, P < 0.001), there was no significant difference in the image quality (P = 0.91). Among patients with baseline HR ≥75/min, the average HR tended to be lower in the high-dose landiolol group (67.2 ± 6.9/min) compared with the low-dose landiolol group (69.0 ± 6.9/min, P = 0.10), and there was a corresponding difference in image quality between these two groups (P = 0.02). In conclusion, Although the decrease of HR was significantly larger in the propranolol group than in the landiolol groups, the image quality was similar. Among the patients who received landiolol, a higher dose was associated with a lower HR and better image quality. Further investigation to assess higher-dose bolus injection of landiolol or bolus injection following oral administration of a β-blocker would be needed. PMID:24634807

  11. The Role of Imaging with Cardiac Computed Tomography in Cardio-Oncology Patients.

    PubMed

    Pitekova, Barbora; Ravi, Sriram; Shah, Shimoli V; Mladosievicova, Beata; Heitner, Stephen; Ferencik, Maros

    2016-09-01

    Cardiovascular diseases and cancer represent the two most common causes of morbidity and mortality in industrialized countries. With the increase in long-term survival of cancer patients, cardiovascular diseases are the leading cause of mortality for many cancer survivors. In this article, we will review the most common cardiovascular toxicities of cancer therapies and will describe the role of cardiac CT in the detection and monitoring of cardiovascular disease. While there is limited evidence for the use of CT imaging in cancer patients, we will discuss the utility of cardiac CT in the detection and management of coronary artery disease, pericardial and valvular heart disease. PMID:27443383

  12. High frequency stimulation of cardiac myocytes: A theoretical and computational study

    NASA Astrophysics Data System (ADS)

    Weinberg, Seth H.

    2014-12-01

    High-frequency stimulation (HFS) has recently been identified as a novel approach for terminating life-threatening cardiac arrhythmias. HFS elevates myocyte membrane potential and blocks electrical conduction for the duration of the stimulus. However, low amplitude HFS can induce rapidly firing action potentials, which may reinitiate an arrhythmia. The cellular level mechanisms underlying HFS-induced electrical activity are not well understood. Using a multiscale method, we show that a minimal myocyte model qualitatively reproduces the influence of HFS on cardiac electrical activity. Theoretical analysis and simulations suggest that persistent activation and de-inactivation of ionic currents, in particular a fast inward window current, underlie HFS-induced action potentials and membrane potential elevation, providing hypotheses for future experiments. We derive analytical expressions to describe how HFS modifies ionic current amplitude and gating dynamics. We show how fast inward current parameters influence the parameter regimes for HFS-induced electrical activity, demonstrating how the efficacy of HFS as a therapy for terminating arrhythmias may depend on the presence of pathological conditions or pharmacological treatments. Finally, we demonstrate that HFS terminates cardiac arrhythmias in a one-dimensional ring of cardiac tissue. In this study, we demonstrate a novel approach to characterize the influence of HFS on ionic current gating dynamics, provide new insight into HFS of the myocardium, and suggest mechanisms underlying HFS-induced electrical activity.

  13. Little impact of tsunami-stricken nuclear accident on awareness of radiation dose of cardiac computed tomography: A questionnaire study

    PubMed Central

    2013-01-01

    Background With the increased use of cardiac computed tomography (CT), radiation dose remains a major issue, although physicians are trying to reduce the substantial risks associated with use of this diagnostic tool. This study was performed to investigate recognition of the level of radiation exposure from cardiac CT and the differences in the level of awareness of radiation before and after the Fukushima nuclear plant accident. Methods We asked 30 physicians who were undergoing training in internal medicine to determine the equivalent doses of radiation for common radiological examinations when a normal chest X-ray is accepted as one unit; questions about the absolute radiation dose of cardiac CT data were also asked. Results According to the results, 86.6% of respondents believed the exposure to be 1 mSv at most, and 93.3% thought that the exposure was less than that of 100 chest X-rays. This finding indicates that their perceptions were far lower than the actual amounts. Even after the occurrence of such a large nuclear disaster in Fukushima, there were no significant differences in the same subjects’ overall awareness of radiation amounts. Conclusions Even after such a major social issue as the Fukushima nuclear accident, the level of awareness of the accurate radiation amount used in 64-channel multidetector CT (MDCT) by clinical physicians who order this test was not satisfactory. Thus, there is a need for the development of effective continuing education programs to improve awareness of radiation from ionizing radiation devices, including cardiac CT, and emphasis on risk-benefit evaluation based on accurate knowledge during medical training. PMID:23631688

  14. The Incremental Prognostic Value of Cardiac Computed Tomography in Comparison with Single-Photon Emission Computed Tomography in Patients with Suspected Coronary Artery Disease

    PubMed Central

    Lee, Heesun; Yoon, Yeonyee E.; Park, Jun-Bean; Kim, Hack-Lyoung; Park, Hyo Eun; Lee, Seung-Pyo; Kim, Hyung-Kwan; Choi, Su-Yeon; Kim, Yong-Jin; Cho, Goo-Yeong; Zo, Joo-Hee; Sohn, Dae-Won

    2016-01-01

    Background Coronary computed tomographic angiography (CCTA) facilitates comprehensive evaluation of coronary artery disease (CAD), including plaque characterization, and can provide additive diagnostic value to single-photon emission computed tomography (SPECT). However, data regarding the incremental prognostic value of CCTA to SPECT remain sparse. We evaluated the independent and incremental prognostic value of CCTA, as compared with clinical risk factors and SPECT. Materials and methods A total of 1,077 patients with suspected CAD who underwent both SPECT and cardiac CT between 2004 and 2012 were enrolled retrospectively. Presence of reversible or fixed perfusion defect (PD) and summed stress score were evaluated on SPECT. Presence, extent of coronary atherosclerosis and diameter stenosis (DS) were evaluated on CCTA. Plaque composition was categorized as non-calcified, mixed, or calcified according to the volume of calcified component (>130 Hounsfield Units). Patients were followed up for the occurrence of adverse cardiac events including cardiac death, non-fatal myocardial infarction, unstable angina, and late revascularization (>90 days after imaging studies). Results During follow-up (median 23 months), adverse cardiac events were observed in 71 patients (6.6%). When adjusted for clinical risk factors and SPECT findings, the presence of any coronary plaque, any plaque in ≥3 segments, coronary artery calcium score (CACS) ≥400, a plaque ≥50% DS, presence of non-calcified plaque (NCP) or mixed plaque (MP), and NCP/MP in ≥2 segments were independent predictors of adverse cardiac events; however, the presence of calcified plaque (CP) was not. Conventional CCTA findings, including CACS ≥400 and a plaque ≥50% DS, demonstrated incremental prognostic value over clinical risk factors and SPECT (χ² 54.19 to 101.03; p <0.001). Addition of NCP/MP in ≥2 segments resulted in further significantly improved prediction (χ² 101.03 to 113.29; p <0

  15. Feasibility study to demonstrate cardiac imaging using fast kVp switching dual-energy computed tomography: phantom study

    NASA Astrophysics Data System (ADS)

    Madhav, Priti; Imai, Yasuhiro; Narayanan, Suresh; Dutta, Sandeep; Chandra, Naveen; Hsieh, Jiang

    2012-03-01

    Dual-energy computed tomography is a novel imaging tool that has the potential to reduce beam hardening artifacts and enhance material separation over conventional imaging techniques. Dual-energy acquisitions can be performed by using a fast kVp technology to switch between acquiring adjacent projections at two distinct x-ray spectra (80 and 140 kVp). These datasets can be used to further compute material density and monochromatic images for better material separation and beam hardening reduction by virtue of the projection domain process. The purpose of this study was to evaluate the feasibility of using dual-energy in cardiac imaging for myocardial perfusion detection and coronary artery lumen visualization. Data was acquired on a heart phantom, which consisted of the chambers and aorta filled with Iodine density solution (500 HU @ 120 kVp), a defect region between the aorta and chamber (40 HU @ 120 kVp), two Iodinefilled vessels (400 HU @ 120 kVp) of different diameters with high attenuation (hydroxyapatite) plaques (HAP), and with a 30-cm water equivalent body ring around the phantom. Prospective ECG-gated single-energy and prospective ECG-gated dual-energy imaging was performed. Results showed that the generated monochromatic images had minimal beam hardening artifacts which improved the accuracy and detection of the myocardial defect region. Material density images were useful in differentiating and quantifying the actual size of the plaque and coronary artery lumen. Overall, this study shows that dual-energy cardiac imaging will be a valuable tool for cardiac applications.

  16. Construction of a computational anatomical model of the peripheral cardiac conduction system.

    PubMed

    Sebastian, Rafael; Zimmerman, Viviana; Romero, Daniel; Frangi, Alejandro F

    2011-12-01

    A methodology is presented here for automatic construction of a ventricular model of the cardiac conduction system (CCS), which is currently a missing block in many multiscale cardiac electromechanic models. It includes the His bundle, left bundle branches, and the peripheral CCS. The algorithm is fundamentally an enhancement of a rule-based method known as the Lindenmayer systems (L-systems). The generative procedure has been divided into three consecutive independent stages, which subsequently build the CCS from proximal to distal sections. Each stage is governed by a set of user parameters together with anatomical and physiological constrains to direct the generation process and adhere to the structural observations derived from histology studies. Several parameters are defined using statistical distributions to introduce stochastic variability in the models. The CCS built with this approach can generate electrical activation sequences with physiological characteristics. PMID:21896384

  17. Coronary venous system in cardiac computer tomography: Visualization, classification and role

    PubMed Central

    Mlynarski, Rafal; Mlynarska, Agnieszka; Sosnowski, Maciej

    2014-01-01

    The role of the coronary venous system was underestimated for many years. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The most important seems to be cardiac resynchronization therapy, which is an invasive method for the treatment of heart failure. Unfortunately, one of the major problems is the significant anatomical variability of the coronary venous system. The description of the selected anatomical structures is only useful in selected cases such as, for example, the obstruction of selected vessels, a huge Thebesian valve, etc. The 3D images can add significant value; however, their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy. After summarizing all of the articles and guidelines, it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization. The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases. PMID:25071880

  18. Cardiac Multidetector Computed Tomography: Basic Physics of Image Acquisition and Clinical Applications

    PubMed Central

    Bardo, Dianna M.E; Brown, Paul

    2008-01-01

    Cardiac MDCT is here to stay. And, it is more than just imaging coronary arteries. Understanding the differences in and the benefits of one CT scanner from another will help you to optimize the capabilities of the scanner, but requires a basic understanding of the MDCT imaging physics. This review provides key information needed to understand the differences in the types of MDCT scanners, from 64 – 320 detectors, flat panels, single and dual source configurations, step and shoot prospective and retrospective gating, and how each factor influences radiation dose, spatial and temporal resolution, and image noise. PMID:19936200

  19. Computational modelling of cardiac electrophysiology: explanation of the variability of results from different numerical solvers.

    PubMed

    Pathmanathan, P; Bernabeu, M O; Niederer, S A; Gavaghan, D J; Kay, D

    2012-08-01

    A recent verification study compared 11 large-scale cardiac electrophysiology solvers on an unambiguously defined common problem. An unexpected amount of variation was observed between the codes, including significant error in conduction velocity in the majority of the codes at certain spatial resolutions. In particular, the results of the six finite element codes varied considerably despite each using the same order of interpolation. In this present study, we compare various algorithms for cardiac electrophysiological simulation, which allows us to fully explain the differences between the solvers. We identify the use of mass lumping as the fundamental cause of the largest variations, specifically the combination of the commonly used techniques of mass lumping and operator splitting, which results in a slightly different form of mass lumping to that supported by theory and leads to increased numerical error. Other variations are explained through the manner in which the ionic current is interpolated. We also investigate the effect of different forms of mass lumping in various types of simulation. PMID:25099569

  20. ASCI 2010 appropriateness criteria for cardiac magnetic resonance imaging: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline working group

    PubMed Central

    Choi, Byoung Wook; Chan, Carmen; Jinzaki, Masahiro; Tsai, I-Chen; Yong, Hwan Seok; Yu, Wei

    2010-01-01

    There has been a growing need for standard Asian population guidelines for cardiac CT and cardiac MR due to differences in culture, healthcare system, ethnicity and disease prevalence. The Asian Society of Cardiovascular Imaging, as the only society dedicated to cardiovascular imaging in Asia, formed a cardiac CT and cardiac MR guideline working group in order to help Asian practitioners to establish cardiac CT and cardiac MR services. In this ASCI cardiac MR appropriateness criteria report, 23 Technical Panel members representing various Asian countries were invited to rate 50 indications that can frequently be encountered in clinical practice in Asia. Indications were rated on a scale of 1–9 to be categorized into ‘appropriate’ (7–9), ‘uncertain’ (4–6), or ‘inappropriate’ (1–3). According to median scores of the 23 members, the final ratings for indications were 24 appropriate, 18 uncertain and 8 inappropriate with 22 ‘highly-agreed’ (19 appropriate and 3 inappropriate) indications. This report is expected to have a significant impact on the cardiac MR practices in many Asian countries by promoting the appropriate use of cardiac MR. Electronic supplementary material The online version of this article (doi:10.1007/s10554-010-9687-z) contains supplementary material, which is available to authorized users. PMID:20734234

  1. The Role of Magnetic Resonance Imaging and Cardiac Computed Tomography in the Assessment of Left Atrial Anatomy, Size, and Function

    PubMed Central

    Kuchynka, Petr; Podzimkova, Jana; Masek, Martin; Lambert, Lukas; Cerny, Vladimir; Danek, Barbara; Palecek, Tomas

    2015-01-01

    In the last decade, there has been increasing evidence that comprehensive evaluation of the left atrium is of utmost importance. Numerous studies have clearly demonstrated the prognostic value of left atrial volume for long-term outcome. Furthermore, advances in catheter ablation procedures used for the treatment of drug-refractory atrial fibrillation require the need for detailed knowledge of left atrial and pulmonary venous morphology as well of atrial wall characteristics. This review article discusses the role of cardiac magnetic resonance and computed tomography in assessment of left atrial size, its normal and abnormal morphology, and function. Special interest is paid to the utility of these rapidly involving noninvasive imaging methods before and after atrial fibrillation ablation. PMID:26221583

  2. COMPUTATIONAL CHALLENGES IN BUILDING MULTI-SCALE AND MULTI-PHYSICS MODELS OF CARDIAC ELECTRO-MECHANICS

    PubMed Central

    Plank, G; Prassl, AJ; Augustin, C

    2014-01-01

    Despite the evident multiphysics nature of the heart – it is an electrically controlled mechanical pump – most modeling studies considered electrophysiology and mechanics in isolation. In no small part, this is due to the formidable modeling challenges involved in building strongly coupled anatomically accurate and biophyically detailed multi-scale multi-physics models of cardiac electro-mechanics. Among the main challenges are the selection of model components and their adjustments to achieve integration into a consistent organ-scale model, dealing with technical difficulties such as the exchange of data between electro-physiological and mechanical model, particularly when using different spatio-temporal grids for discretization, and, finally, the implementation of advanced numerical techniques to deal with the substantial computational. In this study we report on progress made in developing a novel modeling framework suited to tackle these challenges. PMID:24043050

  3. Intrinsic Cardiac Autonomic Ganglionated Plexi within Epicardial Fats Modulate the Atrial Substrate Remodeling: Experiences with Atrial Fibrillation Patients Receiving Catheter Ablation

    PubMed Central

    Singhal, Rahul; Lo, Li-Wei; Lin, Yenn-Jiang Lin; Chang, Shih-Lin; Hu, Yu-Feng; Chao, Tze-Fan; Chung, Fa-Po; Chiou, Cheun-Wang; Tsao, Hsuan-Ming; Chen, Shih-Ann

    2016-01-01

    Background A recent study reported the close relationship between high dominant frequent (DF) sites [atrial fibrillation (AF) nest] and the intrinsic cardiac autonomic nervous system. The aim of this study was to investigate the correlation between the regional distribution of epicardial fat and the properties of the biatrial substrates in AF patients. Methods We studied 32 patients with paroxysmal (n = 23) and persistent (n = 9) AF. The epicardial fat volume around the left atrium (LA) was evaluated using 64-slice multidetector computed tomography and the topographic distribution of the fat volume was assessed. The biatrial DFs, voltages, and total activation times (TATs) were obtained during sinus rhythm. Results Out of the 8 divided LA regions, a significant linear correlation existed between the LA fat and mean DF values in the right upper anterior LA, left upper anterior LA, right lower anterior LA, right upper posterior LA, left upper posterior LA, and left lower posterior LA. There was no significant correlation between the regional LA fat distribution and regional LA peak-to-peak bipolar voltage and TAT. During a mean follow-up of 17 ± 8 months, 22 of the 32 (69%) patients were free of AF. In the multivariate analysis, only the mean LA DF was found to be a significant predictor of recurrence. Conclusions There was a close association between the regional distribution of the LA epicardial fat and the atrial substrate manifesting high frequency during sinus rhythm (AF nest). Those nests were related to ablation outcome. Hence, epicardial fat may play a significant role in atrial substrate remodeling and thereby in the pathogenesis and maintenance of AF. PMID:27122948

  4. Modeling Cardiac Electrophysiology at the Organ Level in the Peta FLOPS Computing Age

    SciTech Connect

    Mitchell, Lawrence; Bishop, Martin; Hoetzl, Elena; Neic, Aurel; Liebmann, Manfred; Haase, Gundolf; Plank, Gernot

    2010-09-30

    Despite a steep increase in available compute power, in-silico experimentation with highly detailed models of the heart remains to be challenging due to the high computational cost involved. It is hoped that next generation high performance computing (HPC) resources lead to significant reductions in execution times to leverage a new class of in-silico applications. However, performance gains with these new platforms can only be achieved by engaging a much larger number of compute cores, necessitating strongly scalable numerical techniques. So far strong scalability has been demonstrated only for a moderate number of cores, orders of magnitude below the range required to achieve the desired performance boost.In this study, strong scalability of currently used techniques to solve the bidomain equations is investigated. Benchmark results suggest that scalability is limited to 512-4096 cores within the range of relevant problem sizes even when systems are carefully load-balanced and advanced IO strategies are employed.

