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Sample records for left cardiac chambers

  1. Congenital cardiac malformation with three-chambered right atrium and a persistent left cranial vena cava in a dog.

    PubMed

    Yang, Vicky K; Nussbaum, Lindsay; Rush, John E; Cunningham, Suzanne M; MacGregor, John; Antoon, Kristen N

    2015-03-01

    This report describes an unusual congenital abnormality in a dog in which multiple distinct membranes were observed within the right atrium, creating obstruction to venous return from both the cranial vena cava and the caudal vena cava. A persistent left cranial vena cava was also identified. In addition to a membrane in the typical location for cor triatriatum dexter, the dog also had a perforated membrane separating the main right atrial body and tricuspid valve from a more cranial right atrial chamber and the right cranial vena cava. Balloon dilation was performed successfully to alleviate the obstruction to systemic venous return created by the two membranes. Due to the unusual anatomic features, angiography plus echocardiography was useful to completely characterize the congenital abnormality prior to intervention. PMID:25683781

  2. Left ventricular accessory chamber: a case report and review of the literature.

    TOXLINE Toxicology Bibliographic Information

    Awad SM; Patel AS; Polimenakos A; Braun R; Abdulla RI

    2009-10-01

    Congenital left ventricular out-pouching, consisting of left ventricular aneurysms, left ventricle diverticulae, and double-chambered left ventricle, is a rare cardiac malformation. Criteria to differentiate between left ventricular aneurysm and diverticulum are defined. Reports of left ventricular accessory chamber in the medical literature are rare. In this article, we present a case of left ventricular accessory chamber diagnosed during the late prenatal period. Review of the literature, imaging modalities used for differentiation of the nature of this lesion, and management plan are discussed.

  3. 12. DETAIL VIEW OF PODIUM, SENATE CHAMBER; MURAL TO LEFT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. DETAIL VIEW OF PODIUM, SENATE CHAMBER; MURAL TO LEFT DEPICTS 'FRANK P. BLAIR'S SPEECH AT LOUISIANA 1866' - Missouri State Capitol, High Street between Broadway & Jefferson Streets, Jefferson City, Cole County, MO

  4. Image-based flow modeling in a two-chamber model of the left heart

    NASA Astrophysics Data System (ADS)

    Vedula, Vijay; Seo, Jung-Hee; Shoele, Kourosh; George, Richard; Younes, Laurent; Mittal, Rajat

    2014-11-01

    Computational modeling of cardiac flows has been an active topic of discussion over the past decade. Modeling approaches have been consistently improved by inclusion of additional complexities and these continue to provide new insights into the dynamics of blood flow in health and disease. The vast majority of cardiac models have been single-chamber models, which have typically focused on the left or right ventricles, and in these models, the atria are modeled in highly simplistic ways. However, the left atrium acts as a mixing chamber and works with the left ventricle in a highly coordinated fashion to move the blood from the pulmonary veins to the aorta. The flow dynamics associated with this two-chamber interaction is not well understood. In addition, the flow in the left atrium has by itself significant clinical implications and our understanding of this is far less than that of the left ventricle. In the current study, we use 4D CT to create a physiological heart model that is functionally normal and use an experimentally validated sharp-interface immersed boundary flow solver to explore the atrio-ventricular interaction and develop insights into some of the questions addressed above. This research is supported by the U.S. National Science Foundation through NSF Grants IOS-1124804 and IIS-1344772. Computational resources are provided in part through the NSF XSEDE grants TG-CTS100002 and TG-CTS130064.

  5. Improvement on the auxiliary total artificial heart (ATAH) left chamber design.

    PubMed

    Andrade, Aron; Fonseca, Jeison; Legendre, Daniel; Nicolosi, Denys; Biscegli, Jose; Pinotti, Marcos; Ohashi, Yukio; Nosé, Yukihiko

    2003-05-01

    The auxiliary total artificial heart (ATAH) is an electromechanically driven artificial heart with reduced dimensions, which is able to be implanted in the right thoracic or abdominal cavities of an average human patient without removing the natural heart or the heart neurohumoral inherent control mechanism for the arterial pressure. This device uses a brushless direct current motor and a mechanical actuator (roller screw) to move two diaphragms. The ATAH's beating frequency is regulated through the change of the left preload, based on Frank-Starling's law, assisting the native heart in obtaining adequate blood flow. The ATAH left and right stroke volumes are 38 ml and 34 ml, respectively, giving approximately 5 L/min of cardiac output at 160 bpm. Flow visualization studies were performed in critical areas on the ATAH left chamber. A closed circuit loop was used with water and glycerin (37%) at 25 degrees C. Amberlite particles (80 mesh) were illuminated by a 1 mm planar helium-neon laser light. With left mean preload fixed at 10 mm Hg and the afterload at 100 mm Hg, the heart rate varied from 60 to 200 bpm. Two porcine valves were used on the inlet and outlet ports. The flow pattern images were obtained using a color micro-camera and a video recorder. Subsequently, these images were digitized using a PC computer. A persistent stagnant flow was detected in the left chamber inlet port. After improvement on the left chamber design, this stagnant flow disappeared. PMID:12752207

  6. Cardiac Dysfunction After Left Permanent Cerebral Focal Ischemia

    PubMed Central

    Min, Jiangyong; Farooq, Muhammad U.; Greenberg, Eric; Aloka, Feras; Bhatt, Archit; Kassab, Mounzer; Morgan, James P.; Majid, Arshad

    2010-01-01

    Background and Purpose Stroke can lead to cerebrogenic cardiac arrhythmias. We sought to investigate the effect of ischemic stroke on cardiac function in a mouse model of permanent middle cerebral artery occlusion (pMCAO). Methods Twenty-four hours after the induction of focal ischemia, cardiac function was measured in mice by endovascular catheterization of the heart. Immediately after hemodynamic measurements, mice were euthanized and brains were excised and sectioned to measure infarct volume and the severity of insular cortex injury. Myocardial damage was evaluated by hematoxylin-eosin staining. Serum and heart levels of norepinephrine (NE) were also determined. Results Cardiac dysfunction occurred in 9 out of 14 mice that underwent left pMCAO. In these 9 mice, the severity of left insular cortex lesion was greater than the mice with normal heart function. The serum and heart levels of NE were significantly higher in left pMCAO mice with heart dysfunction. Liner regression analysis indicates significant inverse correlation between the severity of left insular cortex damage and heart dysfunction. Mice that underwent right pMCAO did not exhibit cardiac dysfunction. Conclusions This study shows that left focal cerebral ischemia can produce cardiac dysfunction, which is associated with the extent of left insular cortex damage. Furthermore, mice exhibiting cardiac dysfunction had elevated levels of NE in the serum and heart. PMID:19443809

  7. Right/left assignment in drift chambers and proportional multiwire chambers (PWC's) using induced signals

    DOEpatents

    Walenta, Albert H.

    1979-01-01

    Improved multiwire chamber having means for resolving the left/right ambiguity in the location of an ionizing event. The chamber includes a plurality of spaced parallel anode wires positioned between spaced planar cathodes. Associated with each of the anode wires are a pair of localizing wires, one positioned on either side of the anode wire. The localizing wires are connected to a differential amplifier whose output polarity is determined by whether the ionizing event occurs to the right or left of the anode wire.

  8. Overview of left ventricular outpouchings on cardiac magnetic resonance imaging

    PubMed Central

    Kumar, Sanjeev

    2015-01-01

    Left ventricular outpouchings commonly include aneurysm, pseudoaneurysm, and diverticulum and are now being increasingly detected on imaging. Distinction between these entities is of prime importance to guide proper management as outcomes for these entities differ substantially. Chest radiograph is usually nonspecific in their diagnosis. Echocardiography, multi-detector computed tomography evaluation and angiography are helpful in the diagnosis with their inherit limitations. Cardiac magnetic resonance imaging (MRI) is emerging as a very useful tool that allows simultaneous anatomical and functional evaluation along with tissue characterization, which has diagnostic, theraputic and prognostic implications. This article gives an overview of left ventricular outpouchings with special emphasis on their differentiation using cardiac MRI. PMID:26675616

  9. A large left ventricular pseudoaneurysm evaluated with multimodality cardiac imaging.

    PubMed

    Çakir, Hakan; Alizade, Elnur; Açar, Göksel; Bayram, Zübeyde; Esen, Ali M

    2012-08-01

    Rarely, the rupture of the free wall of the left ventricle is contained by an adherent pericardium, creating a pseudoaneurysm. This clinical finding calls for emergency surgery. However, true aneurysms, if no ruptures are detectable and myocardium wall integrity is confirmed, can often be managed medically. Therefore, the accurate diagnosis of these conditions is clinically important. In this report, we present a case of large left ventricular pseudoaneurysm evaluated with multimodality cardiac imaging. PMID:22767012

  10. Novel Left Ventricular Assist System: an electrocardiogram-synchronized LVAS that avoids cardiac cannulation.

    PubMed

    Liotta, Domingo

    2003-01-01

    We propose a Novel Left Ventricular Assist System (Novel LVAS) as a bridge to cardiac transplantation and to functional heart recovery in advanced heart failure. This report regards the principles that led to its development. It is our hope that the design of a high-peak-output pump of smaller size will lead to improved functional capacity, when compared with currently available left ventricular assist bridges to heart recovery. Several basic considerations went into the design of this system: 1) we did not want to cannulate the heart chambers; 2) in particular, we rejected the use of a left ventricular apical cannula for myocardial recovery, because it destroys the helical anatomy of the chamber; 3) we chose an atriostomy for blood inflow to the implanted pump; and 4) we synchronized the pump to the patient's electrocardiogram, to ensure blood pump ejection in diastole. The key to success is the atriostomy, which creates an opening larger than the patient's mitral valve. The atriostomy may be performed with the heart beating. Bleeding from the left ventricular apical anastomosis is a fairly common occurrence in currently available left ventricular assist systems; subsequent transfusion can exacerbate right heart dysfunction and sensitize the immune system. These complications are avoided with our system. The new system works either in partial mode or total mode, depending on whether partial or full left ventricular unloading is required. The Novel Left Ventricular Assist System is in its initial clinical trial stage, under the supervision of the author. PMID:12959201

  11. Double outlet from chambers of left ventricular morphology.

    PubMed Central

    Coto, E O; Jimenez, M Q; Castaneda, A R; Rufilanchas, J J; Deverall, P B

    1979-01-01

    This series of 5 cases with double outlet of morphologically left ventricular chamber includes 4 found during a review of 1700 heart specimens (incidence 0.23%) and 1 found at operation and successfully corrected. Abnormal atrioventricular connection precluding total correction was present in the 4 anatomical cases. Clinical diagnosis may be difficult and it is suggested that axial cineangiography may make anatomical diagnosis easier. Absence of the infundibular septum and aortic laevoposition are frequent. As some cases can be surgically corrected, accurate information is required on the size of the right ventricle, the morphology and function of the atrioventricular valves, the presence, size, and position of the ventricular septal defect, and the degree and type of outflow tract obstruction. Images PMID:475930

  12. A strategic approach for cardiac MR left ventricle segmentation.

    PubMed

    Dakua, Sarada Prasad; Sahambi, J S

    2010-09-01

    Quantitative evaluation of cardiac function from cardiac magnetic resonance (CMR) images requires the identification of the myocardial walls. This generally requires the clinician to view the image and interactively trace the contours. Especially, detection of myocardial walls of left ventricle is a difficult task in CMR images that are obtained from subjects having serious diseases. An approach to automated outlining the left ventricular contour is proposed. In order to segment the left ventricle, in this paper, a combination of two approaches is suggested. Difference of Gaussian weighting function (DoG) is newly introduced in random walk approach for blood pool (inner contour) extraction. The myocardial wall (outer contour) is segmented out by a modified active contour method that takes blood pool boundary as the initial contour. Promising experimental results in CMR images demonstrate the potentials of our approach. PMID:20809149

  13. Cardiac catheter complications related to left main stem disease.

    PubMed Central

    Kovac, J. D.; de Bono, D. P.

    1996-01-01

    OBJECTIVE: To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database. SETTING: Coordinating centre for national database. DESIGN: Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. Complications involving the left main coronary artery were flagged at entry. Where necessary additional information was sought from participating centres. 112,921 procedures were registered, 12,849 of which were coronary angioplasties and the remainder diagnostic studies. RESULTS: The total number of cases for which complications were recorded was 993 (0.88%). In 61 (6.14%) of the 993 cases complications were associated with left main coronary disease or damage. In 57 (93%) of these 61 cases complications were major, necessitating resuscitation or immediate coronary bypass grafting. Ten patients (16%) died in the catheter laboratory, a further 9 (15%) within 24 hours, and a total of 23 patients (38%) died within one month of the procedure. Left main stem related complications account for 17% of total mortality in the CECCC database. Urgent coronary bypass grafting was attempted in 42 patients, of whom 31 were alive at one month. In all of the six reported PTCA-related complications the cause was traumatic damage to the left main coronary artery. Operators of all grades of seniority experienced complications in similar proportions. CONCLUSIONS: The risk of a complication relating to the left main stem is relatively low, but when such complications occur they tend to be life-threatening and contribute a fifth of total catheter-related mortality. In the absence of a widely available non-invasive investigation with good predictive value for left main stem disease, the best safeguard is careful technique. Patients who do develop complications should have emergency coronary bypass grafting. PMID:8774333

  14. Variational Reconstruction of Left Cardiac Structure from CMR Images.

    PubMed

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

    2015-01-01

    Cardiovascular Disease (CVD), accounting for 17% of overall deaths in the USA, is the leading cause of death over the world. Advances in medical imaging techniques make the quantitative assessment of both the anatomy and function of heart possible. The cardiac modeling is an invariable prerequisite for quantitative analysis. In this study, a novel method is proposed to reconstruct the left cardiac structure from multi-planed cardiac magnetic resonance (CMR) images and contours. Routine CMR examination was performed to acquire both long axis and short axis images. Trained technologists delineated the endocardial contours. Multiple sets of two dimensional contours were projected into the three dimensional patient-based coordinate system and registered to each other. The union of the registered point sets was applied a variational surface reconstruction algorithm based on Delaunay triangulation and graph-cuts. The resulting triangulated surfaces were further post-processed. Quantitative evaluation on our method was performed via computing the overlapping ratio between the reconstructed model and the manually delineated long axis contours, which validates our method. We envisage that this method could be used by radiographers and cardiologists to diagnose and assess cardiac function in patients with diverse heart diseases. PMID:26689551

  15. Variational Reconstruction of Left Cardiac Structure from CMR Images

    PubMed Central

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

    2015-01-01

    Cardiovascular Disease (CVD), accounting for 17% of overall deaths in the USA, is the leading cause of death over the world. Advances in medical imaging techniques make the quantitative assessment of both the anatomy and function of heart possible. The cardiac modeling is an invariable prerequisite for quantitative analysis. In this study, a novel method is proposed to reconstruct the left cardiac structure from multi-planed cardiac magnetic resonance (CMR) images and contours. Routine CMR examination was performed to acquire both long axis and short axis images. Trained technologists delineated the endocardial contours. Multiple sets of two dimensional contours were projected into the three dimensional patient-based coordinate system and registered to each other. The union of the registered point sets was applied a variational surface reconstruction algorithm based on Delaunay triangulation and graph-cuts. The resulting triangulated surfaces were further post-processed. Quantitative evaluation on our method was performed via computing the overlapping ratio between the reconstructed model and the manually delineated long axis contours, which validates our method. We envisage that this method could be used by radiographers and cardiologists to diagnose and assess cardiac function in patients with diverse heart diseases. PMID:26689551

  16. A novel cardiac MR chamber volume model for mechanical dyssynchrony assessment

    NASA Astrophysics Data System (ADS)

    Song, Ting; Fung, Maggie; Stainsby, Jeffrey A.; Hood, Maureen N.; Ho, Vincent B.

    2009-02-01

    A novel cardiac chamber volume model is proposed for the assessment of left ventricular mechanical dyssynchrony. The tool is potentially useful for assessment of regional cardiac function and identification of mechanical dyssynchrony on MRI. Dyssynchrony results typically from a contraction delay between one or more individual left ventricular segments, which in turn leads to inefficient ventricular function and ultimately heart failure. Cardiac resynchronization therapy has emerged as an electrical treatment of choice for heart failure patients with dyssynchrony. Prior MRI techniques have relied on assessments of actual cardiac wall changes either using standard cine MR images or specialized pulse sequences. In this abstract, we detail a semi-automated method that evaluates dyssynchrony based on segmental volumetric analysis of the left ventricular (LV) chamber as illustrated on standard cine MR images. Twelve sectors each were chosen for the basal and mid-ventricular slices and 8 sectors were chosen for apical slices for a total of 32 sectors. For each slice (i.e. basal, mid and apical), a systolic dyssynchrony index (SDI) was measured. SDI, a parameter used for 3D echocardiographic analysis of dyssynchrony, was defined as the corrected standard deviation of the time at which minimal volume is reached in each sector. The SDI measurement of a healthy volunteer was 3.54%. In a patient with acute myocardial infarction, the SDI measurements 10.98%, 16.57% and 1.41% for basal, mid-ventricular and apical LV slices, respectively. Based on published 3D echocardiogram reference threshold values, the patient's SDI corresponds to moderate basal dysfunction, severe mid-ventricular dysfunction, and normal apical LV function, which were confirmed on echocardiography. The LV chamber segmental volume analysis model and SDI is feasible using standard cine MR data and may provide more reliable assessment of patients with dyssynchrony especially if the LV myocardium is thin or if the MR images have spatial resolution insufficient for proper resolution of wall thickness-features problematic for dyssynchrony assessment using existing MR techniques.

  17. 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.

  18. Percutaneous cardioscopy of the cardiac chambers in patients with hypertrophic cardiomyopathy

    NASA Astrophysics Data System (ADS)

    Fujimori, Yoshiharu; Uchida, Yasumi; Nakamura, Fumitaka; Tomaru, Takanobu; Miwa, Atsuko; Hirose, Junichi; Sasaki, Michihiko; Oshima, Tomomitsu; Tsubouchi, Hiroyuki

    1993-05-01

    Recent advances in fiberoptic technology enables us to observe the cardiac chambers percutaneously in various categories of heart disease. We applied cardioscopy in 4 patients with HCM. Two of them presented excessive or good left ventricular function and no history of congestive heart failure (CHF). The other two patients showed reduced left ventricular function with a history of CHF. Cardioscopy was successfully performed in all patients. In patients with excessive or good left ventricular function, the color of the endocardial surface was light brown mixed with white. The trabeculae were significantly thick and contracted vigorously. In patients with reduced left ventricular function, the color was whiter, and the thickness and contraction of the trabeculae were reduced obviously. Myocardial biopsy revealed that interstitial fibrosis was prominent in the latters. These results indicate that (1) cardioscopy is safe and useful for evaluation of the internal surface of the ventricle in patients with HCM, and (2) cardioscopic characteristics of the ventricle are closely related to histopathological features.

  19. Differential regulation of the β-adrenoceptor density and cyclic AMP level with age and sex in turkey cardiac chambers.

    PubMed

    Hoffmann, Sandra; Böhme, Julia; Kube, Christian; Haufe, Jörg; Krautwald-Junghanns, Maria-Elisabeth; Abraham, Getu

    2016-04-15

    Decreased responses of the heart to β-adrenoceptor stimulation with aging have been shown to occur merely in selected heart chambers in relation to increased catecholamine levels. However, there are no systematic studies that investigate all cardiac chambers with regard to receptor density and cAMP (adenosine 3', 5'-cyclic monophosphate) responses. We used meat-type turkey poults (British United Turkey (B.U.T.) Big 6) with increasing age because their heart seems to decrease in weight in relation to body weight and they are often used as an animal model for heart failure. The receptor density and distribution were quantified by radioligand binding analysis using (-)-[(125)I]-iodocyanopindolol and β-adrenoceptor subtype-specific antagonists (ICI 118.551 and CGP 20712 A) in membranes of four cardiac chambers (right and left atria and ventricles) of 6-week-, 12-week-, 16/21-week-, and 57-week-old B.U.T. BIG 6 turkeys. Receptor function was determined by measuring basal and stimulated cAMP production. In both sexes, the β-adrenoceptor density decreased significantly in all chambers with age without altered β-adrenoceptor subtype distribution. The receptor affinity (KD) to the radioligand was similar in hearts of all age groups. β-adrenoceptor-(isoproterenol and guanosine 5'-triphosphate), G-protein-(NaF) and catalytic unit of adenylate cyclase (forskolin, Mn(2+)) mediated cAMP responses were not chamber-dependent. Indeed, the cAMP level was significantly lower in 57-week-old hearts than in 6-week-, 12-week-, 16/21-week-old hearts. These data suggest that with increasing age and body weight, the β-adrenoceptor signal transduction pathway was highly blunted in all cardiac chambers, occurring by decreased receptor density and cAMP responses. PMID:26957056

  20. Kinematic Characterization of Left Ventricular Chamber Stiffness and Relaxation

    NASA Astrophysics Data System (ADS)

    Mossahebi, Sina

    Heart failure is the most common cause of hospitalization today, and diastolic heart failure accounts for 40-50% of cases. Therefore, it is critical to identify diastolic dysfunction at a subclinical stage so that appropriate therapy can be administered before ventricular function is further, and perhaps irreversibly impaired. Basic concepts in physics such as kinematic modeling provide a unique method with which to characterize cardiovascular physiology, specifically diastolic function (DF). The advantage of an approach that is standard in physics, such as the kinematic modeling is its causal formulation that functions in contrast to correlative approaches traditionally utilized in the life sciences. Our research group has pioneered theoretical and experimental quantitative analysis of DF in humans, using both non-invasive (echocardiography, cardiac MRI) and invasive (simultaneous catheterization-echocardiography) methods. Our group developed and validated the Parametrized Diastolic Filling (PDF) formalism which is motivated by basic physiologic principles (LV is a mechanical suction pump at the mitral valve opening) that obey Newton's Laws. PDF formalism is a kinematic model of filling employing an equation of motion, the solution of which accurately predicts all E-wave contours in accordance with the rules of damped harmonic oscillatory motion. The equation's lumped parameters---ventricular stiffness, ventricular viscoelasticity/relaxation and ventricular load---are obtained by solving the 'inverse problem'. The parameters' physiologic significance and clinical utility have been repeatedly demonstrated in multiple clinical settings. In this work we apply our kinematic modeling approach to better understand how the heart works as it fills in order to advance the relationship between physiology and mathematical modeling. Through the use of this modeling, we thereby define and validate novel, causal indexes of diastolic function such as early rapid filling energy, diastatic stiffness, and relaxation and stiffness components of E-wave deceleration time.

  1. Current cardiac imaging techniques for detection of left ventricular mass

    PubMed Central

    2010-01-01

    Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test. PMID:20515461

  2. Shape and dimensions of cardiac chambers: Importance of CT section thickness and orientation. [Dogs

    SciTech Connect

    Hoffman, E.A.; Ritman, E.L.

    1985-06-01

    Three-dimensional (3D) computed tomography (CT) scan data were used to quantitate the geometry of all heart chambers. The Dynamic Spatial Reconstructor (DSR) was used to scan dogs with in situ casts of the cardiac chambers. Chamber volumes estimated from DSR images were accurate within 5% of water displacement volume measurements of the actual casts for chambers greater than 11 ml and within 10% of water displacement volumes for chambers less than 11 ml. Anatomic features of the actual cast correlated closely with anatomy visible in computer-generated surface images of the 3D DSR image data. The important effect of reconstructed section thickness and orientation on the fidelity of 3D cardiac geometry is demonstrated.

  3. The effects of long-term aerobic exercise on cardiac structure, stroke volume of the left ventricle, and cardiac output.

    PubMed

    Lee, Bo-Ae; Oh, Deuk-Ja

    2016-02-01

    The purpose of this study is to investigate the effect of the long-term aerobic exercises on cardiac structure, left ventricular stroke volume, and cardiac output. To achieve the purpose of the study, a total of 22 volunteers-including 10 people who have continued regular exercises and 12 people as the control group-were selected as subjects. With regard to data processing, the IBM SPSS Statistics ver. 21.0 was used to calculate the mean and standard deviation, and the difference of the means between the groups was verified through an independent t-test. As a result, there were significant differences between groups in the left ventricular end-diastolic internal dimension, left ventricular end-systolic internal dimension, left ventricular end-diastolic septum thickness. There were significant differences between groups in left ventricular end-diastolic volume, left ventricular mass, and left ventricular mass index per body surface area. However, in cardiac function, only left ventricular stroke volume showed a significant difference between groups. PMID:26933658

  4. The effects of long-term aerobic exercise on cardiac structure, stroke volume of the left ventricle, and cardiac output

    PubMed Central

    Lee, Bo-Ae; Oh, Deuk-Ja

    2016-01-01

    The purpose of this study is to investigate the effect of the long-term aerobic exercises on cardiac structure, left ventricular stroke volume, and cardiac output. To achieve the purpose of the study, a total of 22 volunteers—including 10 people who have continued regular exercises and 12 people as the control group—were selected as subjects. With regard to data processing, the IBM SPSS Statistics ver. 21.0 was used to calculate the mean and standard deviation, and the difference of the means between the groups was verified through an independent t-test. As a result, there were significant differences between groups in the left ventricular end-diastolic internal dimension, left ventricular end-systolic internal dimension, left ventricular end-diastolic septum thickness. There were significant differences between groups in left ventricular end-diastolic volume, left ventricular mass, and left ventricular mass index per body surface area. However, in cardiac function, only left ventricular stroke volume showed a significant difference between groups. PMID:26933658

  5. A broken heart: Right-to-left shunt in the setting of normal cardiac pressures

    PubMed Central

    Gomperts, Natalie; Fowler, Robert; Horlick, Eric; McLaughlin, Peter

    2008-01-01

    A patent foramen ovale (PFO) is a common structural cardiac variant occurring in approximately 30% of the general population. Patients are usually asymptomatic because the defect is flap-like and does not permit significant left-to-right shunting. However, pathological conditions that result in cardiac rotation or higher than normal right atrial pressures can reverse the normal left atrial to right atrial pressure gradient and cause a right-to-left shunt through a PFO. If the right-to-left shunt is persistent, systemic hypoxemia or paradoxical emboli may result. The present report describes a case of refractory hypoxemia in a critically ill patient with a PFO who had a right-to-left shunt with normal right-sided cardiac pressures. PMID:18340396

  6. A broken heart: right-to-left shunt in the setting of normal cardiac pressures.

    PubMed

    Gomperts, Natalie; Fowler, Robert; Horlick, Eric; McLaughlin, Peter

    2008-03-01

    A patent foramen ovale (PFO) is a common structural cardiac variant occurring in approximately 30% of the general population. Patients are usually asymptomatic because the defect is flap-like and does not permit significant left-to-right shunting. However, pathological conditions that result in cardiac rotation or higher than normal right atrial pressures can reverse the normal left atrial to right atrial pressure gradient and cause a right-to-left shunt through a PFO. If the right-to-left shunt is persistent, systemic hypoxemia or paradoxical emboli may result. The present report describes a case of refractory hypoxemia in a critically ill patient with a PFO who had a right-to-left shunt with normal right-sided cardiac pressures. PMID:18340396

  7. Novel Left Ventricular Assist Systems® I and II for Cardiac Recovery

    PubMed Central

    Cervino, Claudio; Nasini, Victor; Sroka, Agnieszka; Diluch, Armando; Cáceres, Miguel; Sellanes, Miguel; Malusardi, Adriano; del Rio, Miguel; Pham, Si M.; Liotta, Domingo

    2005-01-01

    We have recently described the Novel Left Ventricular Assist Systems® (Novel LVAS®) I and II, which avoid cannulation of cardiac chambers and synchronize pumping with the patient's electrocardiogram. We now describe the drive system in more detail. The drive unit is an air-driven pulsatile system. The driver's parameters can be programmed. This electro-pneumatic unit contains 3 modules. A remarkable feature of the driver system is that it contains 2 pneumatic units that alternate in their function every 15 minutes. This prevents overheating and component fatigue or failure, and it enables the use of smaller units. If one of the units fails, an alarm will warn of the problem, and the other will continue indefinitely. This LVAS is synchronized with the patient's ECG, which enables it to eject the stroke volume during diastole and in this way to act as a chronic counterpulsator. We have designed the Novel LVAS to operate at a low-frequency rate. This fact, together with the electrocardiographic synchronization, offers the best prospect for myocardial recovery in patients who are also receiving β-adrenergic blocking agents. This dual therapy will help adjust heart rate to pump frequency. PMID:16429898

  8. Left Ventricular Aneurysm and Ventricular Tachycardia as Initial Presentation of Cardiac Sarcoidosis

    PubMed Central

    Jmeian, Ashraf; Thawabi, Mohammad; Goldfarb, Irvin; Shamoon, Fayez

    2015-01-01

    Context: Cardiac sarcoidosis (CS) is a rare, potentially fatal disease. It has a wide range of clinical presentations that range from asymptomatic electrocardiogram changes to sudden cardiac death. Ventricular aneurysms and ventricular tachycardia are seen late in the disease, and are rarely the presenting manifestation of the disease. Diagnosis of CS is challenging and often missed or delayed. Case Report: We report a 35-year-old patient who presented with sustained ventricular tachycardia and ST-elevation on electrocardiogram. Cardiac catheterization showed normal coronaries and left ventricular aneurysm. Subsequent 2D-echocardiography showed an infiltrative disease pattern. Cardiac MRI was done and showed late gadolinium enhancement in the septum, apex and lateral wall. The patient was diagnosed with cardiac sarcoidosis and treated with immune suppression and antiarrhythmic agent. In addition underwent AICD implantation. Conclusion: Our case highlights the importance of suspecting cardiac sarcoidosis in young patients presenting with electrocardiogram changes, and present an atypical presentation of this disease. PMID:25839003

  9. A review of heart chamber segmentation for structural and functional analysis using cardiac magnetic resonance imaging.

    PubMed

    Peng, Peng; Lekadir, Karim; Gooya, Ali; Shao, Ling; Petersen, Steffen E; Frangi, Alejandro F

    2016-04-01

    Cardiovascular magnetic resonance (CMR) has become a key imaging modality in clinical cardiology practice due to its unique capabilities for non-invasive imaging of the cardiac chambers and great vessels. A wide range of CMR sequences have been developed to assess various aspects of cardiac structure and function, and significant advances have also been made in terms of imaging quality and acquisition times. A lot of research has been dedicated to the development of global and regional quantitative CMR indices that help the distinction between health and pathology. The goal of this review paper is to discuss the structural and functional CMR indices that have been proposed thus far for clinical assessment of the cardiac chambers. We include indices definitions, the requirements for the calculations, exemplar applications in cardiovascular diseases, and the corresponding normal ranges. Furthermore, we review the most recent state-of-the art techniques for the automatic segmentation of the cardiac boundaries, which are necessary for the calculation of the CMR indices. Finally, we provide a detailed discussion of the existing literature and of the future challenges that need to be addressed to enable a more robust and comprehensive assessment of the cardiac chambers in clinical practice. PMID:26811173

  10. Lessons from patient-specific 3D models of the cardiac chambers after the Mustard operation.

    PubMed

    Chapron, Julien; Hosny, Hatem; Torii, Ryo; Sedky, Yasser; Donya, Mohamed; Yacoub, Magdi H

    2013-01-01

    The recent ability to create detailed 3D models of the atrial and ventricular chambers using CT, MRI and rapid prototyping offers unique opportunities to study the size and shape of the different cardiac chambers both before and following operation for complex cardiac anomalies. We here describe the techniques for creating detailed 3D models of the heart and demonstrate the utility of these techniques in a patient studied after the Mustard operation. This can give important insights into the changes in size and shape of the different chambers and the patterns of blood flow from the pulmonary and systemic veins to the 'appropriate' ventricle. This information in turn could be extremely helpful in understanding and optimizing the overall hemodynamic function after the Mustard operation. PMID:24749115

  11. Lessons from patient-specific 3D models of the cardiac chambers after the Mustard operation

    PubMed Central

    Chapron, Julien; Hosny, Hatem; Torii, Ryo; Sedky, Yasser; Donya, Mohamed; Yacoub, Magdi H

    2013-01-01

    The recent ability to create detailed 3D models of the atrial and ventricular chambers using CT, MRI and rapid prototyping offers unique opportunities to study the size and shape of the different cardiac chambers both before and following operation for complex cardiac anomalies. We here describe the techniques for creating detailed 3D models of the heart and demonstrate the utility of these techniques in a patient studied after the Mustard operation. This can give important insights into the changes in size and shape of the different chambers and the patterns of blood flow from the pulmonary and systemic veins to the ‘appropriate’ ventricle. This information in turn could be extremely helpful in understanding and optimizing the overall hemodynamic function after the Mustard operation. PMID:24749115

  12. Effects of beta-blocker on left ventricular remodeling in rats with volume overload cardiac failure.

    PubMed

    Kobayashi, Masayuki; Machida, Noboru; Tanaka, Ryou; Yamane, Yoshihisa

    2008-11-01

    The beneficial effects of beta-blockers on left ventricular (LV) remodeling have been reported in association with several conditions that cause heart failure, but their effects on the volume overloaded heart failure have not been well defined. Fifty Wistar rats that survived aortocaval (AC) shunt creation were randomly allotted into the following two groups: untreated animals (ACS; n=26) and animals treated with 100 mg/kg/day metoprolol (MP; ACS+MP; n=24). The effects of MP were evaluated at 1, 4 and 12 weeks post-surgery through echocardiographic, hemodynamic and pathologic studies. At 12 weeks post-surgery, LV wall thinning associated with chamber dilatation was observed in ACS but not in ACS+MP. LV end-diastolic pressure and diastolic wall stress were lower in ACS+MP than in ACS. The increase in LV weight was similar in both ACS and ACS+MP at 1 and 4 weeks post-surgery, but at 12 weeks post-surgery, it was significantly greater in ACS+MP than in ACS. At the cellular level, although the cardiac myocyte length progressively increased to a similar extent in both groups, the mean cross-sectional diameter of these cells in ACS+MP was greater than in ACS. In conclusion, MP did not prevent early eccentric hypertrophy in response to volume overload. However, in the late phase of volume overload-induced heart failure, MP appears to allow for myocyte cross-sectional growth and thus prevents LV wall thinning, resulting in a net increase in LV mass. In this manner, MP might contribute to reduction of diastolic wall stress and thereby delay progression of heart failure. PMID:19057143

  13. Primary Left Cardiac Angiosarcoma with Mitral Valve Involvement Accompanying Coronary Artery Disease

    PubMed Central

    Baran, Cagdas; Durdu, Serkan; Eryilmaz, Sadik; Sirlak, Mustafa; Akar, A. Ruchan

    2015-01-01

    We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation. PMID:26649221

  14. Computer-aided scheme for functional index computation of left ventricle in cardiac CTA: segmentation and partitioning of left ventricle

    NASA Astrophysics Data System (ADS)

    Huang, Hui; Zhuang, Xiahai; Shao, Yi; Lan, Tian; Liu, Liu; Li, Qiang

    2013-02-01

    Cardiac functional indices, such as ejection fraction and regional wall motion/ thickening, are commonly used for assessing the contractility and functionality of the heart in clinical practice. An important step for computer-aided determination of functional indices is the automated segmentation of the heart from computed tomography angiography (CTA) and the partitioning of the left ventricle into 16 segments. We develop a fully automatic scheme which not only segments the whole heart from cardiac CTA images, but also partitions the left ventricle, including the blood pool and myocardium, into 16 segments of bull's eye plot. The segmentation is based on image registration and atlas propagation techniques, whereas the bull's eye plot is first obtained through atlas propagation and then further improved to correct inconsistency across different subjects, uneven size for each segment and "zig-zag" edges between them. In this preliminary study, a cohort of ten clinical CTA data was employed to compute and evaluate the regional functional indices as well as the global indices.

  15. Turning crocodilian hearts into bird hearts: growth rates are similar for alligators with and without right-to-left cardiac shunt

    PubMed Central

    Eme, John; Gwalthney, June; Owerkowicz, Tomasz; Blank, Jason M.; Hicks, James W.

    2010-01-01

    The functional and possible adaptive significance of non-avian reptiles' dual aortic arch system and the ability of all non-avian reptiles to perform central vascular cardiac shunts have been of great interest to comparative physiologists. The unique cardiac anatomy of crocodilians – a four-chambered heart with the dual aortic arch system – allows for only right-to-left (R–L; pulmonary bypass) cardiac shunt and for surgical elimination of this shunt. Surgical removal of the R–L shunt, by occluding the left aorta (LAo) upstream and downstream of the foramen of Panizza, results in a crocodilian with an obligatory, avian/mammalian central circulation. In this study, R–L cardiac shunt was eliminated in age-matched, female American alligators (Alligator mississippiensis; 5–7 months of age). We tested the hypothesis that surgical elimination of R–L cardiac shunt would impair growth (a readily measured proxy for fitness) compared with sham-operated, age-matched controls, especially in animals subjected to exhaustive exercise. While regular exercise caused a decrease in size (snout-to-vent length, head length and body mass), elimination of the capacity for R–L cardiac shunt did not greatly reduce animal growth, despite a chronic ventricular enlargement in surgically altered juvenile alligators. We speculate that, despite being slightly smaller, alligators with an occluded LAo would have reached sexual maturity in the same breeding season as control alligators. This study suggests that crocodilian R–L cardiac shunt does not provide an adaptive advantage for juvenile alligator growth and supports the logic that cardiac shunts persist in crocodilians because they have not been selected against. PMID:20639429

  16. Left ventricular apical hypoplasia: Case report on cardiomyopathy and a history of sudden cardiac death

    PubMed Central

    Alizadeh Sani, Zahra; Vojdanparast, Mohammad; Rezaeian, Nahid; Seifi, Azin; Omidvar Tehrani, Sahar; Nezafati, Pouya

    2016-01-01

    BACKGROUND Isolated left ventricular apical hypoplasia with several different unrecognized dimensions is a newly discovered congenital anomaly of the heart. CASE REPORT In this report, we describe a case of cardiomyopathy of this type occurring in a 13-year-old male with a history of mental retardation and sudden cardiac death (SCD) of second-degree relatives. The patient was referred for an evaluation of cardiac status. An echocardiography analysis demonstrated a spherical left ventricle (LV) appearance with mild mitral regurgitation. Cardiac magnetic resonance imaging (MRI) confirmed a spherical and truncated LV appearance. The right ventricle was found to have elongated and wrapped around the LV, and diverticulum was also seen in the cardiac MRI. CONCLUSION To the best of our knowledge, this is to present the first case of LV apical hypoplasia combined with LV diverticulum and a family history of SCD. As more cases featuring this cardiomyopathy type are recognized, it will be easier to elucidate the natural history and management of such cardiac anomalies. PMID:27114737

  17. Four-chamber heart modeling and automatic segmentation for 3D cardiac CT volumes

    NASA Astrophysics Data System (ADS)

    Zheng, Yefeng; Georgescu, Bogdan; Barbu, Adrian; Scheuering, Michael; Comaniciu, Dorin

    2008-03-01

    Multi-chamber heart segmentation is a prerequisite for quantification of the cardiac function. In this paper, we propose an automatic heart chamber segmentation system. There are two closely related tasks to develop such a system: heart modeling and automatic model fitting to an unseen volume. The heart is a complicated non-rigid organ with four chambers and several major vessel trunks attached. A flexible and accurate model is necessary to capture the heart chamber shape at an appropriate level of details. In our four-chamber surface mesh model, the following two factors are considered and traded-off: 1) accuracy in anatomy and 2) easiness for both annotation and automatic detection. Important landmarks such as valves and cusp points on the interventricular septum are explicitly represented in our model. These landmarks can be detected reliably to guide the automatic model fitting process. We also propose two mechanisms, the rotation-axis based and parallel-slice based resampling methods, to establish mesh point correspondence, which is necessary to build a statistical shape model to enforce priori shape constraints in the model fitting procedure. Using this model, we develop an efficient and robust approach for automatic heart chamber segmentation in 3D computed tomography (CT) volumes. Our approach is based on recent advances in learning discriminative object models and we exploit a large database of annotated CT volumes. We formulate the segmentation as a two step learning problem: anatomical structure localization and boundary delineation. A novel algorithm, Marginal Space Learning (MSL), is introduced to solve the 9-dimensional similarity transformation search problem for localizing the heart chambers. After determining the pose of the heart chambers, we estimate the 3D shape through learning-based boundary delineation. Extensive experiments demonstrate the efficiency and robustness of the proposed approach, comparing favorably to the state-of-the-art. This is the first study reporting stable results on a large cardiac CT dataset with 323 volumes. In addition, we achieve a speed of less than eight seconds for automatic segmentation of all four chambers.

  18. Model-based localization of the left ventricle from cardiac MR scans

    NASA Astrophysics Data System (ADS)

    Gong, Leiguang; Cui, Ting; Kulikowski, Casimir A.; Mezrich, Reuben S.

    1993-07-01

    A new approach for the extraction of the myocardium from MR cardiac scans is presented. Segmentation and recognition of the left ventricle by a sequence of generic image processing operations is carried out in an order determined by a model of domain-specific relational, spatial, and morphological knowledge of the cardiac images. In particular, a new technique for constrained surface deformation by variable morphological dilation is introduced. These methods, incorporated in a prototype system called CARDIAN, have produced encouraging results in initial experiments with MR scans from phantom, dog, and human studies.

  19. Cardiac resynchronization therapy and implantable cardiac defibrillators in left ventricular systolic dysfunction.

    PubMed Central

    McAlister, Finlay A; Ezekowitz, Justin; Dryden, Donna M; Hooton, Nicola; Vandermeer, Ben; Friesen, Carol; Spooner, Carol; Rowe, Brian H

    2007-01-01

    OBJECTIVES To determine the efficacy, effectiveness, and safety of cardiac resynchronization therapy (CRT) and/or implantable cardioverter defibrillators (ICD) in patients with left ventricular systolic dysfunction (LVSD). DATA SOURCES A systematic and comprehensive literature search was conducted to identify randomized controlled trials (RCTs) evaluating efficacy and observational studies evaluating effectiveness or safety of CRT and/or ICD in patients with LVSD. REVIEW METHODS Study selection, quality assessment, and data extraction were completed by several investigators in duplicate and independently. Random-effects models were used for analyses. RESULTS From 11,340 citations, we identified 14 RCTs (4,420 patients) for the CRT efficacy review, 106 studies (9,209 patients) for the CRT effectiveness review, 89 studies (9,677 patients) for the CRT safety review, 12 RCTs (8,516 patients) for the ICD efficacy review, 48 studies (15,097 patients) for the ICD effectiveness review, and 49 studies (12,592 patients) for the ICD safety review-all studies enrolled only patients with LVSD. An additional 12 studies (68,848 patients) were included for an analysis of peri-implant outcomes for all patients with ICD (i.e., not only LVSD patients). All patients in the CRT studies had LVSD (mean LVEF from 21 to 30 percent) and prolonged QRS duration (mean from 155 to 209 msec), and 91 percent had New York Heart Association (NYHA) class III or IV symptoms. In patients with LVSD and heart failure symptoms, CRT improved ejection fraction (weighted mean difference 3.0 percent [95% CI, 0.9 to 5.1]), quality of life (weighted mean reduction in Minnesota Living with Heart Failure Questionnaire 8.0 points [95% CI, 5.6 to 10.4 points]), and function (59 percent of CRT recipients vs. 37 percent of controls improved by at least one NYHA class in the RCTs and between 63 percent and 82 percent of CRT recipients improved by at least one NYHA class in observational studies). The proportion of patients hospitalized for HF was reduced by 37 percent (95% CI, 7 to 57 percent) and all-cause mortality was reduced by 22 percent (95% CI, 9 to 33 percent; NNT=29 over 6 months). Implant success rate was 93 percent, 0.3 percent of patients with LVSD died during implantation. Over a median 11-month followup, 6.6 percent of CRT devices exhibited lead problems and 5 percent malfunctioned. In patients with LVSD, ICD reduced all-cause mortality by 20 percent (95% CI, 10 to 29 percent; NNT=20 over 35 months). ICD implant success rate was 99 percent and peri-implant deaths occurred in 1.2 percent of LVSD patients and 1.3 percent of all implantees. The frequency of post-implantation complications in LVSD patients per 100 patient years included 1.4 (95% CI, 1.2 to 1.6) device malfunctions, 1.5 (95% CI, 1.3 to 1.8) lead problems, 0.6 (95% CI, 0.5 to 0.8) implant site infections, and 19.1 (95% CI, 16.5 to 22.0) inappropriate discharges in RCT participants and 4.7 (95% CI, 4.3 to 5.1) inappropriate discharges in patients enrolled in observational studies. CONCLUSIONS ICD and CRT reduce all-cause mortality in patients with LVSD meeting RCT entry criteria. The incremental benefit of CRT plus ICD over CRT alone in patients with LVSD remains uncertain. None of the trials reported differences in the efficacy of CRT or ICD across patient subgroups, nor did our meta-regression detect any subgroup effects; however, subgroup analyses and meta-regression using aggregate trial data are post-hoc analyses and were underpowered to detect such effects. Examination of individual patient trial data is urgently needed to define which clinical subgroups are most likely to benefit from these devices. PMID:17764218

  20. Automatic localization of the left ventricle in cardiac MRI images using deep learning.

    PubMed

    Emad, Omar; Yassine, Inas A; Fahmy, Ahmed S

    2015-08-01

    Automatic localization of the left ventricle (LV) in cardiac MRI images is an essential step for automatic segmentation, functional analysis, and content based retrieval of cardiac images. In this paper, we introduce a new approach based on deep Convolutional Neural Network (CNN) to localize the LV in cardiac MRI in short axis views. A six-layer CNN with different kernel sizes was employed for feature extraction, followed by Softmax fully connected layer for classification. The pyramids of scales analysis was introduced in order to take account of the different sizes of the heart. A publically-available database of 33 patients was used for learning and testing. The proposed method was able it localize the LV with 98.66%, 83.91% and 99.07% for accuracy, sensitivity and specificity respectively. PMID:26736354

  1. Impact of weightlessness on cardiac shape and left ventricular stress/strain distributions.

    PubMed

    Iskovitz, Ilana; Kassemi, Mohammad; Thomas, James D

    2013-12-01

    In this paper, a finite element model of the heart is developed to investigate the impact of different gravitational loadings of Earth, Mars, Moon, and microgravity on the cardiac shape and strain/stress distributions in the left ventricle. The finite element model is based on realistic 3D heart geometry, detailed fiber/sheet micro-architecture, and a validated orthotropic cardiac tissue model and constitutive relationship that capture the passive behavior of the heart at end-diastole. The model predicts the trend and magnitude of cardiac shape change at different gravitational levels with great fidelity in comparison to recent cardiac sphericity measurements performed during simulated reduced-gravity parabolic flight experiments. Moreover, the numerical predictions indicate that although the left ventricular strain distributions remain relatively unaltered across the gravitational fields and the strain extrema values occur at the same relative locations, their values change noticeably with decreasing gravity. As for the stress, however, both the magnitude and location of the extrema change with a decrease in the gravitational field. Consequently, tension regions of the heart on Earth can change into compression regions in space. PMID:24048335

  2. The right atrium, a forgotten cardiac chamber: An updated review of multimodality imaging.

    PubMed

    Tadic, Marijana

    2015-01-01

    Despite several limitations, two-dimensional echocardiography (2DE) is the standard method for assessing the right atrium (RA) in everyday clinical routine. Cardiac magnetic resonance remains the current "gold standard" for RA visualization and volume quantification. The development of 2DE-derived strain imaging has enabled assessing RA deformation and phasic function in various pathologic conditions. Three-dimensional echocardiography was demonstrated to be more accurate and reproducible than 2DE for cardiac chamber quantification, while also allowing the evaluation of RA phasic function without geometric assumption. The purpose of this review is to summarize currently available data about RA anatomy, phasic function, and mechanics acquired by different imaging modalities. PMID:25732678

  3. Clinical cardiac structural anatomy reconstructed within the cardiac contour using multidetector-row computed tomography: Left ventricular outflow tract.

    PubMed

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

    2016-04-01

    The left ventricular outflow tract (LVOT) is a common site of idiopathic ventricular arrhythmia. Many electrocardiographic characteristics for predicting the origin of arrhythmia have been reported, and their prediction rates are clinically acceptable. Because these approaches are inductive, based on QRS-wave morphology during the arrhythmia and endocardial or epicardial pacing, three-dimensional anatomical accuracy in identifying the exact site of the catheter position is essential. However, fluoroscopic recognition and definition of the anatomy around the LVOT can vary among operators, and three-dimensional anatomical recognition within the cardiac contour is difficult because of the morphological complexity of the LVOT. Detailed knowledge about the three-dimensional fluoroscopic cardiac structural anatomy could help to reduce the need for contrast medium injection and radiation exposure, and to perform safe interventions. In this article, we present a series of structural images of the LVOT reconstructed in combination with the cardiac contour using multidetector-row computed tomography. We also discuss the clinical implications of these findings based on the accumulated insights of research pioneers. Clin. Anat. 29:353-363, 2016. © 2015 Wiley Periodicals, Inc. PMID:25974872

  4. Effect of Discontinuation of Prednisolone Therapy on Risk of Cardiac Mortality Associated With Worsening Left Ventricular Dysfunction in Cardiac Sarcoidosis.

    PubMed

    Nagai, Toshiyuki; Nagano, Nobutaka; Sugano, Yasuo; Asaumi, Yasuhide; Aiba, Takeshi; Kanzaki, Hideaki; Kusano, Kengo; Noguchi, Teruo; Yasuda, Satoshi; Ogawa, Hisao; Anzai, Toshihisa

    2016-03-15

    Prednisolone (PSL) therapy is the gold standard treatment in patients with cardiac sarcoidosis (CS). However, clinicians often have difficulty in deciding whether to discontinue PSL therapy in long-term management. Sixty-one consecutive patients with CS were divided into 2 groups based on the discontinuation of PSL during the median follow-up period of 9.9 years. PSL was discontinued in 12 patients because of improvement of clinical findings. There were no significant differences between the 2 groups in age, gender, left ventricular ejection fraction (LVEF), findings of imaging techniques, incidence of fatal arrhythmias and heart failure, and dose of PSL. After discontinuation of PSL, 5 patients had cardiac death, and discontinuation of PSL was significantly associated with higher cardiac mortality compared with continuation (p = 0.035). Although patients with discontinuation had improvement of LVEF after PSL treatment, LVEF decreased after discontinuation of PSL. Furthermore, discontinuation of PSL was associated with greater percent decrease in LVEF compared with continuation (p = 0.037) during the follow-up period. In conclusion, in the long-term management of patients with CS, discontinuation of PSL was associated with poor clinical outcomes and decreased LVEF, suggesting the importance of PSL maintenance therapy. PMID:26805658

  5. The inverse exponential relationship between cardiac mortality and radionuclide left ventricular ejection fraction

    SciTech Connect

    Kelly, M.J.; Kalff, V.; Pitt, A.

    1985-05-01

    Left ventricular ejection fraction (LVEF) is a known predictor of cardiac death, and may be readily measured with radionuclide ventriculography (RVG). However the quantitative nature of the relationship of LVEF to cardiac death is not agreed. Therefore the authors prospectively followed survival in 592 consecutive adults with confirmed cardiac disease, but no other life limiting illness, in whom LVEF was measured with radionuclide ventriculography >1 year ago. The diagnosis was coronary disease (88%), cardiomyopathy (6%) or valvular disease (6%). Mean age was 56 years (range 30-81); 81% were male. Cardiac mortality/month % (CM/Mo%) was higher (P<0.001) in the 1st 2 months (Mo 1-2) than later, but did not change from the 3rd to 36th month (Mo 3-36). The relationship between CM/Mo% and LVEF is log-linear (inverse exponential). Therefore studies which dichotomise LVEF levels above or below an arbitrary value, or assume a linear relationship between cardiac mortality and LVEF, may overestimate the independent prognostic value of other variables relative to LVEF determined by RVG.

  6. Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle.

    PubMed

    Miwa, Kunihisa

    2015-07-01

    The etiology of chronic fatigue syndrome (CFS) is unknown. Myalgic encephalomyelitis (ME) has been recently postulated to be the cause of CFS. Orthostatic intolerance (OI) has been known as an important symptom in predicting quality of life in CFS patients. Cardiac function may be impaired in patients with ME. The presence or absence of OI was determined both symptomatically and by using a 10-min stand-up test in 40 ME patients. Left ventricular (LV) dimensions and function were determined echocardiographically in the ME patients compared to 40 control subjects. OI was noted in 35 (97%) of the 36 ME patients who could stand up quickly. The mean values for the cardiothoracic ratio, systemic systolic and diastolic pressures, LV end-diastolic diameter (EDD), LV end-systolic diameter, stroke volume index, cardiac index and LV mass index were all significantly smaller in the ME group than in the controls. Both a small LVEDD (<40 mm, 45 vs. 3%) and a low cardiac index (<2 l/ min/mm2, 53 vs. 8%) were significantly more common in the ME group than in the controls. Both heart rate and LV ejection fraction were similar between the groups. In conclusion, a small LV size with a low cardiac output was common in ME patients, in whom OI was extremely common. Cardiac dysfunction with a small heart appears to be related to the symptoms of ME. PMID:24736946

  7. Toward standardized mapping for left atrial analysis and cardiac ablation guidance

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Holmes, D. R.; Linte, C. A.; Packer, D. L.; Robb, R. A.

    2014-03-01

    In catheter-based cardiac ablation, the pulmonary vein ostia are important landmarks for guiding the ablation procedure, and for this reason, have been the focus of many studies quantifying their size, structure, and variability. Analysis of pulmonary vein structure, however, has been limited by the lack of a standardized reference space for population based studies. Standardized maps are important tools for characterizing anatomic variability across subjects with the goal of separating normal inter-subject variability from abnormal variability associated with disease. In this work, we describe a novel technique for computing flat maps of left atrial anatomy in a standardized space. A flat map of left atrial anatomy is created by casting a single ray through the volume and systematically rotating the camera viewpoint to obtain the entire field of view. The technique is validated by assessing preservation of relative surface areas and distances between the original 3D geometry and the flat map geometry. The proposed methodology is demonstrated on 10 subjects which are subsequently combined to form a probabilistic map of anatomic location for each of the pulmonary vein ostia and the boundary of the left atrial appendage. The probabilistic map demonstrates that the location of the inferior ostia have higher variability than the superior ostia and the variability of the left atrial appendage is similar to the superior pulmonary veins. This technique could also have potential application in mapping electrophysiology data, radio-frequency ablation burns, or treatment planning in cardiac ablation therapy.

  8. Toward Standardized Mapping for Left Atrial Analysis and Cardiac Ablation Guidance

    PubMed Central

    Rettmann, M.E.; Holmes, D.R.; Linte, C.A.; Packer, D.L.; Robb, R.A.

    2015-01-01

    In catheter-based cardiac ablation, the pulmonary vein ostia are important landmarks for guiding the ablation procedure, and for this reason, have been the focus of many studies quantifying their size, structure, and variability. Analysis of pulmonary vein structure, however, has been limited by the lack of a standardized reference space for population based studies. Standardized maps are important tools for characterizing anatomic variability across subjects with the goal of separating normal inter-subject variability from abnormal variability associated with disease. In this work, we describe a novel technique for computing flat maps of left atrial anatomy in a standardized space. A flat map of left atrial anatomy is created by casting a single ray through the volume and systematically rotating the camera viewpoint to obtain the entire field of view. The technique is validated by assessing preservation of relative surface areas and distances between the original 3D geometry and the flat map geometry. The proposed methodology is demonstrated on 10 subjects which are subsequently combined to form a probabilistic map of anatomic location for each of the pulmonary vein ostia and the boundary of the left atrial appendage. The probabilistic map demonstrates that the location of the inferior ostia have higher variability than the superior ostia and the variability of the left atrial appendage is similar to the superior pulmonary veins. This technique could also have potential application in mapping electrophysiology data, radio-frequency ablation burns, or treatment planning in cardiac ablation therapy. PMID:26401067

  9. Primary cardiac synovial sarcoma originating from the mitral valve causing left ventricular outflow tract obstruction.

    PubMed

    Veshti, Altin; Prifti, Edvin Mihal; Ikonomi, Majlinda

    2015-01-01

    An 11-year-old boy was admitted due to different episodes of syncope and convulsion. Echocardiogram revealed a mass of 2 × 4 cm originating from the mitral subvalvular apparatus and more precisely from the antero-lateral papillary muscle, protruding in the left ventricle outflow tract causing intermittent obstruction. The patient underwent surgical excision of the left sided mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At 6 months after the operation a small mass in the left ventricle of 1 × 1 cm was detected. The patient underwent reoperation consisting in radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was a cardiac synovial sarcoma. At 1 year after surgery the patient is doing well. PMID:26115156

  10. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    PubMed

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease. PMID:23804483

  11. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

    PubMed Central

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-01

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death. PMID:26839662

  12. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    PubMed

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death. PMID:26839662

  13. Three-dimensional active shape model matching for left ventricle segmentation in cardiac CT

    NASA Astrophysics Data System (ADS)

    van Assen, Hans C.; van der Geest, Rob J.; Danilouchkine, Mikhail G.; Lamb, Hildo J.; Reiber, Johan H. C.; Lelieveldt, Boudewijn P. F.

    2003-05-01

    Manual quantitative analysis of cardiac left ventricular function using multi-slice CT is labor intensive because of the large datasets. We present an automatic, robust and intrinsically three-dimensional segmentation method for cardiac CT images, based on 3D Active Shape Models (ASMs). ASMs describe shape and shape variations over a population as a mean shape and a number of eigenvariations, which can be extracted by e.g. Principal Component Analysis (PCA). During the iterative ASM matching process, the shape deformation is restricted within statistically plausible constraints (+/-3σ). Our approach has two novel aspects: the 3D-ASM application to volume data of arbitrary planar orientation, and the application to image data from another modality than which was used to train the model, without the necessity of retraining it. The 3D-ASM was trained on MR data and quantitatively evaluated on 17 multi-slice cardiac CT data sets, with respect to calculated LV volume (blood pool plus myocardium) and endocardial volume. In all cases, model matching was convergent and final results showed a good model performance. Bland-Altman analysis however, showed that bloodpool volume was slightly underestimated and LV volume was slightly overestimated by the model. Nevertheless, these errors remain within clinically acceptable margins. Based on this evaluation, we conclude that our 3D-ASM combines robustness with clinically acceptable accuracy. Without retraining for cardiac CT, we could adapt a model trained on cardiac MR data sets for application in cardiac CT volumes, demonstrating the flexibility and feasibility of our matching approach. Causes for the systematic errors are edge detection, model constraints, or image data reconstruction. For all these categories, solutions are discussed.

  14. Transient cardiac arrest in patient with left ventricular noncompaction (spongiform cardiomyopathy).

    PubMed

    Yamazaki, Shinya; Ito, Hiroshi; Kawaai, Hiroyoshi

    2011-01-01

    Left ventricular noncompaction (LVNC), also known as spongiform cardiomyopathy, is a severe disease that has not previously been discussed with respect to general anesthesia. We treated a child with LVNC who experienced cardiac arrest. Dental treatment under general anesthesia was scheduled because the patient had a risk of endocarditis due to dental caries along with a history of being uncooperative for dental care. During sevoflurane induction, severe hypotension and laryngospasm resulted in cardiac arrest. Basic life support (cardiopulmonary resuscitation) was initiated to resuscitate the child, and his cardiorespiratory condition improved. Thereafter, an opioid-based anesthetic was performed, and recovery was smooth. In LVNC, opioid-based anesthesia is suggested to avoid the significant cardiac suppression seen with a volatile anesthetic, once intravenous access is established. Additionally, all operating room staff should master Advanced Cardiac Life Support/Pediatric Advanced Life Support (including intraosseous access), and more than 1 anesthesiologist should be present to induce general anesthesia, if possible, for this high-risk patient. PMID:21410361

  15. Automated detection of the left ventricular region in gated nuclear cardiac imaging.

    PubMed

    Boudraa, A E; Arzi, M; Sau, J; Champier, J; Hadj-Moussa, S; Besson, J E; Sappey-Marinier, D; Itti, R; Mallet, J J

    1996-04-01

    An approach to automated outlining the left ventricular contour and its bounded area in gated isotopic ventriculography is proposed. Its purpose is to determine the ejection fraction (EF), an important parameter for measuring cardiac function. The method uses a modified version of the fuzzy C-means (MFCM) algorithm and a labeling technique. The MFCM algorithm is applied to the end diastolic (ED) frame and then the (FCM) is applied to the remaining images in a "box" of interest. The MFCM generates a number of fuzzy clusters. Each cluster is a substructure of the heart (left ventricle,...). A cluster validity index to estimate the optimum clusters number present in image data point is used. This index takes account of the homogeneity in each cluster and is connected to the geometrical property of data set. The labeling is only performed to achieve the detection process in the ED frame. Since the left ventricle (LV) cluster has the greatest area of the cardiac images sequence in ED phase, a framing operation is performed to obtain, automatically, the "box" enclosing the LV cluster. THe EF assessed in 50 patients by the proposed method and a semi-automatic one, routinely used, are presented. A good correlation between the two methods EF values is obtained (R = 0.93). The LV contour found has been judged very satisfactory by a team of trained clinicians. PMID:8626193

  16. Effects of cardiac resynchronization therapy on left ventricular remodeling and dyssynchrony in patients with left ventricular noncompaction and heart failure.

    PubMed

    Qiu, Qiong; Chen, Yang-xin; Mai, Jing-ting; Yuan, Wo-liang; Wei, Yu-lin; Liu, Ying-mei; Yang, Li; Wang, Jing-Feng

    2015-02-01

    Left ventricular noncompaction (LVNC) is a rare cardiomyopathy with high incidence of heart failure (HF). It is unclear whether LVNC patients with desynchronized HF would benefit from cardiac resynchronization therapy (CRT). In order to evaluate the effect of CRT on LVNC, this study explored left ventricular (LV) remodeling and mechanical synchronicity before and after CRT in LVNC patients, and compare with that in idiopathic dilated cardiomyopathy (DCM) patients. We collected 15 LVNC and 30 matched DCM patients. All the patients underwent clinical evaluation,electrocardiogram and echocardiography before CRT and ≥6 months later. LV response was defined as ≥15 % decrease in LV end-systolic volume (LVESV). Longitudinal synchronicity was quantified by YU-index using tissue Doppler imaging. The time delay of peak radial strain from anteroseptal to posterior wall, which derived from speckle tracking imaging, was used to quantify radial synchronicity. In LVNC group, LV ejection fraction increased from 27.6 ± 5.5 to 39.1 ± 7.0 % (P < 0.01) during follow-up, but LV volumes did not change significantly (both P > 0.05). Five LVNC patients (33.3 %) responded to CRT, and all of them were super-responders (reduction in LVESV > 30 %). In addition, the number of noncompacted segments and the thickness ratio of noncompacted to compacted myocardium decreased (both P < 0.05). Inter-ventricular, longitudinal and radial intra-ventricular dyssynchrony also reduced significantly (all P < 0.05). Compared with DCM group, there was no significant difference in LV response rate (33.3 vs. 60.0 %, P = 0.092), improvement of LV function and dyssynchrony index (all P < 0.05). In conclusion, CRT improved heart function, morphology and mechanical dyssynchrony in LVNC patients. PMID:25392055

  17. Sinus Node Dysfunction as the First Manifestation of Left Ventricular Noncompaction with Multiple Cardiac Abnormalities

    PubMed Central

    Gungor, Baris; Alper, Ahmet T; Celebi, Ahmet; Bolca, Osman

    2013-01-01

    Left ventricular noncompaction (LVNC) is a genetically heterogenous form of cardiomyopathy which may remain undiagnosed till adulthood due to the late presentation of typical symptoms such as dyspnea, congestion, ventricular arrhythmias and thromboembolism. Symptomatic bradycardia secondary to persistent sinus node dysfunction is very rare. Coexistent cardiac defects are common in children however in adults the disease is usually in isolated form. Here, we present a case of twenty-three year-old female LVNC patient with patent ductus arteriosus, bicuspid aortic valve and persistent sinus node dysfunction who presented with dizziness as the first manifestation of the disease. PMID:24086099

  18. HDL Mimetic Peptide Administration Improves Left Ventricular Filling and Cardiac output in Lipopolysaccharide-Treated Rats

    PubMed Central

    Datta, Geeta; Gupta, Himanshu; Zhang, Zhenghao; Mayakonda, Palgunachari; Anantharamaiah, G.M.; White, C. Roger

    2012-01-01

    Aims Cardiac dysfunction is a complication of sepsis and contributes to morbidity and mortality. Since raising plasma apolipoprotein (apo) A-I and high density lipoprotein (HDL) concentration reduces sepsis complications, we tested the hypothesis that the apoA-I mimetic peptide 4F confers similar protective effects in rats treated with lipopolysaccharide (LPS). Methods and results Male Sprague-Dawley (SD) rats were randomized to receive saline vehicle (n=13), LPS (10 mg/kg: n=16) or LPS plus 4F (10 mg/kg each: n=13) by intraperitoneal injection. Plasma cytokine and chemokine levels were significantly elevated 24 hrs after LPS administration. Echocardiographic studies revealed changes in cardiac dimensions that resulted in a reduction in left ventricular end-diastolic volume (LVEDV), stroke volume (SV) and cardiac output (CO) 24 hrs after LPS administration. 4F treatment reduced plasma levels of inflammatory mediators and increased LV filling, resulting in improved cardiac performance. Chromatographic separation of lipoproteins from plasma of vehicle, LPS and LPS+4F rats revealed similar profiles. Further analyses showed that LPS treatment reduced the agarose electrophoretic mobility of isolated HDL fractions. HDL-associated proteins were characterized by SDSPAGE and mass spectrometry. ApoA-I and apoA-IV were reduced while apoE content was increased in LPStreated rats. 4F treatment in vivo attenuated changes in HDL-associated apolipoproteins and increased the electrophoretic mobility of the particle. Conclusions The ability of 4F to reduce inflammation and improve cardiac performance in LPS-treated rats may be due to its capacity to neutralize endotoxin and prevent adverse changes in HDL composition and function. PMID:23227448

  19. Techniques for identification of left ventricular asynchrony for cardiac resynchronization therapy in heart failure

    PubMed Central

    Schuster, Peter; Faerestrand, Svein

    2005-01-01

    The most recent treatment option of medically refractory heart failure includes cardiac resynchronization therapy (CRT) by biventricular pacing in selected patients in NYHA functional class III or IV heart failure. The widely used marker to indicate left ventricular (LV) asynchrony has been the surface ECG, but seems not to be a sufficient marker of the mechanical events within the LV and prediction of clinical response. This review presents an overview of techniques for identification of left ventricular intra- and interventricular asynchrony. Both manuscripts for electrical and mechanical asynchrony are reviewed, partly predicting response to CRT. In summary there is still no gold standard for assessment of LV asynchrony for CRT, but both traditional and new echocardiographic methods have shown asynchronous LV contraction in heart failure patients, and resynchronized LV contraction during CRT and should be implemented as additional methods for selecting patients to CRT. PMID:16943866

  20. Primary Cardiac Synovial Sarcoma Originating From the Mitral Valve Causing Left Ventricular Outflow Tract Obstruction.