  5. Computational Characterization of Mutations in Cardiac Troponin T Known to Cause Familial Hypertrophic Cardiomyopathy

    PubMed Central

    Guinto, Pia J.; Manning, Edward P.; Schwartz, Steven D.; Tardiff, Jil C.

    2015-01-01

    Cardiac Troponin T (cTnT) is a central modulator of thin filament regulation of myofilament activation. The lack of structural data for the TNT1 tail domain, a proposed α-helical region, makes the functional implications of the FHC mutations difficult to determine. Studies have suggested that flexibility of TNT1 is important in normal protein-protein interactions within the thin filament. Our groups have previously shown through Molecular Dynamics (MD) simulations that some FHC mutations, Arg92Leu(R92L) and Arg92Trp(R92W), result in increased flexibility at a critical hinge region 12 residues distant from the mutation. To explain this distant effect and its implications for FHC mutations, we characterized the dynamics of wild type and mutational segments of cTnT using MD. Our data shows an opening of the helix between residues 105–110 in mutants. Consequently, the dihedral angles of these residues correspond to non-α-helical regions on Ramachandran plots. We hypothesize the removal of a charged residue decreases electrostatic repulsion between the point mutation and surrounding residues resulting in local helical compaction. Constrained ends of the helix and localized compaction results in expansion within the nearest non-polar helical turn from the mutation site, residues 105–109. PMID:26500385

  6. Pred-hERG: A Novel web-Accessible Computational Tool for Predicting Cardiac Toxicity.

    PubMed

    Braga, Rodolpho C; Alves, Vinicius M; Silva, Meryck F B; Muratov, Eugene; Fourches, Denis; Lião, Luciano M; Tropsha, Alexander; Andrade, Carolina H

    2015-10-01

    The blockage of the hERG K(+) channels is closely associated with lethal cardiac arrhythmia. The notorious ligand promiscuity of this channel earmarked hERG as one of the most important antitargets to be considered in early stages of drug development process. Herein we report on the development of an innovative and freely accessible web server for early identification of putative hERG blockers and non-blockers in chemical libraries. We have collected the largest publicly available curated hERG dataset of 5,984 compounds. We succeed in developing robust and externally predictive binary (CCR≈0.8) and multiclass models (accuracy≈0.7). These models are available as a web-service freely available for public at http://labmol.farmacia.ufg.br/predherg/. Three following outcomes are available for the users: prediction by binary model, prediction by multi-class model, and the probability maps of atomic contribution. The Pred-hERG will be continuously updated and upgraded as new information became available. PMID:27490970

  7. A novel approach for the automated segmentation and volume quantification of cardiac fats on computed tomography.

    PubMed

    Rodrigues, É O; Morais, F F C; Morais, N A O S; Conci, L S; Neto, L V; Conci, A

    2016-01-01

    The deposits of fat on the surroundings of the heart are correlated to several health risk factors such as atherosclerosis, carotid stiffness, coronary artery calcification, atrial fibrillation and many others. These deposits vary unrelated to obesity, which reinforces its direct segmentation for further quantification. However, manual segmentation of these fats has not been widely deployed in clinical practice due to the required human workload and consequential high cost of physicians and technicians. In this work, we propose a unified method for an autonomous segmentation and quantification of two types of cardiac fats. The segmented fats are termed epicardial and mediastinal, and stand apart from each other by the pericardium. Much effort was devoted to achieve minimal user intervention. The proposed methodology mainly comprises registration and classification algorithms to perform the desired segmentation. We compare the performance of several classification algorithms on this task, including neural networks, probabilistic models and decision tree algorithms. Experimental results of the proposed methodology have shown that the mean accuracy regarding both epicardial and mediastinal fats is 98.5% (99.5% if the features are normalized), with a mean true positive rate of 98.0%. In average, the Dice similarity index was equal to 97.6%. PMID:26474835

  8. Cardiac magnetic resonance and computed tomography angiography for clinical imaging of stable coronary artery disease. Diagnostic classification and risk stratification

    PubMed Central

    Korosoglou, Grigorios; Giusca, Sorin; Gitsioudis, Gitsios; Erbel, Christian; Katus, Hugo A.

    2014-01-01

    Despite advances in the pharmacologic and interventional treatment of coronary artery disease (CAD), atherosclerosis remains the leading cause of death in Western societies. X-ray coronary angiography has been the modality of choice for diagnosing the presence and extent of CAD. However, this technique is invasive and provides limited information on the composition of atherosclerotic plaque. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) have emerged as promising non-invasive techniques for the clinical imaging of CAD. Hereby, CCTA allows for visualization of coronary calcification, lumen narrowing and atherosclerotic plaque composition. In this regard, data from the CONFIRM Registry recently demonstrated that both atherosclerotic plaque burden and lumen narrowing exhibit incremental value for the prediction of future cardiac events. However, due to technical limitations with CCTA, resulting in false positive or negative results in the presence of severe calcification or motion artifacts, this technique cannot entirely replace invasive angiography at the present time. CMR on the other hand, provides accurate assessment of the myocardial function due to its high spatial and temporal resolution and intrinsic blood-to-tissue contrast. Hereby, regional wall motion and perfusion abnormalities, during dobutamine or vasodilator stress, precede the development of ST-segment depression and anginal symptoms enabling the detection of functionally significant CAD. While CT generally offers better spatial resolution, the versatility of CMR can provide information on myocardial function, perfusion, and viability, all without ionizing radiation for the patients. Technical developments with these 2 non-invasive imaging tools and their current implementation in the clinical imaging of CAD will be presented and discussed herein. PMID:25147526

  9. Cardiac Rehabilitation

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Cardiac Rehabilitation? Cardiac rehabilitation (rehab) is a medically supervised program ... be designed to meet your needs. The Cardiac Rehabilitation Team Cardiac rehab involves a long-term commitment ...

  10. Dynamics of PKA phosphorylation and gain of function in cardiac pacemaker cells: a computational model analysis.

    PubMed

    Behar, Joachim; Yaniv, Yael

    2016-05-01

    Cardiac pacemaker cell function is regulated by a coupled-clock system that integrates molecular cues on the cell-membrane surface (i.e., membrane clock) and on the sarcoplasmic reticulum (SR) (i.e., Ca(2+) clock). A recent study has shown that cotransfection of spontaneous beating cells (HEK293 cells and neonatal rat myocytes) with R524Q-mutant human hyperpolarization-activated cyclic nucleotide-gated molecules (the dominant component of funny channels) increases the funny channel's sensitivity to cAMP and leads to a decrease in spontaneous action potential (AP) cycle length (i.e., tachycardia). We hypothesize that in rabbit pacemaker cells, the same behavior is expected, and because of the coupled-clock system, the resultant steady-state decrease in AP cycle length will embody contributions from both clocks: the initial decrease in the spontaneous AP beating interval, arising from increased sensitivity of the f-channel to cAMP, will be accompanied by an increase in the adenylyl cyclase (AC)-cAMP-PKA-dependent phosphorylation activity, which will further decrease this interval. To test our hypothesis, we used the recently developed Yaniv-Lakatta pacemaker cell numerical model. This model predicts the cAMP signaling dynamics, as well as the kinetics and magnitude of protein phosphorylation in both normal and mutant pacemaker cells. We found that R524Q-mutant pacemaker cells have a shorter AP firing rate than that of wild-type cells and that gain in pacemaker function is the net effect of the R514Q mutation on the functioning of the coupled-clock system. Specifically, our results directly support the hypothesis that changes in Ca(2+)-activated AC-cAMP-PKA signaling are involved in the development of tachycardia in R524Q-mutant pacemaker cells. PMID:26945074

  11. Calcium and IP3 dynamics in cardiac myocytes: experimental and computational perspectives and approaches

    PubMed Central

    Hohendanner, Felix; McCulloch, Andrew D.; Blatter, Lothar A.; Michailova, Anushka P.

    2014-01-01

    [Ca2+] in the nuclear and cytosolic compartment. In this review, we discuss the state of knowledge regarding the origin and the physiological implications of nuclear Ca2+ transients in different cardiac cell types (adult atrial and ventricular myocytes) as well as experimental and mathematical approaches to study Ca2+ and IP3 signaling in the cytosol and nucleus. In particular, we focus on the concept that highly localized Ca2+ signals are required to translocate and activate Ca2+-dependent transcription factors (e.g., nuclear factor of activated T-cells, NFAT; histone deacetylase, HDAC) through phosphorylation/dephosphorylation processes. PMID:24639654

  12. Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography

    SciTech Connect

    Hsieh Jiang; Londt, John; Vass, Melissa; Li, Jay; Tang Xiangyang; Okerlund, Darin

    2006-11-15

    Coronary artery imaging with x-ray computed tomography (CT) is one of the most recent advancements in CT clinical applications. Although existing ''state-of-the-art'' clinical protocols today utilize helical data acquisition, it suffers from the lack of ability to handle irregular heart rate and relatively high x-ray dose to patients. In this paper, we propose a step-and-shoot data acquisition protocol that significantly overcomes these shortcomings. The key to the proposed protocol is the large volume coverage (40 mm) enabled by the cone beam CT scanner, which allows the coverage of the entire heart in 3 to 4 steps. In addition, we propose a gated complementary reconstruction algorithm that overcomes the longitudinal truncation problem resulting from the cone beam geometry. Computer simulations, phantom experiments, and clinical studies were conducted to validate our approach.

  13. Implementation of a Phase Detection Algorithm for Dynamic Cardiac Computed Tomography Analysis Based on Time Dependent Contrast Agent Distribution

    PubMed Central

    Kendziorra, Carsten; Meyer, Henning; Dewey, Marc

    2014-01-01

    This paper presents a phase detection algorithm for four-dimensional (4D) cardiac computed tomography (CT) analysis. The algorithm detects a phase, i.e. a specific three-dimensional (3D) image out of several time-distributed 3D images, with high contrast in the left ventricle and low contrast in the right ventricle. The purpose is to use the automatically detected phase in an existing algorithm that automatically aligns the images along the heart axis. Decision making is based on the contrast agent distribution over time. It was implemented in KardioPerfusion – a software framework currently being developed for 4D CT myocardial perfusion analysis. Agreement of the phase detection algorithm with two reference readers was 97% (95% CI: 82–100%). Mean duration for detection was 0.020 s (95% CI: 0.018–0.022 s), which was times less than the readers needed (s, ). Thus, this algorithm is an accurate and fast tool that can improve work flow of clinical examinations. PMID:25545863

  14. Comparison of cardiac output of the left and right side of the heart by ultrafast computed tomography

    SciTech Connect

    Wolfkiel, C.J.; Ferguson, J.L.; Law, W.R.; Chomka, E.V.; Brundage, B.H.

    1986-03-05

    Ultrafast computed tomography (CT) evaluation of cardiac output (CO) can be determined using indicator dilution theory. The concentration of an iodinated contrast agent injected into a vein of a subject can be measured as a function of time by serial EKG, gated CT imaging. The contrast density of the blood pool measured by CT defines the indicator concentration. CT CO is proportional to the area under a time density curve from a region of the blood pool. Proper subject position and scanning timing allows CT to measure CO in the pulmonary (PA) artery and the aorta (AO) with the same contrast bolus. Three anesthetized dogs were multiply scanned following simultaneous injections of contrast and radioactive tracer microspheres. Microsphere CO was determined by reference withdrawal method. Multiple thermodilution CO measurements were made just prior and after each CT CO procedure. 24 comparisons were made of thermodilution, microsphere and CT CO measured in the PA (right sided CO (RSCO)) and the AO (left sided CO (LSCO)). CT CO was calculated as the ratio of the volume of contrast injected to the time density curve area corrected for the relation of contrast density to CT number. RSCO agreed very closely to LSCO (r = .99, p < .001; y = 1.0x +/- .32). RSCO correlated to thermodilution (r = .96, p < .001; y = 1.2x +/- 1.3) and microsphere CO (r = .93, p < .001; y = .69x +/- 1.3). These data show that CT CO measurements can be made in the PA and AO with equal accuracy.

  15. In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography

    PubMed Central

    van Deel, Elza; Ridwan, Yanto; van Vliet, J. Nicole; Belenkov, Sasha; Essers, Jeroen

    2016-01-01

    The use of Micro-Computed Tomography (MicroCT) for in vivo studies of small animals as models of human disease has risen tremendously due to the fact that MicroCT provides quantitative high-resolution three-dimensional (3D) anatomical data non-destructively and longitudinally. Most importantly, with the development of a novel preclinical iodinated contrast agent called eXIA160, functional and metabolic assessment of the heart became possible. However, prior to the advent of commercial MicroCT scanners equipped with X-ray flat-panel detector technology and easy-to-use cardio-respiratory gating, preclinical studies of cardiovascular disease (CVD) in small animals required a MicroCT technologist with advanced skills, and thus were impractical for widespread implementation. The goal of this work is to provide a practical guide to the use of the high-speed Quantum FX MicroCT system for comprehensive determination of myocardial global and regional function along with assessment of myocardial perfusion, metabolism and viability in healthy mice and in a cardiac ischemia mouse model induced by permanent occlusion of the left anterior descending coronary artery (LAD). PMID:26967592

  16. In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography.

    PubMed

    van Deel, Elza; Ridwan, Yanto; van Vliet, J Nicole; Belenkov, Sasha; Essers, Jeroen

    2016-01-01

    The use of Micro-Computed Tomography (MicroCT) for in vivo studies of small animals as models of human disease has risen tremendously due to the fact that MicroCT provides quantitative high-resolution three-dimensional (3D) anatomical data non-destructively and longitudinally. Most importantly, with the development of a novel preclinical iodinated contrast agent called eXIA160, functional and metabolic assessment of the heart became possible. However, prior to the advent of commercial MicroCT scanners equipped with X-ray flat-panel detector technology and easy-to-use cardio-respiratory gating, preclinical studies of cardiovascular disease (CVD) in small animals required a MicroCT technologist with advanced skills, and thus were impractical for widespread implementation. The goal of this work is to provide a practical guide to the use of the high-speed Quantum FX MicroCT system for comprehensive determination of myocardial global and regional function along with assessment of myocardial perfusion, metabolism and viability in healthy mice and in a cardiac ischemia mouse model induced by permanent occlusion of the left anterior descending coronary artery (LAD). PMID:26967592

  17. Automatic computation of 2D cardiac measurements from B-mode echocardiography

    NASA Astrophysics Data System (ADS)

    Park, JinHyeong; Feng, Shaolei; Zhou, S. Kevin

    2012-03-01

    We propose a robust and fully automatic algorithm which computes the 2D echocardiography measurements recommended by America Society of Echocardiography. The algorithm employs knowledge-based imaging technologies which can learn the expert's knowledge from the training images and expert's annotation. Based on the models constructed from the learning stage, the algorithm searches initial location of the landmark points for the measurements by utilizing heart structure of left ventricle including mitral valve aortic valve. It employs the pseudo anatomic M-mode image generated by accumulating the line images in 2D parasternal long axis view along the time to refine the measurement landmark points. The experiment results with large volume of data show that the algorithm runs fast and is robust comparable to expert.

  18. The influence of novel CT reconstruction technique and ECG-gated technique on image quality and patient dose of cardiac computed tomography.

    PubMed

    Dyakov, I; Stoinova, V; Groudeva, V; Vassileva, J

    2015-07-01

    The aim of the present study was to compare image quality and patient dose in cardiac computed tomography angiography (CTA) in terms of volume computed tomography dose index (CTDI vol), dose length product (DLP) and effective dose, when changing from filtered back projection (FBP) to adaptive iterative dose reduction (AIDR) reconstruction techniques. Further aim was to implement prospective electrocardiogram (ECG) gating for patient dose reduction. The study was performed with Aquilion ONE 320-row CT of Toshiba Medical Systems. Analysis of cardiac CT protocols was performed before and after integration of the new software. The AIDR technique showed more than 50 % reduction in CTDIvol values and 57 % in effective dose. The subjective evaluation of clinical images confirmed the adequate image quality acquired by the AIDR technique. The preliminary results indicated significant dose reduction when using prospective ECG gating by keeping the adequate diagnostic quality of clinical images. PMID:25836680

  19. Propagation of Electrical Excitation in a Ring of Cardiac Cells: A Computer Simulation Study

    NASA Technical Reports Server (NTRS)

    Kogan, B. Y.; Karplus, W. J.; Karpoukhin, M. G.; Roizen, I. M.; Chudin, E.; Qu, Z.