    PubMed

    Prifti, Edvin; Veshti, Altin; Ikonomi, Majlinda; Demiraj, Aurel

    2015-10-01

    An 11-year-old boy was admitted with complaints of syncope and convulsion. Echocardiogram revealed a mass measuring 2 × 4 cm related to the mitral subvalvular apparatus. The mass, which appeared to be attached to the anterolateral papillary muscle, protruded into the left ventricular outflow tract causing intermittent obstruction. The patient underwent surgical excision of the mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At six months following the operation, a small mass measuring 1 × 1 cm was detected in the left ventricle. The patient underwent reoperation consisting of radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was cardiac synovial sarcoma. One year after surgery, the patient is doing well. PMID:26467881

  1. Electrical storm: Role of stellate ganglion blockade and anesthetic implications of left cardiac sympathetic denervation

    PubMed Central

    Gadhinglajkar, Shrinivas; Sreedhar, Rupa; Unnikrishnan, M.; Namboodiri, Narayanan

    2013-01-01

    An electrical storm is usually associated with catecholaminergic surge following myocardial ischaemia and manifest as recurrent ventricular arrhythmias, requiring frequent DC shocks. Delivering repeated DC shocks induces myocardial damage and further worsens the arrhythmias, which are resistant to the antiarrhythmic drugs. Cardiac sympathetic blockade abates the excessive catecholaminergic drive and help pacifying the malignant ventricular arrhythmias. We treated the electrical storm in a 52-year-old male with ultrasound-guided left sympathetic ganglion block followed by surgical left cardiac sympathetic denervation. The patient remained symptom-free without any incident of ventricular arrhythmias for 8 months after the surgery. The ultrasonography during blockade of the stellate ganglion enhances the success rate of the technique, reduces the quantity of local anaesthetic required to produce desired effects and prevents technical complications. Supraclavicular surgical access to the upper thoracic sympathetic chain obviates the necessity for one lung ventilation and lateral decubitus during surgery, when the patient is in hemodynamically unstable condition. Sympathectomy can be performed under general anaesthesia taking cautions to avoid sympathetic stimulation in intraoperative period. PMID:24163457

  2. Estimating Cardiac Substructures Exposure From Diverse Radiotherapy Techniques in Treating Left-Sided Breast Cancer

    PubMed Central

    Zhang, Li; Mei, Xin; Chen, Xingxing; Hu, Weigang; Hu, Silong; Zhang, Yingjian; Shao, Zhimin; Guo, Xiaomao; Tuan, Jeffrey; Yu, Xiaoli

    2015-01-01

    Abstract The study compares the physical and biologically effective doses (BED) received by the heart and cardiac substructures using three-dimensional conformal RT (3D-CRT), intensity-modulated radiotherapy (IMRT), and simple IMRT (s-IMRT) in postoperative radiotherapy for patients with left-sided breast cancer. From October 2008 to February 2009, 14 patients with histologically confirmed left-sided breast cancer were enrolled and underwent contrast-enhanced computed tomography (CT) simulation and 18F-FDG positron emission tomography-CT to outline the left cardiac ventricle (LV) and other substructures. The linear-quadratic model was used to convert the physical doses received by critical points of inner heart to BED. The maximal dose, minimum dose, dose received by 99% of volume (D99) and dose received by 95% of volume (D95) in target areas were significantly better using IMRT and s-IMRT when compared with 3D-CRT (P < 0.05). IMRT and s-IMRT significantly reduced the maximal cardiac dose (5038.98 vs 5346.47 cGy, P = 0.002; 5146.66 vs 5346.47 cGy, P = 0.03). IMRT reduced the maximal dose to LV by 4% (P = 0.05) in comparison with 3D-CRT. The average doses to heart and LV in 3D-CRT plan were significantly lower than those in IMRT plan (P < 0.05). The average cardiac volumes receiving ≥25 Gy (V25 Gy) in IMRT, s-IMRT, and 3D-CRT plans were 73.98, 76.75, and 60.34 cm3, respectively. The average LV volumes receiving ≥25 Gy (V25 Gy) in IMRT, s-IMRT and 3D-CRT plans were 23.37, 24.68, and 17.61 cm3, respectively. In the IMRT plan, the mean BED to the critical points of inner heart located within the high physical dose area were substantially lower than in 3D-CRT or s-IMRT. Compared with 3D-CRT technique, IMRT and s-IMRT had superior target dose coverage and dose uniformity. IMRT significantly reduced the maximal RT dose to heart and LV. IMRT and s-IMRT techniques did not reduce the volume of heart and LV receiving high doses. PMID:25950697

  3. Tomotherapy and Multifield Intensity-Modulated Radiotherapy Planning Reduce Cardiac Doses in Left-Sided Breast Cancer Patients With Unfavorable Cardiac Anatomy

    SciTech Connect

    Coon, Alan B.; Dickler, Adam; Kirk, Michael C.

    2010-09-01

    Purpose: For patients with left-sided breast cancers, radiation treatment to the intact breast results in high doses to significant volumes of the heart, increasing the risk of cardiac morbidity, particularly in women with unfavorable cardiac anatomy. We compare helical tomotherapy (TOMO) and inverse planned intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiotherapy using opposed tangents (3D-CRT) for reductions in cardiac volumes receiving high doses. Methods and Materials: Fifteen patients with left-sided breast cancers and unfavorable cardiac anatomy, determined by a maximum heart depth (MHD) of {>=}1.0 cm within the tangent fields, were planned for TOMO and IMRT with five to seven beam angles, in addition to 3D-CRT. The volumes of heart and left ventricle receiving {>=}35 Gy (V35) were compared for the plans, as were the mean doses to the contralateral breast and the volume receiving {>=}20 Gy (V20) for the ipsilateral lung. Results: The mean MHD was 1.7 cm, and a significant correlation was observed between MHD and both heart and left ventricle V35. The V35s for IMRT (0.7%) and TOMO (0.5%) were significantly lower than for 3D-CRT (3.6%). The V20 for IMRT (22%) was significantly higher than for 3D-CRT (15%) or TOMO (18%), but the contralateral breast mean dose for TOMO (2.48 Gy) was significantly higher than for 3D-CRT (0.93 Gy) or IMRT (1.38 Gy). Conclusions: Both TOMO and IMRT can significantly reduce cardiac doses, with modest increases in dose to other tissues in left-sided breast cancer patients with unfavorable cardiac anatomy.

  4. Double chamber right ventricle in Williams syndrome: a rare cardiac anomaly reported.

    PubMed

    Mazumdar, Jayitri; Sarkar, Rakesh; Badveli, Anusha; Majumder, Biswajit

    2016-01-01

    Cardiovascular abnormality is the most consistent finding and occur in almost 80 % of all Williams syndrome (WS). Although a number of cardiovascular defects are common to WS, the majority presents in some form of arterial stenosis whereas supravalvular aortic stenosis is the most common one. Here we describe a 12 year old boy with elfin facies, presenting with urinary incontinence and a systolic murmur in right upper parasternal region. Echocardiography showed presence of double chambered right ventricle (DCRV) along with supravalvular aortic stenosis (SVAS) and coronary artery aneurysms, left pulmonary artery stenosis and multiple bladder diverticula in CT abdomen. With the clinical suspicion the diagnosis of WS was made and confirmed by fluorescent in situ hybridisation (FISH) study showing deletion in 7q11.23. Though different forms of arterial stenosis at multiple sites have been demonstrated in WS, DCRV in Williams syndrome is not reported till date in medical literature. PMID:27006883

  5. Surgical removal of right-to-left cardiac shunt in the American alligator (Alligator mississippiensis) causes ventricular enlargement but does not alter apnoea or metabolism during diving

    PubMed Central

    Eme, John; Gwalthney, June; Blank, Jason M.; Owerkowicz, Tomasz; Barron, Gildardo; Hicks, James W.

    2009-01-01

    SUMMARY Crocodilians have complete anatomical separation between the ventricles, similar to birds and mammals, but retain the dual aortic arch system found in all non-avian reptiles. This cardiac anatomy allows surgical modification that prevents right-to-left (R–L) cardiac shunt. A R–L shunt is a bypass of the pulmonary circulation and recirculation of oxygen-poor blood back to the systemic circulation and has often been observed during the frequent apnoeic periods of non-avian reptiles, particularly during diving in aquatic species. We eliminated R–L shunt in American alligators (Alligator mississippiensis) by surgically occluding the left aorta (LAo; arising from right ventricle) upstream and downstream of the foramen of Panizza (FoP), and we tested the hypotheses that this removal of R–L shunt would cause afterload-induced cardiac remodelling and adversely affect diving performance. Occlusion of the LAo both upstream and downstream of the FoP for ∼21 months caused a doubling of RV pressure and significant ventricular enlargement (average ∼65%) compared with age-matched, sham-operated animals. In a separate group of recovered, surgically altered alligators allowed to dive freely in a dive chamber at 23°C, occlusion of the LAo did not alter oxygen consumption or voluntary apnoeic periods relative to sham animals. While surgical removal of R–L shunt causes considerable changes in cardiac morphology similar to aortic banding in mammals, its removal does not affect the respiratory pattern or metabolism of alligators. It appears probable that the low metabolic rate of reptiles, rather than pulmonary circulatory bypass, allows for normal aerobic dives. PMID:19837897

  6. 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.

  7. Left cardiac sympathetic denervation in patients with heart failure: a new indication for an old intervention?

    PubMed

    De Ferrari, Gaetano M; Schwartz, Peter J

    2014-04-01

    Heart failure (HF) is characterized by an autonomic imbalance with withdrawal of vagal activity and increased sympathetic activity. Novel non-pharmacological approaches to HF aimed at increasing vagal activity are being proposed. Left cardiac sympathetic denervation (LCSD) has been shown to modify favorably the outcome of several disorders characterized by life-threatening arrhythmias triggered by increased sympathetic activity. The present manuscript discusses the rationale and the limited experimental and clinical experience suggesting a potential role for LCSD in the treatment of patients with advanced heart failure. Possible future clinical applications of LCSD may include HF patients who are intolerant to β-adrenergic blockade, HF patients who have frequent implantable cardioverter-defibrillator shocks, and HF patients in countries where the likelihood of receiving a device is limited, but the capability to perform a one in a lifetime procedure is present. PMID:24482077

  8. Thrombus formation after left atrial appendage exclusion using an Amplatzer cardiac plug device.

    PubMed

    Cruz-Gonzalez, Ignacio; Martín Moreiras, Javier; García, Eulogio

    2011-11-15

    The feasibility and safety of left atrial appendage closure with the Amplatzer cardiac plug (AGA Medical Corp., Minneapolis, MN) have been recently published; no thrombus formation on the device surface has been reported previously. We describe a case of a 66-year-old man with permanent atrial fibrillation, previous stroke, and contraindication for long-term oral anticoagulant therapy. A 22-mm ACP device was deployed successfully without complications. The patient was discharged on acetyl salicylic acid 100 mg and clopidogrel 75 mg daily. After 4 weeks, the patient was admitted for a lower gastrointestinal bleeding and clopidogrel was stopped. A 3-month follow-up echocardiogram confirmed the exclusion of the LAA but it demonstrated the presence of a thrombus on the atrial surface of the device. It was decided to keep the patient on acetyl salicylic acid 100 mg with the addition of enoxaparin 60 mg bid. Transesophageal echocardiogram demonstrated total resolution of the thrombus after 2 months. PMID:21523900

  9. Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming

    PubMed Central

    Pastromas, Sokratis; Manolis, Antonis S

    2014-01-01

    Cardiac resynchronization therapy (CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class II, III and ambulatory IV, reduced left ventricular (LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes. PMID:25548617

  10. Activation of Cardiac Fibroblast Growth Factor Receptor 4 Causes Left Ventricular Hypertrophy.

    PubMed

    Grabner, Alexander; Amaral, Ansel P; Schramm, Karla; Singh, Saurav; Sloan, Alexis; Yanucil, Christopher; Li, Jihe; Shehadeh, Lina A; Hare, Joshua M; David, Valentin; Martin, Aline; Fornoni, Alessia; Di Marco, Giovana Seno; Kentrup, Dominik; Reuter, Stefan; Mayer, Anna B; Pavenstdt, Hermann; Stypmann, Jrg; Kuhn, Christian; Hille, Susanne; Frey, Norbert; Leifheit-Nestler, Maren; Richter, Beatrice; Haffner, Dieter; Abraham, Reimar; Bange, Johannes; Sperl, Bianca; Ullrich, Axel; Brand, Marcus; Wolf, Myles; Faul, Christian

    2015-12-01

    Chronic kidney disease (CKD) is a worldwide public health threat that increases risk of death due to cardiovascular complications, including left ventricular hypertrophy (LVH). Novel therapeutic targets are needed to design treatments to alleviate the cardiovascular burden of CKD. Previously, we demonstrated that circulating concentrations of fibroblast growth factor (FGF) 23 rise progressively in CKD and induce LVH through an unknown FGF receptor(FGFR)-dependent mechanism. Here, we report that FGF23 exclusively activates FGFR4 on cardiac myocytes to stimulate phospholipase C?/calcineurin/nuclear factor of activated Tcell signaling. A specific FGFR4-blocking antibody inhibits FGF23-induced hypertrophy of isolated cardiac myocytes and attenuates LVH in rats with CKD. Mice lacking FGFR4 do not develop LVH in response to elevated FGF23, whereas knockin mice carrying an FGFR4 gain-of-function mutation spontaneously develop LVH. Thus, FGF23 promotes LVH by activating FGFR4, thereby establishing FGFR4 as a pharmacological target for reducing cardiovascular risk in CKD. PMID:26437603

  11. Segmentation of the left ventricle in cardiac MRI using a probabilistic data association active shape model.

    PubMed

    Santiago, Carlos; Nascimento, Jacinto C; Marques, Jorge S

    2015-08-01

    The 3D segmentation of endocardium of the left ventricle (LV) in cardiac MRI volumes is a challenging problem due to the intrinsic properties of this image modality. Typically, the object shape and position are estimated to fit the observed features collected from the images. The difficulty inherent to the LV segmentation in MRI is that the images contain outliers (i.e., observations not belonging to the LV border) due to the presence of other structures. This paper proposes a robust approach based on the Active Shape Model (ASM) that is able to circumvent the above problem. More specifically, the ASM will be guided by probabilistic data association filtering (PDAF) of strokes (i.e. line segments) computed in the neighborhood of the shape model. Thus, the proposed approach, termed herein as ASM-PDAF, will perform the following main steps: 1) edge detection (low-level features) in the vicinity of the shape model; 2) edge grouping (mid-level features) to obtain potential LV strokes; and 3) filtering using a PDAF framework (high-level features) to update the ASM. Experimental results on a public cardiac MRI database show that the proposed approach outperforms previous literature research. PMID:26737978

  12. Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist

    PubMed Central

    2009-01-01

    Background Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest, while left atrial pressure does not exceed 12 mm Hg. We examined the concept of left ventricular diastolic dysfunction in a cardiac surgery setting. Materials and methods Literature review was carried out in order to identify the overall experience of an important and highly underestimated issue: the unexpected adverse outcome due to ventricular stiffness, following cardiac surgery. Results Although diverse group of patients for cardiac surgery could potentially affected from diastolic dysfunction, there are only few studies looking in to the impact of DD on the postoperative outcome; Trans-thoracic echo-cardiography (TTE) is the main stay for the diagnosis of DD. Intraoperative trans-oesophageal (TOE) adds to the management. Subgroups of DD can be defined with prognostic significance. Conclusion DD with elevated left ventricular end-diastolic pressure can predispose to increased perioperative mortality and morbidity. Furthermore, DD is often associated with systolic dysfunction, left ventricular hypertrophy or indeed pulmonary hypertension. When the diagnosis of DD is made, peri-operative attention to this group of patients becomes mandatory. PMID:19930694

  13. A combined deep-learning and deformable-model approach to fully automatic segmentation of the left ventricle in cardiac MRI.

    PubMed

    Avendi, M R; Kheradvar, Arash; Jafarkhani, Hamid

    2016-05-01

    Segmentation of the left ventricle (LV) from cardiac magnetic resonance imaging (MRI) datasets is an essential step for calculation of clinical indices such as ventricular volume and ejection fraction. In this work, we employ deep learning algorithms combined with deformable models to develop and evaluate a fully automatic LV segmentation tool from short-axis cardiac MRI datasets. The method employs deep learning algorithms to learn the segmentation task from the ground true data. Convolutional networks are employed to automatically detect the LV chamber in MRI dataset. Stacked autoencoders are used to infer the LV shape. The inferred shape is incorporated into deformable models to improve the accuracy and robustness of the segmentation. We validated our method using 45 cardiac MR datasets from the MICCAI 2009 LV segmentation challenge and showed that it outperforms the state-of-the art methods. Excellent agreement with the ground truth was achieved. Validation metrics, percentage of good contours, Dice metric, average perpendicular distance and conformity, were computed as 96.69%, 0.94, 1.81 mm and 0.86, versus those of 79.2-95.62%, 0.87-0.9, 1.76-2.97 mm and 0.67-0.78, obtained by other methods, respectively. PMID:26917105

  14. Left ventricular flow analysis: recent advances in numerical methods and applications in cardiac ultrasound.

    PubMed

    Borazjani, Iman; Westerdale, John; McMahon, Eileen M; Rajaraman, Prathish K; Heys, Jeffrey J; Belohlavek, Marek

    2013-01-01

    The left ventricle (LV) pumps oxygenated blood from the lungs to the rest of the body through systemic circulation. The efficiency of such a pumping function is dependent on blood flow within the LV chamber. It is therefore crucial to accurately characterize LV hemodynamics. Improved understanding of LV hemodynamics is expected to provide important clinical diagnostic and prognostic information. We review the recent advances in numerical and experimental methods for characterizing LV flows and focus on analysis of intraventricular flow fields by echocardiographic particle image velocimetry (echo-PIV), due to its potential for broad and practical utility. Future research directions to advance patient-specific LV simulations include development of methods capable of resolving heart valves, higher temporal resolution, automated generation of three-dimensional (3D) geometry, and incorporating actual flow measurements into the numerical solution of the 3D cardiovascular fluid dynamics. PMID:23690874

  15. Left Ventricular Flow Analysis: Recent Advances in Numerical Methods and Applications in Cardiac Ultrasound

    PubMed Central

    Borazjani, Iman; Westerdale, John; McMahon, Eileen M.; Rajaraman, Prathish K.; Heys, Jeffrey J.

    2013-01-01

    The left ventricle (LV) pumps oxygenated blood from the lungs to the rest of the body through systemic circulation. The efficiency of such a pumping function is dependent on blood flow within the LV chamber. It is therefore crucial to accurately characterize LV hemodynamics. Improved understanding of LV hemodynamics is expected to provide important clinical diagnostic and prognostic information. We review the recent advances in numerical and experimental methods for characterizing LV flows and focus on analysis of intraventricular flow fields by echocardiographic particle image velocimetry (echo-PIV), due to its potential for broad and practical utility. Future research directions to advance patient-specific LV simulations include development of methods capable of resolving heart valves, higher temporal resolution, automated generation of three-dimensional (3D) geometry, and incorporating actual flow measurements into the numerical solution of the 3D cardiovascular fluid dynamics. PMID:23690874

  16. The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy

    PubMed Central

    Gold, Michael R.; Birgersdotter-Green, Ulrika; Singh, Jagmeet P.; Ellenbogen, Kenneth A.; Yu, Yinghong; Meyer, Timothy E.; Seth, Milan; Tchou, Patrick J.

    2011-01-01

    Aims The aim of the present study was to evaluate the relationship between left ventricular (LV) electrical delay, as measured by the QLV interval, and outcomes in a prospectively designed substudy of the SMART-AV Trial. Methods and results This was a multicentre study of patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT) defibrillator implantation. In 426 subjects, QLV was measured as the interval from the onset of the QRS from the surface ECG to the first large peak of the LV electrogram. Left ventricular volumes were measured by echocardiography at baseline and after 6 months of CRT by a blinded core laboratory. Quality of life (QOL) was assessed by a standardized questionnaire. When separated by quartiles based on QLV duration, reverse remodelling response rates (>15% reduction in LV end systolic volume) increased progressively from 38.7 to 68.4% and QOL response rate (>10 points reduction) increased from 50 to 72%. Patients in the highest quartile of QLV had a 3.21-fold increase (1.58–6.50, P = 0.001) in their odds of a reverse remodelling response after correcting for QRS duration, bundle branch block type, and clinical characteristics by multivariate logistic regression analysis. Conclusion Electrical dyssynchrony, as measured by QLV, was strongly and independently associated with reverse remodelling and QOL with CRT. Acute measurements of QLV may be useful to guide LV lead placement. PMID:21875862

  17. Myocardial Hypertrophic Remodeling and Impaired Left Ventricular Function in Mice with a Cardiac-Specific Deletion of Janus Kinase 2.

    PubMed

    Gan, Xiaohong T; Rajapurohitam, Venkatesh; Xue, Jenny; Huang, Cathy; Bairwa, Suresh; Tang, Xilan; Chow, Jeffrey T-Y; Liu, Melissa F W; Chiu, Felix; Sakamoto, Kazuhito; Wagner, Kay-Uwe; Karmazyn, Morris

    2015-12-01

    The Janus kinase (JAK) system is involved in numerous cell signaling processes and is highly expressed in cardiac tissue. The JAK isoform JAK2 is activated by numerous factors known to influence cardiac function and pathologic conditions. However, although abundant, the role of JAK2 in the regulation or maintenance of cardiac homeostasis remains poorly understood. Using the Cre-loxP system, we generated a cardiac-specific deletion of Jak2 in the mouse to assess the effect on cardiac function with animals followed up for a 4-month period after birth. These animals had marked mortality during this period, although at 4 months mortality in male mice (47%) was substantially higher compared with female mice (30%). Both male and female cardiac Jak2-deleted mice had hypertrophy, dilated cardiomyopathy, and severe left ventricular dysfunction, including a marked reduction in ejection fractions as assessed by serial echocardiography, although the responses in females were somewhat less severe. Defective cardiac function was associated with altered protein levels of sarcoplasmic reticulum calcium-regulatory proteins particularly in hearts from male mice that had depressed levels of SERCA2 and phosphorylated phospholamban. In contrast, SERCA2 was unchanged in hearts of female mice, whereas phosphorylated phospholamban was increased. Our findings suggest that cardiac JAK2 is critical for maintaining normal heart function, and its ablation produces a severe pathologic phenotype composed of myocardial remodeling, heart failure, and pronounced mortality. PMID:26475415

  18. Optimizing the programation of cardiac resynchronization therapy devices in patients with heart failure and left bundle branch block.

    PubMed

    Vidal, Bàrbara; Sitges, Marta; Marigliano, Alba; Delgado, Victoria; Díaz-Infante, Ernesto; Azqueta, Manel; Tamborero, David; Tolosana, José María; Berruezo, Antonio; Pérez-Villa, Félix; Paré, Carles; Mont, Lluís; Brugada, Josep

    2007-09-15

    This study was conducted to investigate the clinical impact of cardiac resynchronization device optimization. A series of 100 consecutive patients received cardiac resynchronization therapy. In the first 49 patients, an empirical atrioventricular delay of 120 ms was set, with simultaneous biventricular stimulation (interventricular [VV] interval=0 ms). In the next 51 patients, systematic atrioventricular optimization was performed. VV optimization was also performed, selecting 1 VV delay: right or left ventricular preactivation (+30 or -30 ms) or simultaneous (VV interval=0 ms), according to the best synchrony obtained by tissue Doppler-derived wall displacement. At follow-up, patients who were alive without cardiac transplantation and showed improvement of >or=10% in the distance walked in the 6-minute walking test were considered responders. There were no differences between the 2 groups at baseline. Left ventricular ejection fraction improved in the 2 groups, but left ventricular cardiac output improved only in the optimized group. At 6 months, patients with optimized devices walked slightly further in the 6-minute walking test (497+/-167 vs 393+/-123 m, p<0.01), with no differences in New York Heart Association functional class or quality of life compared with nonoptimized patients. Overall, the number of nonresponders were similar in the 2 groups (27% vs 23%, p=NS). In conclusion, the echocardiographic optimization of cardiac resynchronization devices provided a slight incremental clinical benefit at midterm follow-up. Simple and rapid methods to routinely optimize the devices are warranted. PMID:17826387

  19. Natakalim improves post-infarction left ventricular remodeling by restoring the coordinated balance between endothelial function and cardiac hypertrophy.

    PubMed

    Zhou, Hong-Min; Zhong, Ming-Li; Zhang, Yan-Fang; Cui, Wen-Yu; Long, Chao-Liang; Wang, Hai

    2014-11-01

    Endothelial dysfunction can lead to congestive heart failure and the activation of endothelial ATP-sensitive potassium (K(ATP)) channels may contribute to endothelial protection. Therefore, the present study was carried out to investigate the hypothesis that natakalim, a novel K(ATP) channel opener, ameliorates post-infarction left ventricular remodeling and failure by correcting endothelial dysfunction. The effects of myocardial infarction were assessed 8 weeks following left anterior descending coronary artery occlusion in male Wistar rats. Depressed blood pressure, cardiac dysfunction, evidence of left ventricular remodeling and congestive heart failure were observed in the rats with myocardial infarction. Treatment with natakalim at daily oral doses of 1, 3 or 9 mg/kg/day for 8 weeks prevented these changes. Natakalim also prevented the progression to cardiac failure, which was demonstrated by the increase in right ventricular weight/body weight (RVW/BW) and relative lung weight, signs of cardiac dysfunction, as well as the overexpression of atrial and brain natriuretic peptide mRNAs. Our results also demonstrated that natakalim enhanced the downregulation of endothelium-derived nitric oxide, attenuated the upregulation of inducible nitric oxide synthase-derived nitric oxide (NO), inhibited the upregulated endothelin system and corrected the imbalance between prostacyclin and thromboxane A(2). Overall, our findings suggest that natakalim prevents post-infarction hypertrophy and cardiac failure by restoring the coordinated balance between endothelial function and cardiac hypertrophy. PMID:25215478

  20. The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review

    SciTech Connect

    Smyth, Lloyd M; Knight, Kellie A; Aarons, Yolanda K; Wasiak, Jason

    2015-03-15

    Despite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique. An electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed. Ten studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease. DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.

  1. The Effects of Training on the Time Components of the Left Ventricle, and Cardiac Time Components: Sedentary versus Active Individuals.

    ERIC Educational Resources Information Center

    Plowman, Sharon Ann

    A review of previous research was completed to determine (a) the response of the cardiac time components of the left ventricle to varying types and intensities of training programs, (b) the probable physiological explanations for these responses, and (c) the significance of the changes which did or did not occur. It was found that, at rest,…

  2. Ultrasonographic features of the persistence of superior left vena cava and pathological cardiac associations in fetus. Case series.

    PubMed

    Mărginean, Claudiu; Mărginean, Cristina Oana; Muntean, Iolanda; Togănel, Rodica; Meliț, Lorena Elena; Mărginean, Maria Oana; Gozar, Liliana

    2016-06-01

    The persistence of superior left vena cava (PLSVC) is a pathological condition in fetus with risk of association with abnormalities like heterotaxy, cardiac abnormalities - atrioventricular septum defect, and conotruncal anomalies. In this paper we report 23 cases of fetuses with PLSVCs, reviewing their diagnosis, co-morbidities, and evolution in the newborns. PMID:27239657

  3. Segmentation of left atrial intracardiac ultrasound images for image guided cardiac ablation therapy

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Stephens, T.; Holmes, D. R.; Linte, C.; Packer, D. L.; Robb, R. A.

    2013-03-01

    Intracardiac echocardiography (ICE), a technique in which structures of the heart are imaged using a catheter navigated inside the cardiac chambers, is an important imaging technique for guidance in cardiac ablation therapy. Automatic segmentation of these images is valuable for guidance and targeting of treatment sites. In this paper, we describe an approach to segment ICE images by generating an empirical model of blood pool and tissue intensities. Normal, Weibull, Gamma, and Generalized Extreme Value (GEV) distributions are fit to histograms of tissue and blood pool pixels from a series of ICE scans. A total of 40 images from 4 separate studies were evaluated. The model was trained and tested using two approaches. In the first approach, the model was trained on all images from 3 studies and subsequently tested on the 40 images from the 4th study. This procedure was repeated 4 times using a leave-one-out strategy. This is termed the between-subjects approach. In the second approach, the model was trained on 10 randomly selected images from a single study and tested on the remaining 30 images in that study. This is termed the within-subjects approach. For both approaches, the model was used to automatically segment ICE images into blood and tissue regions. Each pixel is classified using the Generalized Liklihood Ratio Test across neighborhood sizes ranging from 1 to 49. Automatic segmentation results were compared against manual segmentations for all images. In the between-subjects approach, the GEV distribution using a neighborhood size of 17 was found to be the most accurate with a misclassification rate of approximately 17%. In the within-subjects approach, the GEV distribution using a neighborhood size of 19 was found to be the most accurate with a misclassification rate of approximately 15%. As expected, the majority of misclassified pixels were located near the boundaries between tissue and blood pool regions for both methods.

  4. Assessment of Left Ventricular Function in Cardiac MSCT Imaging by a 4D Hierarchical Surface-Volume Matching Process.

    PubMed

    Garreau, Mireille; Simon, Antoine; Boulmier, Dominique; Coatrieux, Jean-Louis; Le Breton, Hervé

    2006-01-01

    Multislice computed tomography (MSCT) scanners offer new perspectives for cardiac kinetics evaluation with 4D dynamic sequences of high contrast and spatiotemporal resolutions. A new method is proposed for cardiac motion extraction in multislice CT. Based on a 4D hierarchical surface-volume matching process, it provides the detection of the heart left cavities along the acquired sequence and the estimation of their 3D surface velocity fields. A Markov random field model is defined to find, according to topological descriptors, the best correspondences between a 3D mesh describing the left endocardium at one time and the 3D acquired volume at the following time. The global optimization of the correspondences is realized with a multiresolution process. Results obtained on simulated and real data show the capabilities to extract clinically relevant global and local motion parameters and highlight new perspectives in cardiac computed tomography imaging. PMID:23165027

  5. Relationship of number of phases per cardiac cycle and accuracy of measurement of left ventricular volumes, ejection fraction, and mass.

    PubMed

    Roussakis, Arkadios; Baras, Panagiotis; Seimenis, Ioannis; Andreou, John; Danias, Peter G

    2004-01-01

    In cine cardiac magnetic resonance imaging (MRI) studies, for any preset imaging parameters the number of phases per cardiac cycle for a single slice is proportional to breath-hold duration. We investigated the relationship between the accuracy of measurement of left ventricular (LV) end-diastolic and end-systolic volumes (EDV and ESV, respectively), mass and ejection fraction (EF), and the number of phases acquired per cardiac cycle. Twelve adult volunteers underwent cardiac MRI and five complete LV functional studies were obtained with 8, 11, 14, 17, and 20 phases per cardiac cycle. We calculated LV volumes, EF, and mass for each acquisition, and compared them using the 20-phase acquisition as the reference standard. The scan duration was proportional to the number of phases acquired. There was a systematic underestimation of LV, EDV, and EF, with decreasing number of phases. Differences from the reference standard became significant for the 8-phase acquisition (p<0.05). Subgroup analysis showed that only those with slower heart rates (<65/min) had significant differences in EDV, but not in EF, for the 8-phase acquisition. For those with faster heart rates, no differences were detected between the different acquisitions. There were no significant differences between all acquisitions for the LV ESV and mass. We conclude that at least 11 phases per cardiac cycle are needed to maintain accuracy for cine cardiac MRI studies. Decreasing the number of phases per cardiac cycle beyond this cutoff may introduce significant error of measurement, particularly for the left ventricular EDV and EF and especially for those with bradycardia, and should be avoided. PMID:15646887

  6. Postinfarct cytokine therapy regenerates cardiac tissue and improves left ventricular function.

    PubMed

    Dawn, Buddhadeb; Guo, Yiru; Rezazadeh, Arash; Huang, Yiming; Stein, Adam B; Hunt, Greg; Tiwari, Sumit; Varma, Jai; Gu, Yan; Prabhu, Sumanth D; Kajstura, Jan; Anversa, Piero; Ildstad, Suzanne T; Bolli, Roberto

    2006-04-28

    We systematically investigated the comparative efficacy of three different cytokine regimens, administered after a reperfused myocardial infarction, in regenerating cardiac tissue and improving left ventricular (LV) function. Wild-type (WT) mice underwent a 30-minute coronary occlusion followed by reperfusion and received vehicle, granulocyte colony-stimulating factor (G-CSF)+Flt-3 ligand (FL), G-CSF+stem cell factor (SCF), or G-CSF alone starting 4 hours after reperfusion. In separate experiments, chimeric mice generated by reconstitution of radioablated WT mice with bone marrow from enhanced green fluorescent protein (EGFP) transgenic mice underwent identical protocols. Mice were euthanized 5 weeks later. Echocardiographically, LV function was improved in G-CSF+FL- and G-CSF+SCF-treated but not in G-CSF-treated mice, whereas LV end-diastolic dimensions were smaller in all three groups. Morphometrically, cytokine-treated hearts had smaller LV diameter and volume. Numerous EGFP-positive cardiomyocytes, capillaries, and arterioles were noted in the infarcted region in cytokine-treated chimeric mice treated with G-CSF+FL or G-CSF+SCF, but the numbers were much smaller in G-CSF-treated mice. G-CSF+FL therapy mobilized bone marrow-derived cells exhibiting increased expression of surface antigens (CD62L and CD11a) that facilitate homing. We conclude that postinfarct cytokine therapy with G-CSF+FL or G-CSF+SCF limits adverse LV remodeling and improves LV performance by promoting cardiac regeneration and probably also by exerting other beneficial actions unrelated to regeneration, and that G-CSF alone is less effective. PMID:16556872

  7. Postinfarct Cytokine Therapy Regenerates Cardiac Tissue and Improves Left Ventricular Function

    PubMed Central

    Dawn, Buddhadeb; Guo, Yiru; Rezazadeh, Arash; Huang, Yiming; Stein, Adam B.; Hunt, Greg; Tiwari, Sumit; Varma, Jai; Gu, Yan; Prabhu, Sumanth D.; Kajstura, Jan; Anversa, Piero; Ildstad, Suzanne T.; Bolli, Roberto

    2013-01-01

    We systematically investigated the comparative efficacy of three different cytokine regimens, administered after a reperfused myocardial infarction, in regenerating cardiac tissue and improving left ventricular (LV) function. Wild-type (WT) mice underwent a 30-minute coronary occlusion followed by reperfusion and received vehicle, granulocyte colony-stimulating factor (G-CSF)+Flt-3 ligand (FL), G-CSF+stem cell factor (SCF), or G-CSF alone starting 4 hours after reperfusion. In separate experiments, chimeric mice generated by reconstitution of radioablated WT mice with bone marrow from enhanced green fluorescent protein (EGFP) transgenic mice underwent identical protocols. Mice were euthanized 5 weeks later. Echocardiographically, LV function was improved in G-CSF+FL– and G-CSF+SCF–treated but not in G-CSF–treated mice, whereas LV end-diastolic dimensions were smaller in all three groups. Morphometrically, cytokine-treated hearts had smaller LV diameter and volume. Numerous EGFP-positive cardiomyocytes, capillaries, and arterioles were noted in the infarcted region in cytokine-treated chimeric mice treated with G-CSF+FL or G-CSF+SCF, but the numbers were much smaller in G-CSF–treated mice. G-CSF+FL therapy mobilized bone marrow–derived cells exhibiting increased expression of surface antigens (CD62L and CD11a) that facilitate homing. We conclude that postinfarct cytokine therapy with G-CSF+FL or G-CSF+SCF limits adverse LV remodeling and improves LV performance by promoting cardiac regeneration and probably also by exerting other beneficial actions unrelated to regeneration, and that G-CSF alone is less effective. PMID:16556872

  8. Left Ventricular Hypertrophy in New Hemodialysis Patients without Symptomatic Cardiac Disease

    PubMed Central

    Foley, Robert N.; Curtis, Bryan M.; Randell, Edward W.

    2010-01-01

    Background and objectives: Although left ventricular hypertrophy (LVH) is a characteristic finding in hemodialysis (HD) populations, few risk factors for progressive LVH have been identified. Design, setting, participants, & measurements: As part of a multinational, blinded, randomized, controlled trial that demonstrated no effect of hemoglobin targets on LV size, 596 incident HD patients, without symptomatic cardiac disease or cardiac dilation, had baseline echocardiograms within 18 months of starting dialysis and subsequently at 24, 48, and 96 weeks later. A wide array of baseline risk factors were assessed, as were BP and hemoglobin levels during the trial. Results: The median age and duration of dialysis were 51.5 years and 9 months, respectively. LV mass index (LVMI) rose substantially during follow-up (114.2 g/m2 at baseline, 121 at week 48, 123.4 at week 48, and 128.3 at week 96), as did fractional shortening, whereas LV volume (68.7, 70.1, 68.7, and 68.1 ml/m2) and E/A ratio remained unchanged. At baseline, the only multivariate associations of LVMI were gender and N terminal pro–B type natriuretic peptide. Comparing first and last echocardiograms in those without LVH at baseline, independent predictors of increase in LVMI were higher time-integrated systolic BP and cause of ESRD. An unadjusted association between baseline LVMI and subsequent cardiovascular events or death was eliminated by adjusting for age, diabetes, systolic BP, and N terminal pro–B type natriuretic peptide. Conclusions: Progressive concentric LVH and hyperkinesis occur in HD patients, which is partly explained by hypertension but not by a wide array of potential risk factors, including anemia. PMID:20378644

  9. Docosahexaenoic Acid Supplementation Alters Key Properties of Cardiac Mitochondria and Modestly Attenuates Development of Left Ventricular Dysfunction in Pressure Overload-Induced Heart Failure

    PubMed Central

    Dabkowski, Erinne R.; O’Connell, Kelly A.; Xu, Wenhong; Ribeiro, Rogerio F.; Hecker, Peter A.; Shekar, Kadambari Chandra; Stanley, William C.; Daneault, Caroline; Rosiers, Christine Des

    2015-01-01

    Purpose Supplementation with the n3 polyunsaturated fatty acid docosahexaenoic acid (DHA) is beneficial in heart failure patients, however the mechanisms are unclear. DHA is incorporated into membrane phospholipids, which may prevent mitochondrial dysfunction. Thus we assessed the effects of DHA supplementation on cardiac mitochondria and the development of heart failure caused by aortic pressure overload. Methods Pathological cardiac hypertrophy was generated in rats by thoracic aortic constriction. Animals were fed either a standard diet or were supplemented with DHA (2.3 % of energy intake). Results After 14 weeks, heart failure was evident by left ventricular hypertrophy and chamber enlargement compared to shams. Left ventricle fractional shortening was unaffected by DHA treatment in sham animals (44.1±1.6 % vs. 43.5±2.2 % for standard diet and DHA, respectively), and decreased with heart failure in both treatment groups, but to a lesser extent in DHA treated animals (34.9±1.7 %) than with the standard diet (29.7±1.5 %, P <0.03). DHA supplementation increased DHA content in mitochondrial phospholipids and decreased membrane viscosity. Myocardial mitochondrial oxidative capacity was decreased by heart failure and unaffected by DHA. DHA treatment enhanced Ca2+ uptake by subsarcolemmal mitochondria in both sham and heart failure groups. Further, DHA lessened Ca2+-induced mitochondria swelling, an index of permeability transition, in heart failure animals. Heart failure increased hydrogen peroxide-induced mitochondrial permeability transition compared to sham, which was partially attenuated in interfibrillar mitochondria by treatment with DHA. Conclusions DHA decreased mitochondrial membrane viscosity and accelerated Ca2+ uptake, and attenuated susceptibility to mitochondrial permeability transition and development of left ventricular dysfunction. PMID:24013804

  10. Asiatic acid inhibits left ventricular remodeling and improves cardiac function in a rat model of myocardial infarction

    PubMed Central

    HUO, LIANYING; SHI, WENBING; CHONG, LING; WANG, JINLONG; ZHANG, KAI; LI, YUFENG

    2016-01-01

    Left ventricular remodeling results in cardiac dysfunction and accounts for the majority of the morbidity and mortality following myocardial infarction (MI). The aim of the present study was to investigate the effect of asiatic acid (AA) on cardiac function and left ventricular remodeling in a rat model of MI and explore the underlying mechanisms. Rats were subjected to coronary artery ligation to model MI and orally treated with AA. After 4 weeks, cardiac function was assessed by echocardiography. Cardiomyocyte cross-sectional area was recorded, and the expression levels of a number of inflammatory cytokines were detected using ELISA. The degree of interstitial fibrosis was determined by evaluating the mRNA expression levels of collagen II and III. Western blot analysis was performed to detect the expression levels of total and phosphorylated p38 MAPK and ERK1/2, to investigate whether they are involved in the mechanism underlying the effect of AA on the heart. Rats subjected to MI displayed significantly impaired cardiac function compared with those subjected to a sham procedure, while this change was reversed by treatment with AA. Furthermore, AA markedly inhibited cardiac hypertrophy, reduced the mRNA expression levels of inflammatory cytokines and decreased interstitial fibrosis in the infarct border zone of MI model rats compared with those in vehicle-treated MI model rats. Furthermore, the phosphorylation of p38 MAPK and ERK1/2 was blocked by AA in the MI rats but not in the sham rats. In summary, AA treatment preserved cardiac function and inhibited left ventricular remodeling, potentially by blocking the phosphorylation of p38 MAPK and ERK1/2 in the infarct border zone of the ischemic myocardium, indicating that AA may be a novel candidate for development as a therapy for MI. PMID:26889217

  11. Anomalous Left Circumflex Coronary Artery Arising from the Right Pulmonary Artery: A Rare Cause of Aborted Sudden Cardiac Death

    PubMed Central

    Fursevich, Dzmitry; O'Dell, Matthew C; Flores, Miguel; Feranec, Nicholas

    2016-01-01

    We report a case of anomalous origin of the left circumflex coronary artery arising from the right pulmonary artery resulting in stress-induced cardiac arrest. The patient collapsed after running a 5K race and was resuscitated. Subsequent workup revealed the culprit anatomy, which was successfully treated with surgical ligation. To the authors’ knowledge, this is only the second case of this variant coronary anomaly resulting in aborted sudden cardiac death, subsequent surgical ligation, and recovery in a healthy young adult and is the first case treated by ligation alone without coronary bypass. PMID:27014533

  12. Correlation of Prehypertension with Left Ventricular Mass Assessed by Cardiac Magnetic Resonance Imaging

    PubMed Central

    Mousa, Tarek M.; Akinseye, Oluwaseun A.; Berekashvili, Ketevan; Akinboboye, Olakunle O.

    2015-01-01

    Introduction. The purpose of this observational cross-sectional study was to assess left ventricular mass (LVM) in prehypertensive individuals in comparison to normotensives and to determine if central blood pressure (BP) correlates better with LVM index (LVMI) than brachial BP. Methods and Result. Brachial and central BP measurements were completed at first visit and at 4 weeks in 65 healthy volunteers who were at least 40 years old and not on medication. Subjects were divided into two groups of normotensives and prehypertensives based on JNC-7 criteria and LVM was obtained using cardiac magnetic resonance imaging. Prehypertensives had significantly higher LVMI compared to normotensives (P < 0.01). Brachial and central BP also both positively correlate with LVMI (r = 0.460, P < 0.01; r = 0.318, P = 0.012, resp.) in both groups and neither method was superior to the other. After multivariate regression analysis and adjusting for cardiovascular risk factors, prehypertension remained an independent determinant of LVM. Conclusion. Prehypertension is associated with cardiovascular target organ damage, and central BP was not superior to brachial BP or vice versa for association with LVMI. PMID:26543640

  13. Cardiac MRI based numerical modeling of left ventricular fluid dynamics with mitral valve incorporated.

    PubMed

    Su, Boyang; Tan, Ru San; Tan, Ju Le; Guo, Kenneth Wei Qiang; Zhang, Jun Mei; Leng, Shuang; Zhao, Xiaodan; Allen, John Carson; Zhong, Liang

    2016-05-01

    Recent numerical studies were focused on the modeling of flow in patient-specific left ventricle (LV); however, the mitral valve (MV) was usually excluded. In this study, both patient-specific LV and MV were modeled to achieve a more realistic intraventricular flow. Cardiac MRI images were acquired from a pulmonary arterial hypertension (PAH) patient and a healthy volunteer, and manual segmentation was conducted to reconstruct three-dimensional (3D) LV and MV geometries at each frame. Based on these 3D geometries, vortex formation time (VFT) was derived, and the values were 4.0 and 6.5 for the normal subject and the PAH patient, respectively. Based on studies in the literature, VTF in the healthy subject fell within the normal range, while that in the PAH patient exceeded the threshold for normality. The vortex structures in the LV clearly showed that the vortex ring was initiated from the tips of the MV instead of the mitral annulus. The excessive VFT during the rapid filling phase in the PAH patient resulted in a trailing flow structure behind the primary vortex ring, which was not observed in the normal subject. It can be deduced from this study that incorporating the MV into a patient-specific model is necessary to produce more reasonable VFT and intraventricular flow. PMID:26993615

  14. Left Bundle Branch Block in Acute Cardiac Events: Insights From a 23-Year Registry.

    PubMed

    Alkindi, Fahad; El-Menyar, Ayman; Al-Suwaidi, Jassim; Patel, Ashfaq; Gehani, Abdurrazzak A; Singh, Rajvir; Albinali, Hajar; Arabi, Abdulrahman

    2015-10-01

    Between 1991 and 2013, we evaluated the demographics, presentations, and final diagnosis of patients hospitalized with acute cardiac events and left bundle branch block (LBBB). Of 50 992 patients, 768 (1.5%) had LBBB. Compared with non-LBBB patients, patients with LBBB were mostly older, female, diabetic, and had hypertension and chronic kidney failure (CKF; P < .001 for all). Dyspnea (P < .001) and dizziness (P = .037) were more frequent in patients with LBBB. The most frequent cause of admission with LBBB was congestive heart failure (CHF; 54.2%), followed by ST-elevation myocardial infarction (STEMI; 13.3%), valvular heart disease (9.4%), unstable angina (8.3%) and Non-STEMI (7.7%). On multivariate analysis, CKF (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.09-3.70) and LBBB (OR: 2.96, 95% CI: 2.01-4.42) were predictors of in-hospital mortality in the entire study population. Further analysis of patients with LBBB showed that CKF (OR: 2.93, 95% CI: 1.40-6.12) was the only predictor of in-hospital mortality. Regardless the presenting symptoms, CHF was the final diagnosis in most cases with LBBB. PMID:25477500

  15. Diastolic chamber properties of the left ventricle assessed by global fitting of pressure-volume data: improving the gold standard of diastolic function

    PubMed Central

    Yotti, Raquel; del Villar, Candelas Pérez; del Álamo, Juan C.; Rodríguez-Pérez, Daniel; Martínez-Legazpi, Pablo; Benito, Yolanda; Carlos Antoranz, J.; Mar Desco, M.; González-Mansilla, Ana; Barrio, Alicia; Elízaga, Jaime; Fernández-Avilés, Francisco

    2013-01-01

    In cardiovascular research, relaxation and stiffness are calculated from pressure-volume (PV) curves by separately fitting the data during the isovolumic and end-diastolic phases (end-diastolic PV relationship), respectively. This method is limited because it assumes uncoupled active and passive properties during these phases, it penalizes statistical power, and it cannot account for elastic restoring forces. We aimed to improve this analysis by implementing a method based on global optimization of all PV diastolic data. In 1,000 Monte Carlo experiments, the optimization algorithm recovered entered parameters of diastolic properties below and above the equilibrium volume (intraclass correlation coefficients = 0.99). Inotropic modulation experiments in 26 pigs modified passive pressure generated by restoring forces due to changes in the operative and/or equilibrium volumes. Volume overload and coronary microembolization caused incomplete relaxation at end diastole (active pressure > 0.5 mmHg), rendering the end-diastolic PV relationship method ill-posed. In 28 patients undergoing PV cardiac catheterization, the new algorithm reduced the confidence intervals of stiffness parameters by one-fifth. The Jacobian matrix allowed visualizing the contribution of each property to instantaneous diastolic pressure on a per-patient basis. The algorithm allowed estimating stiffness from single-beat PV data (derivative of left ventricular pressure with respect to volume at end-diastolic volume intraclass correlation coefficient = 0.65, error = 0.07 ± 0.24 mmHg/ml). Thus, in clinical and preclinical research, global optimization algorithms provide the most complete, accurate, and reproducible assessment of global left ventricular diastolic chamber properties from PV data. Using global optimization, we were able to fully uncouple relaxation and passive PV curves for the first time in the intact heart. PMID:23743396

  16. Cardiac resynchronisation therapy in the presence of left-to-right intracardiac shunting: more good than harm?

    PubMed

    Kyu, Kyu; Seow, Swee Chong; Wong, Raymond; Kojodjojo, Pipin

    2016-01-01

    An elderly Chinese man with moderately impaired left ventricular function, left bundle branch block and ST-elevation myocardial infarction complicated by ventricular septal rupture had class IV heart failure symptoms refractory to medical and surgical interventions. As a treatment of last resort, a cardiac resynchronisation therapy (CRT) pacemaker was implanted apprehensively, as preoperative concerns were raised whether CRT could exacerbate left-to-right shunting, hence negating the potential benefits of CRT. Introduction of CRT significantly improved the patient's haemodynamic status and symptoms, allowing for successful discharge home. To the best of our knowledge, this is the first report of a patient with severely symptomatic acute heart failure, widened QRS and active left-to-right intracardiac shunting, treated successfully with CRT. PMID:26989133

  17. 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

  18. Cardiac Wound Healing Post-myocardial Infarction: A Novel Method to Target Extracellular Matrix Remodeling in the Left Ventricle

    PubMed Central

    Zamilpa, Rogelio; Zhang, Jianhua; Chiao, Ying Ann; Bras, Lisandra de Castro; Halade, Ganesh; Ma, Yonggang; Hacker, Sander O.; Lindsey, Merry L.

    2014-01-01

    Myocardial infarction (MI) is a leading cause of death worldwide. Permanent ligation of the left anterior descending coronary artery (LAD) is a commonly used surgical model to study post-MI effects in mice. LAD occlusion induces a robust wound healing response that includes extracellular matrix (ECM) remodeling. This chapter provides a detailed guide on the surgical procedure to permanently ligate the LAD. Additionally, we describe a prototype method to enrich cardiac tissue for ECM, which allows one to focus on ECM remodeling in the left ventricle following surgically induced MI in mice. PMID:24029944

  19. Association of Cardiac Troponin T With Left Ventricular Structure and Function in CKD

    PubMed Central

    Mishra, Rakesh K.; Li, Yongmei; DeFilippi, Christopher; Fischer, Michael J.; Yang, Wei; Keane, Martin; Chen, Jing; He, Jiang; Kallem, Radhakrishna; Horwitz, Ed; Rafey, Mohammad; Raj, Dominic S.; Go, Alan S.; Shlipak, Michael G.

    2013-01-01

    Background Serum cardiac troponin T (cTnT) is associated with increased risk of heart failure and cardiovascular death in several population settings. We evaluated associations of cTnT with cardiac structural and functional abnormalities in a cohort of chronic kidney disease (CKD) patients without heart failure. Study Design Cross-sectional. Setting & Participants Chronic Renal Insufficiency Cohort (CRIC; N= 3,243) Predictor The primary predictor was cTnT. Secondary predictors included demographic and clinical characteristics, hemoglobin level, high-sensitivity C-reactive protein, and estimated glomerular filtration rate using cystatin C. Outcomes Echocardiography was used to determine left ventricular (LV) mass and LV systolic and diastolic function. Measurements Circulating cTnT was measured in stored sera using the highly sensitive assay. Logistic and linear regression models were used to examine associations of cTnT with each echocardiographic outcome. Results cTnT was detectable in 2,735 (84%) persons; the median was 13.3 (IQR, 7.7–23.8) pg/mL. Compared with undetectable cTnT (<3.0 pg/mL), the highest quartile (23.9 – 738.7 pg/mL) was associated with approximately two times as likely to experience LV hypertrophy (OR, 2.43; 95% CI, 1.44–4.09) in the fully adjusted model. cTnT had a more modest association with LV systolic dysfunction; as a log-linear variable, a significant association was present in the fully adjusted model (OR of 1.4 [95% CI, 1.1–1.7] per 1-log unit; p<0.01). There was no significant independent association between cTnT and LV diastolic dysfunction. When evaluated as a screening test, cTnT functioned only modestly for LV hypertrophy and concentric hypertrophy detection (area under the curve, 0.64 for both) with weaker areas under the curve for the other outcomes. Limitations The presence of coronary artery disease was not formally assessed using either noninvasive or angiographic techniques in this study. Conclusions In this large CKD cohort without heart failure, detectable cTnT had a strong association with LV hypertrophy, a more modest association with LV systolic dysfunction, and no association with diastolic dysfunction. These findings indicate that circulating cTnT levels in CKD are predominantly an indicator of pathological LV hypertrophy. PMID:23291148

  20. Rupture of a giant cardiac hydatid cyst in the left ventricular free wall: successful surgical management of a rare entity

    PubMed Central

    Hosseinian, Adallat; Mohammadzadeh, Alireza; Shahmohammadi, Ghader; Hasanpour, Mohammad; Maleki, Nasrollah; Doustkami, Hossein; Haghdoost, Zarafshan

    2013-01-01

    Hydatid cyst of heart is a rare but potentially fatal site of pathology, especially left ventricular free wall. We managed a successful surgical treatment on a case of a 24 year old man who had a giant cardiac hydatid cyst (71 x 64 mm) that ruptured left ventricular free wall. The cyst was excised gently and all the cystic materials were removed, the cyst cavity was closed with GORE-TEX soft tissue patch. The patient was discharged on the 9th postoperative day without symptoms. This case is different from other cardiac hydatid cysts that have been reported in literature previously; because this patient was young and had advanced phase of the disease that presented to our clinic lately. Additionally, the cyst had limited both ventricular volumes significantly. PMID:23785588

  1. Detection of Left Ventricular Regional Dysfunction and Myocardial Abnormalities Using Complementary Cardiac Magnetic Resonance Imaging in Patients with Systemic Sclerosis without Cardiac Symptoms: A Pilot Study.

    PubMed

    Kobayashi, Yasuyuki; Kobayashi, Hitomi; T Giles, Jon; Yokoe, Isamu; Hirano, Masaharu; Nakajima, Yasuo; Takei, Masami

    2016-01-01

    Objective We sought to detect the presence of left ventricular regional dysfunction and myocardial abnormalities in systemic sclerosis (SSc) patients without cardiac symptoms using a complementary cardiac magnetic resonance (CMR) imaging approach. Methods Consecutive patients with SSc without cardiac symptoms and healthy controls underwent CMR on a 1.5 T scanner. The peak systolic regional function in the circumferential and radial strain (Ecc, % and Err, %) were calculated using a feature tracking analysis on the mid-left ventricular slices obtained with cine MRI. In addition, we investigated the myocardial characteristics by contrast MRI. Pharmacological stress and rest perfusion scans were performed to assess perfusion defect (PD) due to micro- or macrovascular impairment, and late gadolinium enhancement (LGE) images were obtained for the assessment of myocarditis and/or fibrosis. Results We compared 15 SSc patients with 10 healthy controls. No statistically significant differences were observed in the baseline characteristics between the patients and healthy controls. The mean peak Err and Ecc of all segments was significantly lower in the patients than the controls (p=0.011 and p=0.003, respectively). Four patients with LGE (28.6%) and seven patients with PD (50.0%) were observed. PD was significantly associated with digital ulcers (p=0.005). Utilizing a linear regression model, the presence of myocardial LGE was significantly associated with the peak Ecc (p=0.024). After adjusting for age, the association between myocardial LGE and the peak Ecc was strengthened. Conclusion A subclinical myocardial involvement, as detected by CMR, was prevalent in the SSc patients without cardiac symptoms. Regional dysfunction might predict the myocardial abnormalities observed in SSc patients without cardiac symptoms. PMID:26831016

  2. Early cardiac toxicity following adjuvant radiotherapy of left-sided breast cancer with or without concurrent trastuzumab

    PubMed Central

    Cao, Lu; Cai, Gang; Chang, Cai; Yang, Zhao-Zhi; Feng, Yan; Yu, Xiao-Li; Ma, Jin-Li; Wu, Jiong; Guo, Xiao-Mao; Chen, Jia-Yi

    2016-01-01

    Purpose To evaluate the influence of concurrent trastuzumab on the cardiotoxicity in patients receiving left-sided adjuvant radiotherapy. Materials and Methods Medical records of stage I-III left-sided breast cancer patients, including 64 receiving concurrent trastuzumab with radiotherapy and 73 receiving radiotherapy alone were retrospectively reviewed. All of the patients had normal LVEF after adjuvant chemotherapy. Information of doses volume to cardiac structures was collected. Cardiac events were assessed according to CTC 2.0. Results Median follow-up of LVEF and clinical assessment of cardiac function from the initiation of radiotherapy was 6.7 months (range 3–60.9) and 26 months (range 6.4–60.9), respectively. Grade 1 LVEF dysfunction occurred in 5 (7.8%) and 3 (4.1%) patients of the concurrent-trastuzumab and radiotherapy alone cohort, respectively. Trastuzumab was the only significant factor influencing absolute LVEF decrease in univariate analysis. In multivariate analysis of concurrent-trastuzumab cohort, IMC radiotherapy and start trastuzumab during radiotherapy were independent risk factors. For concurrent cohort, mean heart dose, as well as D10-D30, D50-D55, V5-V20 of the heart and D30-D45, D65-D75, V6-V15 of the LV were significantly higher in patients developing LVEF dysfunction. Conclusions Concurrent trastuzumab and left-sided radiotherapy is well tolerated in terms of cardiotoxicity in patients with normal baseline cardiac function after adjuvant chemotherapy. However, increases in mean dose and low–dose volume of cardiac structures are associated with a higher risk of acute LVEF dysfunction. PMID:26460956

  3. Association Between Tangential Beam Treatment Parameters and Cardiac Abnormalities After Definitive Radiation Treatment for Left-Sided Breast Cancer

    SciTech Connect

    Correa, Candace R.; Das, Indra J. Litt, Harold I.; Ferrari, Victor; Hwang, W.-T.; Solin, Lawrence J.; Harris, Eleanor E.

    2008-10-01

    Purpose: To examine the association between radiation treatment (RT) parameters, cardiac diagnostic test abnormalities, and clinical cardiovascular diagnoses among patients with left-sided breast cancer after breast conservation treatment with tangential beam RT. Methods and Materials: The medical records of 416 patients treated between 1977 and 1995 with RT for primary left-sided breast cancer were reviewed for myocardial perfusion imaging and echocardiograms. Sixty-two patients (62/416, 15%) underwent these cardiac diagnostic tests for cardiovascular symptoms and were selected for further study. Central lung distance and maximum heart width and length in the treatment field were determined for each patient. Medical records were reviewed for cardiovascular diagnoses and evaluation of cardiac risk factors. Results: At a median of 12 years post-RT the incidence of cardiac diagnostic test abnormalities among symptomatic left-sided irradiated women was significantly higher than the predicted incidence of cardiovascular disease in the patient population, 6/62 (9%) predicted vs. 24/62 (39%) observed, p 0.001. As compared with patients with normal tests, patients with cardiac diagnostic test abnormalities had a larger median central lung distance (2.6 cm vs. 2.2 cm, p = 0.01). Similarly, patients with vs. without congestive heart failure had a larger median central lung distance (2.8 cm vs. 2.3 cm, p = 0.008). Conclusions: Contemporary RT for early breast cancer may be associated with a small, but potentially avoidable, risk of cardiovascular morbidity that is associated with treatment technique.

  4. [Unusual epicardial location of ventricular ectopy in left ventricular outflow tract, cured with RF ablation from the great cardiac vein].

    PubMed

    Błaszyk, Krzysztof; Waśniewski, Michał; Łojewska, Katarzyna; Hiczkiewicz, Jarosław; Grajek, Stefan

    2013-01-01

    The case report refers to a 54-year-old woman with a drug-refractory premature ventricular contractions (total number of ventricular ectopy: 40,851 beats/24 h) where an ectopy focus was localised in epicardial part of the left ventricular outflow tract. Successful radiofrequency ablation with the open-irrigated-tip catheter was performed at the site of earliest activation in the great cardiac vein. PMID:24065304

  5. Right-to-left patent ductus arteriosus with dysplastic left ventricle in a dog.

    PubMed

    O'Brien, S E; Riedesel, E A; Myers, R K; Riedesel, D H

    1988-05-15

    A 6-week-old Siberian Husky pup had an unusual group of congenital heart anomalies that included a right-to-left patent ductus arteriosus, a small left ventricular chamber and ascending aorta, and a dysplastic mitral valve that may have been stenotic. Anomalies were diagnosed, using cardiac catheterization, angiocardiography, and blood gas determinations. Findings were confirmed by postmortem examination. PMID:3391837

  6. Deterioration of left ventricular chamber performance after bed rest : "cardiovascular deconditioning" or hypovolemia?

    NASA Technical Reports Server (NTRS)

    Perhonen, M. A.; Zuckerman, J. H.; Levine, B. D.; Blomqvist, C. G. (Principal Investigator)

    2001-01-01

    BACKGROUND: Orthostatic intolerance after bed rest is characterized by hypovolemia and an excessive reduction in stroke volume (SV) in the upright position. We studied whether the reduction in SV is due to a specific adaptation of the heart to head-down tilt bed rest (HDTBR) or acute hypovolemia alone. METHODS AND RESULTS: We constructed left ventricular (LV) pressure-volume curves from pulmonary capillary wedge pressure and LV end-diastolic volume and Starling curves from pulmonary capillary wedge pressure and SV during lower body negative pressure and saline loading in 7 men (25+/-2 years) before and after 2 weeks of -6 degrees HDTBR and after the acute administration of intravenous furosemide. Both HDTBR and hypovolemia led to a similar reduction in plasma volume. However, baseline LV end-diastolic volume decreased by 20+/-4% after HDTBR and by 7+/-2% after hypovolemia (interaction P<0.001). Moreover, SV was reduced more and the Starling curve was steeper during orthostatic stress after HDTBR than after hypovolemia. The pressure-volume curve showed a leftward shift and the equilibrium volume of the left ventricle was decreased after HDTBR; however, after hypovolemia alone, the curve was identical, with no change in equilibrium volume. Lower body negative pressure tolerance was reduced after both conditions; it decreased by 27+/-7% (P<0.05) after HDTBR and by 18+/-8% (P<0.05) after hypovolemia. CONCLUSIONS: Chronic HDTBR leads to ventricular remodeling, which is not seen with equivalent degrees of acute hypovolemia. This remodeling leads to a greater decrease in SV during orthostatic stress after bed rest than hypovolemia alone, potentially contributing to orthostatic intolerance.