    1996-01-01

    The propagation of electrical excitation in a ring of cells described by the Noble, Beeler-Reuter (BR), Luo-Rudy I (LR I), and third-order simplified (TOS) mathematical models is studied using computer simulation. For each of the models it is shown that after transition from steady-state circulation to quasi-periodicity achieved by shortening the ring length (RL), the action potential duration (APD) restitution curve becomes a double-valued function and is located below the original ( that of an isolated cell) APD restitution curve. The distributions of APD and diastolic interval (DI) along a ring for the entire range of RL corresponding to quasi-periodic oscillations remain periodic with the period slightly different from two RLs. The 'S' shape of the original APD restitution curve determines the appearance of the second steady-state circulation region for short RLs. For all the models and the wide variety of their original APD restitution curves, no transition from quasi-periodicity to chaos was observed.

  20. Marketing cardiac CT programs.

    PubMed

    Scott, Jason

    2010-01-01

    There are two components of cardiac CT discussed in this article: coronary artery calcium scoring (CACS) and coronary computed tomography angiography (CCTA).The distinctive advantages of each CT examination are outlined. In order to ensure a successful cardiac CT program, it is imperative that imaging facilities market their cardiac CT practices effectively in order to gain a competitive advantage in this valuable market share. If patients receive quality care by competent individuals, they are more likely to recommend the facility's cardiac CT program. Satisfied patients will also be more willing to come back for any further testing. PMID:22276376

  1. Noninvasive Three-dimensional Cardiac Activation Imaging from Body Surface Potential Maps: A Computational and Experimental Study on a Rabbit Model

    PubMed Central

    Han, Chengzong; Liu, Zhongming; Zhang, Xin; Pogwizd, Steven; He, Bin

    2009-01-01

    Three-dimensional (3-D) cardiac activation imaging (3-DCAI) is a recently developed technique that aims at imaging the activation sequence throughout the 3-D volume of myocardium. 3-DCAI entails the modeling and estimation of the cardiac equivalent current density (ECD) distribution from which the local activation time within myocardium is determined as the time point with the peak amplitude of local ECD estimates. In this paper, we report, for the first time, an experimental study of the performance and applicability of 3-DCAI as judged by measured 3-D cardiac activation sequence using 3-D intra-cardiac mapping, in a group of 4 healthy rabbits during ventricular pacing. During the experiments, the body surface potentials and the intramural bipolar electrical recordings were simultaneously measured in a closed-chest condition to allow for a rigorous evaluation of the noninvasive 3-DCAI algorithm using the intra-cardiac mapping. The ventricular activation sequence non-invasively imaged from the body surface measurements by using 3-DCAI was generally in agreement with that obtained from the invasive intra-cardiac recordings. The overall difference between them, quantified as the root mean square (RMS) error, was 7.42±0.61 ms, and the normalized difference, quantified as the relative error (RE), was 0.24±0.03. The distance from the reconstructed site of initial activation to the actual pacing site, defined as the localization error (LE), was 5.47±1.57 mm. In addition, computer simulations were conducted to provide additional assessment of the performance of the 3-DCAI algorithm using a realistic-geometry rabbit heart-torso model. Averaged over 9 pacing sites, the RE and LE were 0.20±0.07 and 4.56±1.12 mm, respectively, for single-pacing, when 20 μV Gaussian white noise was added to the body surface potentials at 53 body surface locations. Averaged over 8 pairs of dual pacing, the RE was 0.25±0.06 for 20 μV additive noise. The present results obtained through

  2. CARDIO--a Lotus 1-2-3 based computer program for rapid calculation of cardiac output from dye or thermal dilution curves.

    PubMed

    Brill, R W; Bushnell, P G

    1989-01-01

    We have developed a menu-driven computer program (CARDIO), based on a Lotus 1-2-3 template and a series of macrocommands, that rapidly and semiautomatically calculates cardiac output from dye or thermal dilution curves. CARDIO works with any dye or thermal dilution recorder with an analog output, any analog to digital (A-to-D) conversion system, and any computer capable of running Lotus 1-2-3 version 2. No prior experience with Lotus 1-2-3 is needed to operate CARDIO, but experienced users can take full advantage of Lotus 1-2-3's graphics, data manipulation, and data retrieval capabilities. PMID:2689079

  3. Cardiac Catheterization

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Cardiac Catheterization? Cardiac catheterization (KATH-eh-ter-ih-ZA-shun) is a ... disease. Doctors also can use ultrasound during cardiac catheterization to see blockages in the coronary arteries. Ultrasound ...

  4. Computer-assisted diagnosis for chronic heart failure by the analysis of their cardiac reserve and heart sound characteristics.

    PubMed

    Zheng, Yineng; Guo, Xingming; Qin, Jian; Xiao, Shouzhong

    2015-12-01

    An innovative computer-assisted diagnosis system for chronic heart failure (CHF) was proposed in this study, based on cardiac reserve (CR) indexes extraction, heart sound hybrid characteristics extraction and intelligent diagnosis model definition. Firstly, the modified wavelet packet-based denoising method was applied to data pre-processing. Then, the CR indexes such as the ratio of diastolic to systolic duration (D/S) and the amplitude ratio of the first to second heart sound (S1/S2) were extracted. The feature set consisting of the heart sound characteristics such as multifractal spectrum parameters, the frequency corresponding to the maximum peak of the normalized PSD curve (fPSDmax) and adaptive sub-band energy fraction (sub_EF) were calculated based on multifractal detrended fluctuation analysis (MF-DFA), maximum entropy spectra estimation (MESE) and empirical mode decomposition (EMD). Statistical methods such as t-test and receiver operating characteristic (ROC) curve analysis were performed to analyze the difference of each parameter between the healthy and CHF patients. Finally, least square support vector machine (LS-SVM) was employed for the implementation of intelligent diagnosis. The result indicates the achieved diagnostic accuracy, sensitivity and specificity of the proposed system are 95.39%, 96.59% and 93.75% for the detection of CHF, respectively. The selected cutoff values of the diagnosis features are D/S=1.59, S1/S2=1.31, Δα=1.34 and fPSDmax=22.49, determined by ROC curve analysis. This study suggests the proposed methodology could provide a technical clue for the CHF point-of-care system design and be a supplement for CHF diagnosis. PMID:26387633

  5. Cardiac Dual-source Computed Tomography for the Detection of Left Main Compression Syndrome in Patients with Pulmonary Hyper-tension

    PubMed Central

    Demerouti, Eftychia; Manginas, Athanassios; Petrou, Emmanouil; Katsilouli, Spyridoula; Karyofillis, Panagiotis; Athanassopoulos, George; Karatasakis, George; Iakovou, Ioannis; Mihas, Konstantinos; Mastorakou, Irene

    2016-01-01

    Introduction: Left Main Compression Syndrome (LMCS) represents an entity described as the extrinsic compression of the left main coronary artery (LMCA) by a dilated pulmonary artery (PA) trunk. We examined the presence of LMCS in patients with pulmonary hypertension (PH) using dual-source computed tomography (DSCT), as a non-invasive diagnostic tool. Methods: The following parameters were measured: PA trunk diameter (PAD), the distance between PAD and LMCA (LMPA) and the distance between PA and aorta (AoPA). These measurements were related with demographic, echocardiographic, hemodynamic and clinical parameters. Angiography was performed in two patients with LMCS suspected by cardiac computed tomographic angiography. Patients without PH but with angina were examined as controls, using DSCT cardiac angiography to assess the same measurements and to detect the prevalence of coronary artery disease. Results: PA diameter value over 40.00 mm has been associated with PH and LMCS. Furthermore, LMCS did not occur at a distance smaller than 0.50 mm between the PA and the LMCA, and did not correlate with the distance between the PA and the aorta or with cardiac index and NT-proBNP. Conclusion: DSCT may represent the initial testing modality in PH patients with dilated PA trunk to exclude LMCS. A periodical rule-out of this rare entity, as assessed by DSCT, in patients with a severely dilated PA seems to be mandatory for PH patients contributing to survival improvement. PMID:27499817

  6. Reproducibility and clinical potential of myocardial mass at risk calculated by a novel software utilizing cardiac computed tomography information.

    PubMed

    Sumitsuji, Satoru; Ide, Seiko; Siegrist, Patrick T; Salah, Youssef; Yokoi, Kensuke; Yoshida, Masatoki; Awata, Masaki; Yamasaki, Keita; Tachibana, Kouichi; Kaneda, Hideaki; Nanto, Shinsuke; Sakata, Yasushi

    2016-07-01

    To select the best revascularization strategy a correct understanding of the ischemic territory and the coronary anatomy is crucial. Stress myocardial perfusion single photon emission computed tomography (SPECT) is the gold standard to assess ischemia, however, SPECT has important limitations such as lack of coronary anatomical information or false negative results due to balanced ischemia in multi-vessel disease. Angiographic scores are based on anatomical characteristics of coronary arteries but they lack information on the extent of jeopardized myocardium. Cardiac computed tomography (CCT) has the ability to evaluate the coronary anatomy and myocardium in one sequence, which is theoretically the ideal method to assess the myocardial mass at risk (MMAR) for any target lesion located at any point in the coronary tree. In this study we analyzed MMAR of the three main coronary arteries and three major side branches; diagonal (Dx), obtuse marginal (OM), and posterior descending artery (PDA) in 42 patients with normal coronary arteries using an algorithm based on the Voronoi method. The distribution of MMAR among the three main coronary arteries was 44.3 ± 5.6 % for the left anterior descending artery, 28.2 ± 7.3 % for the left circumflex artery, and 26.8 ± 8.6 % for the right coronary artery. MMAR of the three major side branches was 11.3 ± 3.9 % for the Dx, 12.6 ± 5.2 % for the OM and 10.2 ± 3.4 % for the PDA. Intra- and inter-observer analysis showed excellent correlation (r = 0.97; p < 0.0001 and r = 0.95; p < 0.0001, respectively). In conclusion, CCT-based MMAR assessment is reliable and may offer important information for selection of the optimal revascularization procedure. PMID:26646280

  7. Myocardial hypoperfusion detected by cardiac computed tomography in an adult patient with heart failure after classic repair for corrected transposition of the great arteries.

    PubMed

    Okayama, Satoshi; Seno, Ayako; Soeda, Tsunenari; Takami, Yasuhiro; Horii, Manabu; Uemura, Shiro; Saito, Yoshihiko

    2011-08-01

    A 69-year-old male with a history of classic repair for corrected transposition of the great arteries (TGA) arrived at our hospital with dyspnoea upon exertion. Echocardiography revealed severe dilation and diffuse hypokinesis of the systemic ventricle without obvious valvular dysfunction. Cardiac computed tomography (CT) revealed no significant stenosis. However, the morphological right coronary artery (CA) on the left side was unequally distributed to the large systemic ventricle and was mostly obscured, especially on the anterior wall. A low attenuation area in the anterior wall of the systemic ventricle and prominent trabeculations suggested ischaemia or infarction. We considered that chronic myocardial hypoperfusion due to an inadequate coronary arterial supply was one cause of the exacerbated heart failure long after the classic repair. Cardiac CT is useful for evaluating the distribution of the CA and to predict blood supply to the myocardium in corrected TGA. PMID:21894815

  8. The Cardiac Atlas Project—an imaging database for computational modeling and statistical atlases of the heart

    PubMed Central

    Fonseca, Carissa G.; Backhaus, Michael; Bluemke, David A.; Britten, Randall D.; Chung, Jae Do; Cowan, Brett R.; Dinov, Ivo D.; Finn, J. Paul; Hunter, Peter J.; Kadish, Alan H.; Lee, Daniel C.; Lima, Joao A. C.; Medrano−Gracia, Pau; Shivkumar, Kalyanam; Suinesiaputra, Avan; Tao, Wenchao; Young, Alistair A.

    2011-01-01

    Motivation: Integrative mathematical and statistical models of cardiac anatomy and physiology can play a vital role in understanding cardiac disease phenotype and planning therapeutic strategies. However, the accuracy and predictive power of such models is dependent upon the breadth and depth of noninvasive imaging datasets. The Cardiac Atlas Project (CAP) has established a large-scale database of cardiac imaging examinations and associated clinical data in order to develop a shareable, web-accessible, structural and functional atlas of the normal and pathological heart for clinical, research and educational purposes. A goal of CAP is to facilitate collaborative statistical analysis of regional heart shape and wall motion and characterize cardiac function among and within population groups. Results: Three main open-source software components were developed: (i) a database with web-interface; (ii) a modeling client for 3D + time visualization and parametric description of shape and motion; and (iii) open data formats for semantic characterization of models and annotations. The database was implemented using a three-tier architecture utilizing MySQL, JBoss and Dcm4chee, in compliance with the DICOM standard to provide compatibility with existing clinical networks and devices. Parts of Dcm4chee were extended to access image specific attributes as search parameters. To date, approximately 3000 de-identified cardiac imaging examinations are available in the database. All software components developed by the CAP are open source and are freely available under the Mozilla Public License Version 1.1 (http://www.mozilla.org/MPL/MPL-1.1.txt). Availability: http://www.cardiacatlas.org Contact: a.young@auckland.ac.nz Supplementary information: Supplementary data are available at Bioinformatics online. PMID:21737439

  9. Morphological and Volumetric Analysis of Left Atrial Appendage and Left Atrium: Cardiac Computed Tomography-Based Reproducibility Assessment

    PubMed Central

    Taina, Mikko; Korhonen, Miika; Haataja, Mika; Muuronen, Antti; Arponen, Otso; Hedman, Marja; Jäkälä, Pekka; Sipola, Petri; Mustonen, Pirjo; Vanninen, Ritva

    2014-01-01

    Objectives Left atrial appendage (LAA) dilatation and morphology may influence an individual's risk for intracardiac thrombi and ischemic stroke. LAA size and morphology can be evaluated using cardiac computed tomography (cCT). The present study evaluated the reproducibility of LAA volume and morphology assessments. Methods A total of 149 patients (47 females; mean age 60.9±10.6 years) with suspected cardioembolic stroke/transient ischemic attack underwent cCT. Image quality was rated based on four categories. Ten patients were selected from each image quality category (N = 40) for volumetric reproducibility analysis by two individual readers. LAA and left atrium (LA) volume were measured in both two-chamber (2CV) and transversal view (TV) orientation. Intertechnique reproducibility was assessed between 2CV and TV (200 measurement pairs). LAA morphology (A = Cactus, B = ChickenWing, C = WindSock, D = CauliFlower), LAA opening height, number of LAA lobes, trabeculation, and orientation of the LAA tip was analysed in all study subjects by three individual readers (447 interobserver measurement pairs). The reproducibility of volume measurements was assessed by intra-class correlation (ICC) and the reproducibility of LAA morphology assessments by Cohen's kappa. Results The intra-observer and interobserver reproducibility of LAA and LA volume measurements was excellent (ICCs>0.9). The LAA (ICC = 0.954) and LA (ICC = 0.945) volume measurements were comparable between 2CV and TV. Morphological classification (ĸ = 0.24) and assessments of LAA opening height (ĸ = 0.1), number of LAA lobes (ĸ = 0.16), trabeculation (ĸ = 0.15), and orientation of the LAA tip (ĸ = 0.37) was only slightly to fairly reproducible. Conclusions LA and LAA volume measurements on cCT provide excellent reproducibility, whereas visual assessment of LAA morphological features is challenging and results in unsatisfactory agreement between readers

  10. Quantitative Analysis of Intraventricular Dyssynchrony Using Wall Thickness by Multidetector Computed Tomography

    PubMed Central

    Truong, Quynh A.; Singh, Jagmeet P.; Cannon, Christopher P.; Sarwar, Ammar; Nasir, Khurram; Auricchio, Angelo; Faletra, Francesco F.; Sorgente, Antonio; Conca, Cristina; Moccetti, Tiziano; Handschumacher, Mark; Brady, Thomas J.; Hoffmann, Udo

    2009-01-01

    OBJECTIVES We sought to determine the feasibility of cardiac computed tomography (CT) to detect significant differences in the extent of left ventricular dyssynchrony in heart failure (HF) patients with wide QRS, HF patients with narrow QRS, and age-matched controls. BACKGROUND The degree of mechanical dyssynchrony has been suggested as a predictor of response to cardiac resynchronization therapy. There have been no published reports of dyssynchrony assessment with the use of CT. METHODS Thirty-eight subjects underwent electrocardiogram-gated contrast-enhanced 64-slice multidetector CT. The left ventricular endocardial and epicardial boundaries were delineated from short-axis images reconstructed at 10% phase increments of the cardiac cycle. Global and segmental CT dyssynchrony metrics that used changes in wall thickness, wall motion, and volume over time were assessed for reproducibility. We defined a global metric using changes in wall thickness as the dyssynchrony index (DI). RESULTS The DI was the most reproducible metric (interobserver and intraobserver intraclass correlation coefficients ≥0.94, p < 0.0001) and was used to determine differences between the 3 groups: HF-wide QRS group (ejection fraction [EF] 22 ± 8%, QRS 163 ± 28 ms), HF-narrow QRS (EF 26 ± 7%, QRS 96 ± 11 ms), and age-matched control subjects (EF 64 ± 5%, QRS 87 ± 9 ms). Mean DI was significantly different between the 3 groups (HF-wide QRS: 152 ± 44 ms, HF-narrow QRS: 121 ± 58 ms, and control subjects: 65 ± 12 ms; p < 0.0001) and greater in the HF-wide QRS (p < 0.0001) and HF-narrow QRS (p = 0.005) groups compared with control subjects. We found that DI had a good correlation with 2-dimensional (r = 0.65, p = 0.012) and 3-dimensional (r = 0.68, p = 0.008) echocardiographic dyssynchrony. CONCLUSIONS Quantitative assessment of global CT-derived DI, based on changes in wall thickness over time, is highly reproducible and renders significant differences between subjects most likely to

  11. Automatic localization of the left ventricle from cardiac cine magnetic resonance imaging: a new spectrum-based computer-aided tool.