  7. Tweeting From Left to Right: Is Online Political Communication More Than an Echo Chamber?

    PubMed

    Barberá, Pablo; Jost, John T; Nagler, Jonathan; Tucker, Joshua A; Bonneau, Richard

    2015-10-01

    We estimated ideological preferences of 3.8 million Twitter users and, using a data set of nearly 150 million tweets concerning 12 political and nonpolitical issues, explored whether online communication resembles an "echo chamber" (as a result of selective exposure and ideological segregation) or a "national conversation." We observed that information was exchanged primarily among individuals with similar ideological preferences in the case of political issues (e.g., 2012 presidential election, 2013 government shutdown) but not many other current events (e.g., 2013 Boston Marathon bombing, 2014 Super Bowl). Discussion of the Newtown shootings in 2012 reflected a dynamic process, beginning as a national conversation before transforming into a polarized exchange. With respect to both political and nonpolitical issues, liberals were more likely than conservatives to engage in cross-ideological dissemination; this is an important asymmetry with respect to the structure of communication that is consistent with psychological theory and research bearing on ideological differences in epistemic, existential, and relational motivation. Overall, we conclude that previous work may have overestimated the degree of ideological segregation in social-media usage. PMID:26297377

  8. Cardiac steatosis and left ventricular function in men with metabolic syndrome

    PubMed Central

    2013-01-01

    Background Ectopic accumulation of fat accompanies visceral obesity with detrimental effects. Lipid oversupply to cardiomyocytes leads to cardiac steatosis, and in animal studies lipotoxicity has been associated with impaired left ventricular (LV) function. In humans, studies have yielded inconclusive results. The aim of the study was to evaluate the role of epicardial, pericardial and myocardial fat depots on LV structure and function in male subjects with metabolic syndrome (MetS). Methods A study population of 37 men with MetS and 38 men without MetS underwent cardiovascular magnetic resonance and proton magnetic spectroscopy at 1.5 T to assess LV function, epicardial and pericardial fat area and myocardial triglyceride (TG) content. Results All three fat deposits were greater in the MetS than in the control group (p <0.001). LV diastolic dysfunction was associated with MetS as measured by absolute (471 mL/s vs. 667 mL/s, p = 0.002) and normalized (3.37 s-1 vs. 3.75 s-1, p = 0.02) LV early diastolic peak filling rate and the ratio of early diastole (68% vs. 78%, p = 0.001). The amount of epicardial and pericardial fat correlated inversely with LV diastolic function. However, myocardial TG content was not independently associated with LV diastolic dysfunction. Conclusions In MetS, accumulation of epicardial and pericardial fat is linked to the severity of structural and functional alterations of the heart. The role of increased intramyocardial TG in MetS is more complex and merits further study. PMID:24228979

  9. Risk stratification after myocardial infarction: is left ventricular ejection fraction enough to prevent sudden cardiac death?

    PubMed

    Dagres, Nikolaos; Hindricks, Gerhard

    2013-07-01

    Patients who have experienced a myocardial infarction (MI) are at increased risk of sudden cardiac death (SCD). With the advent of implantable cardioverter-defibrillators (ICDs), accurate risk stratification has become very relevant. Numerous investigations have proven that a reduced left ventricular ejection fraction (LVEF) significantly increases the SCD risk. Furthermore, ICD implantation in patients with reduced LVEF confers significant survival benefit. As a result, LVEF is the cornerstone of current decision making for prophylactic ICD implantation after MI. However, LVEF as standalone risk stratifier has major limitations: (i) the majority of SCD cases occur in patients with preserved or moderately reduced LVEF, (ii) only relatively few patients with reduced LVEF will benefit from an ICD (most will never experience a threatening arrhythmic event, others have a high risk for non-sudden death), (iii) a reduced LVEF is a risk factor for both sudden and non-sudden death. Several other non-invasive and invasive risk stratifiers, such as ventricular ectopy, QRS duration, signal-averaged electrocardiogram, microvolt T-wave alternans, markers of autonomic tone as well as programmed ventricular stimulation, have been evaluated. However, none of these techniques has unequivocally demonstrated the efficacy when applied alone or in combination with LVEF. Apart from their limited sensitivity, most of them are risk factors for both sudden and non-sudden death. Considering the multiple mechanisms involved in SCD, it seems unlikely that a single test will prove adequate for all patients. A combination of clinical characteristics with selected stratification tools may significantly improve risk stratification in the future. PMID:23644180

  10. The thick left ventricular wall of the giraffe heart normalises wall tension, but limits stroke volume and cardiac output.

    PubMed

    Smerup, Morten; Damkjær, Mads; Brøndum, Emil; Baandrup, Ulrik T; Kristiansen, Steen Buus; Nygaard, Hans; Funder, Jonas; Aalkjær, Christian; Sauer, Cathrine; Buchanan, Rasmus; Bertelsen, Mads Frost; Østergaard, Kristine; Grøndahl, Carsten; Candy, Geoffrey; Hasenkam, J Michael; Secher, Niels H; Bie, Peter; Wang, Tobias

    2016-02-01

    Giraffes - the tallest extant animals on Earth - are renowned for their high central arterial blood pressure, which is necessary to secure brain perfusion. Arterial pressure may exceed 300 mmHg and has historically been attributed to an exceptionally large heart. Recently, this has been refuted by several studies demonstrating that the mass of giraffe heart is similar to that of other mammals when expressed relative to body mass. It thus remains unexplained how the normal-sized giraffe heart generates such massive arterial pressures. We hypothesized that giraffe hearts have a small intraventricular cavity and a relatively thick ventricular wall, allowing for generation of high arterial pressures at normal left ventricular wall tension. In nine anaesthetized giraffes (495±38 kg), we determined in vivo ventricular dimensions using echocardiography along with intraventricular and aortic pressures to calculate left ventricular wall stress. Cardiac output was also determined by inert gas rebreathing to provide an additional and independent estimate of stroke volume. Echocardiography and inert gas-rebreathing yielded similar cardiac outputs of 16.1±2.5 and 16.4±1.4 l min(-1), respectively. End-diastolic and end-systolic volumes were 521±61 ml and 228±42 ml, respectively, yielding an ejection fraction of 56±4% and a stroke volume of 0.59 ml kg(-1). Left ventricular circumferential wall stress was 7.83±1.76 kPa. We conclude that, relative to body mass, a small left ventricular cavity and a low stroke volume characterizes the giraffe heart. The adaptations result in typical mammalian left ventricular wall tensions, but produce a lowered cardiac output. PMID:26643090

  11. Alterations in myostatin expression are associated with changes in cardiac left ventricular mass but not ejection fraction in the mouse.

    PubMed

    Artaza, Jorge N; Reisz-Porszasz, Suzanne; Dow, Joan S; Kloner, Robert A; Tsao, James; Bhasin, Shalender; Gonzalez-Cadavid, Nestor F

    2007-07-01

    Myostatin (Mst) is a negative regulator of skeletal muscle in humans and animals. It is moderately expressed in the heart of sheep and cattle, increasing considerably after infarction. Genetic blockade of Mst expression increases cardiomyocyte growth. We determined whether Mst overexpression in the heart of transgenic mice reduces left ventricular size and function, and inhibits in vitro cardiomyocyte proliferation. Young transgenic mice overexpressing Mst in the heart (Mst transgenic mice (TG) under a muscle creatine kinase (MCK) promoter active in cardiac and skeletal muscle, and Mst knockout (Mst (-/-)) mice were used. Xiscan angiography revealed that the left ventricular ejection fraction did not differ between the Mst TG and the Mst (-/-) mice, when compared with their respective wild-type strains, despite the decrease in whole heart and left ventricular size in Mst TG mice, and their increase in Mst (-/-) animals. The expected changes in cardiac Mst were measured by RT-PCR and western blot. Mst and its receptor (ActRIIb) were detected by RT-PCR in rat H9c2 cardiomyocytes. Transfection of H9c2 with plasmids expressing Mst under muscle-specific creatine kinase promoter, or cytomegalovirus promoter, enhanced p21 and reduced cdk2 expression, when assessed by western blot. A decrease in cell number occurred by incubation with recombinant Mst (formazan assay), without affecting apoptosis or cardiomyocyte size. Anti-Mst antibody increased cardiomyocyte replication, whereas transfection with the Mst-expressing plasmids inhibited it. In conclusion, Mst does not affect cardiac systolic function in mice overexpressing or lacking the active protein, but it reduces cardiac mass and cardiomyocyte proliferation. PMID:17592022

  12. Echocardiographic assessment of left ventricular function in thyrotoxicosis and implications for the therapeutics of thyrotoxic cardiac disease

    PubMed Central

    Anakwue, Raphael C; Onwubere, Basden J; Ikeh, Vincent; Anisiuba, Benedict; Ike, Samuel; Anakwue, Angel-Mary C

    2015-01-01

    Introduction Thyrotoxicosis is an endocrine disorder with prominent cardiovascular manifestations. Thyroid hormone acts through genomic and non-genomic mechanisms to regulate cardiac function. Echocardiography is a useful, non-invasive, easily accessible, and affordable tool for studying the structural and physiological function of the heart. Aim We studied thyrotoxicosis patients in a Nigerian Teaching Hospital and employed trans-thoracic echocardiography to find out if there were abnormalities in the hearts of these patients. Methods Fifty adult thyrotoxicosis patients diagnosed with clinical and thyroid function tests in the medical out-patient unit of the hospital were recruited and we performed transthoracic echocardiography with a Sonos 2000 HP machine. Results We documented the presence of abnormalities in the following proportion of thyrotoxicosis patients: left ventricular enhanced systolic function in 30%, enhanced diastolic function in 34%, diastolic dysfunction in 34%, heart failure with preserved ejection fraction in10%, heart failure with reduced ejection fraction in 6%, and left ventricular hypertrophy in 34%. Conclusion Echocardiography was useful in the stratification of cardiac function abnormalities and is indispensable as a guide in the choice of therapeutic options in patients with thyrocardiac disease. The finding of left ventricular enhanced systolic and diastolic functions signify early echocardiographic detectable cardiac abnormalities in thyrotoxicosis, and the clinical management includes the use of anti-thyroid drugs and β-adrenoceptor blockade. Diastolic dysfunction in thyrotoxicosis patients asymptomatic for cardiac disease should be treated with anti-thyroid drugs, and β-adrenoceptor blockade. The judicious application of clinical therapeutics will guide the use of anti-thyroid drugs, diuretics, digoxin, angiotensin inhibitors, and β-adrenoceptor blockade in the successful management of thyrotoxicosis patients with heart failure and reduced, preserved, or increased ejection fraction: parameters which are derived from echocardiography. PMID:25709461

  13. Neurotransmission to parasympathetic cardiac vagal neurons in the brain stem is altered with left ventricular hypertrophy-induced heart failure.

    PubMed

    Cauley, Edmund; Wang, Xin; Dyavanapalli, Jhansi; Sun, Ke; Garrott, Kara; Kuzmiak-Glancy, Sarah; Kay, Matthew W; Mendelowitz, David

    2015-10-01

    Hypertension, cardiac hypertrophy, and heart failure (HF) are widespread and debilitating cardiovascular diseases that affect nearly 23 million people worldwide. A distinctive hallmark of these cardiovascular diseases is autonomic imbalance, with increased sympathetic activity and decreased parasympathetic vagal tone. Recent device-based approaches, such as implantable vagal stimulators that stimulate a multitude of visceral sensory and motor fibers in the vagus nerve, are being evaluated as new therapeutic approaches for these and other diseases. However, little is known about how parasympathetic activity to the heart is altered with these diseases, and this lack of knowledge is an obstacle in the goal of devising selective interventions that can target and selectively restore parasympathetic activity to the heart. To identify the changes that occur within the brain stem to diminish the parasympathetic cardiac activity, left ventricular hypertrophy was elicited in rats by aortic pressure overload using a transaortic constriction approach. Cardiac vagal neurons (CVNs) in the brain stem that generate parasympathetic activity to the heart were identified with a retrograde tracer and studied using patch-clamp electrophysiological recordings in vitro. Animals with left cardiac hypertrophy had diminished excitation of CVNs, which was mediated both by an augmented frequency of spontaneous inhibitory GABAergic neurotransmission (with no alteration of inhibitory glycinergic activity) as well as a diminished amplitude and frequency of excitatory neurotransmission to CVNs. Opportunities to alter these network pathways and neurotransmitter receptors provide future targets of intervention in the goal to restore parasympathetic activity and autonomic balance to the heart in cardiac hypertrophy and other cardiovascular diseases. PMID:26371169

  14. Correlation-based discrimination between cardiac tissue and blood for segmentation of the left ventricle in 3-D echocardiographic images.

    PubMed

    Saris, Anne E C M; Nillesen, Maartje M; Lopata, Richard G P; de Korte, Chris L

    2014-03-01

    For automated segmentation of 3-D echocardiographic images, incorporation of temporal information may be helpful. In this study, optimal settings for calculation of temporal cross-correlations between subsequent time frames were determined, to obtain the maximum cross-correlation (MCC) values that provided the best contrast between blood and cardiac tissue over the entire cardiac cycle. Both contrast and boundary gradient quality measures were assessed to optimize MCC values with respect to signal choice (radiofrequency or envelope data) and axial window size. Optimal MCC values were incorporated into a deformable model to automatically segment the left ventricular cavity. MCC values were tested against, and combined with, filtered, demodulated radiofrequency data. Results reveal that using envelope data in combination with a relatively small axial window (0.7-1.25 mm) at fine scale results in optimal contrast and boundary gradient between the two tissues over the entire cardiac cycle. Preliminary segmentation results indicate that incorporation of MCC values has additional value for automated segmentation of the left ventricle. PMID:24412178

  15. Joint multi-object registration and segmentation of left and right cardiac ventricles in 4D cine MRI

    NASA Astrophysics Data System (ADS)

    Ehrhardt, Jan; Kepp, Timo; Schmidt-Richberg, Alexander; Handels, Heinz

    2014-03-01

    The diagnosis of cardiac function based on cine MRI requires the segmentation of cardiac structures in the images, but the problem of automatic cardiac segmentation is still open, due to the imaging characteristics of cardiac MR images and the anatomical variability of the heart. In this paper, we present a variational framework for joint segmentation and registration of multiple structures of the heart. To enable the simultaneous segmentation and registration of multiple objects, a shape prior term is introduced into a region competition approach for multi-object level set segmentation. The proposed algorithm is applied for simultaneous segmentation of the myocardium as well as the left and right ventricular blood pool in short axis cine MRI images. Two experiments are performed: first, intra-patient 4D segmentation with a given initial segmentation for one time-point in a 4D sequence, and second, a multi-atlas segmentation strategy is applied to unseen patient data. Evaluation of segmentation accuracy is done by overlap coefficients and surface distances. An evaluation based on clinical 4D cine MRI images of 25 patients shows the benefit of the combined approach compared to sole registration and sole segmentation.

  16. The role of the sca-1+/CD31- cardiac progenitor cell population in postinfarction left ventricular remodeling.

    PubMed

    Wang, Xiaohong; Hu, Qingsong; Nakamura, Yasuhiro; Lee, Joseph; Zhang, Ge; From, Arthur H L; Zhang, Jianyi

    2006-07-01

    Cardiac stem cell-like populations exist in adult hearts, and their roles in cardiac repair remain to be defined. Sca-1 is an important surface marker for cardiac and other somatic stem cells. We hypothesized that heart-derived Sca-1(+)/CD31(-) cells may play a role in myocardial infarction-induced cardiac repair/remodeling. Mouse heart-derived Sca-1(+)/CD31(-) cells cultured in vitro could be induced to express both endothelial cell and cardiomyocyte markers. Immunofluorescence staining and fluorescence-activated cell sorting analysis indicated that endogenous Sca-1(+)/CD31(-) cells were significantly increased in the mouse heart 7 days after myocardial infarction (MI). Western blotting confirmed elevated Sca-1 protein expression in myocardium 7 days after MI. Transplantation of Sca-1(+)/CD31(-) cells into the acutely infarcted mouse heart attenuated the functional decline and adverse structural remodeling initiated by MI as evidenced by an increased left ventricular (LV) ejection fraction, a decreased LV end-diastolic dimension, a decreased LV end-systolic dimension, a significant increase of myocardial neovascularization, and modest cardiomyocyte regeneration. Attenuation of LV remodeling was accompanied by remarkably improved myocardial bioenergetic characteristics. The beneficial effects of cell transplantation appear to primarily depend on paracrine effects of the transplanted cells on new vessel formation and native cardiomyocyte function. Sca-1(+)/CD31(-) cells may hold therapeutic possibilities with regard to the treatment of ischemic heart disease. PMID:16614004

  17. Left ventricular restoration devices.

    PubMed

    Oliveira, Guilherme H; Al-Kindi, Sadeer G; Bezerra, Hiram G; Costa, Marco A

    2014-04-01

    Left ventricular (LV) remodeling results in continuous cardiac chamber enlargement and contractile dysfunction, perpetuating the syndrome of heart failure. With current exhaustion of the neurohormonal medical paradigm, surgical and device-based therapies have been increasingly investigated as a way to restore LV chamber architecture and function. Left ventricular restoration has been attempted with surgical procedures, such as partial left ventriculectomy, surgical ventricular restoration with or without revascularization, and devices, such as the Acorn CorCap, the Paracor HeartNet, and the Myocor Myosplint. Whereas all these techniques require surgical access, with or without cardiopulmonary bypass, a newer ventricular partitioning device (VPD) called Parachute, can be delivered percutaneously through the aortic valve. Designed to achieve LV restoration from within the ventricle, this VPD partitions the LV by isolating aneurysmal from normal myocardium thereby diminishing the functioning cavity. This review aims to critically appraise the above methods, with particular attention to device-based therapies. PMID:24574107

  18. Evaluating cardiac physiology through echocardiography in bottlenose dolphins: using stroke volume and cardiac output to estimate systolic left ventricular function during rest and following exercise.

    PubMed

    Miedler, Stefan; Fahlman, Andreas; Valls Torres, Mónica; Álvaro Álvarez, Teresa; Garcia-Parraga, Daniel

    2015-11-01

    Heart-rate (fH) changes during diving and exercise are well documented for marine mammals, but changes in stroke volume (SV) and cardiac output (CO) are much less known. We hypothesized that both SV and CO are also modified following intense exercise. Using transthoracic ultrasound Doppler at the level of the aortic valve, we compared blood flow velocities in the left ventricle and cardiac frequencies during rest and at 1, 3 and 4 min after a bout of exercise in 13 adult bottlenose dolphins (Tursiops truncatus, six male and seven female, body mass range 143-212 kg). Aortic cross-sectional area and ventricle blood velocity at the aortic valve were used to calculate SV, which together with fH provided estimates of left CO at rest and following exercise. fH and SV stabilized approximately 4-7 s following the post-respiratory tachycardia, so only data after the fH had stabilized were used for analysis and comparison. There were significant increases in fH, SV and CO associated with each breath. At rest, fH, SV and CO were uncorrelated with body mass, and averaged 41±9 beats min(-1), 136±19 ml and 5514±1182 l min(-1), respectively. One minute following high intensity exercise, the cardiac variables had increased by 104±43%, 63±11% and 234±84%, respectively. All variables remained significantly elevated in all animals for at least 4 min after the exercise. These baseline values provide the first data on SV and CO in awake and unrestrained cetaceans in water. PMID:26385334

  19. SU-E-J-33: Cardiac Movement in Deep Inspiration Breath-Hold for Left-Breast Cancer Radiotherapy

    SciTech Connect

    Kim, M; Lee, S; Suh, T

    2014-06-01

    Purpose: The present study was designed to investigate the displacement of heart using Deep Inspiration Breath Hold (DIBH) CT data compared to free-breathing (FB) CT data and radiation exposure to heart. Methods: Treatment planning was performed on the computed tomography (CT) datasets of 20 patients who had received lumpectomy treatments. Heart, lung and both breasts were outlined. The prescribed dose was 50 Gy divided into 28 fractions. The dose distributions in all the plans were required to fulfill the International Commission on Radiation Units and Measurement specifications that include 100% coverage of the CTV with ≥ 95% of the prescribed dose and that the volume inside the CTV receiving > 107% of the prescribed dose should be minimized. Displacement of heart was measured by calculating the distance between center of heart and left breast. For the evaluation of radiation dose to heart, minimum, maximum and mean dose to heart were calculated. Results: The maximum and minimum left-right (LR) displacements of heart were 8.9 mm and 3 mm, respectively. The heart moved > 4 mm in the LR direction in 17 of the 20 patients. The distances between the heart and left breast ranged from 8.02–17.68 mm (mean, 12.23 mm) and 7.85–12.98 mm (mean, 8.97 mm) with DIBH CT and FB CT, respectively. The maximum doses to the heart were 3115 cGy and 4652 cGy for the DIBH and FB CT dataset, respectively. Conclusion: The present study has demonstrated that the DIBH technique could help to reduce the risk of radiation dose-induced cardiac toxicity by using movement of cardiac; away from radiation field. The DIBH technique could be used in an actual treatment room for a few minutes and could effectively reduce the cardiac dose when used with a sub-device or image acquisition standard to maintain consistent respiratory motion.

  20. Increased cardiac alpha-myosin heavy chain in left atria and decreased myocardial insulin-like growth factor (Igf-I) expression accompany low heart rate in hibernating grizzly bears.

    PubMed

    Barrows, N D; Nelson, O L; Robbins, C T; Rourke, B C

    2011-01-01

    Grizzly bears (Ursus arctos horribilis) tolerate extended periods of extremely low heart rate during hibernation without developing congestive heart failure or cardiac chamber dilation. Left ventricular atrophy and decreased left ventricular compliance have been reported in this species during hibernation. We evaluated the myocardial response to significantly reduced heart rate during hibernation by measuring relative myosin heavy-chain (MyHC) isoform expression and expression of a set of genes important to muscle plasticity and mass regulation in the left atria and left ventricles of active and hibernating bears. We supplemented these data with measurements of systolic and diastolic function via echocardiography in unanesthetized grizzly bears. Atrial strain imaging revealed decreased atrial contractility, decreased expansion/reservoir function (increased atrial stiffness), and decreased passive-filling function (increased ventricular stiffness) in hibernating bears. Relative MyHC-α protein expression increased significantly in the atrium during hibernation. The left ventricle expressed 100% MyHC-β protein in both groups. Insulin-like growth factor (IGF-I) mRNA expression was reduced by ∼50% in both chambers during hibernation, consistent with the ventricular atrophy observed in these bears. Interestingly, mRNA expression of the atrophy-related ubiquitin ligases Muscle Atrophy F-box (MAFBx) and Muscle Ring Finger 1 did not increase, nor did expression of myostatin or hypoxia-inducible factor 1α (HIF-1α). We report atrium-specific decreases of 40% and 50%, respectively, in MAFBx and creatine kinase mRNA expression during hibernation. Decreased creatine kinase expression is consistent with lowered energy requirements and could relate to reduced atrial emptying function during hibernation. Taken together with our hemodynamic assessment, these data suggest a potential downregulation of atrial chamber function during hibernation to prevent fatigue and dilation due to excessive work against an optimally filled ventricle, a response unpredicted by the Frank-Starling mechanism. PMID:21117961

  1. Quantitative Assessment of Left Ventricular Function and Myocardial Mass: A Comparison of Coronary CT Angiography with Cardiac MRI and Echocardiography

    PubMed Central

    Kara, Bedia; Nayman, Alaaddin; Guler, Ibrahim; Gul, Enes Elvin; Koplay, Mustafa; Paksoy, Yahya

    2016-01-01

    Summary Background The purpose of this study was to compare the left ventricular parameters obtained from multi-detector row computed tomography (MDCT) studies with two-dimensional echocardiography (2DE), and magnetic resonance imaging (MRI), which is accepted as the gold standard in the evaluation of left ventricular functions. The study also aimed to evaluate whether or not there is a relationship between the MR-Argus and CMR tools software programs which are used in post-process calculations of data obtained by MRI. Material/Methods Forty patients with an average age of 51.4±14.9 years who had been scanned with cardiac MDCT were evaluated with cardiac MRI and 2DE. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), and myocardial mass values calculated by MDCT, MRI, and 2DE were compared with each other. Two different MR software programs were used to compare left ventricular functions. The CMR tools LV tutorials method is accepted as the gold standard because it can be used in three-dimensional functional evaluation. The Pearson Correlation and Bland-Altman analysis were performed to compare the results from the two MR methods (MR-Argus and CMR tools) and the results from both the MDCT and the 2DE with the CMR tools results. Results Strong positive correlations for EF values were found between the MDCT and CMR tools (r=0.702 p<0.001), and between the MR-Argus and CMR tools (r=0.746 p<0.001). The correlation between the 2DE and CMR tools (r=0.449 p<0.004), however, was only moderate. Similar results were obtained for the other parameters. The strongest correlation for ESV, EDV, and EF was between the two MR software programs. The correlation coefficient between the MDCT and CMR tools is close to the correlation coefficient between the two software programs. While the correlation between 2DE and CMR tools was satisfactory for ESV, EDV, and CO values, it was at a moderate level for the other parameters. Conclusions Left ventricular functional analysis can be performed easily and reliably with cardiac MDCT used for coronary artery evaluation and it also gives more accurate results than 2DE. PMID:27026794

  2. Left ventricular diastolic function in workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement

    SciTech Connect

    Poręba, Rafał Skoczyńska, Anna; Gać, Paweł; Turczyn, Barbara; Wojakowska, Anna

    2012-09-15

    The aim of the study was to evaluate left ventricular diastolic function in workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement. The studies included 115 workers (92 men and 23 women) occupationally exposed to mercury vapour without clinical presentation of cardiac involvement (mean age: 47.83 ± 8.29). Blood samples were taken to determine blood lipid profile, urine was collected to estimate mercury concentration (Hg-U) and echocardiographic examination was performed to evaluate diastolic function of the left ventricle. In the entire group of workers occupationally exposed to mercury vapour without clinical presentation of cardiac involvement, Spearman correlations analysis demonstrated the following significant linear relationships: between body mass index (BMI) and ratio of maximal early diastolic mitral flow velocity/early diastolic mitral annular velocity (E/E') (r = 0.32, p < 0.05), between serum HDL concentration and E/E' (r = − 0.22, p < 0.05), between Hg-U and E/E' (r = 0.35, p < 0.05), between Hg-U and isovolumetric relaxation time (IVRT') (r = 0.41, p < 0.05), between Hg-U and ratio of maximal early diastolic mitral flow velocity/maximal late diastolic mitral flow velocity (E/A) (r = − 0.31, p < 0.05) and between serum HDL concentration and E/A (r = 0.43, p < 0,05). In logistic regression analysis it as shown that independent factors of left ventricular diastolic dysfunction risk in the study group included a higher urine mercury concentration, a higher value of BMI and a lower serum HDL concentration (OR{sub Hg}-{sub U} = 1.071, OR{sub BMI} = 1.200, OR{sub HDL} = 0.896, p < 0.05). Summing up, occupational exposure to mercury vapour may be linked to impaired left ventricular diastolic function in workers without clinical presentation of cardiac involvement. -- Highlights: ► Study aimed at evaluation of LVDD in workers occupationally exposed to Hg. ► There was significant linear relationships between Hg-U and E/E'. ► Independent risk factor of LVDD in study group included higher Hg-U. ► Independent risk factor of LVDD in study group included higher BMI and lower HDL. ► Occupational exposure to Hg may be linked to LVDD.

  3. Catch of the day: interventional device retrieval after late embolization of an Amplatzer cardiac plug left atrial appendage occluder.

    PubMed

    Tiyerili, Vedat; Nickenig, Georg; Hammerstingl, Christoph

    2015-12-01

    Transcatheter left atrial appendage (LAA) closure has proven to be an effective method to reduce the risk of thromboembolic events in patients who have nonvalvular atrial fibrillation (AF) that is unsuitable for chronic oral anticoagulation. In this case report, we describe the rare case of a late LAA occluder (28-mm Amplatzer cardiac plug) embolization, which was treated uneventfully with interventional device capture. Special interventional and device specific characteristics must be taken into account when planning such a complex procedure as described in our case. PMID:26199065

  4. Usefulness of cardiac meta-iodobenzylguanidine imaging to identify patients with chronic heart failure and left ventricular ejection fraction <35% at low risk for sudden cardiac death.

    PubMed

    Kawai, Tsutomu; Yamada, Takahisa; Tamaki, Shunsuke; Morita, Takashi; Furukawa, Yoshio; Iwasaki, Yusuke; Kawasaki, Masato; Kikuchi, Atsushi; Kondo, Takumi; Takahashi, Satoshi; Ishimi, Masashi; Hakui, Hideyuki; Ozaki, Tatsuhisa; Sato, Yoshihiro; Seo, Masahiro; Sakata, Yasushi; Fukunami, Masatake

    2015-06-01

    Patients with chronic heart failure (CHF) at risk of sudden cardiac death (SCD) are often treated with implantable cardiac defibrillators (ICDs). However, current criteria for device use that is based largely on left ventricular ejection fraction (LVEF) lead to many patients receiving ICDs that never deliver therapy. It is of clinical significance to identify patients who do not require ICDs. Although cardiac I-123 meta-iodobenzylguanidine (MIBG) imaging provides prognostic information about CHF, whether it can identify patients with CHF who do not require an ICD remains unclear. We studied 81 patients with CHF and LVEF <35%, assessed by cardiac MIBG imaging at enrollment. The heart-to-mediastinal ratio (H/M) in delayed images and washout rates were divided into 6 grades from 0 to 5, according to the degree of deviation from control values. The study patients were classified into 3 groups: low (1 to 4), intermediate (5 to 7), and high (8 to 10), according to the MIBG scores defined as the sum of the H/M and washout rate scores. Sixteen patients died of SCD during a follow-up period. Patients with low MIBG score had a significantly lower risk of SCD than those with intermediate and high scores (low [n = 19], 0%; intermediate [n = 37], 19%; high [n = 25], 36%; p = 0.001). The positive predictive value of low MIBG score for identifying patients without SCD was 100%. In conclusion, the MIBG score can identify patients with CHF and LVEF <35% who have low risk of developing SCD. PMID:25851796

  5. Cardiac resynchronization therapy in heart failure patients with less severe left ventricular dysfunction.

    PubMed

    Hai, Ofek Y; Mentz, Robert J; Zannad, Faiez; Gasparini, Maurizio; De Ferrari, Gaetano M; Daubert, Jean-Claude; Holzmeister, Johannes; Lam, Carolyn S P; Pochet, Thierry; Vincent, Alphons; Linde, Cecilia

    2015-02-01

    Cardiac resynchronization therapy is beneficial in heart failure patients with LVEF ≤35% and electrical dyssynchrony. However, its effects among patients with less severe LV dysfunction have not been established. Recent post-hoc analyses of landmark CRT trials suggest that CRT benefit may be present in patients with LVEF >35% and is associated with improvement in cardiac reverse remodelling, all-cause mortality, and need for heart failure hospitalizations. This review summarizes the currently available literature regarding the potential impact of CRT in patients with more modest reductions in LVEF. PMID:25469668

  6. Mesenchymal stem cells overexpressing integrin-linked kinase attenuate left ventricular remodeling and improve cardiac function after myocardial infarction.

    PubMed

    Mao, Qing; Lin, Chengxi; Gao, Jianshu; Liang, Xiulin; Gao, Wei; Shen, Li; Kang, Lina; Xu, Biao

    2014-12-01

    In the present study, we investigated whether mesenchymal stem cells (MSCs) overexpressing integrin-linked kinase (ILK) might regulate ventricular remodeling and cardiac function in a porcine myocardial infarction model. ILK-modified MSCs (ILK-MSCs) (n = 8), MSCs (n = 8) or placebo (n = 8) were injected into peri-infarct myocardium 7 days after ligation of the left anterior descending coronary artery. ILK expression was confirmed by immunofluorescence, real-time PCR, Western blot analysis, and flow cytometry. In vitro assays indicated increased proliferation and reduced apoptosis of MSCs due to overexpression of ILK. Echocardiographic, single-photon emission computed tomography and positron emission tomography analyses demonstrated preserved cardiac function and myocardial perfusion. Reduced fibrosis, increased cardiomyocyte proliferation, and enhanced angiogenesis were observed in the ILK-MSC group. Reduced apoptosis, as demonstrated by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling analysis, was also noted. In conclusion, ILK promotes MSC proliferation and suppresses apoptosis. ILK-MSC transplantation improves ventricular remodeling and cardiac function in pigs after MI. It is associated with increased angiogenesis, reduced apoptosis, and increased cardiomyocyte proliferation. This may represent a new approach to the treatment of post-infarct remodeling and subsequent heart failure. PMID:25134935

  7. Electrical Wave Propagation in an Anisotropic Model of the Left Ventricle Based on Analytical Description of Cardiac Architecture

    PubMed Central

    Pravdin, Sergey F.; Dierckx, Hans; Katsnelson, Leonid B.; Solovyova, Olga; Markhasin, Vladimir S.; Panfilov, Alexander V.