    PubMed

    Zhong, Liang; Zhang, Jun-Mei; Zhao, Xiaodan; Tan, Ru San; Wan, Min

    2014-01-01

    Traditionally, cardiac image analysis is done manually. Automatic image processing can help with the repetitive tasks, and also deal with huge amounts of data, a task which would be humanly tedious. This study aims to develop a spectrum-based computer-aided tool to locate the left ventricle using images obtained via cardiac magnetic resonance imaging. Discrete Fourier Transform was conducted pixelwise on the image sequence. Harmonic images of all frequencies were analyzed visually and quantitatively to determine different patterns of the left and right ventricles on spectrum. The first and fifth harmonic images were selected to perform an anisotropic weighted circle Hough detection. This tool was then tested in ten volunteers. Our tool was able to locate the left ventricle in all cases and had a significantly higher cropping ratio of 0.165 than did earlier studies. In conclusion, a new spectrum-based computer aided tool has been proposed and developed for automatic left ventricle localization. The development of this technique, which will enable the automatic location and further segmentation of the left ventricle, will have a significant impact in research and in diagnostic settings. We envisage that this automated method could be used by radiographers and cardiologists to diagnose and assess ventricular function in patients with diverse heart diseases. PMID:24722328

  12. The association between a quantitative computed tomography (CT) measurement of cerebral edema and outcomes in post-cardiac arrest – a validation study

    PubMed Central

    Cristia, Cristal; Ho, Mai-Lan; Levy, Sean; Andersen, Lars W.; Perman, Sarah M.; Giberson, Tyler; Salciccoli, Justin; Saindon, Brian Z.; Cocchi, Michael N.; Donnino, Michael W.

    2014-01-01

    Aim Previous studies have examined the association between quantitative computed tomography (CT) measures of cerebral edema and patient outcomes. It has been reported that a calculated gray matter to white matter attenuation ratio (GWR) of < 1.2 indicates a near 100% non-survivable injury post-cardiac arrest. The objective of the current study was to validate whether a GWR < 1.2 reliably indicates poor survival post-cardiac arrest. We also sought to determine the inter-rater variability among reviewers, and examine the utility of a novel GWR measurement to facilitate easier practical use. Methods We performed a retrospective analysis of post-cardiac arrest patients admitted to a single center from 2008 to 2012. Inclusion criteria were age ≥ 18 years, non-traumatic arrest, and available CT imaging within 24 hours after ROSC. Three independent physician reviewers from different specialties measured CT attenuation of pre-specified gray and white matter areas for GWR calculations. Results Out of 171 consecutive patients, 90 met the study inclusion criteria. Thirteen patients were excluded for technical reasons and/or significant additional pathology, leaving 77 head CT scans for evaluation. Median age was 66 years and 63% were male. In-hospital mortality was 65% and 70% of patients received therapeutic hypothermia. For the validation measurement, the intra-class correlation coefficient was 0.70. In our dataset, a GWR below 1.2 did not accurately predict mortality or poor neurological outcome (sensitivity 0.56–0.62 and specificity 0.63–0.81). A score below 1.1 predicted a near 100% mortality but was not a sensitive metric (sensitivity 0.14–0.20 and specificity 0.96–1.00). Similar results were found for the exploratory model. Conclusion A GWR < 1.2 on CT imaging within 24 hours after cardiac arrest was moderately specific for poor neurologic outcome and mortality. Based on our data, a threshold GWR < 1.1 may be a safer cut-off to identify patients with low

  13. Cardiac C-arm computed tomography using a 3D + time ROI reconstruction method with spatial and temporal regularization

    SciTech Connect

    Mory, Cyril; Auvray, Vincent; Zhang, Bo; Grass, Michael; Schäfer, Dirk; Chen, S. James; Carroll, John D.; Rit, Simon; Peyrin, Françoise; Douek, Philippe; Boussel, Loïc

    2014-02-15

    Purpose: Reconstruction of the beating heart in 3D + time in the catheter laboratory using only the available C-arm system would improve diagnosis, guidance, device sizing, and outcome control for intracardiac interventions, e.g., electrophysiology, valvular disease treatment, structural or congenital heart disease. To obtain such a reconstruction, the patient's electrocardiogram (ECG) must be recorded during the acquisition and used in the reconstruction. In this paper, the authors present a 4D reconstruction method aiming to reconstruct the heart from a single sweep 10 s acquisition. Methods: The authors introduce the 4D RecOnstructiOn using Spatial and TEmporal Regularization (short 4D ROOSTER) method, which reconstructs all cardiac phases at once, as a 3D + time volume. The algorithm alternates between a reconstruction step based on conjugate gradient and four regularization steps: enforcing positivity, averaging along time outside a motion mask that contains the heart and vessels, 3D spatial total variation minimization, and 1D temporal total variation minimization. Results: 4D ROOSTER recovers the different temporal representations of a moving Shepp and Logan phantom, and outperforms both ECG-gated simultaneous algebraic reconstruction technique and prior image constrained compressed sensing on a clinical case. It generates 3D + time reconstructions with sharp edges which can be used, for example, to estimate the patient's left ventricular ejection fraction. Conclusions: 4D ROOSTER can be applied for human cardiac C-arm CT, and potentially in other dynamic tomography areas. It can easily be adapted to other problems as regularization is decoupled from projection and back projection.

  14. Cardiac metastases

    PubMed Central

    Bussani, R; De‐Giorgio, F; Abbate, A; Silvestri, F

    2007-01-01

    Tumours metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic. Although primary cardiac tumours are extremely uncommon (various postmortem studies report rates between 0.001% and 0.28%), secondary tumours are not, and at least in theory, the heart can be metastasised by any malignant neoplasm able to spread to distant sites. In general, cardiac metastases are considered to be rare; however, when sought for, the incidence seems to be not as low as expected, ranging from 2.3% and 18.3%. Although no malignant tumours are known that diffuse preferentially to the heart, some do involve the heart more often than others—for example, melanoma and mediastinal primary tumours. This paper attempts to review the pathophysiology of cardiac metastatic disease, epidemiology and clinical presentation of cardiac metastases, and pathological characterisation of the lesions. PMID:17098886

  15. Coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) imaging in the assessment of patients presenting with chest pain suspected for acute coronary syndrome

    PubMed Central

    De Filippo, Massimo; Capasso, Raffaella

    2016-01-01

    Acute chest pain is an important clinical challenge and a major reason for presentation to the emergency department. Although multiple imaging techniques are available to assess patients with suspected acute coronary syndrome (ACS), considerable interest has been focused on the use of non-invasive imaging options as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR). According to several recent evidences, CCTA has been shown to represent a useful tool to rapidly and accurately diagnose coronary artery disease (CAD) in patients with low to intermediate cardiovascular risk. CCTA examination has the unique ability to non-invasively depict the coronary anatomy, not only allowing visualization of the lumen of the arteries in order to detect severe stenosis or occlusion responsible of myocardial ischemia, but also allows the assessment of coronary artery wall by demonstrating the presence or absence of CAD. However, routine CCTA is not able to differentiate ischemic from non-ischemic chest pain in patients with known CAD and it does not provide any functional assessment of the heart. Conversely, CMR is considered the gold standard in the evaluation of morphology, function, viability and tissue characterization of the heart. CMR offers a wide range of tools for diagnosing myocardial infarction (MI) at least at the same time of the elevation of cardiac troponin values, differentiating infarct tissue and ischemic myocardium from normal myocardium or mimicking conditions, and distinguishing between new and old ischemic events. In high-risk patients, with acute and chronic manifestations of CAD, CMR may be preferable to CCTA, since it would allow detection, differential diagnosis, prognostic evaluation and management of MI. PMID:27500156

  16. Imaging patients with cardiac trauma.

    PubMed

    Restrepo, Carlos S; Gutierrez, Fernando R; Marmol-Velez, Juan A; Ocazionez, Daniel; Martinez-Jimenez, Santiago

    2012-01-01

    In the United States, trauma is the leading cause of death among those who are 1-44 years old, with cardiovascular injuries representing the second most common cause of traumatic death after central nervous system injuries. Evaluation of trauma patients with suspected cardiac injury may be complex and include electrocardiography, measurement of cardiac biomarkers, and imaging examinations. Contrast material-enhanced computed tomography (CT) has become one of the most valuable imaging tools available for evaluating hemodynamically stable patients with suspected cardiac injury. The presence of hemopericardium, with or without cardiac tamponade, is one of the most significant findings of cardiac injury. Other complications that result from blunt cardiac injury, such as pericardial rupture and cardiac herniation, may be readily depicted at multidetector CT. Assessment of patients with cardiac injuries, particularly those with penetrating injuries, is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. Patients who are hemodynamically stable, particularly those with penetrating cardiac injuries, also may benefit from a timely imaging examination. In addition to chest radiography, other available modalities such as transthoracic and transesophageal echocardiography, nuclear medicine, and magnetic resonance imaging may play a role in selected cases. PMID:22582351

  17. Cardiac Lymphoma.

    PubMed

    Jeudy, Jean; Burke, Allen P; Frazier, Aletta Ann

    2016-07-01

    Lymphoma of the heart and pericardium may develop in up to 25% of patients with disseminated nodal disease, but primary cardiac lymphoma is rare. The majority are diffuse large B-cell lymphomas, which arise in immunocompetent older individuals, men twice as often as women. Subsets are found in immunocompromised patients, including those with HIV-AIDS or allograft recipients. Cardiac lymphomas tend to arise in the wall of the right heart, especially right atrium, with contiguous infiltration of epicardium and pericardium. Pericardial implants and effusions are common. The disease is often multifocal in the heart, but cardiac valves are usually spared. PMID:27265603

  18. Conformational changes of an ion-channel during gating and emerging electrophysiologic properties: Application of a computational approach to cardiac Kv7.1.

    PubMed

    Nekouzadeh, Ali; Rudy, Yoram

    2016-01-01

    Ion channels are the "building blocks" of the excitation process in excitable tissues. Despite advances in determining their molecular structure, understanding the relationship between channel protein structure and electrical excitation remains a challenge. The Kv7.1 potassium channel is an important determinant of the cardiac action potential and its adaptation to rate changes. It is subject to beta adrenergic regulation, and many mutations in the channel protein are associated with the arrhythmic long QT syndrome. In this theoretical study, we use a novel computational approach to simulate the conformational changes that Kv7.1 undergoes during activation gating and compute the resulting electrophysiologic function in terms of single-channel and macroscopic currents. We generated all possible conformations of the S4-S5 linker that couples the S3-S4 complex (voltage sensor domain, VSD) to the pore, and all associated conformations of VSD and the pore (S6). Analysis of these conformations revealed that VSD-to-pore mechanical coupling during activation gating involves outward translation of the voltage sensor, accompanied by a translation away from the pore and clockwise twist. These motions cause pore opening by moving the S4-S5 linker upward and away from the pore, providing space for the S6 tails to move away from each other. Single channel records, computed from the simulated motion trajectories during gating, have stochastic properties similar to experimentally recorded traces. Macroscopic current through an ensemble of channels displays two key properties of Kv7.1: an initial delay of activation and fast inactivation. The simulations suggest a molecular mechanism for fast inactivation; a large twist of the VSD following its outward translation results in movement of the base of the S4-S5 linker toward the pore, eliminating open pore conformations to cause inactivation. PMID:26743208

  19. Should computed tomography angiography supersede invasive coronary angiography for the evaluation of graft patency following coronary artery bypass graft surgery?

    PubMed

    Gabriel, Joseph; Klimach, Stefan; Lang, Peter; Hildick-Smith, David

    2015-08-01

    Invasive coronary angiography (ICA) has long been the established gold standard in assessing graft patency following coronary artery bypass graft (CABG). Over the past decade or so however, improvements in computed tomography angiography (CTA) technology have allowed its emergence as a useful clinical tool in graft assessment. The recent introduction of 64-slice and now 128-slice scanners into widespread distribution, and the development of 320-detector row technology allowing volumetric imaging of the entire heart at single points in time within one cardiac cycle, has increased the potential of CTA to supersede ICA in this capacity. This study sought to examine the evidence surrounding this potential. A best evidence topic was constructed according to a structured protocol. The enquiry: In [patients who have undergone coronary artery bypass graft surgery] is [computed tomography angiography or invasive coronary angiography] superior in terms of [graft patency assessment, stenosis detection, radiation exposure and complication rate]? Four hundred and twenty-four articles were identified from the search strategy. Four additional articles were identified from references of key articles. Seventeen articles selected as best evidence were tabulated. The reliability of CTA as a tool in the detection of graft patency and stenosis has continued to improve with each successive generation of multislice technology. The latest 64- and 128-slice CTA techniques are able to detect graft patency and stenosis with very high sensitivities and specificities comparable with ICA, while remaining non-invasive procedures associated with fewer complications (ICA carries a 0.08% risk of myocardial infarction and 0.7% risk of minor complications in clinically stable patients). Present limitations of the technology include the accurate visualization of distal anastomoses and clip artefacts. In addition, the capacity of diagnostic ICA to be combined simultaneously with percutaneous coronary

  20. Cardiac rehabilitation

    MedlinePlus

    ... 123-210. Thomas PD. Exercise-Based, Comprehensive Cardiac Rehabilitation. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 9th ed. Philadelphia, PA: Saunders Elsevier; 2011: ...

  1. Cardiac rehabilitation

    MedlinePlus

    ... goal of cardiac rehab is to: Improve your cardiovascular function Improve your overall health and quality of ... E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015: ...

  2. Cardiac arrest

    MedlinePlus

    ... treatment for cardiac arrest. It is a medical device that gives an electrical shock to the heart. The shock can get the heart beating normally again. Small, portable defibrillators are often available in public areas for ...

  3. Cardiac amyloidosis

    MedlinePlus

    ... the way electrical signals move through the heart (conduction system). This can lead to abnormal heart beats ( ... due to medication) Sick sinus syndrome Symptomatic cardiac conduction system disease (arrhythmias related to abnormal conduction of ...

  4. Cardiac Sarcoidosis

    MedlinePlus

    ... is Cardiac Sarcoidosis? Sarcoidosis is a poorly understood disease that commonly affects the lungs. It can also involve the lymph nodes, liver, spleen, eyes, skin, bones, salivary glands and heart. ...

  5. Towards Computational Modeling of Excitation-Contraction Coupling in Cardiac Myocytes: Reconstruction of Structures and Proteins from Confocal Imaging

    PubMed Central

    Sachse, Frank B.; Savio-galimberti, Eleonora; Goldhaber, Joshua I.; Bridge, John H. B.

    2014-01-01

    Computational models of excitation-contraction (EC) coupling in myocytes are valuable tools for studying the signaling cascade that transduces transmembrane voltage into mechanical responses. A key component of these models is the appropriate description of structures involved in EC coupling, such as the sarcolemma and ion channels. This study aims at developing an approach for spatial reconstruction of these structures. We exemplified our approach by reconstructing clusters of ryanodine receptors (RyRs) together with the sarcolemma of rabbit ventricular myocytes. The reconstructions were based on dual labeling and three-dimensional (3D) confocal imaging of segments of fixed and permeabilized myocytes lying flat or on end. The imaging led to 3D stacks of cross-sections through myocytes. Methods of digital image processing were applied to deconvolve, filter and segment these stacks. Finally, we created point meshes representing RyR distributions together with volume and surface meshes of the sarcolemma. We suggest that these meshes are suitable for computational studies of structure-function relationships in EC coupling. We propose that this approach can be extended to reconstruct other structures and proteins involved in EC coupling. PMID:19209712

  6. Pulmonary Findings on Computed Tomography in Asymptomatic Total Joint Arthroplasty Patients.

    PubMed

    Vigdorchik, Jonathan M; Riesgo, Aldo M; Lincoln, Denis; Markel, David C

    2016-08-01

    An increase in the diagnosis of pulmonary embolus (PE) in the early postoperative period has been attributed to the use of multidetector 64-slice computed tomographic (CT) scans. It was suspected that this finding was the result of marrow or fat emboli that are commonly associated with arthroplasty rather than a true venous thromboembolic phenomenon. The purpose of this study was to determine the baseline pulmonary findings in asymptomatic patients after total joint arthroplasty (TJA). Over a 1-year period, an institutional review board-approved prospective study of 20 asymptomatic patients using a multidetector 64-slice CT scanner was performed. Overall, 15 TKAs and 5 total hip arthroplasties were included for analysis. All of the CT scans were negative for PE. There were no signs of microemboli or fat emboli on any scan. No patient went on to develop a PE at 2 years postoperatively. Despite the fact that emboli are created during TJA, if emboli are seen on a CT scan postoperatively, they should be assumed to be real events with clinical sequelae. If pulmonary symptoms develop postoperatively, they should not simply be assumed to be the result of fat or marrow embolism. PMID:26551068

  7. A multiscale computational model of spatially resolved calcium cycling in cardiac myocytes: from detailed cleft dynamics to the whole cell concentration profiles

    PubMed Central

    Vierheller, Janine; Neubert, Wilhelm; Falcke, Martin; Gilbert, Stephen H.; Chamakuri, Nagaiah

    2015-01-01

    Mathematical modeling of excitation-contraction coupling (ECC) in ventricular cardiac myocytes is a multiscale problem, and it is therefore difficult to develop spatially detailed simulation tools. ECC involves gradients on the length scale of 100 nm in dyadic spaces and concentration profiles along the 100 μm of the whole cell, as well as the sub-millisecond time scale of local concentration changes and the change of lumenal Ca2+ content within tens of seconds. Our concept for a multiscale mathematical model of Ca2+ -induced Ca2+ release (CICR) and whole cardiomyocyte electrophysiology incorporates stochastic simulation of individual LC- and RyR-channels, spatially detailed concentration dynamics in dyadic clefts, rabbit membrane potential dynamics, and a system of partial differential equations for myoplasmic and lumenal free Ca2+ and Ca2+-binding molecules in the bulk of the cell. We developed a novel computational approach to resolve the concentration gradients from dyadic space to cell level by using a quasistatic approximation within the dyad and finite element methods for integrating the partial differential equations. We show whole cell Ca2+-concentration profiles using three previously published RyR-channel Markov schemes. PMID:26441674

  8. Diagnostic accuracy of late iodine enhancement on cardiac computed tomography with a denoise filter for the evaluation of myocardial infarction.

    PubMed

    Matsuda, Takuya; Kido, Teruhito; Itoh, Toshihide; Saeki, Hideyuki; Shigemi, Susumu; Watanabe, Kouki; Kido, Tomoyuki; Aono, Shoji; Yamamoto, Masaya; Matsuda, Takeshi; Mochizuki, Teruhito

    2015-12-01

    We evaluated the image quality and diagnostic performance of late iodine enhancement (LIE) in dual-source computed tomography (DSCT) with low kilo-voltage peak (kVp) images and a denoise filter for the detection of acute myocardial infarction (AMI) in comparison with late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). The Hospital Ethics Committee approved the study protocol. Before discharge, 19 patients who received percutaneous coronary intervention after AMI underwent DSCT and 1.5 T MRI. Immediately after coronary computed tomography (CT) angiography, contrast medium was administered at a slow injection rate. LIE-CT scans were acquired via dual-energy CT and reconstructed as 100-, 140-kVp, and mixed images. An iterative three-dimensional edge-preserved smoothing filter was applied to the 100-kVp images to obtain denoised 100-kVp images. The mixed, 140-kVp, 100-kVp, and denoised 100-kVp images were assessed using contrast-to-noise ratio (CNR), and their diagnostic performance in comparison with MRI and infarcted volumes were evaluated. Three hundred four segments of 19 patients were evaluated. Fifty-three segments showed LGE in MRI. The median CNR of the mixed, 140-, 100-kVp and denoised 100-kVp images was 3.49, 1.21, 3.57, and 6.08, respectively. The median CNR was significantly higher in the denoised 100-kVp images than in the other three images (P < 0.05). The denoised 100-kVp images showed the highest diagnostic accuracy and sensitivity. The percentage of myocardium in the four CT image types was significantly correlated with the respective MRI findings. The use of a denoise filter with a low-kVp image can improve CNR, sensitivity, and accuracy in LIE-CT. PMID:26202159

  9. Cardiac Sarcoidosis.

    PubMed

    Birnie, David H; Nery, Pablo B; Ha, Andrew C; Beanlands, Rob S B

    2016-07-26

    Clinically manifest cardiac involvement occurs in perhaps 5% of patients with sarcoidosis. The 3 principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. An estimated 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic cardiac involvement (clinically silent disease). In 2014, the first international guideline for the diagnosis and management of CS was published. In patients with clinically manifest CS, the extent of left ventricular dysfunction seems to be the most important predictor of prognosis. There is controversy in published reports as to the outcome of patients with clinically silent CS. Despite a paucity of data, immunosuppression therapy (primarily with corticosteroids) has been advocated for the treatment of clinically manifest CS. Device therapy, primarily with implantable cardioverter-defibrillators, is often recommended for patients with clinically manifest disease. PMID:27443438

  10. Cardiac sarcoidosis

    PubMed Central

    Smedema, J.P.; Zondervan, P.E.; van Hagen, P.; ten Cate, F.J.; Bresser, P.; Doubell, A.F.; Pattynama, P.; Hoogsteden, H.C.; Balk, A.H.M.M.

    2002-01-01

    Sarcoidosis is a multi-system granulomatous disorder of unknown aetiology. Symptomatic cardiac involvement occurs in approximately 5% of patients. The prevalence of sarcoidosis in the Netherlands is unknown, but estimated to be approximately 20 per 100,000 population (3200 patients). We report on five patients who presented with different manifestations of cardiac sarcoidosis, and give a brief review on the current management of this condition. Magnetic Resonance Imaging (MRI) can be of great help in diagnosing this condition as well as in the follow-up of the response to therapy. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:25696121

  11. Computed Tomography Evaluation of the Brain and Upper Cervical Spine in Patients With Traumatic Cardiac Arrest Who Achieved Return of Spontaneous Circulation

    PubMed Central

    Inamasu, Joji; Nakatsukasa, Masashi; Hirose, Yuichi

    2013-01-01

    The outcomes of patients with traumatic cardiac arrest (TCA) have been dismal. However, imaging modalities are improving rapidly and are expected to play a role in treatment of patients with TCA. In this retrospective study, whether obtaining computed tomography (CT) immediately after resuscitation had any clinical value was evaluated. Among 145 patients with TCA admitted to our institution during 4 years, hemodynamically stable return of spontaneous circulation (ROSC) was achieved in 38 (26%). Brain and cervical spine CT was obtained prospectively, and the frequency and type of traumatic brain injury (TBI)/upper cervical spine injury (UCSI) were investigated. CT was performed uneventfully in all patients with an average door-to-CT time of 51.5 ± 18.6 min. Twenty (53%) had CT evidence of TBI. However, no patients underwent brain surgery because of lack of return of brainstem functions. Among the 18 patients without TBI, CT signs of hypoxia were present in 15 patients (39%), and CT was considered intact in 3 patients (8%). None of the 35 patients with abnormal CT findings survived, and the presence of such findings predicted fatality with high sensitivity and specificity. While 13 of the 38 patients (34%) had CT evidence of UCSI, concomitant TBI and USCI were uncommon. None of the 13 patients with UCSI underwent spine surgery because of lack of return of brainstem functions, and the presence of USCI might also be associated with fatality. Although obtaining CT was useful in the prognostication of TCA patients with ROSC, it did not have much impact in therapeutic decision making. PMID:24067768

  12. Stress Computed Tomography Myocardial Perfusion Imaging: A New Topic in Cardiology.

    PubMed

    Seitun, Sara; Castiglione Morelli, Margherita; Budaj, Irilda; Boccalini, Sara; Galletto Pregliasco, Athena; Valbusa, Alberto; Cademartiri, Filippo; Ferro, Carlo

    2016-02-01

    Since its introduction about 15 years ago, coronary computed tomography angiography has become today the most accurate clinical instrument for noninvasive assessment of coronary atherosclerosis. Important technical developments have led to a continuous stream of new clinical applications together with a significant reduction in radiation dose exposure. Latest generation computed tomography scanners (≥ 64 slices) allow the possibility of performing static or dynamic perfusion imaging during stress by using coronary vasodilator agents (adenosine, dipyridamole, or regadenoson), combining both functional and anatomical information in the same examination. In this article, the emerging role and state-of-the-art of myocardial computed tomography perfusion imaging are reviewed and are illustrated by clinical cases from our experience with a second-generation dual-source 128-slice scanner (Somatom Definition Flash, Siemens; Erlangen, Germany). Technical aspects, data analysis, diagnostic accuracy, radiation dose and future prospects are reviewed. PMID:26774540

  13. Cardiac manifestations in systemic sclerosis

    PubMed Central

    Lambova, Sevdalina

    2014-01-01

    Primary cardiac involvement, which develops as a direct consequence of systemic sclerosis (SSc), may manifest as myocardial damage, fibrosis of the conduction system, pericardial and, less frequently, as valvular disease. In addition, cardiac complications in SSc may develop as a secondary phenomenon due to pulmonary arterial hypertension and kidney pathology. The prevalence of primary cardiac involvement in SSc is variable and difficult to determine because of the diversity of cardiac manifestations, the presence of subclinical periods, the type of diagnostic tools applied, and the diversity of patient populations. When clinically manifested, cardiac involvement is thought to be an important prognostic factor. Profound microvascular disease is a pathognomonic feature of SSc, as both vasospasm and structural alterations are present. Such alterations are thought to predict macrovascular atherosclerosis over time. There are contradictory reports regarding the prevalence of atherosclerosis in SSc. According to some authors, the prevalence of atherosclerosis of the large epicardial coronary arteries is similar to that of the general population, in contrast with other rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, the level of inflammation in SSc is inferior. Thus, the atherosclerotic process may not be as aggressive and not easily detectable in smaller studies. Echocardiography (especially tissue Doppler imaging), single-photon emission computed tomography, magnetic resonance imaging and cardiac computed tomography are sensitive techniques for earlier detection of both structural and functional scleroderma-related cardiac pathologies. Screening for subclinical cardiac involvement via modern, sensitive tools provides an opportunity for early diagnosis and treatment, which is of crucial importance for a positive outcome. PMID:25276300

  14. Cardiac cone-beam CT

    SciTech Connect

    Manzke, Robert . E-mail: robert.manzke@philips.com

    2005-10-15

    This doctoral thesis addresses imaging of the heart with retrospectively gated helical cone-beam computed tomography (CT). A thorough review of the CT reconstruction literature is presented in combination with a historic overview of cardiac CT imaging and a brief introduction to other cardiac imaging modalities. The thesis includes a comprehensive chapter about the theory of CT reconstruction, familiarizing the reader with the problem of cone-beam reconstruction. The anatomic and dynamic properties of the heart are outlined and techniques to derive the gating information are reviewed. With the extended cardiac reconstruction (ECR) framework, a new approach is presented for the heart-rate-adaptive gated helical cardiac cone-beam CT reconstruction. Reconstruction assessment criteria such as the temporal resolution, the homogeneity in terms of the cardiac phase, and the smoothness at cycle-to-cycle transitions are developed. Several reconstruction optimization approaches are described: An approach for the heart-rate-adaptive optimization of the temporal resolution is presented. Streak artifacts at cycle-to-cycle transitions can be minimized by using an improved cardiac weighting scheme. The optimal quiescent cardiac phase for the reconstruction can be determined automatically with the motion map technique. Results for all optimization procedures applied to ECR are presented and discussed based on patient and phantom data. The ECR algorithm is analyzed for larger detector arrays of future cone-beam systems throughout an extensive simulation study based on a four-dimensional cardiac CT phantom. The results of the scientific work are summarized and an outlook proposing future directions is given. The presented thesis is available for public download at www.cardiac-ct.net.

  15. Cardiac optogenetics

    PubMed Central

    2013-01-01

    Optogenetics is an emerging technology for optical interrogation and control of biological function with high specificity and high spatiotemporal resolution. Mammalian cells and tissues can be sensitized to respond to light by a relatively simple and well-tolerated genetic modification using microbial opsins (light-gated ion channels and pumps). These can achieve fast and specific excitatory or inhibitory response, offering distinct advantages over traditional pharmacological or electrical means of perturbation. Since the first demonstrations of utility in mammalian cells (neurons) in 2005, optogenetics has spurred immense research activity and has inspired numerous applications for dissection of neural circuitry and understanding of brain function in health and disease, applications ranging from in vitro to work in behaving animals. Only recently (since 2010), the field has extended to cardiac applications with less than a dozen publications to date. In consideration of the early phase of work on cardiac optogenetics and the impact of the technique in understanding another excitable tissue, the brain, this review is largely a perspective of possibilities in the heart. It covers the basic principles of operation of light-sensitive ion channels and pumps, the available tools and ongoing efforts in optimizing them, overview of neuroscience use, as well as cardiac-specific questions of implementation and ideas for best use of this emerging technology in the heart. PMID:23457014

  16. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  17. Cardiac dosimetric evaluation of deep inspiration breath-hold level variances using computed tomography scans generated from deformable image registration displacement vectors.

    PubMed

    Harry, Taylor; Rahn, Doug; Semenov, Denis; Gu, Xuejun; Yashar, Catheryn; Einck, John; Jiang, Steve; Cerviño, Laura

    2016-01-01

    There is a reduction in cardiac dose for left-sided breast radiotherapy during treatment with deep inspiration breath-hold (DIBH) when compared with treatment with free breathing (FB). Various levels of DIBH may occur for different treatment fractions. Dosimetric effects due to this and other motions are a major component of uncertainty in radiotherapy in this setting. Recent developments in deformable registration techniques allow displacement vectors between various temporal and spatial patient representations to be digitally quantified. We propose a method to evaluate the dosimetric effect to the heart from variable reproducibility of DIBH by using deformable registration to create new anatomical computed tomography (CT) scans. From deformable registration, 3-dimensional deformation vectors are generated with FB and DIBH. The obtained deformation vectors are scaled to 75%, 90%, and 110% and are applied to the reference image to create new CT scans at these inspirational levels. The scans are then imported into the treatment planning system and dose calculations are performed. The average mean dose to the heart was 2.5Gy (0.7 to 9.6Gy) at FB, 1.2Gy (0.6 to 3.8Gy, p < 0.001) at 75% inspiration, 1.1Gy (0.6 to 3.1Gy, p = 0.004) at 90% inspiration, 1.0Gy (0.6 to 3.0Gy) at 100% inspiration or DIBH, and 1.0Gy (0.6 to 2.8Gy, p = 0.019) at 110% inspiration. The average mean dose to the left anterior descending artery (LAD) was 19.9Gy (2.4 to 46.4Gy), 8.6Gy (2.0 to 43.8Gy, p < 0.001), 7.2Gy (1.9 to 40.1Gy, p = 0.035), 6.5Gy (1.8 to 34.7Gy), and 5.3Gy (1.5 to 31.5Gy, p < 0.001), correspondingly. This novel method enables numerous anatomical situations to be mimicked and quantifies the dosimetric effect they have on a treatment plan. PMID:26206154

  18. Contemporary Breast Radiotherapy and Cardiac Toxicity.

    PubMed

    Yeboa, Debra Nana; Evans, Suzanne Buckley

    2016-01-01

    Long-term cardiac effects are an important component of survivorship after breast radiotherapy. The pathophysiology of cardiotoxicity, history of breast radiotherapy, current methods of cardiac avoidance, modern outcomes, context of historical outcomes, quantifying cardiac effects, and future directions are reviewed in this article. Radiation-induced oxidative stress induces proinflammatory cytokines and is a process that potentiates late effects of fibrosis and intimal proliferation in endothelial vasculature. Breast radiation therapy has changed substantially in recent decades. Several modern technologies exist to improve cardiac avoidance such as deep inspiration breath hold, gating, accelerated partial breast irradiation, and use of modern 3-dimensional planning. Modern outcomes may vary notably from historical long-term cardiac outcomes given the differences in cardiac dose with modern techniques. Methods of quantifying radiation-related cardiotoxicity that correlate with future cardiac risks are needed with current data exploring techniques such as measuring computed tomography coronary artery calcium score, single-photon emission computed tomography imaging, and biomarkers. Placing historical data, dosimetric correlations, and relative cardiac risk in context are key when weighing the benefits of radiotherapy in breast cancer control and survival. Estimating present day cardiac risk in the modern treatment era includes challenges in length of follow-up and the use of confounding cardiotoxic agents such as evolving systemic chemotherapy and targeted therapies. Future directions in both multidisciplinary management and advancing technology in radiation oncology may provide further improvements in patient risk reduction and breast cancer survivorship. PMID:26617212

  19. Cardiac MRI

    MedlinePlus

    ... a powerful magnetic field, radio waves and a computer to produce detailed pictures of the structures within ... powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, ...