    2014-01-01

    We develop a numerical approach based on our recent analytical model of fiber structure in the left ventricle of the human heart. A special curvilinear coordinate system is proposed to analytically include realistic ventricular shape and myofiber directions. With this anatomical model, electrophysiological simulations can be performed on a rectangular coordinate grid. We apply our method to study the effect of fiber rotation and electrical anisotropy of cardiac tissue (i.e., the ratio of the conductivity coefficients along and across the myocardial fibers) on wave propagation using the ten Tusscher–Panfilov (2006) ionic model for human ventricular cells. We show that fiber rotation increases the speed of cardiac activation and attenuates the effects of anisotropy. Our results show that the fiber rotation in the heart is an important factor underlying cardiac excitation. We also study scroll wave dynamics in our model and show the drift of a scroll wave filament whose velocity depends non-monotonically on the fiber rotation angle; the period of scroll wave rotation decreases with an increase of the fiber rotation angle; an increase in anisotropy may cause the breakup of a scroll wave, similar to the mother rotor mechanism of ventricular fibrillation. PMID:24817308

  8. Full neurologic recovery and return of spontaneous circulation following prolonged cardiac arrest facilitated by percutaneous left ventricular assist device.

    PubMed

    Heidlebaugh, Michael; Kurz, Michael C; Turkelson, Carman L; Sawyer, Kelly N

    2014-12-01

    Sudden cardiac arrest is associated with high early mortality, which is largely related to postcardiac arrest syndrome characterized by an acute but often transient decrease in left ventricular (LV) function. The stunned LV provides poor cardiac output, which compounds the initial global insult from hypoperfusion. If employed early, an LV assist device (LVAD) may improve survival and neurologic outcome; however, traditional methods of augmenting LV function have significant drawbacks, limiting their usefulness in the periarrest period. Full cardiac support with cardiopulmonary bypass is not always readily available but is increasingly being studied as a tool to intensify resuscitation. There have been no controlled trials studying the early use of percutaneous LVADs (pLVADs) in pericardiac arrest patients or intra-arrest as a bridge to return of spontaneous circulation. This article presents a case study and discussion of a patient who arrested while undergoing an elective coronary angioplasty and suffered prolonged cardiopulmonary resuscitation. During resuscitation, treatment included placement of a pLVAD and initiation of therapeutic hypothermia. The patient made a rapid and full recovery. PMID:25184627

  9. Has Microsoft® Left Behind Risk Modeling in Cardiac and Thoracic Surgery?

    PubMed Central

    Poullis, Mike

    2011-01-01

    Abstract: This concept paper examines a number of key areas central to quality and risk assessment in cardiac surgery. The effect of surgeon and institutional factors with regard to outcomes in cardiac surgery is utilized to demonstrate the need to sub analyze cardiac surgeons performance in a more sophisticated manner than just operation type and patient risk factors, as in current risk models. By utilizing the mathematical/engineering concept of Fourier analysis in the breakdown of cardiac surgical results the effects of each of the core components that makes up the care package of a patient’s experiences are examined. The core components examined include: institutional, regional, patient, and surgeon effects. The limitations of current additive (Parsonnet, Euroscore) and logistic (Euroscore, Southern Thoracic Society) regression risk analysis techniques are discussed. The inadequacy of current modeling techniques is demonstrated via the use of known medical formula for calculating flow in the internal mammary artery and the calculation of blood pressure. By examining the fundamental limitations of current risk analysis techniques a new technique is proposed that embraces modern software computer technology via the use of structured query language. PMID:21449233

  10. Low-cost pulsatile cardiac assist device with compliant input chamber.

    PubMed

    del Caizo, Juan; Rodrguez-Martnez, Daniel; Perez-Caballero, Ramon; Quintana, Begoa; Ruiz-Fernandez, Manuel

    2010-02-01

    We propose a new, low-cost pulsatile ventricular assist device (VAD) for short-term applications. The new device could prove very useful in emergency ventricular failure in which patient survival is not assured. In these cases, the device allows ventricular function to be maintained as the patient's situation is evaluated and a decision is made on whether to perform a heart transplant or to replace the device with a long-term VAD. The device has a pneumatic tubular blood chamber, clip valves over the cannulae, and a compliant input chamber that improves filling of the pump. Clip valves and all other functions of the device are controlled by means of a computerized console. The use of clip valves reduces the cost of the disposable part of the device. PMID:19817728

  11. A Voluntary Breath-Hold Treatment Technique for the Left Breast With Unfavorable Cardiac Anatomy Using Surface Imaging

    SciTech Connect

    Gierga, David P.; Turcotte, Julie C.; Sharp, Gregory C.; Harvard Medical School, Boston, Massachusetts ; Sedlacek, Daniel E.; Cotter, Christopher R.; Taghian, Alphonse G.; Harvard Medical School, Boston, Massachusetts

    2012-12-01

    Purpose: Breath-hold (BH) treatments can be used to reduce cardiac dose for patients with left-sided breast cancer and unfavorable cardiac anatomy. A surface imaging technique was developed for accurate patient setup and reproducible real-time BH positioning. Methods and Materials: Three-dimensional surface images were obtained for 20 patients. Surface imaging was used to correct the daily setup for each patient. Initial setup data were recorded for 443 fractions and were analyzed to assess random and systematic errors. Real time monitoring was used to verify surface placement during BH. The radiation beam was not turned on if the BH position difference was greater than 5 mm. Real-time surface data were analyzed for 2398 BHs and 363 treatment fractions. The mean and maximum differences were calculated. The percentage of BHs greater than tolerance was calculated. Results: The mean shifts for initial patient setup were 2.0 mm, 1.2 mm, and 0.3 mm in the vertical, longitudinal, and lateral directions, respectively. The mean 3-dimensional vector shift was 7.8 mm. Random and systematic errors were less than 4 mm. Real-time surface monitoring data indicated that 22% of the BHs were outside the 5-mm tolerance (range, 7%-41%), and there was a correlation with breast volume. The mean difference between the treated and reference BH positions was 2 mm in each direction. For out-of-tolerance BHs, the average difference in the BH position was 6.3 mm, and the average maximum difference was 8.8 mm. Conclusions: Daily real-time surface imaging ensures accurate and reproducible positioning for BH treatment of left-sided breast cancer patients with unfavorable cardiac anatomy.

  12. Cardiac function after surgery for subaortic stenosis: non-invasive assessment of left ventricular performance.

    PubMed Central

    Chan, K Y; Redington, A N; Rigby, M L; Gibson, D G

    1991-01-01

    OBJECTIVE--To examine left ventricular function after surgical resection of subaortic stenosis during childhood. DESIGN--Left ventricular performance was measured non-invasively in all patients who responded to an invitation for formal assessment. SETTING--Outpatient study, tertiary referral centre. PATIENTS--Twenty three (12 male and 11 female) patients (age range 3 to 31 years) of 43 consecutive patients with fixed subaortic stenosis undergoing surgical resection between 1975 and 1989 reattended for formal assessment 16 months to 15 years (median 4 years 4 months) after operation. MAIN OUTCOME MEASURES--Left ventricular dimension, left ventricular wall thickness, left ventricular Doppler inflow velocities, and left ventricular diastolic pressure (measured from apexcardiograms). Results were compared with those in controls individually matched for age and sex. RESULTS--All patients were symptom free. Left ventricular cavity dimensions were normal, as was the mean fractional shortening. Posterior wall thickness tended to be greater in the patients and there was a significant increase in septal thickness. Normalised peak rate of posterior wall thinning was significantly lower in the patients and the isovolumic relaxation time was significantly shorter. Doppler inflow velocity measurements showed that early diastolic mitral flow acceleration time was normal but deceleration time was significantly shorter in the patients. The ratio of mitral flow in early diastole (E) to E plus mitral flow in late diastole (A) was significantly higher in the patients and in two patients there was complete absence of A wave flow despite large A waves on the apexcardiogram. CONCLUSIONS--Systolic function was well preserved in patients after operation for subaortic stenosis. A restrictive pattern of left ventricular filling was common, however, and presumably reflected a response to the chronic pressure load and to surgery in the paediatric heart. Images PMID:1883668

  13. A novel cardiac positioning device for left main coronary artery stenosis.

    PubMed

    Singh, Sushil Kumar; Kumar, Ambrish; Rajput, Nitin; Devenraj, Vijyant; Kumar, Shailendra; Goyal, Tushar; Lal Sahni, Jeevan

    2012-02-01

    Significant hemodynamic alterations often occur during off-pump coronary artery bypass operations. Historically, left main coronary artery stenosis has been excluded from off-pump coronary artery bypass operations because of this concern. Many articles in recent times support off-pump operations in left main coronary artery (LMCA) stenosis. We describe here a safe and effective method to reduce the incidence of hemodynamic changes during beating heart surgery in patients with LMCA stenosis. PMID:22269749

  14. Cardiac energy metabolic alterations in pressure overload–induced left and right heart failure (2013 Grover Conference Series)

    PubMed Central

    Lopaschuk, Gary D.

    2015-01-01

    Abstract Pressure overload of the heart, such as seen with pulmonary hypertension and/or systemic hypertension, can result in cardiac hypertrophy and the eventual development of heart failure. The development of hypertrophy and heart failure is accompanied by numerous molecular changes in the heart, including alterations in cardiac energy metabolism. Under normal conditions, the high energy (adenosine triphosphate [ATP]) demands of the heart are primarily provided by the mitochondrial oxidation of fatty acids, carbohydrates (glucose and lactate), and ketones. In contrast, the hypertrophied failing heart is energy deficient because of its inability to produce adequate amounts of ATP. This can be attributed to a reduction in mitochondrial oxidative metabolism, with the heart becoming more reliant on glycolysis as a source of ATP production. If glycolysis is uncoupled from glucose oxidation, a decrease in cardiac efficiency can occur, which can contribute to the severity of heart failure due to pressure-overload hypertrophy. These metabolic changes are accompanied by alterations in the enzymes that are involved in the regulation of fatty acid and carbohydrate metabolism. It is now becoming clear that optimizing both energy production and the source of energy production are potential targets for pharmacological intervention aimed at improving cardiac function in the hypertrophied failing heart. In this review, we will focus on what alterations in energy metabolism occur in pressure overload induced left and right heart failure. We will also discuss potential targets and pharmacological approaches that can be used to treat heart failure occurring secondary to pulmonary hypertension and/or systemic hypertension. PMID:25992268

  15. Optimized temporary bi-ventricular pacing improves haemodynamic function after on-pump cardiac surgery in patients with severe left ventricular systolic dysfunction: a two-centre randomized control trial

    PubMed Central

    Russell, Stuart J.; Tan, Christine; O'Keefe, Peter; Ashraf, Saeed; Zaidi, Afzal; Fraser, Alan G.; Yousef, Zaheer R.

    2012-01-01

    OBJECTIVES Optimized temporary bi-ventricular (BiV) pacing may benefit heart failure patients after on-pump cardiac surgery compared with conventional dual-chamber right ventricular (RV) pacing. An improvement in haemodynamic function with BiV pacing may reduce the duration of ‘Level 3’ intensive care. METHODS Thirty-eight patients in sinus rhythm, ejection fraction ≤35%, undergoing on-pump surgical revascularization, valve surgery or both were enrolled in this study. Before closing the sternum, temporary epicardial pacing wires were attached to the right atrium, RV outflow tract and basal posterolateral wall of the left ventricle. Patients were randomly assigned to postoperative BiV pacing with the optimization of the atrio- (AV) and inter-ventricular (VV) pacing intervals (Group 1) or conventional dual-chamber right AV pacing (Group 2). The primary end-point was the duration of ‘Level 3’ intensive care. Secondary end-points included cardiac output which was measured by thermodiluation at admission to the intensive care unit and at 6 and 18 h later, in five different pacing modes. RESULTS The duration of ‘Level 3’ care was similar between groups (40 ± 35 vs 54 ± 63 h; Group 1 vs 2; P = 0.43). Cardiac output was similar in all pacing modes at baseline. At 18 h, cardiac output with BiV pacing (5.8 l/min) was 7% higher than atrial inhibited (5.4 l/min) and 9% higher than dual-chamber RV pacing (5.3 l/min; P = 0.02 and 0.001, respectively). Optimization of the VV interval produced a further 4% increase in cardiac output compared with baseline settings (P = 0.005). CONCLUSIONS Postoperative haemodynamic function may be enhanced by temporary BiV pacing of high-risk patients after on-pump cardiac surgery. PMID:23138590

  16. Immediate-early gene responses to different cardiac loads in the ejecting rabbit left ventricle.

    PubMed

    Slinker, B K; Stephens, R L; Fisher, S A; Yang, Q

    1996-07-01

    Clinical and experimental observations in humans and animals have shown that different cardiac adaptations occur in response to different types of hemodynamic overload. However, very little is known about how different hemodynamic loads lead to these different cardiac adaptations. Accordingly, we studied the acute response of ejecting isolated rabbit hearts to independently varied systolic and diastolic mechanical loads at constant coronary perfusion pressure. We studied the combined effects of low end-diastolic volume (EDV) and low systolic ejection pressure (Pej), compared to low EDV and high Pej, high EDU and low Pej, and high EDV and high Pej, on the expression of c-fos, c-jun, and egr-1. Further, although we did not seek to clarify the role of these immediate-early genes in cardiac hypertrophy, we hypothesized that they should not all respond in the same manner to these different mechanical loads. In these ejecting hearts we found that the expression of these immediate-early genes did not all respond alike to the different mechanical loads: both c-fos and egr-1 were strongly induced at both 30 and 60 min. However, at 30 min only c-fos depended on the level of EDV (P = 0.01). Neither c-fos nor egr-1 was influenced by EDV at 60 min. The expression of c-jun was largely insensitive to all loading conditions. We conclude that EDV, independent of Pej, influences the pattern and time course of expression of some immediately-early genes and that these different immediate-early genes do not respond in parallel to changes in cardiac loading. PMID:8841944

  17. Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect.

    PubMed

    Mangukia, Chirantan; Sethi, Sonali; Agarwal, Saket; Mishra, Smita; Satsangi, Deepak Kumar

    2014-05-01

    Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels. PMID:24987265

  18. Independent Value of Cardiac Troponin T and Left Ventricular Global Longitudinal Strain in Predicting All-Cause Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

    PubMed Central

    Su, Chi-Ting; Chang, Yu-Tzu; Wang, Saprina P. H.; Yang, Chun-Shin; Tsai, Liang-Miin; Chen, Jyh-Hong

    2014-01-01

    Using a speckle-tracking echocardiography (STE), we recently demonstrated that a left ventricular (LV) global longitudinal strain (GLS) ? ?15% and the serum cardiac troponin T (cTnT) concentration are associated with mortality in stable hemodialysis patients with preserved LV ejection fraction (LVEF). In this study, we explored the relationship between cTnT and echocardiographic parameters and evaluated whether the prognostic value provided by cTnT is independent of a GLS ? ?15% and vice versa. Eighty-eight stable hemodialysis patients with preserved LVEF were followed for 31 months. STE studies and measurements of cTnT were performed at baseline. CTnT concentration had a modest correlation with GLS (rs = 0.44; P < 0.001) but had a weak or nonsignificant correlation with other echocardiographic parameters. Adjusting for clinical parameters, hazard ratios for each increase of 0.01?ng/mL in cTnT, and a GLS ? ?15% on mortality were 1.13 (P = 0.009) and 3.09 (P = 0.03) without significant interaction between cTnT and GLS ? ?15%. In addition, an increased cTnT concentration, a GLS ? ?15%, or their combination showed significant additional predictive value for mortality when included in models consisting of clinical parameters. Therefore, both cTnT and a GLS ? ?15% are independent predictors of mortality and are useful for risk stratification. PMID:24895553

  19. Adverse Left Ventricular Remodeling and Age Assessed with Cardiac MR Imaging: The Multi-Ethnic Study of Atherosclerosis.

    PubMed

    Eng, John; McClelland, Robyn L; Gomes, Antoinette S; Hundley, W Gregory; Cheng, Susan; Wu, Colin O; Carr, J Jeffrey; Shea, Steven; Bluemke, David A; Lima, Joao A C

    2016-03-01

    Purpose To evaluate age-related left ventricular (LV) remodeling during longitudinal observation of a large cohort of asymptomatic individuals who were free of clinical cardiovascular disease at baseline. Materials and Methods The applicable institutional review boards approved this study, and all participants gave informed consent. Cardiac magnetic resonance (MR) imaging was used to identify longitudinal changes in LV structure and function in 2935 participants who underwent baseline and follow-up cardiac MR imaging in the Multi-Ethnic Study of Atherosclerosis. Participants were free of clinical cardiovascular disease at baseline. Participants who experienced an incident coronary heart disease event were excluded. Data were analyzed with multivariable mixed-effects regression models in which the outcome was cardiac MR imaging measurement, and the covariates included follow-up time and cardiac risk factors. Results Participants were aged 54-94 years at follow-up, and 53% of the participants were women. Median time between baseline and follow-up cardiac MR imaging was 9.4 years. Over this period, LV mass increased in men and decreased slightly in women (8.0 and -1.6 g per decade, respectively; P < .001). In both men and women, LV end-diastolic volume decreased (-9.8 and -13.3 mL per decade, respectively; P < .001), stroke volume decreased (-8.8 and -8.6 mL per decade, respectively; P < .001), and mass-to-volume ratio increased (0.14 and 0.11 g/mL per decade, respectively; P < .001). Change in LV mass was positively associated with systolic blood pressure and body mass index and negatively associated with treated hypertension and high-density lipoprotein cholesterol level. In men, the longitudinal LV mass increase was in contrast to a cross-sectional pattern of LV mass decrease. Conclusion As patients age, the LV responds differently in its mass and volume between men and women, although both men and women experience increased concentric LV remodeling with age. In men, the opposition of longitudinal and cross-sectional changes in LV mass highlights the importance of longitudinal study. (©) RSNA, 2015 Online supplemental material is available for this article. PMID:26485617

  20. Cardiac and Metabolic Effects of Anabolic-Androgenic Steroid Abuse on Lipids, Blood Pressure, Left Ventricular Dimensions, and Rhythm

    PubMed Central

    Achar, Suraj; Rostamian, Armand; Narayan, Sanjiv M.

    2014-01-01

    Recent surveys and reports suggest that many athletes and bodybuilders abuse anabolic-androgenic steroids (AAS). However, scientific data on the cardiac and metabolic complications of AAS abuse are divergent and often conflicting. A total of 49 studies describing 1,467 athletes were reviewed to investigate the cardiovascular effects of the abuse of AAS. Although studies were typically small and retrospective, some associated AAS abuse with unfavorable effects. Otherwise healthy young athletes abusing AAS may show elevated levels of low-density lipoprotein and low levels of high-density lipoprotein. Although data are conflicting, AAS have also been linked with elevated systolic and diastolic blood pressure and with left ventricular hypertrophy that may persist after AAS cessation. Finally, in small case studies, AAS abuse has been linked with acute myocardial infarction and fatal ventricular arrhythmias. In conclusion, recognition of these adverse effects may improve the education of athletes and increase vigilance when evaluating young athletes with cardiovascular abnormalities. PMID:20816133

  1. Human Ischemic Cardiomyopathy Shows Cardiac Nos1 Translocation and its Increased Levels are Related to Left Ventricular Performance

    PubMed Central

    Roselló-Lletí, Esther; Carnicer, Ricardo; Tarazón, Estefanía; Ortega, Ana; Gil-Cayuela, Carolina; Lago, Francisca; González-Juanatey, Jose Ramón; Portolés, Manuel; Rivera, Miguel

    2016-01-01

    The role of nitric oxide synthase 1 (NOS1) as a major modulator of cardiac function has been extensively studied in experimental models; however, its role in human ischemic cardiomyopathy (ICM) has never been analysed. Thus, the objectives of this work are to study NOS1 and NOS-related counterparts involved in regulating physiological function of myocyte, to analyze NOS1 localisation, activity, dimerisation, and its relationship with systolic function in ICM. The study has been carried out on left ventricular tissue obtained from explanted human hearts. Here we demonstrate that the upregulation of cardiac NOS1 is not accompanied by an increase in NOS activity, due in part to the alterations found in molecules involved in the regulation of its activity. We observed partial translocation of NOS1 to the sarcolemma in ischemic hearts, and a direct relationship between its protein levels and systolic ventricular function. Our findings indicate that NOS1 may be significant in the pathophysiology of human ischemic heart disease with a preservative role in maintaining myocardial homeostasis. PMID:27041589

  2. Association of Left Ventricular Systolic Function and Vasopressor Support with Survival Following Pediatric Out of Hospital Cardiac Arrest

    PubMed Central

    Conlon, Thomas W.; Falkensammer, Christine B.; Hammond, Rachel S.; Nadkarni, Vinay M.; Berg, Robert A.; Topjian, Alexis A.

    2014-01-01

    Objective To characterize the association of hospital discharge survival with left ventricular (LV) systolic function evaluated by transthoracic echocardiography (TTE) and vasoactive infusion support following return of spontaneous circulation (ROSC) after pediatric out-of-hospital cardiac arrest (OHCA). Design Retrospective case series Setting Single center tertiary care pediatric cardiac arrest and critical care referral center Patients Consecutive OHCA patients <18 years surviving to Pediatric Intensive Care Unit (ICU) admission who had a TTE obtained by the clinical team within 24 hours of admission from January 2006 to May 2012. Interventions None Measurements and Main Results Fifty-eight patients had a post-ROSC TTE performed within 24 hours of admission. The median time from ROSC to echo was 6.5 [IQR 4.7, 15.0] hours. LV systolic function was decreased in 24/58 (41%) patients. The mortality rate was 67% (39/58). Thirty-six patients (62%) received vasoactive infusions at the time of TTE and increased vasopressor inotropic score (VIS) was associated with increased mortality on univariate analysis (p<0.001). After controlling for defibrillation, VIS and interaction between VIS and LV systolic function, decreased LV systolic function was associated with increased mortality (OR 13.7 [95% CI: 1.54, 122]). Conclusions In patients receiving TTE within the first 24 hours following ROSC after pediatric OHCA, decreased LV systolic function and vasopressor use were common. Decreased LV systolic function was associated with increased mortality. PMID:25560427

  3. The effect of disease on human cardiac protein expression profiles in paired samples from right and left ventricles

    PubMed Central

    2014-01-01

    Background Cardiac diseases (e.g. coronary and valve) are associated with ventricular cellular remodeling. However, ventricular biopsies from left and right ventricles from patients with different pathologies are rare and thus little is known about disease-induced cellular remodeling in both sides of the heart and between different diseases. We hypothesized that the protein expression profiles between right and left ventricles of patients with aortic valve stenosis (AVS) and patients with coronary artery disease (CAD) are different and that the protein profile is different between the two diseases. Left and right ventricular biopsies were collected from patients with either CAD or AVS. The biopsies were processed for proteomic analysis using isobaric tandem mass tagging and analyzed by reverse phase nano-LC-MS/MS. Western blot for selected proteins showed strong correlation with proteomic analysis. Results Proteomic analysis between ventricles of the same disease (intra-disease) and between ventricles of different diseases (inter-disease) identified more than 500 proteins detected in all relevant ventricular biopsies. Comparison between ventricles and disease state was focused on proteins with relatively high fold (±1.2 fold difference) and significant (P < 0.05) differences. Intra-disease protein expression differences between left and right ventricles were largely structural for AVS patients and largely signaling/metabolism for CAD. Proteins commonly associated with hypertrophy were also different in the AVS group but with lower fold difference. Inter-disease differences between left ventricles of AVS and CAD were detected in 9 proteins. However, inter-disease differences between the right ventricles of CAD and AVS patients were associated with differences in 73 proteins. The majority of proteins which had a significant difference in one ventricle compared to the other pathology also had a similar trend in the adjacent ventricle. Conclusions This work demonstrates for the first time that left and right ventricles have a different proteome and that the difference is dependent on the type of disease. Inter-disease differential expression was more prominent for right ventricles. The finding that a protein change in one ventricle was often associated with a similar trend in the adjacent ventricle for a large number of proteins suggests cross-talk proteome remodeling between adjacent ventricles. PMID:25249829

  4. Impact of cardiac rehabilitation exercise program on left ventricular diastolic function in coronary artery disease: a pilot study.

    PubMed

    Wuthiwaropas, Punsak; Bellavia, Diego; Omer, Mohamed; Squires, Ray W; Scott, Christopher G; Pellikka, Patricia A

    2013-04-01

    Diastolic dysfunction is common in coronary artery disease (CAD). Exercise-based cardiac rehabilitation (CR) improves survival and quality of life but its effect on diastolic function is unclear. We sought to determine the impact of CR on diastolic function. We conducted a prospective study of CAD patients referred for 3-month outpatient CR, with pre-CR and post-CR echocardiograms. Twenty-five outpatients (age [mean SD], 66 11 ! years; 7 [28 %] women; 22 [88 %] with recent acute coronary syndrome) were recruited upon beginning CR; one patient lacking follow-up was excluded from analysis. Before CR, patients' mean ejection fraction was 61 7 %; regional wall motion score index was 1.18 0.28; and left ventricular diastolic dysfunction existed in 21 (88 %). Of the 24 (96 %) patients with post-CR follow-up, 12 (50 %) had improved diastolic function, 2 of the 24 (8 %) had normal diastolic function throughout, nine (38 %) remained at the same grade, and one (4 %) had worsened diastolic function. The E/e' ratio improved significantly after CR (11.9 4.5 vs. 10.7 4.5; P = .048). Fourteen patients with normal or improved diastolic function had a greater decrease in left atrial volume index (-4.2 6.3 vs. 1.6 6.3 mL/m(2); P = .04) and a greater increase in peak untwisting rate (20 36 vs. -42 45 /s; P = .003) than did patients with no diastolic improvement. Three-month, exercise-based CR was associated with improved left ventricular diastolic function in half of our patients. Further large studies are needed to clarify the effect of CR on diastolic dysfunction in patients with CAD. PMID:23160976

  5. Zic3 is required in the extra-cardiac perinodal region of the lateral plate mesoderm for left-right patterning and heart development

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mutations in ZIC3 cause human X-linked heterotaxy and isolated cardiovascular malformations. A mouse model with targeted deletion of Zic3 demonstrates an early role for Zic3 in gastrulation, CNS, cardiac and left-right axial development. The observation of multiple malformations in Zic3(null) mice a...

  6. Giant Left Ventricular Pseudoaneurysm and Myocardial Dissection as a Complication of Multiple Ventricular Tachycardia Ablations in a Patient with Cardiac Sarcoidosis

    PubMed Central

    Koch, Krysthel Engstrom; Raiszadeh, Farbod; Godelman, Alla; Palma, Eugen; Forman, Robert

    2015-01-01

    Late development of left ventricular (LV) pseudoaneurysms after ventricular tachycardia (VT) catheter ablation is a rare phenomenon, and very few cases have been reported in the medical literature. We describe the case of a giant LV pseudoaneurysm as a late complication of multiple epicardial and endocardial VT ablations in a female in her 50s with known cardiac sarcoidosis. PMID:26604849

  7. Sudden Cardiac Death Associated with Anomalous Origin of the Left Main Coronary Artery from the Right Sinus, with an Intramural Course

    PubMed Central

    Chang, Huai-Ren; Hsieh, Jen-Che; Chao, Shen-Feng; Wang, Ji-Hung

    2015-01-01

    Anomalous origin of the left main coronary artery from the right sinus of Valsalva is extremely rare and can lead to sudden cardiac death. We report a case in which an 18-year-old college student collapsed immediately after a long-distance run of 10 km. After cardiopulmonary resuscitation and electrical shock for ventricular fibrillation, she experienced a return of spontaneous circulation. Cardiac catheterization and cardiac computed tomographic angiography revealed an unusually long intramural course of the left main coronary artery from the right sinus of Valsalva. The young woman underwent a successful unroofing operation for coronary artery correction. She remained asymptomatic upon exercise during 2.5 years of follow-up. PMID:26664310

  8. Dipyridamole-thallium tests are predictive of severe cardiac arrhythmias in patients with left ventricular hypertrophy

    SciTech Connect

    Saragoca, M.A.; Canziani, M.E.; Gil, M.A.; Castiglioni, M.L.; Cassiolato, J.L.; Barbieri, A.; Lima, V.C.; Draibe, S.A.; Martinez, E.E. )

    1991-01-01

    In a population of patients with chronic renal failure (CRF) and a high prevalence of left ventricular hypertrophy (LVH) undergoing chronic hemodialysis, the authors investigated the association between the results of dipyridamole-thallium tests (DTTs) and the occurrence of ventricular arrhythmias. They observed a positive significant association between positive DTTs and the occurrence of severe forms of ventricular arrhythmias. A significant association was also observed between the presence of severe LVH and the occurrence of severe ventricular arrhythmias. However, no association was found between the presence of LVH and the positivity of the DTT. As most of their patients with positive DTTs had unimpaired coronary circulations, they conclude that positive DTTs, although falsely indicative of impaired myocardial blood supply, does have an important clinical relevance, indicating increased risk of morbidity (and, possibly, mortality) due to ventricular arrhythmias in a population of CRF patients submitted to chronic renal function replacement program.

  9. Fever and Cardiac Arrest in a Patient With a Left Ventricular Assist Device.

    PubMed

    Tan, Eugene M; Marcelin, Jasmine R; Tande, Aaron J; Rizza, Stacey A; Cummins, Nathan W

    2015-04-01

    A 68-year-old avid deer hunter with ischemic cardiomyopathy underwent left ventricular assist device (LVAD) implantation for destination therapy two years ago. He was living an active lifestyle, tracking deer and fishing in a Midwestern forest in November. His wife removed an engorged tick on his thorax. A few days later, he experienced fever, confusion, and ataxia and was hospitalized with septic shock and ventricular fibrillation. The LVAD site had no signs of trauma, drainage, warmth, or tenderness. A peripheral blood smear revealed intraleukocytic anaplasma microcolony inclusions. After completing 14 days of doxycycline, he recovered. Typical non-device-associated infections in LVAD recipients include pneumonia, urinary tract infection, or Clostridium difficile colitis. Human granulocytic anaplasmosis (HGA) is a very atypical non-LVAD infection, and the incidence of tickborne illnesses in LVAD recipients is unknown. PMID:26380334

  10. Fever and Cardiac Arrest in a Patient With a Left Ventricular Assist Device

    PubMed Central

    Tan, Eugene M.; Marcelin, Jasmine R.; Tande, Aaron J.; Rizza, Stacey A.; Cummins, Nathan W.

    2015-01-01

    A 68-year-old avid deer hunter with ischemic cardiomyopathy underwent left ventricular assist device (LVAD) implantation for destination therapy two years ago. He was living an active lifestyle, tracking deer and fishing in a Midwestern forest in November. His wife removed an engorged tick on his thorax. A few days later, he experienced fever, confusion, and ataxia and was hospitalized with septic shock and ventricular fibrillation. The LVAD site had no signs of trauma, drainage, warmth, or tenderness. A peripheral blood smear revealed intraleukocytic anaplasma microcolony inclusions. After completing 14 days of doxycycline, he recovered. Typical non-device-associated infections in LVAD recipients include pneumonia, urinary tract infection, or Clostridium difficile colitis. Human granulocytic anaplasmosis (HGA) is a very atypical non-LVAD infection, and the incidence of tickborne illnesses in LVAD recipients is unknown. PMID:26380334

  11. Diacerein Improves Left Ventricular Remodeling and Cardiac Function by Reducing the Inflammatory Response after Myocardial Infarction

    PubMed Central

    Torina, Anali Galluce; Reichert, Karla; Lima, Fany; de Souza Vilarinho, Karlos Alexandre; de Oliveira, Pedro Paulo Martins; do Carmo, Helison Rafael Pereira; de Carvalho, Daniela Diógenes; Saad, Mário José Abdalla; Sposito, Andrei Carvalho; Petrucci, Orlando

    2015-01-01

    Background The inflammatory response has been implicated in the pathogenesis of left ventricular (LV) remodeling after myocardial infarction (MI). An anthraquinone compound with anti-inflammatory properties, diacerein inhibits the synthesis and activity of pro-inflammatory cytokines, such as tumor necrosis factor and interleukins 1 and 6. The purpose of this study was to investigate the effects of diacerein on ventricular remodeling in vivo. Methods and Results Ligation of the left anterior descending artery was used to induce MI in an experimental rat model. Rats were divided into two groups: a control group that received saline solution (n = 16) and a group that received diacerein (80 mg/kg) daily (n = 10). After 4 weeks, the LV volume, cellular signaling, caspase 3 activity, and nuclear factor kappa B (NF-κB) transcription were compared between the two groups. After 4 weeks, end-diastolic and end-systolic LV volumes were reduced in the treatment group compared to the control group (p < .01 and p < .01, respectively). Compared to control rats, diacerein-treated rats exhibited less fibrosis in the LV (14.65%± 7.27% vs. 22.57%± 8.94%; p < .01), lower levels of caspase-3 activity, and lower levels of NF-κB p65 transcription. Conclusions Treatment with diacerein once a day for 4 weeks after MI improved ventricular remodeling by promoting lower end-systolic and end-diastolic LV volumes. Diacerein also reduced fibrosis in the LV. These effects might be associated with partial blockage of the NF-κB pathway. PMID:25816098

  12. Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance Study

    PubMed Central

    Tsao, Connie W; Gona, Philimon N; Salton, Carol J; Chuang, Michael L; Levy, Daniel; Manning, Warren J; O’Donnell, Christopher J

    2015-01-01

    Background Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are related to adverse cardiovascular disease (CVD) events. The predictive utility of LV concentric remodeling and LV mass in the prediction of CVD events is not well characterized. Methods and Results Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715, 50% men, aged 65±9 years) underwent cardiovascular magnetic resonance for LVMI and geometry (2002–2006) and were prospectively followed for incident CVD (myocardial infarction, coronary insufficiency, heart failure, stroke) or CVD death. Over 13 808 person-years of follow-up (median 8.4, range 0.0 to 10.5 years), 85 CVD events occurred. In multivariable-adjusted proportional hazards regression models, each 10-g/m2 increment in LVMI and each 0.1 unit in relative wall thickness was associated with 33% and 59% increased risk for CVD, respectively (P=0.004 and P=0.009, respectively). The association between LV mass/LV end-diastolic volume and incident CVD was borderline significant (P=0.053). Multivariable-adjusted risk reclassification models showed a modest improvement in CVD risk prediction with the incorporation of cardiovascular magnetic resonance LVMI and measures of LV concentricity (C-statistic 0.71 [95% CI 0.65 to 0.78] for the model with traditional risk factors only, improved to 0.74 [95% CI 0.68 to 0.80] for the risk factor model additionally including LVMI and relative wall thickness). Conclusions Among adults free of prevalent CVD in the community, greater LVMI and LV concentric hypertrophy are associated with a marked increase in adverse incident CVD events. The potential benefit of aggressive primary prevention to modify LV mass and geometry in these adults requires further investigation. PMID:26374295

  13. Left atrial aging: a cardiac magnetic resonance feature-tracking study.

    PubMed

    Evin, Morgane; Redheuil, Alban; Soulat, Gilles; Perdrix, Ludivine; Ashrafpoor, Golmehr; Giron, Alain; Lamy, Jérôme; Defrance, Carine; Roux, Charles; Hatem, Stéphane N; Diebold, Benoit; Mousseaux, Elie; Kachenoura, Nadjia

    2016-03-01

    Importance of left atrial (LA) phasic function evaluation is increasingly recognized for its incremental value in terms of prognosis and risk stratification. LA phasic deformation in the pathway of normal aging has been characterized using echocardiographic speckle tracking. However, no data are available regarding age-related variations using feature-racking (FT) techniques from standard cine magnetic resonance imaging (MRI). We studied 94 healthy adults (41 ± 14 yr, 47 women), who underwent MRI and Doppler echocardiography on the same day for left ventricular (LV) diastolic function evaluation. From cine MRI, longitudinal strain and strain rate, radial motion fraction, and radial relative velocity, respectively, corresponding to the reservoir, conduit, and LA contraction phases, were measured using dedicated FT software. Longitudinal strain and radial motion fraction decreased gradually and significantly with aging for both reservoir (r > 0.31, P < 0.003) and conduit (r > 0.54, P < 0.001) phases, whereas they remained unchanged during the LA contraction phase. Subsequently, the LA contraction-to-reservoir ratio increased significantly with age (r > 0.44, P < 0.001). Longitudinal strain rate and radial relative velocity significantly decreased with age (reservoir: r = 0.39, P < 0.001, conduit: r > 0.54, P < 0.001), and these associations tended to be stronger in women than in men. Finally, associations of LA functional indexes with age were stronger in individuals with lower transmitral early-to-atrial maximal velocity ratio and mitral annulus maximal longitudinal velocity, as well as higher transmitral early maximal-to-mitral annulus maximal longitudinal velocity ratio, highlighting the LV-LA interplay. Age-related changes in LA phasic function indexes were quantified by cine MRI images using a FT technique and were significantly related to age and LV diastolic function. PMID:26747498

  14. Details of left ventricular radial wall motion supporting the ventricular theory of the third heart sound obtained by cardiac MR

    PubMed Central

    Robson, M D; Rider, O J; Pegg, T J; Dasanu, C A; Jung, B A; Rotaru, N; Clarke, K; Holloway, C J

    2014-01-01

    Objective: Obtaining new details of radial motion of left ventricular (LV) segments using velocity-encoding cardiac MRI. Methods: Cardiac MR examinations were performed on 14 healthy volunteers aged between 19 and 26 years. Cine images for navigator-gated phase contrast velocity mapping were acquired using a black blood segmented κ-space spoiled gradient echo sequence with a temporal resolution of 13.8 ms. Peak systolic and diastolic radial velocities as well as radial velocity curves were obtained for 16 ventricular segments. Results: Significant differences among peak radial velocities of basal and mid-ventricular segments have been recorded. Particular patterns of segmental radial velocity curves were also noted. An additional wave of outward radial movement during the phase of rapid ventricular filling, corresponding to the expected timing of the third heart sound, appeared of particular interest. Conclusion: The technique has allowed visualization of new details of LV radial wall motion. In particular, higher peak systolic radial velocities of anterior and inferior segments are suggestive of a relatively higher dynamics of anteroposterior vs lateral radial motion in systole. Specific patterns of radial motion of other LV segments may provide additional insights into LV mechanics. Advances in knowledge: The outward radial movement of LV segments impacted by the blood flow during rapid ventricular filling provides a potential substrate for the third heart sound. A biphasic radial expansion of the basal anteroseptal segment in early diastole is likely to be related to the simultaneous longitudinal LV displacement by the stretched great vessels following repolarization and their close apposition to this segment. PMID:24641347

  15. [Contractility of the left ventricle of the human heart noninvasive measurement in each cardiac cycle].

    PubMed

    Khaiutin, V M; Lukoshkova, E V; Ermishkin, V V; Sonina, R S

    2010-01-01

    History of development of the method of measurement of duration of the preejection (DPE) period - characteristic of left ventricular (LV) contractility is presented. On the basis of physiological prerequisites a novel computerized method of DPE measurement in each consecutive cardiocycle has been created. Distinct features of this method are: 1) principle of measurement - tetrapolar impedancemetry, with signal electrodes located along projection of the ascending aorta, one in the center of presternum, second - 5 cm caudally; 2) starting point for DPE counting - the point on ascending portion of R wave of electrocardiogram at which the first derivative of ECG signal reaches maximum, stopping point - the point of maximum of the second derivative of the primary impedance signal on the ascending front of its pulse wave. The method has been tested on healthy people for 10 functional tests. The results are presented characterizing dynamic peculiarities of changes of LV contractility during veloergometer exercise test with staderly increasing work load and reflecting development of positive inotropic action of sympathetic nervous system. Special characteristics of this action: small concealed period, preservation of achieved elevated level during lowering of work load (before its switching off) and subsequent slow (compared with chronotropic effect) diminution, as well as turning on at low loads. PMID:20459420

  16. Markov random field modeling for three-dimensional reconstruction of the left ventricle in cardiac angiography

    PubMed Central

    Medina, Rubén; Garreau, Mireille; Toro, Javier; Le Breton, Hervé; Coatrieux, Jean-Louis; Jugo, Diego

    2006-01-01

    This paper reports on a method for left ventricle three-dimensional reconstruction from two orthogonal ventriculograms. The proposed algorithm is voxel-based and takes into account the conical projection geometry associated with the biplane image acquisition equipment. The reconstruction process starts with an initial ellipsoidal approximation derived from the input ventriculograms. This model is subsequently deformed in such a way as to match the input projections. To this end, the object is modeled as a three-dimensional Markov-Gibbs random field, and an energy function is defined so that it includes one term that models the projections compatibility and another one that includes the space–time regularity constraints. The performance of this reconstruction method is evaluated by considering the reconstruction of mathematically synthesized phantoms and two 3-D binary databases from two orthogonal synthesized projections. The method is also tested using real biplane ventriculograms. In this case, the performance of the reconstruction is expressed in terms of the projection error, which attains values between 9.50% and 11.78 % for two biplane sequences including a total of 55 images. PMID:16895001

  17. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    SciTech Connect

    Rettmann, Maryam E. Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A.; Kwartowitz, David M.; Gunawan, Mia; Johnson, Susan B.; Packer, Douglas L.; Dalegrave, Charles; Kolasa, Mark W.

    2014-02-15

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration provided the noise in the surface points is not excessively high. Increased variability on the landmark fiducials resulted in increased registration errors; however, refinement of the initial landmark registration by the surface-based algorithm can compensate for small initial misalignments. The surface-based registration algorithm is quite robust to noise on the surface points and continues to improve landmark registration even at high levels of noise on the surface points. Both the canine and patient studies also demonstrate that combined landmark and surface registration has lower errors than landmark registration alone. Conclusions: In this work, we describe a model for evaluating the impact of noise variability on the input parameters of a registration algorithm in the context of cardiac ablation therapy. The model can be used to predict both registration error as well as assess which inputs have the largest effect on registration accuracy.

  18. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    PubMed Central

    Rettmann, Maryam E.; Holmes, David R.; Kwartowitz, David M.; Gunawan, Mia; Johnson, Susan B.; Camp, Jon J.; Cameron, Bruce M.; Dalegrave, Charles; Kolasa, Mark W.; Packer, Douglas L.; Robb, Richard A.

    2014-01-01

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamic in vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration provided the noise in the surface points is not excessively high. Increased variability on the landmark fiducials resulted in increased registration errors; however, refinement of the initial landmark registration by the surface-based algorithm can compensate for small initial misalignments. The surface-based registration algorithm is quite robust to noise on the surface points and continues to improve landmark registration even at high levels of noise on the surface points. Both the canine and patient studies also demonstrate that combined landmark and surface registration has lower errors than landmark registration alone. Conclusions: In this work, we describe a model for evaluating the impact of noise variability on the input parameters of a registration algorithm in the context of cardiac ablation therapy. The model can be used to predict both registration error as well as assess which inputs have the largest effect on registration accuracy. PMID:24506630

  19. Cardiac chamber volumes by echocardiography using a new mathematical method: A promising technique for zero-G use

    NASA Technical Reports Server (NTRS)

    Buckey, J. C.; Beattie, J. M.; Gaffney, F. A.; Nixon, J. V.; Blomqvist, C. G.

    1984-01-01

    Accurate, reproducible, and non-invasive means for ventricular volume determination are needed for evaluating cardiovascular function zero-gravity. Current echocardiographic methods, particularly for the right ventricle, suffer from a large standard error. A new mathematical approach, recently described by Watanabe et al., was tested on 1 normal formalin-fixed human hearts suspended in a mineral oil bath. Volumes are estimated from multiple two-dimensional echocardiographic views recorded from a single point at sequential angles. The product of sectional cavity area and center of mass for each view summed over the range of angles (using a trapezoidal rule) gives volume. Multiple (8-14) short axis right ventricle and left ventricle views at 5.0 deg intervals were videotaped. The images were digitized by two independent observers (leading-edge to leading-edge technique) and analyzed using a graphics tablet and microcomputer. Actual volumes were determined by filling the chambers with water. These data were compared to the mean of the two echo measurements.

  20. Genome-wide association study of maternal and inherited effects on left-sided cardiac malformations

    PubMed Central

    Mitchell, Laura E.; Agopian, A.J.; Bhalla, Angela; Glessner, Joseph T.; Kim, Cecilia E.; Swartz, Michael D.; Hakonarson, Hakon; Goldmuntz, Elizabeth

    2015-01-01

    Congenital left-sided lesions (LSLs) are serious, heritable malformations of the heart. However, little is known about the genetic causes of LSLs. This study was undertaken to identify common variants acting through the genotype of the affected individual (i.e. case) or the mother (e.g. via an in utero effect) that influence the risk of LSLs. A genome-wide association study (GWAS) was performed using data from 377 LSL case-parent triads, with follow-up studies in an independent sample of 224 triads and analysis of the combined data. Associations with both the case and maternal genotypes were assessed using log-linear analyses under an additive model. An association between LSLs and the case genotype for one intergenic SNP on chromosome 16 achieved genome-wide significance in the combined data (rs8061121, combined P = 4.0 × 10−9; relative risk to heterozygote: 2.6, 95% CI: 1.9–3.7). In the combined data, there was also suggestive evidence of association between LSLs and the case genotype for a variant in the synaptoporin gene (rs1975649, combined P = 3.4 × 10−7; relative risk to heterozygote: 1.6, 95% CI: 1.4–2.0) and between LSLs and the maternal genotype for an intergenic SNP on chromosome 10 (rs11008222, combined P = 6.3 × 10−7; relative risk to heterozygote: 1.6, 95% CI: 1.4–2.0). This is the first GWAS of LSLs to evaluate associations with both the case and maternal genotypes. The results of this study identify three candidate LSL susceptibility loci, including one that appears to be associated with the risk of LSLs via the maternal genotype. PMID:25138779

  1. Source parameters of the left ventricle related to the physiological characteristics of the cardiac muscle.

    PubMed Central

    Beyar, R; Sideman, S

    1986-01-01

    An attempt is made here to correlate the physiological muscle parameters with the dynamic source parameters of the left ventricle (LV), i.e. the source (isovolumic) pressure Po and the source (internal) resistance, Rs. The internal resistance is described here as a time-dependent parameter, corresponding to the pressure drop (from the theoretical instantaneous isovolumic pressure) associated with the instantaneous ejection flow rate. The source pressure, which relates to the muscle stress and the ventricular volume, is represented by the time-varying elastance concept and a spheroidal model relating the average wall stress to LV pressure. Linear and exponential force-velocity relationships (FVR), expressed in stress-strain rate terms, are compared. Two possible characteristics of the dynamic FVR in the partially active state, based on either a parallel or a fanlike shift of the stress-strain rate curve, are studied by utilizing simple analytical models as well as a computer simulation model. Comparing the calculated results with experimental data indicates that the dynamic FVR shift occurs in a fanlike pattern in which the maximum strain rate remains constant throughout the cycle. This pattern of the FVR shift is consistent with experimental data that show that the internal resistance is linearly related to the instantaneous isovolumic pressure. The analysis also indicates that the difference between the hyperbolic and linear FVR is rather minor, and in spite of some effects on the ejection pattern and the value of Rs, the functional shape has no effect on the global LV characteristics, such as the ejection fraction and stroke volume. PMID:3755065

  2. [Cardiac arrhythmias in hypertensive subjects with and without left ventricular hypertrophy compared to the circadian profile of the blood pressure].

    PubMed

    Novo, S; Barbagallo, M; Abrignani, M G; Alaimo, G; Longo, B; Corrao, S; Nardi, E; Liquori, M; Forte, G; Raineri, A

    1990-08-01

    To evaluate possible correlations between cardiac arrhythmias and circadian pattern of blood pressure (BP) and of heart rate (HR), we studied 2 groups of 20 males with stable arterial hypertension of mild to moderate entity, with (Group I) or without (Group II) left ventricular hypertrophy (LVH). In patients with LVH the mean age (56 vs 46 years), the duration of the hypertensive state (48.1 vs 15.7 months), the thickening of interventricular septum (IVS; 13.7 vs 9.6 mm) and of the posterior wall of the left ventricle (13.2 vs 9.2 mm) and the mass of LV (149.8 vs 99.7 g/m2) were significantly greater (p less than 0.01). On the contrary, the 2 groups did not show significant differences concerning casual BP determined in the morning (178.3/108.4 vs 171.5/106.2 mmHg). After a pharmacological washout of 2 weeks, patients underwent a noninvasive, intermittent, monitoring of BP (every 15 min during daytime and every 30 min from 11 pm to 7 am), using a pressure meter II Del Mar Avionics, and a continuous monitoring of ECG for 24 hours, employing an instrument 445/B Del Mar Avionics. Mean 24-hour BP was not different in the 2 groups of patients (161.7/99.0 vs 158.2/98.3 mmHg); however, patients with LVH showed a significantly greater variability of BP in the morning (7 am-3 pm), while mean 24-hour HR was significantly less (71.6 vs 78.2 b/min).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2150345

  3. QRS pattern and improvement in right and left ventricular function after cardiac resynchronization therapy: a radionuclide study

    PubMed Central

    2012-01-01

    Background Predicting response to cardiac resynchronization therapy (CRT) remains a challenge. We evaluated the role of baseline QRS pattern to predict response in terms of improvement in biventricular ejection fraction (EF). Methods Consecutive patients (pts) undergoing CRT implantation underwent radionuclide angiography at baseline and at mid-term follow-up. The relationship between baseline QRS pattern and mechanical dyssynchrony using phase analysis was evaluated. Changes in left and right ventricular EF (LVEF and RVEF) were analyzed with regard to baseline QRS pattern. Results We enrolled 56 pts, 32 with left bundle branch block (LBBB), 4 with right bundle branch block (RBBB) and 20 with non-specific intraventricular conduction disturbance (IVCD). A total of 48 pts completed follow-up. LBBB pts had significantly greater improvement in LVEF compared to RBBB or non-specific IVCD pts (+9.6 ± 10.9% vs. +2.6 ± 7.6%, p = 0.003). Response (defined as ≥ 5% increase in LVEF) was observed in 68% of LBBB vs. 24% of non-specific IVCD pts (p = 0.006). None of the RBBB pts were responders. RVEF was significantly improved in LBBB (+5.0 ± 9.0%, p = 0.007), but not in non-specific IVCD and RBBB pts (+0.4 ± 5.8%, p = 0.76). At multivariate analysis, LBBB was the only predictor of LVEF response (OR, 7.45; 95% CI 1.80-30.94; p = 0.006), but not QRS duration or extent of mechanical dyssynchrony. Conclusions Presence of a LBBB is a marker of a positive response to CRT in terms of biventricular improvement. Pts with non-LBBB pattern show significantly less benefit from CRT than those with LBBB. PMID:22494365

  4. Left ventricular wall thickness in patients with hypertrophic cardiomyopathy: a comparison between cardiac magnetic resonance imaging and echocardiography.

    PubMed

    Corona-Villalobos, Celia P; Sorensen, Lars L; Pozios, Iraklis; Chu, Linda; Eng, John; Abraham, Maria Roselle; Abraham, Theodore P; Kamel, Ihab R; Zimmerman, Stefan L

    2016-06-01

    We assessed whether cardiac MRI (CMR) and echocardiography (echo) have significant differences measuring left ventricular (LV) wall thickness (WT) in hypertrophic cardiomyopathy (HCM) as performed in the clinical routine. Retrospectively identified, clinically diagnosed HCM patients with interventricular-septal (IVS) pattern hypertrophy who underwent CMR and echo within the same day were included. Left Ventricular WT was measured by CMR in two planes and compared to both echo and contrast echo (cecho). 72 subjects, mean age 50.7 ± 16.2 years, 68 % males. Interventricular septal WT by echo and CMR planes showed good to excellent correlation. However, measurements of the postero-lateral wall showed poor correlation. Bland-Altman plots showed greater maximal IVS WT by echo compared to CMR measurement [SAX = 1.7 mm (-5.8, 9.3); LVOT = 1.1 mm (-5.6, 7.8)]. Differences were smaller between cecho and CMR [SAX = 0.8 mm (-9.2, 10.8); LVOT = -0.2 mm (-10.0, 9.6)]. Severity of WT by quartiles showed greater differences between echo and SAX CMR WT compared to cecho. Echocardiography typically measures greater WT than CMR, with the largest differences in moderate to severe hypertrophy. Contrast echocardiography more closely approximates CMR measurements of WT. These findings have potential clinical implications for risk stratification of subjects with HCM. PMID:26896038

  5. A rare combination of undiagnosed hypertrophic cardiomyopathy revealed by intraoperative anaphylaxis resulting in acute left ventricular outflow obstruction and cardiac arrest.

    PubMed

    Smith, Bradford B; Nickels, Andrew S; Sviggum, Hans P

    2016-06-01

    A 75-year-old female presented for left total hip reimplantation and suffered pulseless electrical activity arrest upon lateral positioning and administering vancomycin. Resuscitation was achieved according to Advanced Cardiac Life Support protocol. Post-event echocardiography showed hypertrophic cardiomyopathy with asymmetrical septal thickening, an under-filled left ventricle, dynamic left ventricular outflow obstruction, and severe mitral regurgitation related to systolic anterior motion of the mitral valve. Laboratory analysis showed a tryptase level of 209 ng/mL. After multispecialty evaluation, it was concluded that the patient's arrest was due to vancomycin anaphylaxis in the setting of previously undiagnosed hypertrophic cardiomyopathy leading to acute left ventricular outflow tract obstruction. After medical optimization of the patient's cardiomyopathy and an evaluation of potential intraoperative allergic triggers, the patient underwent a successful hip reimplantation without incident. This case presents a novel combination of events leading to intraoperative cardiac arrest. Rapid identification and an understanding of the cause(s) of cardiac arrest in this setting are critical for effective perioperative care. PMID:27185714

  6. Parametric ultrasound and fluoroscopy image fusion for guidance of left ventricle lead placement in cardiac resynchronization therapy

    PubMed Central

    Babic, Aleksandar; Odland, Hans Henrik; Gérard, Olivier; Samset, Eigil

    2015-01-01

    Abstract. Recent studies show that the response rate to cardiac resynchronization therapy (CRT) could be improved if the left ventricle (LV) is paced at the site of the latest mechanical activation, but away from the myocardial scar. A prototype system for CRT lead placement guidance that combines LV functional information from ultrasound with live x-ray fluoroscopy was developed. Two mean anatomical models, each containing LV epi-, LV endo- and right ventricle endocardial surfaces, were computed from a database of 33 heart failure patients as a substitute for a patient-specific model. The sphericity index was used to divide the observed population into two groups. The distance between the mean and the patient-specific models was determined using a signed distance field metric (reported in mm). The average error values for LV epicardium were −0.4±4.6 and for LV endocardium were −0.3±4.4. The validity of using average LV models for a CRT procedure was tested by simulating coronary vein selection in a group of 15 CRT candidates. The probability of selecting the same coronary branch, when basing the selection on the average model compared to a patient-specific model, was estimated to be 95.3±2.9%. This was found to be clinically acceptable. PMID:26158110

  7. 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.

  8. An Inverse Finite Element Method for Determining the Tissue Compressibility of Human Left Ventricular Wall during the Cardiac Cycle

    PubMed Central

    Hassaballah, Abdallah I.; Hassan, Mohsen A.; Mardi, Azizi N.; Hamdi, Mohd

    2013-01-01

    The determination of the myocardiums tissue properties is important in constructing functional finite element (FE) models of the human heart. To obtain accurate properties especially for functional modeling of a heart, tissue properties have to be determined in vivo. At present, there are only few in vivo methods that can be applied to characterize the internal myocardium tissue mechanics. This work introduced and evaluated an FE inverse method to determine the myocardial tissue compressibility. Specifically, it combined an inverse FE method with the experimentally-measured left ventricular (LV) internal cavity pressure and volume versus time curves. Results indicated that the FE inverse method showed good correlation between LV repolarization and the variations in the myocardium tissue bulk modulus K (K?=?1/compressibility), as well as provided an ability to describe in vivo human myocardium material behavior. The myocardium bulk modulus can be effectively used as a diagnostic tool of the heart ejection fraction. The model developed is proved to be robust and efficient. It offers a new perspective and means to the study of living-myocardium tissue properties, as it shows the variation of the bulk modulus throughout the cardiac cycle. PMID:24367544

  9. Complete left pericardial defect: evaluation with supine and decubitus dual source CT.

    PubMed

    Hoey, Edward T D; Yap, Ki Sing; Darby, Michael J; Mankad, Kshitij; Puppala, Sapna; Sivananthan, Mohan U

    2009-01-01

    We present a case of complete left pericardial defect which was evaluated with retrospectively gated dual source CT. Imaging findings included right heart chamber dilatation, extreme levoposition and excessive cardiac mobility which was demonstrated by repeat imaging in the left lateral decubitus position. Cardiac CT is an excellent means of evaluating pericardial disease owing to its high spatial resolution. Decubitus imaging helps confidently distinguish partial from complete forms of pericardial defect. PMID:19733526

  10. The effect of obesity on electrocardiographic detection of hypertensive left ventricular hypertrophy: recalibration against cardiac magnetic resonance.

    PubMed

    Rodrigues, J C L; McIntyre, B; Dastidar, A G; Lyen, S M; Ratcliffe, L E; Burchell, A E; Hart, E C; Bucciarelli-Ducci, C; Hamilton, M C K; Paton, J F R; Nightingale, A K; Manghat, N E

    2016-03-01

    Electrocardiograph (ECG) criteria for left ventricular hypertrophy (LVH) are a widely used clinical tool. We recalibrated six ECG criteria for LVH against gold-standard cardiac magnetic resonance (CMR) and assessed the impact of obesity. One hundred and fifty consecutive tertiary hypertension clinic referrals for CMR (1.5 T) were reviewed. Patients with cardiac pathology potentially confounding hypertensive LVH were excluded (n=22). The final sample size was 128 (age: 51.0±15.2 years, 48% male). LVH was defined by CMR. From a 12-lead ECG, Sokolow-Lyon voltage and product, Cornell voltage and product, Gubner-Ungerleidger voltage and Romhilt-Estes score were evaluated, blinded to the CMR. ECG diagnostic performance was calculated. LVH by CMR was present in 37% and obesity in 51%. Obesity significantly reduced ECG sensitivity, because of significant attenuation in mean ECG values for Cornell voltage (22.2±5.7 vs 26.4±9.4 mm, P<0.05), Cornell product (2540±942 vs 3023±1185 mm • ms, P<0.05) and for Gubner-Ungerleider voltage (18.2±7.1 vs 23.3±1.2 mm, P<0.05). Obesity also significantly reduced ECG specificity, because of significantly higher prevalence of LV remodeling (no LVH but increased mass-to-volume ratio) in obese subjects without LVH (36% vs 16%, P<0.05), which correlated with higher mean ECG LVH criteria values. Obesity-specific partition values were generated at fixed 95% specificity; Cornell voltage had highest sensitivity in non-obese (56%) and Sokolow-Lyon product in obese patients (24%). Obesity significantly lowers ECG sensitivity at detecting LVH, by attenuating ECG LVH values, and lowers ECG specificity through changes associated with LV remodeling. Our obesity-specific ECG partition values could improve the diagnostic performance in obese patients with hypertension. PMID:26040440

  11. The effect of obesity on electrocardiographic detection of hypertensive left ventricular hypertrophy: recalibration against cardiac magnetic resonance

    PubMed Central

    Rodrigues, J C L; McIntyre, B; Dastidar, A G; Lyen, S M; Ratcliffe, L E; Burchell, A E; Hart, E C; Bucciarelli-Ducci, C; Hamilton, M C K; Paton, J F R; Nightingale, A K; Manghat, N E

    2016-01-01

    Electrocardiograph (ECG) criteria for left ventricular hypertrophy (LVH) are a widely used clinical tool. We recalibrated six ECG criteria for LVH against gold-standard cardiac magnetic resonance (CMR) and assessed the impact of obesity. One hundred and fifty consecutive tertiary hypertension clinic referrals for CMR (1.5 T) were reviewed. Patients with cardiac pathology potentially confounding hypertensive LVH were excluded (n=22). The final sample size was 128 (age: 51.0±15.2 years, 48% male). LVH was defined by CMR. From a 12-lead ECG, Sokolow–Lyon voltage and product, Cornell voltage and product, Gubner–Ungerleidger voltage and Romhilt–Estes score were evaluated, blinded to the CMR. ECG diagnostic performance was calculated. LVH by CMR was present in 37% and obesity in 51%. Obesity significantly reduced ECG sensitivity, because of significant attenuation in mean ECG values for Cornell voltage (22.2±5.7 vs 26.4±9.4 mm, P<0.05), Cornell product (2540±942 vs 3023±1185 mm • ms, P<0.05) and for Gubner–Ungerleider voltage (18.2±7.1 vs 23.3±1.2 mm, P<0.05). Obesity also significantly reduced ECG specificity, because of significantly higher prevalence of LV remodeling (no LVH but increased mass-to-volume ratio) in obese subjects without LVH (36% vs 16%, P<0.05), which correlated with higher mean ECG LVH criteria values. Obesity-specific partition values were generated at fixed 95% specificity; Cornell voltage had highest sensitivity in non-obese (56%) and Sokolow–Lyon product in obese patients (24%). Obesity significantly lowers ECG sensitivity at detecting LVH, by attenuating ECG LVH values, and lowers ECG specificity through changes associated with LV remodeling. Our obesity-specific ECG partition values could improve the diagnostic performance in obese patients with hypertension. PMID:26040440

  12. Extended Application of the Hybrid Procedure in Neonates with Left-Sided Obstructive Lesions in an Evolving Cardiac Program.

    PubMed

    Taqatqa, Anas; Diab, Karim A; Stuart, Christopher; Fogg, Louis; Ilbawi, Michel; Awad, Sawsan; Caputo, Massimo; Amin, Zahid; Abdulla, Ra-Id; Kenny, Damien; Hijazi, Ziyad M

    2016-03-01

    The hybrid approach to management of hypoplastic left heart syndrome (HLHS) was developed as an alternative to neonatal Norwood surgery, providing a less invasive initial palliation for HLHS. We describe our experience in extending the concept of the hybrid procedure to palliate neonates with anatomically compromised systemic arterial blood flow in a variety of congenital cardiac anomalies and supporting its application as first-line palliation in centers developing their HLHS programs. Retrospective review of patients undergoing therapy for HLHS at a single institution from June 2008 to December 2014 was performed. Subject demographics, clinical and procedural data, along with follow-up, were collected. Thirteen patients had initial hybrid palliation for HLHS during the time frame indicated at a median age of 8 days (range 1-29 days) and median weight of 3.4 kg (range 2.4-4.6 kg). Diagnoses included typical HLHS (n = 6), right-dominant unbalanced atrioventricular septal defect with arch hypoplasia (n = 4), double outlet right ventricle [subpulmonic VSD (n = 1) and intact ventricular septum (n = 1)] with hypoplastic transverse aortic arch and borderline left ventricular dimensions. Standard approach with bilateral pulmonary artery banding and ductal stenting was carried out in all thirteen patients. Two patients required two ductal stents at the time of index procedure. There were no intraprocedural complications. Median intubation length post-procedure was 4 days (range 1-74 days). Median hospital stay post-procedure was 47 days (range 15-270 days). The overall mortality rate on follow-up through comprehensive stage 2 over the 6-year experience was 38 % (5 out of 13). Of note, the mortality rate was significantly lower in the latter 3 years of the study period when the procedure was adopted as a primary palliation for HLHS (14 % or 1 out of 7) compared to the initial 3-year period when it was reserved for higher risk cohorts (67 % or 4 out of 6). Median time to subsequent surgery was 3 months (range 1-4 months). One patient required further ductal stenting on follow-up and developed subsequently airway compression. On median follow-up of 24 months, two patients required pulmonary artery arterioplasty. The hybrid procedure may be used for palliation for a variety of cardiac lesions to avoid high-risk surgery in the neonatal period. This approach may be also an alternative in centers performing lower number of Norwood surgery, which has been associated with higher mortality. PMID:26538212

  13. A practical review for cardiac rehabilitation professionals of continuous-flow left ventricular assist devices: historical and current perspectives.