  20. RELATION OF LEFT VENTRICULAR MASS AND CONCENTRIC REMODELING TO EXTENT OF CORONARY ARTERY DISEASE BY COMPUTED TOMOGRAPHY IN PATIENTS WITHOUT LEFT VENTRICULAR HYPERTROPHY: ROMICAT STUDY

    PubMed Central

    Truong, Quynh A.; Toepker, Michael; Mahabadi, Amir A.; Bamberg, Fabian; Rogers, Ian S.; Blankstein, Ron; Brady, Thomas J.; Nagurney, John T.; Hoffmann, Udo

    2010-01-01

    Objective Cardiac computed tomography (CT) allows for simultaneous assessment of left ventricular mass (LVM) and coronary artery disease (CAD). We aimed to determine whether LVM, LVM index (LVMi), and the left ventricular (LV) geometric pattern of concentric remodeling are associated with the extent of CAD in patients without left ventricular hypertrophy (LVH). Methods In 348 patients from the ROMICAT trial, 64-slice CT was performed and LVM measured at end-diastole. We used 3 LVM indexation criteria to obtain 3 cohorts: LVM indexed to body surface area by echocardiography (n=337) and CT criteria (n=325), and by height2.7 (n=326). The cohorts were subdivided into concentric remodeling and normal geometry. Extent of coronary plaque was classified based on a 17-segment model, treated as a continuous variable, and stratified into 3 groups: 0 segments, 1–4 segments, >4 segments. Results Patients with >4 segments of coronary plaque had higher LVM (Δ12.8–15.1g) and LVMi (Δ4.0–5.5g/m2 and Δ2.2g/m2.7) than those without CAD (all p≤0.03). After multivariable adjustment, LVM and LVMi remained independent predictors of extent of coronary plaque, with 0.27–0.29 segments more plaque per 20 g increase of LVM (all p=0.02), 0.32–0.34 segments more plaque per 10 g/m2 increase of LVMi (both p=0.02), and 0.80 segments more plaque per 10 g/m2.7 increase of LVMi (p=0.008). Concentric remodeling patients had 1.1–1.3 segments more plaque than those with normal geometry (all p≤0.05). Patients with >4 segments of plaque had 2-fold increase odds (all p≤0.05) of having concentric remodeling as compared to those without CAD. Conclusion Increased LVM, LVMi, and concentric remodeling are associated with a greater degree of coronary plaque burden in patients without LVH. These findings could provide an indication to intensify medical therapy in patients with subclinical CAD and hypertension. PMID:19696685

  1. Cardiac rehabilitation.

    PubMed

    Ehsani, A A

    1984-02-01

    Exercise training is a major, and the most important, component of cardiac rehabilitation. Besides providing psychological benefits and promoting a "sense of well being," it elicits a number of adaptations in patients with ischemic heart disease. Among the clinically important adaptations are changes in the trained skeletal muscles and autonomic nervous system, resulting not only in increased maximum exercise capacity but also a slower heart rate and, at times, a lower systolic blood pressure during submaximal exercise. The reduction in the rate pressure product decreases myocardial O2 demand at any given submaximal exercise intensity and may thus alleviate myocardial ischemia and angina in patients with coronary artery disease. These adaptive responses occur even with a relatively modest exercise intensity. Although short-term exercise training of moderate intensity has not been reported to result in improvement in left ventricular performance, recent data suggest that exercise training of higher intensity and longer duration (12 months or longer) than has conventionally been used in cardiac rehabilitation programs may favorably affect the heart. This is characterized by improvements in left ventricular function, diminished electrocardiographic criteria of myocardial ischemia and increased stroke volume during exercise. Modest weight reduction accompanies regularly performed prolonged exercise training. It is important, however, to recognize that high-intensity exercise programs are suitable for only some patients with coronary artery disease who are stable and should be used only under strict medical supervision. PMID:6400004

  2. Mechanical regulation of cardiac development

    PubMed Central

    Lindsey, Stephanie E.; Butcher, Jonathan T.; Yalcin, Huseyin C.

    2014-01-01

    Mechanical forces are essential contributors to and unavoidable components of cardiac formation, both inducing and orchestrating local and global molecular and cellular changes. Experimental animal studies have contributed substantially to understanding the mechanobiology of heart development. More recent integration of high-resolution imaging modalities with computational modeling has greatly improved our quantitative understanding of hemodynamic flow in heart development. Merging these latest experimental technologies with molecular and genetic signaling analysis will accelerate our understanding of the relationships integrating mechanical and biological signaling for proper cardiac formation. These advances will likely be essential for clinically translatable guidance for targeted interventions to rescue malforming hearts and/or reconfigure malformed circulations for optimal performance. This review summarizes our current understanding on the levels of mechanical signaling in the heart and their roles in orchestrating cardiac development. PMID:25191277

  3. Imaging of cardiac sarcoidosis.

    PubMed

    Erthal, Fernanda; Juneau, Daniel; Lim, Siok P; Dwivedi, Girish; Nery, Pablo B; Birnie, David; Beanlands, Rob S

    2016-09-01

    Sarcoidosis is a multisystem inflammatory disease. Cardiac involvement is described in up to 50% of the cases. The disease spectrum is wide and cardiac manifestations ranges from being asymptomatic to heart failure, arrhythmias and sudden cardiac death. The diagnosis of cardiac sarcoidosis can be challenging due to its non-specific nature and the focal involvement of the heart. In this review, we discuss the utility of a stepwise approach with multimodality cardiac imaging in the diagnosis and management of CS. PMID:27225318

  4. Cardiac perception and cardiac control. A review.

    PubMed

    Carroll, D

    1977-12-01

    The evidence regarding specific cardiac perception and discrimination, and its relationship to voluntary cardiac control, is critically reviewed. Studies are considered in three sections, depending on the method used to assess cardiac perception: questionnaire assessment, discrimination procedures, and heartbeat tracking. The heartbeat tracking procedure would appear to suffer least from interpretative difficulties. Recommendations are made regarding the style of analysis used to assess heartbeat perception in such tracking tasks. PMID:348240

  5. Subperiosteal Orbital Hemorrhage Complicating Cardiac Surgery

    SciTech Connect

    Peden, Marc C.; Bhatti, M. Tariq

    2004-09-15

    Subperiosteal orbital hemorrhage (SPOH) following cardiac surgery has not been previously reported. We present a patient who developed diplopia and right eye proptosis immediately after cardiac surgery for a mitral valve repair and coronary artery bypass graft. A computed tomography (CT) study demonstrated a right superior SPOH. The diplopia and proptosis resolved spontaneously within 4 weeks. Follow-up CT showed complete resolution of the SPOH.

  6. Physics of Cardiac Arrhythmogenesis

    NASA Astrophysics Data System (ADS)

    Karma, Alain

    2013-04-01

    A normal heartbeat is orchestrated by the stable propagation of an excitation wave that produces an orderly contraction. In contrast, wave turbulence in the ventricles, clinically known as ventricular fibrillation (VF), stops the heart from pumping and is lethal without prompt defibrillation. I review experimental, computational, and theoretical studies that have shed light on complex dynamical phenomena linked to the initiation, maintenance, and control of wave turbulence. I first discuss advances made to understand the precursor state to a reentrant arrhythmia where the refractory period of cardiac tissue becomes spatiotemporally disordered; this is known as an arrhythmogenic tissue substrate. I describe observed patterns of transmembrane voltage and intracellular calcium signaling that can contribute to this substrate, and symmetry breaking instabilities to explain their formation. I then survey mechanisms of wave turbulence and discuss novel methods that exploit electrical pacing stimuli to control precursor patterns and low-energy pulsed electric fields to control turbulence.

  7. What Is Cardiac Rehabilitation?

    MedlinePlus

    ANSWERS by heart Treatments + Tests What Is Cardiac Rehabilitation? A cardiac rehabilitation (rehab) program takes place in a hospital or ... special help in making lifestyle changes. During your rehabilitation program you’ll… • Have a medical evaluation to ...

  8. Sudden Cardiac Arrest

    MedlinePlus

    ... from American Heart Association Aneurysms and Dissections Angina Arrhythmia Bundle Branch Block Cardiomyopathy Carotid Artery Disease Chronic ... terms: SCA, sudden cardiac death (SCD), sudden death, arrhythmias, ... ventricular fibrillation, defibrillator, automatic cardiac defibrillator ( ...

  9. Cardiac conduction system

    MedlinePlus Videos and Cool Tools

    ... cardiac muscle cells in the walls of the heart that send signals to the heart muscle causing it to contract. The main components ... the cardiac conduction system’s electrical activity in the heart.

  10. Cardiac Biomarkers: a Focus on Cardiac Regeneration

    PubMed Central

    Forough, Reza; Scarcello, Catherine; Perkins, Matthew

    2011-01-01

    Historically, biomarkers have been used in two major ways to maintain and improve better health status: first, for diagnostic purposes, and second, as specific targets to treat various diseases. A new era in treatment and even cure for the some diseases using reprograming of somatic cells is about to be born. In this approach, scientists are successfully taking human skin cells (previously considered terminally-differentiated cells) and re-programming them into functional cardiac myocytes and other cell types in vitro. A cell reprograming approach for treatment of cardiovascular diseases will revolutionize the field of medicine and significantly expand the human lifetime. Availability of a comprehensive catalogue for cardiac biomarkers is necessary for developing cell reprograming modalities to treat cardiac diseases, as well as for determining the progress of reprogrammed cells as they become cardiac cells. In this review, we present a comprehensive survey of the cardiac biomarkers currently known. PMID:23074366

  11. Image quality in low-dose coronary computed tomography angiography with a new high-definition CT scanner.

    PubMed

    Kazakauskaite, Egle; Husmann, Lars; Stehli, Julia; Fuchs, Tobias; Fiechter, Michael; Klaeser, Bernd; Ghadri, Jelena R; Gebhard, Catherine; Gaemperli, Oliver; Kaufmann, Philipp A

    2013-02-01

    A new generation of high definition computed tomography (HDCT) 64-slice devices complemented by a new iterative image reconstruction algorithm-adaptive statistical iterative reconstruction, offer substantially higher resolution compared to standard definition CT (SDCT) scanners. As high resolution confers higher noise we have compared image quality and radiation dose of coronary computed tomography angiography (CCTA) from HDCT versus SDCT. Consecutive patients (n = 93) underwent HDCT, and were compared to 93 patients who had previously undergone CCTA with SDCT matched for heart rate (HR), HR variability and body mass index (BMI). Tube voltage and current were adapted to the patient's BMI, using identical protocols in both groups. The image quality of all CCTA scans was evaluated by two independent readers in all coronary segments using a 4-point scale (1, excellent image quality; 2, blurring of the vessel wall; 3, image with artefacts but evaluative; 4, non-evaluative). Effective radiation dose was calculated from DLP multiplied by a conversion factor (0.014 mSv/mGy × cm). The mean image quality score from HDCT versus SDCT was comparable (2.02 ± 0.68 vs. 2.00 ± 0.76). Mean effective radiation dose did not significantly differ between HDCT (1.7 ± 0.6 mSv, range 1.0-3.7 mSv) and SDCT (1.9 ± 0.8 mSv, range 0.8-5.5 mSv; P = n.s.). HDCT scanners allow low-dose 64-slice CCTA scanning with higher resolution than SDCT but maintained image quality and equally low radiation dose. Whether this will translate into higher accuracy of HDCT for CAD detection remains to be evaluated. PMID:22825255

  12. A numerical method for cardiac mechanoelectric simulations.

    PubMed

    Pathmanathan, Pras; Whiteley, Jonathan P

    2009-05-01

    Much effort has been devoted to developing numerical techniques for solving the equations that describe cardiac electrophysiology, namely the monodomain equations and bidomain equations. Only a limited selection of publications, however, address the development of numerical techniques for mechanoelectric simulations where cardiac electrophysiology is coupled with deformation of cardiac tissue. One problem commonly encountered in mechanoelectric simulations is instability of the coupled numerical scheme. In this study, we develop a stable numerical scheme for mechanoelectric simulations. A number of convergence tests are carried out using this stable technique for simulations where deformations are of the magnitude typically observed in a beating heart. These convergence tests demonstrate that accurate computation of tissue deformation requires a nodal spacing of around 1 mm in the mesh used to calculate tissue deformation. This is a much finer computational grid than has previously been acknowledged, and has implications for the computational efficiency of the resulting numerical scheme. PMID:19263223

  13. Mathematical Models of Cardiac Pacemaking Function

    NASA Astrophysics Data System (ADS)

    Li, Pan; Lines, Glenn T.; Maleckar, Mary M.; Tveito, Aslak

    2013-10-01

    Over the past half century, there has been intense and fruitful interaction between experimental and computational investigations of cardiac function. This interaction has, for example, led to deep understanding of cardiac excitation-contraction coupling; how it works, as well as how it fails. However, many lines of inquiry remain unresolved, among them the initiation of each heartbeat. The sinoatrial node, a cluster of specialized pacemaking cells in the right atrium of the heart, spontaneously generates an electro-chemical wave that spreads through the atria and through the cardiac conduction system to the ventricles, initiating the contraction of cardiac muscle essential for pumping blood to the body. Despite the fundamental importance of this primary pacemaker, this process is still not fully understood, and ionic mechanisms underlying cardiac pacemaking function are currently under heated debate. Several mathematical models of sinoatrial node cell membrane electrophysiology have been constructed as based on different experimental data sets and hypotheses. As could be expected, these differing models offer diverse predictions about cardiac pacemaking activities. This paper aims to present the current state of debate over the origins of the pacemaking function of the sinoatrial node. Here, we will specifically review the state-of-the-art of cardiac pacemaker modeling, with a special emphasis on current discrepancies, limitations, and future challenges.

  14. Cardiac gated ventilation

    SciTech Connect

    Hanson, C.W. III; Hoffman, E.A.

    1995-12-31

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. The authors evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50 msec scan aperture. Multi slice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. The authors observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a non-failing model of the heart.

  15. Cardiac gated ventilation

    NASA Astrophysics Data System (ADS)

    Hanson, C. William, III; Hoffman, Eric A.

    1995-05-01

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. We evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50msec scan aperture. Multislice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. We observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a nonfailing model of the heart.

  16. Image reconstruction and image quality evaluation for a 64-slice CT scanner with z-flying focal spot.

    PubMed

    Flohr, T G; Stierstorfer, K; Ulzheimer, S; Bruder, H; Primak, A N; McCollough, C H

    2005-08-01

    We present a theoretical overview and a performance evaluation of a novel z-sampling technique for multidetector row CT (MDCT), relying on a periodic motion of the focal spot in the longitudinal direction (z-flying focal spot) to double the number of simultaneously acquired slices. The z-flying focal spot technique has been implemented in a recently introduced MDCT scanner. Using 32 x 0.6 mm collimation, this scanner acquires 64 overlapping 0.6 mm slices per rotation in its spiral (helical) mode of operation, with the goal of improved longitudinal resolution and reduction of spiral artifacts. The longitudinal sampling distance at isocenter is 0.3 mm. We discuss in detail the impact of the z-flying focal spot technique on image reconstruction. We present measurements of spiral slice sensitivity profiles (SSPs) and of longitudinal resolution, both in the isocenter and off-center. We evaluate the pitch dependence of the image noise measured in a centered 20 cm water phantom. To investigate spiral image quality we present images of an anthropomorphic thorax phantom and patient scans. The full width at half maximum (FWHM) of the spiral SSPs shows only minor variations as a function of the pitch, measured values differ by less than 0.15 mm from the nominal values 0.6, 0.75, 1, 1.5, and 2 mm. The measured FWHM of the smallest slice ranges between 0.66 and 0.68 mm at isocenter, except for pitch 0.55 (0.72 mm). In a centered z-resolution phantom, bar patterns up to 15 lp/cm can be visualized independent of the pitch, corresponding to 0.33 mm longitudinal resolution. 100 mm off-center, bar patterns up to 14 lp/cm are visible, corresponding to an object size of 0.36 mm that can be resolved in the z direction. Image noise for constant effective mAs is almost independent of the pitch. Measured values show a variation of less than 7% as a function of the pitch, which demonstrates correct utilization of the applied radiation dose at any pitch. The product of image noise and square root of the slice width (FWHM of the respective SSP) is the same constant for all slices except 0.6 mm. For the thinnest slice, relative image noise is increased by 17%. Spiral windmill-type artifacts are effectively suppressed with the z-flying focal spot technique, which has the potential to maintain a low artifact level up to pitch 1.5, in this way increasing the maximum volume coverage speed that can be clinically used. PMID:16193784

  17. Image reconstruction and image quality evaluation for a 64-slice CT scanner with z-flying focal spot

    SciTech Connect

    Flohr, T.G.; Stierstorfer, K.; Ulzheimer, S.; Bruder, H.; Primak, A.N.; McCollough, C.H.

    2005-08-15

    We present a theoretical overview and a performance evaluation of a novel z-sampling technique for multidetector row CT (MDCT), relying on a periodic motion of the focal spot in the longitudinal direction (z-flying focal spot) to double the number of simultaneously acquired slices. The z-flying focal spot technique has been implemented in a recently introduced MDCT scanner. Using 32x0.6 mm collimation, this scanner acquires 64 overlapping 0.6 mm slices per rotation in its spiral (helical) mode of operation, with the goal of improved longitudinal resolution and reduction of spiral artifacts. The longitudinal sampling distance at isocenter is 0.3 mm. We discuss in detail the impact of the z-flying focal spot technique on image reconstruction. We present measurements of spiral slice sensitivity profiles (SSPs) and of longitudinal resolution, both in the isocenter and off-center. We evaluate the pitch dependence of the image noise measured in a centered 20 cm water phantom. To investigate spiral image quality we present images of an anthropomorphic thorax phantom and patient scans. The full width at half maximum (FWHM) of the spiral SSPs shows only minor variations as a function of the pitch, measured values differ by less than 0.15 mm from the nominal values 0.6, 0.75, 1, 1.5, and 2 mm. The measured FWHM of the smallest slice ranges between 0.66 and 0.68 mm at isocenter, except for pitch 0.55 (0.72 mm). In a centered z-resolution phantom, bar patterns up to 15 lp/cm can be visualized independent of the pitch, corresponding to 0.33 mm longitudinal resolution. 100 mm off-center, bar patterns up to 14 lp/cm are visible, corresponding to an object size of 0.36 mm that can be resolved in the z direction. Image noise for constant effective mAs is almost independent of the pitch. Measured values show a variation of less than 7% as a function of the pitch, which demonstrates correct utilization of the applied radiation dose at any pitch. The product of image noise and square root of the slice width (FWHM of the respective SSP) is the same constant for all slices except 0.6 mm. For the thinnest slice, relative image noise is increased by 17%. Spiral windmill-type artifacts are effectively suppressed with the z-flying focal spot technique, which has the potential to maintain a low artifact level up to pitch 1.5, in this way increasing the maximum volume coverage speed that can be clinically used.

  18. Primary Cardiac Lymphoma: Diagnosis and the Impact of Chemotherapy on Cardiac Structure and Function.

    PubMed

    Pagé, Maude; Grasso, Agata E; Carpenter, John-Paul; Sheppard, Mary N; Karwatowski, Stefan P; Mohiaddin, Raad H

    2016-07-01

    We report a case of primary cardiac lymphoma presenting as myopericarditis and rapidly deteriorating into biventricular heart failure and ventricular arrhythmias. Computed tomography and cardiac magnetic resonance (CMR) imaging showed extensive myocardial infiltration with typical patterns on tissue characterization CMR images, raising clinical suspicion. Diagnosis was confirmed by myocardial histologic examination. Marked regression of tumor burden was apparent after 6 cycles of anthracycline-based chemotherapy. This case illustrates that a high degree of suspicion for this rare entity is mandated to institute timely treatment. Rapid tumor lysis may induce life-threatening acute cardiac decompensation that requires intensive monitoring and support therapy. PMID:26755242

  19. Stimulating endogenous cardiac repair

    PubMed Central

    Finan, Amanda; Richard, Sylvain

    2015-01-01

    The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration, a combination of these approaches could ameliorate the overall repair process to incorporate the participation of multiple cellular players. PMID:26484341

  20. Cardiac Innervation and Sudden Cardiac Death

    PubMed Central

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L.; Shivkumar, Kalyanam

    2015-01-01

    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem and higher centers) which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes-hours) and long term (days-years). This important neurovisceral /autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death (SCD). Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extra-cardiac neural remodeling have also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provides a rational mechanistic basis for development of neuraxial therapies for preventing SCD and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. PMID:26044253

  1. Modeling the isolated cardiac myocyte.

    PubMed

    Puglisi, Jose L; Wang, Fei; Bers, Donald M

    2004-01-01

    Computer modeling of cardiac myocytes has flourished in recent years. Models have evolved from mathematical descriptions of ionic channels alone to more sophisticated formulations that include calcium transport mechanisms, ATP production and metabolic pathways. The increased complexity is fueled by the new data available in the field. The continuous production of experimental data has led to the evolution of increasingly refined descriptions of the phenomena by modelers. Integrating the numerous systems involved in cardiac myocyte homeostasis makes the use of computer models necessary due to the unreliability of intuitive approaches. However the complexity of the model should not imply a cumbersome operation of the program. As with any tool, computer models have to be easy to operate or their strength will be diminished and potential users will not benefit fully from them. The contribution of the computer modeler to their respective biological fields will be more successful and enduring if modelers devote sufficient time to implement their equations into a model with user-friendly characteristics. PMID:15142742

  2. Numerical Investigation of Macroscopic Cardiac Mechanics.

    NASA Astrophysics Data System (ADS)

    Buxton, Gavin; Balazs, Anna

    2003-03-01

    In order to gain insight into the complex interactions between electrical excitation of the myocardial tissue, the mechanical contraction of the heart muscles and cardiac fluid dynamics, three computational techniques are successfully coupled. A Gerhardt-Schuster-Tyson Cellular Automata algorithm enables the excitation kinetics of myocardial tissue to be simulated in a computationally efficient manner. The cardiac excitation spreading is then coupled with a dynamic Born Lattice Spring Model which enables the contraction of the heart muscles and their subsequent relaxation to be modelled. The velocities at the inner surfaces of the heart can then be transferred to a Lattice Boltzmann simulation of blood flow within the cardiac chambers. The interactions (and complex feedback mechanisms) between electrical excitation, mechanical deformation, and fluid flow in the heart are explored through these three-dimensional models and the regular functionality of the whole heart is visualised.

  3. Digital retrospective motion-mode display and processing of electron beam cine-computed tomography and other cross-sectional cardiac imaging techniques

    NASA Astrophysics Data System (ADS)

    Reed, Judd E.; Rumberger, John A.; Buithieu, Jean; Behrenbeck, Thomas; Breen, Jerome F.; Sheedy, Patrick F., II

    1995-05-01

    Electron beam computed tomography is unparalleled in its ability to consistently produce high quality dynamic images of the human heart. Its use in quantification of left ventricular dynamics is well established in both clinical and research applications. However, the image analysis tools supplied with the scanners offer a limited number of analysis options. They are based on embedded computer systems which have not been significantly upgraded since the scanner was introduced over a decade ago in spite of the explosive improvements in available computer power which have occured during this period. To address these shortcomings, a workstation-based ventricular analysis system has been developed at our institution. This system, which has been in use for over five years, is based on current workstation technology and therefore has benefited from the periodic upgrades in processor performance available to these systems. The dynamic image segmentation component of this system is an interactively supervised, semi-automatic surface identification and tracking system. It characterizes the endocardial and epicardial surfaces of the left ventricle as two concentric 4D hyper-space polyhedrons. Each of these polyhedrons have nearly ten thousand vertices which are deposited into a relational database. The right ventricle is also processed in a similar manner. This database is queried by other custom components which extract ventricular function parameters such as regional ejection fraction and wall stress. The interactive tool which supervises dynamic image segmentation has been enhanced with a temporal domain display. The operator interactively chooses the spatial location of the endpoints of a line segment while the corresponding space/time image is displayed. These images, with content resembling M-Mode echocardiography, benefit form electron beam computed tomography's high spatial and contrast resolution. The segmented surfaces are displayed along with the imagery. These

  4. High-performance computing and networking as tools for accurate emission computed tomography reconstruction.

    PubMed

    Passeri, A; Formiconi, A R; De Cristofaro, M T; Pupi, A; Meldolesi, U

    1997-04-01

    It is well known that the quantitative potential of emission computed tomography (ECT) relies on the ability to compensate for resolution, attenuation and scatter effects. Reconstruction algorithms which are able to take these effects into account are highly demanding in terms of computing resources. The reported work aimed to investigate the use of a parallel high-performance computing platform for ECT reconstruction taking into account an accurate model of the acquisition of single-photon emission tomographic (SPET) data. An iterative algorithm with an accurate model of the variable system response was ported on the MIMD (Multiple Instruction Multiple Data) parallel architecture of a 64-node Cray T3D massively parallel computer. The system was organized to make it easily accessible even from low-cost PC-based workstations through standard TCP/IP networking. A complete brain study of 30 (64x64) slices could be reconstructed from a set of 90 (64x64) projections with ten iterations of the conjugate gradients algorithm in 9 s, corresponding to an actual speed-up factor of 135. This work demonstrated the possibility of exploiting remote high-performance computing and networking resources from hospital sites by means of low-cost workstations using standard communication protocols without particular problems for routine use. The achievable speed-up factors allow the assessment of the clinical benefit of advanced reconstruction techniques which require a heavy computational burden for the compensation effects such as variable spatial resolution, scatter and attenuation. The possibility of using the same software on the same hardware platform with data acquired in different laboratories with various kinds of SPET instrumentation is appealing for software quality control and for the evaluation of the clinical impact of the reconstruction methods. PMID:9096089

  5. Imminent cardiac risk assessment via optical intravascular biochemical analysis.

    PubMed

    Wetzel, David L; Wetzel, Louis H; Wetzel, Mark D; Lodder, Robert A

    2009-06-01

    are still the first line of defense. However, with the fidelity of 64-slice CT imaging, this technique has recently become an option when the patient presents with symptoms of reduced arterial flow. Single photon emission computerized tomography (SPECT) treadmill exercise testing is a standard non-invasive test for decreased perfusion of heart muscle, but is time consuming and not suited for emergent evaluation. Once the invasive clinical option of catherization is chosen, this provides the opportunity for intravascular ultrasound (IVUS) imaging. As the probe is pulled through the artery, the diameter at different parts is measurable, and monochrome contrast in the constricted area reveals the presence of tissue with a different ultrasonic response. Also, via an optical catheter with a fiber-optic conductor, the possibly of spectroscopic analysis of arterial walls is now a reality. In this case, the optical transducer is coupled to a near-infrared spectrometer. Revealing the arterial chemical health means that plaque vulnerability and imminent risk could be assessed by the physician. The classical emergency use of catherization involves a contrast agent and dynamic X-ray imaging to locate the constriction, determine its severity, and possibly perform angioplasty, and stent placement. PMID:19475135

  6. Imminent Cardiac Risk Assessment via Optical Intravascular Biochemical Analysis

    SciTech Connect

    Wetzel, D.; Wetzel, L; Wetzel, M; Lodder, R

    2009-01-01

    still the first line of defense. However, with the fidelity of 64-slice CT imaging, this technique has recently become an option when the patient presents with symptoms of reduced arterial flow. Single photon emission computerized tomography (SPECT) treadmill exercise testing is a standard non-invasive test for decreased perfusion of heart muscle, but is time consuming and not suited for emergent evaluation. Once the invasive clinical option of catherization is chosen, this provides the opportunity for intravascular ultrasound (IVUS) imaging. As the probe is pulled through the artery, the diameter at different parts is measurable, and monochrome contrast in the constricted area reveals the presence of tissue with a different ultrasonic response. Also, via an optical catheter with a fiber-optic conductor, the possibly of spectroscopic analysis of arterial walls is now a reality. In this case, the optical transducer is coupled to a near-infrared spectrometer. Revealing the arterial chemical health means that plaque vulnerability and imminent risk could be assessed by the physician. The classical emergency use of catherization involves a contrast agent and dynamic X-ray imaging to locate the constriction, determine its severity, and possibly perform angioplasty, and stent placement.

  7. Repeatability and reproducibility of phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging used to quantify cardiac dyssynchrony

    PubMed Central

    Trimble, Mark A.; Velazquez, Eric J.; Adams, George L.; Honeycutt, Emily F.; Pagnanelli, Robert A.; Barnhart, Huiman X.; Chen, Ji; Iskandrian, Ami E.; Garcia, Ernest V.; Borges-Neto, Salvador

    2010-01-01

    Background A novel method to quantify dyssynchrony has been developed using phase analysis of gated single-photon emission computed tomography perfusion imaging. We report on the effect of variability in image reconstruction on the phase analysis results (repeatability) and on the interobserver and intraobserver reproducibility of the technique. Methods Phase standard deviation (SD) and bandwidth are phase indices that quantify dyssynchrony. To evaluate repeatability, raw data sets were processed twice in 50 patients with left ventricular dysfunction and 50 normal controls. To determine the optimal processing method, two replicated phase analysis results were obtained using automated and manual base parameter placement. Reproducibility of the phase analysis was determined using the data from 20 patients. Results In normal controls, manual base parameter placement improves repeatability of the phase analysis as measured by the mean absolute difference between two reads for phase SD (12.0° vs. 1.2°, P< 0.0001) and bandwidth (33.7° vs. 3.6°, P< 0.0001). Repeatability is better for normal controls than for patients with left ventricular dysfunction for phase SD (1.2° vs. 6.0°, P < 0.0001) and bandwidth (3.6° vs. 26.5°, P < 0.0001). Reproducibility of the phase analysis is high as measured by the intraclass correlation coefficients for phase SD and bandwidth of 0.99 and 0.99 for the interobserver comparisons and 1.00 and 1.00 for the intraobserver comparisons. Conclusion A novel method to quantify dyssynchrony has been developed using gated single-photon emission computed tomography perfusion imaging. Manual base parameter placement reduces the effect that variability in image reconstruction has on phase analysis. A high degree of reproducibility of phase analysis is observed. PMID:18317303

  8. Automated cardiac sarcomere analysis from second harmonic generation images

    NASA Astrophysics Data System (ADS)

    Garcia-Canadilla, Patricia; Gonzalez-Tendero, Anna; Iruretagoyena, Igor; Crispi, Fatima; Torre, Iratxe; Amat-Roldan, Ivan; Bijnens, Bart H.; Gratacos, Eduard

    2014-05-01

    Automatic quantification of cardiac muscle properties in tissue sections might provide important information related to different types of diseases. Second harmonic generation (SHG) imaging provides a stain-free microscopy approach to image cardiac fibers that, combined with our methodology of the automated measurement of the ultrastructure of muscle fibers, computes a reliable set of quantitative image features (sarcomere length, A-band length, thick-thin interaction length, and fiber orientation). We evaluated the performance of our methodology in computer-generated muscle fibers modeling some artifacts that are present during the image acquisition. Then, we also evaluated it by comparing it to manual measurements in SHG images from cardiac tissue of fetal and adult rabbits. The results showed a good performance of our methodology at high signal-to-noise ratio of 20 dB. We conclude that our automated measurements enable reliable characterization of cardiac fiber tissues to systematically study cardiac tissue in a wide range of conditions.

  9. Blunt cardiac rupture.

    PubMed

    Martin, T D; Flynn, T C; Rowlands, B J; Ward, R E; Fischer, R P

    1984-04-01

    Blunt injury to the heart ranges from contusion to disruption. This report comprises 14 patients seen during a 6-year period with cardiac rupture secondary to blunt trauma. Eight patients were injured in automobile accidents, two patients were injured in auto-pedestrian accidents, two were kicked in the chest by ungulates, and two sustained falls. Cardiac tamponade was suspected in ten patients. Five patients presented with prehospital cardiac arrest or arrested shortly after arrival. All underwent emergency department thoracotomy without survival. Two patients expired in the operating room during attempted cardiac repair; both had significant extracardiac injury. Seven patients survived, three had right atrial injuries, three had right ventricular injuries, and one had a left atrial injury. Cardiopulmonary bypass was not required for repair of the surviving patients. There were no significant complications from the cardiac repair. The history of significant force dispersed over a relatively small area of the precordium as in a kicking injury from an animal or steering wheel impact should alert the physician to possible cardiac rupture. Cardiac rupture should be considered in patients who present with signs of cardiac tamponade or persistent thoracic bleeding after blunt trauma. PMID:6708151

  10. Sudden Cardiac Death

    PubMed Central

    Weinberg, Marc

    1978-01-01

    Over the past decade, there has been a significant decrease in the hospital mortality of patients with coronary artery disease. However, sudden cardiac death, which accounts for the majority of deaths from coronary artery disease, hasbeen little affected. This report reviews the pathology, electrophysiology, demographics and clinical presentation of sudden cardiac death. Emergency care and possible preventative measures are examined. PMID:356435

  11. Cardiac Hegemony of Senescence.

    PubMed

    Siddiqi, Sailay; Sussman, Mark A

    2013-12-01

    Cardiac senescence and age-related disease development have gained general attention and recognition in the past decades due to increased accessibility and quality of health care. The advancement in global civilization is complementary to concerns regarding population aging and development of chronic degenerative diseases. Cardiac degeneration has been rigorously studied. The molecular mechanisms of cardiac senescence are on multiple cellular levels and hold a multilayer complexity level, thereby hampering development of unambiguous treatment protocols. In particular, the synergistic exchange of the senescence phenotype through a senescence secretome between myocytes and stem cells appears complicated and is of great future therapeutic value. The current review article will highlight hallmarks of senescence, cardiac myocyte and stem cell senescence, and the mutual exchange of senescent secretome. Future cardiac cell therapy approaches require a comprehensive understanding of myocardial senescence to improve therapeutic efficiency as well as efficacy. PMID:24349878

  12. Cardiac Hegemony of Senescence

    PubMed Central

    Siddiqi, Sailay; Sussman, Mark A.

    2013-01-01

    Cardiac senescence and age-related disease development have gained general attention and recognition in the past decades due to increased accessibility and quality of health care. The advancement in global civilization is complementary to concerns regarding population aging and development of chronic degenerative diseases. Cardiac degeneration has been rigorously studied. The molecular mechanisms of cardiac senescence are on multiple cellular levels and hold a multilayer complexity level, thereby hampering development of unambiguous treatment protocols. In particular, the synergistic exchange of the senescence phenotype through a senescence secretome between myocytes and stem cells appears complicated and is of great future therapeutic value. The current review article will highlight hallmarks of senescence, cardiac myocyte and stem cell senescence, and the mutual exchange of senescent secretome. Future cardiac cell therapy approaches require a comprehensive understanding of myocardial senescence to improve therapeutic efficiency as well as efficacy. PMID:24349878

  13. Temporally Targeted Imaging Method Applied to ECG Gated Computed Tomography: Preliminary Phantom and In Vivo Experience

    PubMed Central

    Nett, Brian E.; Leng, Shuai; Zambelli, Joseph N.; Reeder, Scott B.; Speidel, Michael A.; Chen, Guang-Hong

    2009-01-01

    Rationale and Objectives Existing cardiac imaging methods do not allow for improved temporal resolution when considering a targeted region of interest (ROI). The imaging method presented here enables improved temporal resolution for ROI imaging (namely, a reconstruction volume smaller than the complete field of view). Clinically, temporally targeted reconstruction would not change the primary means of reconstructing and evaluating images, but rather would enable the adjunct technique of ROI imaging, with improved temporal resolution compared with standard reconstruction (~20% smaller temporal scan window). In gated cardiac CT scans improved temporal resolution directly translates into a reduction in motion artifacts for rapidly moving objects such as the coronary arteries. Materials and Methods Retrospectively electrocardiogram gated coronary angiography data from a 64-slice CT system were utilized. A motion phantom simulating the motion profile of a coronary artery was constructed and scanned. Additionally, an in vivo study was performed using a porcine model. Comparisons between the new reconstruction technique and the standard reconstruction are given for an ROI centered on the right coronary artery, and a pulmonary ROI. Results In both a well controlled motion model and a porcine model results show a decrease in motion induced artifacts including motion blur and streak artifacts from contrast enhanced vessels within the targeted ROIs, as assessed through both qualitative and quantitative observations. Conclusion Temporally targeted reconstruction techniques demonstrate the potential to reduce motion artifacts in coronary CT. Further study is warranted to demonstrate the conditions under which this technique will offer direct clinical utility. Improvement in temporal resolution for gated cardiac scans has implications for improving: contrast enhanced CT angiography, calcium scoring, and assessment of the pulmonary anatomy. PMID:18078912

  14. Cardiac lipoma and lipomatous hypertrophy of the interatrial septum: cardiac magnetic resonance imaging findings.

    PubMed

    Salanitri, John C; Pereles, F Scott

    2004-01-01

    Cardiac lipomas are uncommon, usually asymptomatic benign primary tumors of the heart that may incidentally be discovered during computed tomography (CT) or magnetic resonance imaging (MRI). Although the finding of a low-attenuation mass with density similar to fat on CT is pathognomonic, the MRI appearances of fatty cardiac masses are variable depending on the sequences employed. The MRI findings of 4 patients with cardiac lipomas or lipomatous hypertrophy of the interatrial septum are presented. All patients had lesions with characteristic low-signal-intensity margins and high central signal intensity on "bright-blood" balanced gradient-echo cardiac MRI sequences with very low repetition and echo times. It is proposed that this appearance results from intravoxel phase cancellation effects occurring at the fat/tissue interface and is sufficiently characteristic to obviate the need for confirmatory CT. PMID:15538164

  15. [Cardiac evaluation before non-cardiac surgery].

    PubMed

    Menzenbach, Jan; Boehm, Olaf

    2016-07-01

    Before non-cardiac surgery, evaluation of cardiac function is no frequent part of surgical treatment. European societies of anesthesiology and cardiology published consensus-guidelines in 2014 to present a reasonable approach for preoperative evaluation. This paper intends to differentiate the composite of perioperative risk and to display the guidelines methodical approach to handle it. Features to identify patients at risk from an ageing population with comorbidities, are the classification of surgical risk, functional capacity and risk indices. Application of diagnostic means, should be used adjusted to this risk estimation. Cardiac biomarkers are useful to discover risk of complications or mortality, that cannot be assessed by clinical signs. After preoperative optimization and perioperative cardiac protection, the observation of the postoperative period remains, to prohibit complications or even death. In consideration of limited resources of intensive care department, postoperative ward rounds beyond intensive care units are considered to be an appropriate instrument to avoid or recognize complications early to reduce postoperative mortality. PMID:27479258

  16. Naturally occurring cardiac glycosides.

    PubMed

    Radford, D J; Gillies, A D; Hinds, J A; Duffy, P

    1986-05-12

    Cardiac glycoside poisoning from the ingestion of plants, particularly of oleanders, occurs with reasonable frequency in tropical and subtropical areas. We have assessed a variety of plant specimens for their cardiac glycoside content by means of radioimmunoassays with antibodies that differ in their specificity for cardiac glycosides. Significant amounts of immunoreactive cardiac glycoside were found to be present in the ornamental shrubs: yellow oleander (Thevetia peruviana); oleander (Nerium oleander); wintersweet (Carissa spectabilis); bushman's poison (Carissa acokanthera); sea-mango (Cerbera manghas); and frangipani (Plumeria rubra); and in the milkweeds: redheaded cotton-bush (Asclepias curassavica); balloon cotton (Asclepias fruiticosa); king's crown (Calotropis procera); and rubber vine (Cryptostegia grandifolia). The venom gland of the cane toad (Bufo marinus) also contained large quantities of cardiac glycosides. The competitive immunoassay method permits the rapid screening of specimens that are suspected to contain cardiac glycosides. Awareness of the existence of these plant and animal toxins and their dangers allows them to be avoided and poisoning prevented. The method is also useful for the confirmation of the presence of cardiac glycosides in serum in cases of poisoning. PMID:3086679

  17. Role of breathing in cardiac performance: experimental and mathematical models

    NASA Astrophysics Data System (ADS)

    Tran, Binh Q.; Hoffman, Eric A.

    1999-05-01

    Due to the close proximity of the heart and lungs within a closed chest environment, we expect breathing to affect various cardiac performance parameters and hence cardiac output. We present an integrative approach to study heart-lung interactions, combining a mathematical formulation of the circulation system with imaging techniques using echo-planar magnetic resonance imaging (EPI) and dynamic x-ray CT (EBCT). We hypothesize that appropriate synchronization of mechanical ventilation to cardiac-cycle specific events can improve cardiac function, i.e. stroke volume (SV) and cardiac output (CO). Computational and experimental results support the notion that heart-lung interaction, leading to altered cardiac output associated with inspiration/expiration, is not directly associated with lung inflation/deflation and thus is felt to be more influenced by pleural pressure changes. The mathematical model of the circulation demonstrates the importance of cardiac-cycle specific timing of ventilation on cardiac function and matches with experimentally observed relationships found in animal models studied via EBCT and human studies using EPI. Results show that positive pressure mechanical ventilation timed to systolic events may increase SV and CO by up to 30%, mainly by increased filling of the ventricles during diastole. Similarly, negative pressure (spontaneous) respiration has its greatest effect on ventricular diastolic filling. Cardiac-gated mechanical ventilation may provide sufficient cardiac augmentation to warrant further investigation as a minimally-invasive technique for temporary cardiac assist. Through computational modeling and advanced imaging protocols, we were able to uniquely study heart-lung interactions within the intact milieu of the never-invaded thorax.

  18. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-11-23

    The American College of Cardiology Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:20975004

  19. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D; Kramer, Christopher M; Berman, Daniel; Brown, Alan; Chaudhry, Farooq A; Cury, Ricardo C; Desai, Milind Y; Einstein, Andrew J; Gomes, Antoinette S; Harrington, Robert; Hoffmann, Udo; Khare, Rahul; Lesser, John; McGann, Christopher; Rosenberg, Alan; Schwartz, Robert; Shelton, Marc; Smetana, Gerald W; Smith, Sidney C

    2010-11-23

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21087721

  20. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-01-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21232696

  1. [Cardiac Rehabilitation 2015].

    PubMed

    Hoffmann, Andreas

    2015-11-25

    The goals of cardiac rehabilitation are (re-)conditioning and secondary prevention in patients with heart disease or an elevated cardiovascular risk profile. Rehabilitation is based on motivation through education, on adapted physical activity, instruction of relaxation techniques, psychological support and optimized medication. It is performed preferably in groups either in outpatient or inpatient settings. The Swiss working group on cardiac rehabilitation provides a network of institutions with regular quality auditing. Positive effects of rehabilitation programs on mortality and morbidity have been established by numerous studies. Although a majority of patients after cardiac surgery are being referred to rehabilitation, these services are notoriously underused after catheter procedures. PMID:26602848

  2. Computational Cardiology: The Heart of the Matter

    PubMed Central

    Trayanova, Natalia A.

    2012-01-01

    This paper reviews the newest developments in computational cardiology. It focuses on the contribution of cardiac modeling to the development of new therapies as well as the advancement of existing ones for cardiac arrhythmias and pump dysfunction. Reviewed are cardiac modeling efforts aimed at advancing and optimizing existent therapies for cardiac disease (defibrillation, ablation of ventricular tachycardia, and cardiac resynchronization therapy) and at suggesting novel treatments, including novel molecular targets, as well as efforts to use cardiac models in stratification of patients likely to benefit from a given therapy, and the use of models in diagnostic procedures. PMID:23213566

  3. Nuclear imaging modalities for cardiac amyloidosis

    PubMed Central

    Bokhari, Sabahat; Shahzad, Reehan; Castaño, Adam; Maurer, Mathew S.

    2015-01-01

    Amyloidosis is a heterogeneous group of diseases characterized by localized or systemic deposition of insoluble extracellular fibrillary proteins in organs and tissues. Several types of amyloid can infiltrate the heart resulting in a restrictive cardiomyopathy, heart failure, and atrial and ventricular arrhythmias. Scintigraphy is a noninvasive method that may facilitate early diagnosis, distinguish various forms of cardiac amyloid, and may be useful in following disease burden. The amyloid-specific tracers presented in this article have been used with planar imaging and/or single-photon emission computed tomography. To date, there are no approved cardiac amyloid tracers although investigational tracers are currently under examination. This article serves to review the current nuclear imaging modalities available in the detection of cardiac amyloid. PMID:24162886

  4. Diagnosis of traumatic cardiac contusion

    SciTech Connect

    Waxman, K.; Soliman, M.H.; Braunstein, P.; Formosa, P.; Cohen, A.J.; Matsuura, P.; Mason, G.R.

    1986-06-01

    Cardiac contusion following blunt chest trauma remains a diagnostic problem because of a lack of sensitive diagnostic tests. This study evaluated thallous chloride Tl 201 single-photon-emission computed tomography in a series of 48 patients following blunt chest trauma. Of the 48 patients, 23 had normal scans. None of these patients proved to have serious arrhythmias during three days of continuous monitoring. Of 25 patients with abnormal or ambiguous studies, five (20%) developed serious arrhythmias requiring therapy. Single-photon-emission computed tomography scanning thus was sensitive in indicating that group of patients at risk of serious arrhythmias, and may therefore prove to be a useful screening test to determine the need for hospitalization and arrhythmia monitoring following blunt chest trauma.

  5. Robust temporal alignment of multimodal cardiac sequences

    NASA Astrophysics Data System (ADS)

    Perissinotto, Andrea; Queirós, Sandro; Morais, Pedro; Baptista, Maria J.; Monaghan, Mark; Rodrigues, Nuno F.; D'hooge, Jan; Vilaça, João. L.; Barbosa, Daniel

    2015-03-01

    Given the dynamic nature of cardiac function, correct temporal alignment of pre-operative models and intraoperative images is crucial for augmented reality in cardiac image-guided interventions. As such, the current study focuses on the development of an image-based strategy for temporal alignment of multimodal cardiac imaging sequences, such as cine Magnetic Resonance Imaging (MRI) or 3D Ultrasound (US). First, we derive a robust, modality-independent signal from the image sequences, estimated by computing the normalized cross-correlation between each frame in the temporal sequence and the end-diastolic frame. This signal is a resembler for the left-ventricle (LV) volume curve over time, whose variation indicates different temporal landmarks of the cardiac cycle. We then perform the temporal alignment of these surrogate signals derived from MRI and US sequences of the same patient through Dynamic Time Warping (DTW), allowing to synchronize both sequences. The proposed framework was evaluated in 98 patients, which have undergone both 3D+t MRI and US scans. The end-systolic frame could be accurately estimated as the minimum of the image-derived surrogate signal, presenting a relative error of 1.6 +/- 1.9% and 4.0 +/- 4.2% for the MRI and US sequences, respectively, thus supporting its association with key temporal instants of the cardiac cycle. The use of DTW reduces the desynchronization of the cardiac events in MRI and US sequences, allowing to temporally align multimodal cardiac imaging sequences. Overall, a generic, fast and accurate method for temporal synchronization of MRI and US sequences of the same patient was introduced. This approach could be straightforwardly used for the correct temporal alignment of pre-operative MRI information and intra-operative US images.

  6. The benefits of the Atlas of Human Cardiac Anatomy website for the design of cardiac devices.

    PubMed

    Spencer, Julianne H; Quill, Jason L; Bateman, Michael G; Eggen, Michael D; Howard, Stephen A; Goff, Ryan P; Howard, Brian T; Quallich, Stephen G; Iaizzo, Paul A

    2013-11-01

    This paper describes how the Atlas of Human Cardiac Anatomy website can be used to improve cardiac device design throughout the process of development. The Atlas is a free-access website featuring novel images of both functional and fixed human cardiac anatomy from over 250 human heart specimens. This website provides numerous educational tutorials on anatomy, physiology and various imaging modalities. For instance, the 'device tutorial' provides examples of devices that were either present at the time of in vitro reanimation or were subsequently delivered, including leads, catheters, valves, annuloplasty rings and stents. Another section of the website displays 3D models of the vasculature, blood volumes and/or tissue volumes reconstructed from computed tomography and magnetic resonance images of various heart specimens. The website shares library images, video clips and computed tomography and MRI DICOM files in honor of the generous gifts received from donors and their families. PMID:24195457

  7. [Cardiac tumor, constrictive pericarditis and pulmonary thromboembolism].

    PubMed

    Takano, Tamaki; Amano, Jun

    2011-07-01

    Cardiac tumors are rare, and 3-quarters of these tumors are benign and nearly half of the benign tumors are myxomas. Metastases to the heart are more common than primary cardiac tumors. Cardiac tumors present obstructive, constitutional and embolic signs and symptoms. Echocardiograms, chest computed tomography (CT) and magnetic resonance imaging (MRI) scan are very useful for diagnosis. Surgery is indicated in patients with benign tumor, and chemo/radio-therapy in patients with malignant tumors. Prognosis after surgery is good, instead poor prognosis for patients with malignancy. Constrictive pericarditis is mainly result of idiopathic, previous cardiac surgery and radiation in recent years. Diagnosis is made by echo cardiography and cardiac catheterization along with clinical presentation. Thickened pericardium is directly diagnosed by currently advanced transesophageal echocardiography, CT and MRI although normal thickness of the pericardium with constrictive pericarditis is observed in some patients. Pericardiectomy is the only treatment for permanent constriction. The incidence of pulmonary thromboembolism is currently increasing in Japan. Guidelines for the diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009) is helpful for diagnosis and treatment decision. Anticoagulant is initial treatment for acute pulmonary thromboembolism, and intravenous thrombolysis is performed in hemodynamically unstable cases. Chronic thromboembolic pulmonary hypertention is treated by pulmonary endarterectomy whereas anticoagulant and vasodilator are used for peripheral type and mild cases. PMID:21916175

  8. Cardiac sarcoidosis - silent destroyer.

    PubMed

    Martusewicz-Boros, Magdalena M; Piotrowska-Kownacka, Dorota; Wiatr, Elżbieta; Roszkowski-Śliż, Kazimierz

    2016-01-01

    We report a case of histologically proven pulmonary sarcoidosis and cardiac involvement in a 53-year old woman with progression leading to the heart failure documented in cardiovascular magnetic resonsnce studies. PMID:27537722

  9. Cardiac glycoside overdose

    MedlinePlus

    ... found in the leaves of the digitalis (foxglove) plant. This plant is the original source of this medicine. People ... Digitoxin (Crystodigin) Digoxin (Lanoxicaps, Lanoxin) Besides the foxglove plant, cardiac glycosides also occur naturally in plants such ...

  10. Cardiac conduction system

    MedlinePlus Videos and Cool Tools

    ... signals to the heart muscle causing it to contract. The main components of the cardiac conduction system ... the sequence by causing the atrial muscles to contract. From there, the signal travels to the AV ...