    PubMed

    Compostella, Leonida; Russo, Nicola; Setzu, Tiziana; Bottio, Tomaso; Compostella, Caterina; Tarzia, Vincenzo; Livi, Ugolino; Gerosa, Gino; Iliceto, Sabino; Bellotto, Fabio

    2015-01-01

    An increasing number of patients with end-stage heart failure are being treated with continuous-flow left ventricular assist devices (cf-LVADs). These patients provide new challenges to the staff in exercise-based cardiac rehabilitation (CR) programs. Even though experience remains limited, it seems that patients supported by cf-LVADs may safely engage in typical rehabilitative activities, provided that some attention is paid to specific aspects, such as the presence of a short external drive line. In spite of initial physical deconditioning, CR allows progressive improvement of symptoms such as fatigue and dyspnea. Intensity of rehabilitative activities should ideally be based on measured aerobic capacity and increased appropriately over time. Regular, long-term exercise training results in improved physical fitness and survival rates. Appropriate adjustment of cf-LVAD settings, together with maintenance of adequate blood volume, provides maximal output, while avoiding suction effects. Ventricular arrhythmias, although not necessarily constituting an immediate life-threatening situation, deserve treatment as they could lead to an increased rate of hospitalization and poorer quality of life. Atrial fibrillation may worsen symptoms of right ventricular failure and reduce exercise tolerance. Blood pressure measurements are possible in cf-LVAD patients only using a Doppler technique, and a mean blood pressure ≤80 mmHg is considered "ideal." Some patients may present with orthostatic intolerance, related to autonomic dysfunction. While exercise training constitutes the basic rehabilitative tool, a comprehensive intervention that includes psychological and social support could better meet the complex needs of patients in which cf-LVAD may offer prolonged survival. PMID:25856733

  14. Wasted septal work in left ventricular dyssynchrony: a novel principle to predict response to cardiac resynchronization therapy

    PubMed Central

    Vecera, J.; Penicka, M.; Eriksen, M.; Russell, K.; Bartunek, J.; Vanderheyden, M.; Smiseth, O.A.

    2016-01-01

    Aims Cardiac resynchronization therapy (CRT) in heart failure is limited by many non-responders. This study explores whether degree of wasted left ventricular (LV) work identifies CRT responders. Methods and results Twenty-one patients who received CRT according to guidelines were studied before and after 8 ± 3 months. By definition, segments that shorten in systole perform positive work, whereas segments that lengthen do negative work. Work was calculated from non-invasive LV pressure and strain by speckle tracking echocardiography. For each myocardial segment and for the entire LV, wasted work was calculated as negative work in percentage of positive work. LV wall motion score index (WMSI) was assessed by echocardiography. Response to CRT was defined as ≥15% reduction in end-systolic volume (ESV). Responder rate to CRT was 71%. In responders, wasted work for septum was 117 ± 102%, indicating more negative than positive work, and decreased to 14 ± 12% with CRT (P < 0.01). In the LV free wall, wasted work was 19 ± 16% and showed no significant change. Global LV wasted work decreased from 39 ± 21 to 17 ± 7% with CRT (P < 0.01). In non-responders, there were no significant changes. In multiple linear regression analysis, septal wasted work and WMSI were the only significant predictors of ESV reduction (β = 0.14, P = 0.01; β = 1.25, P = 0.03). Septal wasted work together with WMSI showed an area under the curve of 0.86 (95% confidence interval 0.71–1.0) for CRT response prediction. Conclusion Wasted work in the septum together with WMSI was a strong predictor of response to CRT. This novel principle should be studied in future larger studies. PMID:26921169

  15. Left Atrial Function Following Surgical Ablation of Atrial Fibrillation: Prospective Evaluation Using Dual-Source Cardiac Computed Tomography

    PubMed Central

    Kim, Joon Bum; Yang, Dong Hyun; Kang, Joon-Won; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Song, Jae-Kwan

    2015-01-01

    Purpose The Maze procedure has shown excellent efficacy in the elimination of atrial fibrillation (AF); however, little is known about the quality of functional recovery in the left atrium (LA) following successful sinus rhythm conversion by the Maze procedure. Materials and Methods We prospectively enrolled 12 patients (aged 52.5±10.1 years, 1 female) with valvular AF undergoing mitral valve surgery combined with the Maze procedure. Parameters of LA function in three anatomic compartments [anterior, posterior, and LA appendage (LAA)] were evaluated using electrocardiography-gated dual-source cardiac CT at one month and at six months after surgery. Twelve subjects matched by age, gender, and body surface area served as controls. Results At one month after surgery, ejection fraction (EF) and emptying volume (EV) of the LA were 14.9±7.4% and 21.3±9.7 mL, respectively, and they were significantly lower than those of the control group (EF, 47.9±11.2%; EV, 46.0±10.7%; p<0001). These values did not significantly change throughout late periods (p=0.22 and 0.21, respectively). Functional contributions of the anterior, posterior, and appendage compartments (EV of each compartment/overall EV) were 80.4%, -0.9%, and 20.5%, respectively, for those with LAA preservation (n=6); 100.1%, -0.1%, and 0% for those with LAA resection (n=6; p<0.05); and 62.2%, 28.2%, and 9.7% in the control subjects (p<0.001). Conclusion Contractile functions of the LA significantly decreased after the Maze procedure. Functional contributions of three compartments of the LA were also altered. The influence of LAA preservation on postoperative LA functions needs to be evaluated through studies of larger populations. PMID:25837164

  16. Sci—Thur AM: YIS - 01: Dosimetric Analysis of Respiratory Induced Cardiac Intrafraction Motion in Left-sided Breast Cancer Radiotherapy

    SciTech Connect

    El-Sherif, O; Xhaferllari, I; Patrick, J; Yu, E; Gaede, S

    2014-08-15

    Introduction: Long-term cardiac side effects in left-sided breast cancer patients (BREL) after post-operative radiotherapy has become one of the most debated issues in radiation oncology. Through breathing-adapted radiotherapy the volume of the heart exposed to radiation can be significantly reduced by delivering the radiation only at the end of inspiration phase of the respiratory cycle, this is referred to as inspiration gating (IG). The purpose of this study is to quantify the potential reduction in cardiac exposure during IG compared to conventional BREL radiotherapy and to assess the dosimetric impact of cardiac motion due to natural breathing. Methods: 24 BREL patients treated with tangential parallel opposed photon beams were included in this study. All patients received a standard fast helical planning CT (FH-CT) and a 4D-CT. Treatment plans were created on the FH-CT using a clinical treatment planning system. The original treatment plan was then superimposed onto the end of inspiration CT and all 10 phases of the 4D-CT to quantify the dosimetric impact of respiratory motion and IG through 4D dose accumulation. Results: Through IG the mean dose to the heart, left ventricle, and left anterior descending artery (LAD) can be reduced in comparison to the clinical standard BREL treatment by as much as 8.39%, 10.11%, and 13.71% respectively (p < 0.05). Conclusion: Failure to account for respiratory motion can lead to under or overestimation in the calculated DVH for the heart, and it's sub-structures. IG can reduce cardiac exposure especially to the LAD during BREL radiotherapy.

  17. Dual chamber pacing in hypertrophic obstructive cardiomyopathy: beneficial effect of atrioventricular junction ablation for optimal left ventricular capture and filling.

    PubMed

    Jeanrenaud, X; Schläpfer, J; Fromer, M; Aebischer, N; Kappenberger, L

    1997-02-01

    Clinical improvement with dual chamber pacing has largely been reported in patients suffering from hypertrophic obstructive cardiomyopathy and mainly attributed to the reduction of the subaortic pressure gradient. To be effective, pacing must induce a permanent and complete capture of the LV. In two patients of our collective, symptoms (angina and dyspnea NYHA Class III and/or syncopes) persisted or relapsed despite pacing. This was related to the inability to obtain full LV capture due to a too-short native PR interval. RF ablation of the AV junction was therefore performed in both patients, resulting in permanent AV block in one and prolonged PR interval up 310 ms in the second. Pacing was thereafter associated with an immediate and significant clinical improvement related to permanent LV capture, whatever the patient's activity. After RF ablation, the AV delay was set up to induce the best LV filling, as assessed by Doppler analysis of mitral flow. Our observations suggest that RF ablation or modification of the AV junction can be a successful procedure in some patients with residual or recurrent symptoms, when the latter result from a loss of capture or from the inability to program an AV delay that does not compromise the active component to LV filling. Doppler echocardiography is a simple and effective mean to assess the hemodynamic effect of AV interval modulation in this setting. PMID:9058866

  18. Relationship between changes of chamber mechanical parameters and mean pressure-mean flow diagrams of the left ventricle.

    PubMed

    Negroni, J A; Lascano, E C; Pichel, R H

    1988-01-01

    A theoretical relationship between mean ventricular pressure (P) and mean ventricular outflow (Q) was developed based on a model of the left ventricle with elastic-resistive properties. Using a polynomial interpolation method, a fifth-order polynomial equation for the P-Q relationship was obtained. Its coefficients are functions of end-diastolic volume (VD), heart rate (HR), contractile state (CS), diastolic elastance (ED), asymmetry (S) of the elastance function E(t), and ventricular internal resistance factor (K). Effect of changes of these parameters indicated that normal and enhanced CS relations diverge toward the P axis but have a common intercept toward the Q axis. A similar effect was obtained with increased asymmetry of E(t). Changes in VD, HR and ED produced a parallel shift of the P-Q relation. The effect of K was negligible, however, which would reduce the description of the P-Q relationship to a third-order polynomial equation. A flow-dependent deactivation component was introduced, altering the asymmetry factor S, which decreases in a linear proportion to Q. This factor shifted the pump function graph downwards. We conclude that the theoretical description of the P-Q relation we present reproduces the experimental behavior of pump function diagrams reported in the literature (changes in VD, HR, and CS) and predicts the possible behavior due to other parameter changes. PMID:3400909

  19. Predictive Value of Beat-to-Beat QT Variability Index across the Continuum of Left Ventricular Dysfunction: Competing Risks of Non-cardiac or Cardiovascular Death, and Sudden or Non-Sudden Cardiac Death

    PubMed Central

    Tereshchenko, Larisa G.; Cygankiewicz, Iwona; McNitt, Scott; Vazquez, Rafael; Bayes-Genis, Antoni; Han, Lichy; Sur, Sanjoli; Couderc, Jean-Philippe; Berger, Ronald D.; de Luna, Antoni Bayes; Zareba, Wojciech

    2012-01-01

    Background The goal of this study was to determine the predictive value of beat-to-beat QT variability in heart failure (HF) patients across the continuum of left ventricular dysfunction. Methods and Results Beat-to-beat QT variability index (QTVI), heart rate variance (LogHRV), normalized QT variance (QTVN), and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca (MUSIC) HF study (mean age 63.1±11.7; males 70.6%; LVEF >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance (IDEAL) database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death [hazard ratio (HR) 1.67(95%CI 1.14-2.47), P=0.009] and in particular with non-sudden cardiac death [HR 2.91(1.69-5.01), P<0.001]. Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular [HR 1.57(1.04-2.35), P=0.031], and non-sudden cardiac death in multivariate competing risk model [HR 2.58(1.13-3.78), P=0.001]. No interaction between QTVI and LVEF was found. QTVI predicted neither non-cardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability (HRV) rather than increased QT variability was the reason for increased QTVI in this study. Conclusions Increased QTVI due to depressed HRV predicts cardiovascular mortality and non-sudden cardiac death, but neither SCD nor excracardiac mortality in HF across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from HF patients at risk. PMID:22730411

  20. Left ventricular diastolic dysfunction in Nrf2 knock out mice is associated with cardiac hypertrophy, decreased expression of SERCA2a, and preserved endothelial function.

    PubMed

    Erkens, Ralf; Kramer, Christian M; Lückstädt, Wiebke; Panknin, Christina; Krause, Lisann; Weidenbach, Mathias; Dirzka, Jennifer; Krenz, Thomas; Mergia, Evanthia; Suvorava, Tatsiana; Kelm, Malte; Cortese-Krott, Miriam M

    2015-12-01

    Increased production of reactive oxygen species and failure of the antioxidant defense system are considered to play a central role in the pathogenesis of cardiovascular disease. The transcription factor nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is a key master switch controlling the expression of antioxidant and protective enzymes, and was proposed to participate in protection of vascular and cardiac function. This study was undertaken to analyze cardiac and vascular phenotype of mice lacking Nrf2. We found that Nrf2 knock out (Nrf2 KO) mice have a left ventricular (LV) diastolic dysfunction, characterized by prolonged E wave deceleration time, relaxation time and total diastolic time, increased E/A ratio and myocardial performance index, as assessed by echocardiography. LV dysfunction in Nrf2 KO mice was associated with cardiac hypertrophy, and a downregulation of the sarcoplasmic reticulum Ca(2+)-ATPase (SERCA2a) in the myocardium. Accordingly, cardiac relaxation was impaired, as demonstrated by decreased responses to β-adrenergic stimulation by isoproterenol ex vivo, and to the cardiac glycoside ouabain in vivo. Surprisingly, we found that vascular endothelial function and endothelial nitric oxide synthase (eNOS)-mediated vascular responses were fully preserved, blood pressure was decreased, and eNOS was upregulated in the aorta and the heart of Nrf2 KO mice. Taken together, these results show that LV dysfunction in Nrf2 KO mice is mainly associated with cardiac hypertrophy and downregulation of SERCA2a, and is independent from changes in coronary vascular function or systemic hemodynamics, which are preserved by a compensatory upregulation of eNOS. These data provide new insights into how Nrf2 expression/function impacts the cardiovascular system. PMID:26475037

  1. Complex cardiac congenital defects in an adult dog: An ultrasonographic and magnetic resonance imaging study

    PubMed Central

    García-Rodríguez, M. Belén; Granja, M. Angeles Ríos; García, C. César Pérez; Gonzalo Orden, Jose M.; Cano Rábano, Maria J.; Prieto, Inmaculada Diez

    2009-01-01

    This article describes a complex and not previously reported combination of congenital cardiac defects. Echocardiography showed dilation of right and left chambers, accompanied with patent ductus arteriosus, persistence of the left cranial vena cava, atrial septal defect (ASD), subaortic stenosis, and tricuspid dysplasia. The interatrial wall was examined and the diameter of the ASD was measured by magnetic resonance imaging (MRI). PMID:19949552

  2. Postmortem mRNA Expression Patterns in Left Ventricular Myocardial Tissues and Their Implications for Forensic Diagnosis of Sudden Cardiac Death

    PubMed Central

    Son, Gi Hoon; Park, Seong Hwan; Kim, Yunmi; Kim, Ji Yeon; Kim, Jin Wook; Chung, Sooyoung; Kim, Yu-Hoon; Kim, Hyun; Hwang, Juck-Joon; Seo, Joong-Seok

    2014-01-01

    Sudden cardiac death (SCD), which is primarily caused by lethal heart disorders resulting in structural and arrhythmogenic abnormalities, is one of the prevalent modes of death in most developed countries. Myocardial ischemia, mainly due to coronary artery disease, is the most common type of heart disease leading to SCD. However, postmortem diagnosis of SCD is frequently complicated by obscure histological evidence. Here, we show that certain mRNA species, namely those encoding hemoglobin A1/2 and B (Hba1/2 and Hbb, respectively) as well as pyruvate dehydrogenase kinase 4 (Pdk4), exhibit distinct postmortem expression patterns in the left ventricular free wall of SCD subjects when compared with their expression patterns in the corresponding tissues from control subjects with non-cardiac causes of death. Hba1/2 and Hbb mRNA expression levels were higher in ischemic SCD cases with acute myocardial infarction or ischemic heart disease without recent infarction, and even in cardiac death subjects without apparent pathological signs of heart injuries, than control subjects. By contrast, Pdk4 mRNA was expressed at lower levels in SCD subjects. In conclusion, we found that altered myocardial Hba1/2, Hbb, and Pdk4 mRNA expression patterns can be employed as molecular signatures of fatal cardiac dysfunction to forensically implicate SCD as the primary cause of death. PMID:24642708

  3. A Comprehensive Analysis of Cardiac Dose in Balloon-Based High-Dose-Rate Brachytherapy for Left-Sided Breast Cancer

    SciTech Connect

    Valakh, Vladimir; Kim, Yongbok; Werts, E. Day; Trombetta, Mark G.

    2012-04-01

    Purpose: To investigate radiation dose to the heart in 60 patients with left-sided breast cancer who were treated with balloon-based high-dose-rate brachytherapy using MammoSite or Contura applicators. Methods and Materials: We studied 60 consecutive women with breast cancer who were treated with 34 Gy in 10 twice-daily fractions using MammoSite (n = 37) or Contura (n = 23) applicators. The whole heart and the left and right ventricles were retrospectively delineated, and dose-volume histograms were analyzed. Multiple dosimetrics were reported, such as mean dose (D{sub mean}); relative volume receiving 1.7, 5, 10, and 20 Gy (V1.7, V5, V10, and V20, respectively); dose to 1 cc (D{sub 1cc}); and maximum point dose (D{sub max}). Biologic metrics, biologically effective dose and generalized equivalent uniform dose were computed. The impact of lumpectomy cavity location on cardiac dose was investigated. Results: The average {+-} standard deviation of D{sub mean} was 2.45 {+-} 0.94 Gy (range, 0.56-4.68) and 3.29 {+-} 1.28 Gy (range, 0.77-6.35) for the heart and the ventricles, respectively. The average whole heart V5 and V10 values were 10.2% and 1.3%, respectively, and the heart D{sub max} was >20 Gy in 7 of 60 (11.7%) patients and >25 Gy in 3 of 60 (5%) patients. No cardiac tissue received {>=}30 Gy. The V1.7, V5, V10, V20, and D{sub mean} values were all higher for the ventricles than for the whole heart. For balloons located in the upper inner quadrant of the breast, the average whole heart D{sub mean} was highest. The D{sub mean}, biologically effective dose, and generalized equivalent uniform dose values for heart and ventricles decreased with increasing minimal distance from the surface of the balloon. Conclusions: On the basis of these comprehensive cardiac dosimetric data, we recommend that cardiac dose be routinely reported and kept as low as possible in balloon-based high-dose-rate brachytherapy treatment planning for patients with left-sided breast cancer so the correlation with future cardiac toxicity data can be investigated.

  4. Geometric and Dosimetric Approach to Determine Probability of Late Cardiac Mortality in Left Tangential Breast Irradiation: Comparison Between Wedged Beams and Field-in-Field Technique

    SciTech Connect

    Pili, Giorgio; Grimaldi, Luca; Fidanza, Christian; Florio, Elena T.; Petruzzelli, Maria F.; D'Errico, Maria P.; De Tommaso, Cristina; Tramacere, Francesco; Musaio, Francesca; Castagna, Roberta; Francavilla, Maria C.; Gianicolo, Emilio A.L.; Portaluri, Maurizio

    2011-11-01

    Purpose: To evaluate the probability of late cardiac mortality resulting from left breast irradiation planned with tangential fields and to compare this probability between the wedged beam and field-in-field (FIF) techniques and to investigate whether some geometric/dosimetric indicators can be determined to estimate the cardiac mortality probability before treatment begins. Methods and Materials: For 30 patients, differential dose-volume histograms were calculated for the wedged beam and FIF plans, and the corresponding cardiac mortality probabilities were determined using the relative seriality model. As a comparative index of the dose distribution uniformity, the planning target volume (PTV) percentages involved in 97-103% of prescribed dose were determined for the two techniques. Three geometric parameters were measured for each patient: the maximal length, indicates how much the heart contours were displaced toward the PTV, the angle subtended at the center of the computed tomography slice by the PTV contour, and the thorax width/thickness ratio. Results: Evaluating the differential dose-volume histograms showed that the gain in uniformity between the two techniques was about 1.5. With the FIF technique, the mean dose sparing for the heart, the left anterior descending coronary artery, and the lung was 15% (2.5 Gy vs. 2.2 Gy), 21% (11.3 Gy vs. 9.0 Gy), and 42% (8.0 Gy vs. 4.6 Gy) respectively, compared with the wedged beam technique. Also, the cardiac mortality probability decreased by 40% (from 0.9% to 0.5%). Three geometric parameters, the maximal length, angle subtended at the center of the computed tomography slice by the PTV contour, and thorax width/thickness ratio, were the determining factors (p = .06 for FIF, and p = .10 for wedged beam) for evaluating the cardiac mortality probability. Conclusion: The FIF technique seemed to yield a lower cardiac mortality probability than the conventional wedged beam technique. However, although our study demonstrated that FIF technique improved the dose coverage of the PTV, the restricted number of patients enrolled and the short follow-up did not allow us to evaluate and compare the breast cancer survival rates of the patients.

  5. Minimally invasive implantation of an extracorporeal membrane oxygenation circuit used as a temporary left ventricular assist device: a new concept for bridging to permanent cardiac support.

    PubMed

    Saito, Shunsuke; Fleischer, Bernhard; Maeß, Christoph; Baraki, Hassina; Kutschka, Ingo

    2015-03-01

    The implantation of cardiac assist devices is associated with poor outcome in patients with multiple organ failure and unknown neurologic status. Therefore, temporary left ventricular assist devices (LVAD) using, for example, extracorporeal centrifugal pumps may provide the chance to further evaluate the patient's clinical course and a potential qualification for implantable LVAD therapy. On the other hand, a main disadvantage of the temporary LVAD implantation is the need for redo surgery, increasing the risk of the final LVAD Implantation. To minimize this drawback of the temporary LVAD implantation, we implanted the temporary LVAD using a minimally invasive technique. The operation was done without cardiopulmonary bypass support, and the temporary LVAD was implanted through upper hemisternotomy and left anterior mini-thoracotomy. The patient recovered from multiple organ failure and was successfully bridged to a permanent LVAD therapy. PMID:25370719

  6. Exercise effects on cardiac size and left ventricular diastolic function: relationships to changes in fitness, fatness, blood pressure and insulin resistance

    PubMed Central

    Stewart, K J; Ouyang, P; Bacher, A C; Lima, S; Shapiro, E P

    2006-01-01

    Objectives To determine exercise training effects on cardiac size and left ventricular (LV) diastolic function and relationships of exercise induced changes in physiological and body composition parameters with cardiac parameters. Design Prospective, randomised controlled trial. Subjects Men and women (63.6 (5.7) years, body mass index 29.5 (4.4) kg/m2) with untreated hypertension (systolic blood pressure (BP) 130–159 or diastolic BP 85–99 mm Hg). Main outcome measures Cardiac size and LV diastolic function, peak oxygen uptake (Vo2), muscle strength, general and abdominal fatness, and insulin resistance. Interventions 6 months of exercise training versus usual care. Results When analysed by group at six months, cardiac size and LV diastolic function did not differ between exercisers (n  =  51) and controls (n  =  53), whereas exercisers had significantly higher peak Vo2 (28 v 24 ml/kg/min) and strength (383 v 329 kg), and lower fatness (34% v 37%), diastolic BP (73 v 75 mm Hg) and insulin resistance (quantitative insulin sensitivity check index 0.35 v 0.34) versus controls (all p ⩽ 0.05). By regression analysis, among six month changes, increased peak Vo2 and reduced abdominal fat were associated with increased cardiac size. Increased peak Vo2 and reduced abdominal fat, BP and insulin resistance were associated with improved LV diastolic function. r Values ranged from 0.20 to 0.32 (p ⩽ 0.05). Conclusions When examined by group assignment, exercise had no effect on cardiac size or LV diastolic function. When individual variations in six month changes were examined, participants attaining the greatest increases in fitness and reductions in abdominal fatness, insulin resistance and BP showed a modest trend towards physiological hypertrophy characterised by increased cardiac size and improved LV diastolic function. These results suggest that decreased abdominal fatness may have a role in improving cardiovascular health. PMID:16308413

  7. Hypoplastic left heart syndrome

    MedlinePlus

    ... with two of these connections: Foramen ovale (a hole between the right and left atrium) Ductus arteriosus ( ... foramen ovale or an atrial septal defect (a hole connecting the collecting chambers on the left and ...

  8. The number of cardiac myocytes in the hypertrophic and hypotrophic left ventricle of the obese and calorie-restricted mouse heart.

    PubMed

    Schipke, Julia; Banmann, Ewgenija; Nikam, Sandeep; Voswinckel, Robert; Kohlstedt, Karin; Loot, Annemarieke E; Fleming, Ingrid; Mühlfeld, Christian

    2014-11-01

    Changes in body mass due to varying amounts of calorie intake occur frequently with obesity and anorexia/cachexia being at opposite sides of the scale. Here, we tested whether a high-fat diet or calorie restriction (CR) decreases the number of cardiac myocytes and affects their volume. Ten 6-8-week-old mice were randomly assigned to a normal (control group, n = 5) or high-fat diet (obesity group, n = 5) for 28 weeks. Ten 8-week-old mice were randomly assigned to a normal (control group, n = 5) or CR diet (CR group, n = 5) for 7 days. The left ventricles of the hearts were prepared for light and electron microscopy, and analysed by design-based stereology. In CR, neither the number of cardiac myocytes, the relationship between one- and multinucleate myocytes nor their mean volume were significantly different between the groups. In contrast, in the obese mice we observed a significant increase in cell size combined with a lower number of cardiomyocytes (P < 0.05 in the one-sided U-test) and an increase in the mean number of nuclei per myocyte. The mean volume of myofibrils and mitochondria per cardiac myocyte reflected the hypertrophic and hypotrophic remodelling in obesity and CR, respectively, but were only significant in the obese mice, indicating a more profound effect of the obesity protocol than in the CR experiments. Taken together, our data indicate that long-lasting obesity is associated with a loss of cardiomyocytes of the left ventricle, but that short-term CR does not alter the number of cardiomyocytes. PMID:25322944

  9. Lactate Up-Regulates the Expression of Lactate Oxidation Complex-Related Genes in Left Ventricular Cardiac Tissue of Rats

    PubMed Central

    Gabriel-Costa, Daniele; da Cunha, Telma Fatima; Bechara, Luiz Roberto Grassmann; Fortunato, Rodrigo Soares; Bozi, Luiz Henrique Marchesi; Coelho, Marcele de Almeida; Barreto-Chaves, Maria Luiza; Brum, Patricia Chakur

    2015-01-01

    Background Besides its role as a fuel source in intermediary metabolism, lactate has been considered a signaling molecule modulating lactate-sensitive genes involved in the regulation of skeletal muscle metabolism. Even though the flux of lactate is significantly high in the heart, its role on regulation of cardiac genes regulating lactate oxidation has not been clarified yet. We tested the hypothesis that lactate would increase cardiac levels of reactive oxygen species and up-regulate the expression of genes related to lactate oxidation complex. Methods/Principal Findings Isolated hearts from male adult Wistar rats were perfused with control, lactate or acetate (20mM) added Krebs-Henseleit solution during 120 min in modified Langendorff apparatus. Reactive oxygen species (O2●-/H2O2) levels, and NADH and NADPH oxidase activities (in enriched microsomal or plasmatic membranes, respectively) were evaluated by fluorimetry while SOD and catalase activities were evaluated by spectrophotometry. mRNA levels of lactate oxidation complex and energetic enzymes MCT1, MCT4, HK, LDH, PDH, CS, PGC1α and COXIV were quantified by real time RT-PCR. Mitochondrial DNA levels were also evaluated. Hemodynamic parameters were acquired during the experiment. The key findings of this work were that lactate elevated cardiac NADH oxidase activity but not NADPH activity. This response was associated with increased cardiac O2●-/H2O2 levels and up-regulation of MCT1, MCT4, LDH and PGC1α with no changes in HK, PDH, CS, COXIV mRNA levels and mitochondrial DNA levels. Lactate increased NRF-2 nuclear expression and SOD activity probably as counter-regulatory responses to increased O2●-/H2O2. Conclusions Our results provide evidence for lactate-induced up-regulation of lactate oxidation complex associated with increased NADH oxidase activity and cardiac O2●-/H2O2 driving to an anti-oxidant response. These results unveil lactate as an important signaling molecule regulating components of the lactate oxidation complex in cardiac muscle. PMID:25996919

  10. Combined score using clinical, electrocardiographic, and echocardiographic parameters to predict left ventricular remodeling in patients having had cardiac resynchronization therapy six months earlier.

    PubMed

    Brunet-Bernard, Anne; Maréchaux, Sylvestre; Fauchier, Laurent; Guiot, Aurélie; Fournet, Maxime; Reynaud, Amélie; Schnell, Frédéric; Leclercq, Christophe; Mabo, Philippe; Donal, Erwan

    2014-06-15

    The aim of this study was to evaluate whether a scoring system integrating clinical, electrocardiographic, and echocardiographic measurements can predict left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). The derivation cohort consisted of 162 patients with heart failure implanted with a CRT device. Baseline clinical, electrocardiographic, and echocardiographic characteristics were entered into univariate and multivariate models to predict reverse remodeling as defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months (60%). Combinations of predictors were then tested under different scoring systems. A new 7-point CRT response score termed L2ANDS2: Left bundle branch block (2 points), Age >70 years, Nonischemic origin, left ventricular end-diastolic Diameter <40 mm/m(2), and Septal flash (2 points) was calculated for these patients. This score was then validated against a validation cohort of 45 patients from another academic center. A highly significant incremental predictive value was noted when septal flash was added to an initial 4-factor model including left bundle branch block (difference between area under the curve C statistics = 0.125, p <0.001). The predictive accuracy using the L2ANDS2 score was then 0.79 for the C statistic. Application of the new score to the validation cohort (71% of responders) gave a similar C statistic (0.75). A score >5 had a high positive likelihood ratio (+LR = 5.64), whereas a score <2 had a high negative likelihood ratio (-LR = 0.19). In conclusion, this L2ANDS2 score provides an easy-to-use tool for the clinician to assess the pretest probability of a patient being a CRT responder. PMID:24793667

  11. MicroRNA expression profiles of human left ventricle derived cardiac cells in normoxic and hypoxic conditions.

    PubMed

    Chen, Yei-Tsung; Liew, Oi-Wah; Richards, Arthur Mark

    2015-09-01

    Studies in the cardiovascular research field have demonstrated the vital roles of microRNAs for proper cardiovascular development and functional maintenance. The involvement of aberrant microRNA expression leading to ontogenesis of cardiovascular diseases lends further support of the regulatory role of microRNAs in heart function. Hypoxic insult is one of the major factors that trigger downstream signal cascades which contribute to the pathogenesis of hypoxic/ischemic-related heart diseases. Here, we report the microRNA expression profile in human cardiac-derived cells subjected to 120-h hypoxic treatment. By comparing with the normoxic control state, we identified microRNAs differentially expressed in cardiac cells subjected to hypoxic challenge. MicroRNA microarray data are available at NCBI under the GEO accession number, GSE55387. PMID:26484225

  12. [Assessment of structure and cardiac function of the left ventricle in young men with family history of hypertension].

    PubMed

    Balwierz, Paweł; Grzeszczak, Władysław

    2003-01-01

    Hypertension belongs to the group of most frequent illnesses of the circulatory system; especially due to its spread and great effects. It is determined as one of the most important medical, social and economical problems. The purpose of these studies was to find answers to questions, if young men between the ages of 18-30 with family medical hypertension history have a difference in middle systolic, diastolic and mean blood pressure in comparison to an analogical group without familiar hypertension. The influence of blood pressure on central circulatory system, such as the heart was also evaluated--measurements of left atrium and ventricular thickness and LV mass were made. Analysis was made of velocities through left atrioventricular ostium and aortic ostium system searching for early indexes of systolic and diastolic left ventricular dysfunction. 24-hour blood pressure registration was made by means of ERKA machine with frequency three times a hour during daily activity (6 a.m.-10 p.m.) and one time a hour during the night (10 p.m.-6 a.m.), arranging in this way 57 time points (measuring points). From the midst of evaluated parameters, morphology of the left heart the major difference was caused in the thickness of left ventricular posterior wall (p < 0.03) and in the mass counted after Penn convention (p < 0.02) and mass index (p < 0.05) of the left ventricular heart. There was no differences in reality in systolic and diastolic functions of the left ventricular heart. Parameters of the systolic function (ejection fraction, fractional shortening, mean rate of circumferential shortening of left ventricle, aortal integration flow) were minimally better in the group with familiar hypertension medical history, and parameters of diastolic function (mitral flow--analysis of its ingredients) in the group without family hypertension medical history. A significant linear regression was obtained between: mean systolic pressure from daily activity, 24-hour mean systolic pressure of left ventricular mass in both groups but significantly was higher in the group with family hypertension. PMID:15065334

  13. Assessment of dedicated low-dose cardiac micro-CT reconstruction algorithms using the left ventricular volume of small rodents as a performance measure

    SciTech Connect

    Maier, Joscha; Sawall, Stefan; Kachelrieß, Marc

    2014-05-15

    Purpose: Phase-correlated microcomputed tomography (micro-CT) imaging plays an important role in the assessment of mouse models of cardiovascular diseases and the determination of functional parameters as the left ventricular volume. As the current gold standard, the phase-correlated Feldkamp reconstruction (PCF), shows poor performance in case of low dose scans, more sophisticated reconstruction algorithms have been proposed to enable low-dose imaging. In this study, the authors focus on the McKinnon-Bates (MKB) algorithm, the low dose phase-correlated (LDPC) reconstruction, and the high-dimensional total variation minimization reconstruction (HDTV) and investigate their potential to accurately determine the left ventricular volume at different dose levels from 50 to 500 mGy. The results were verified in phantom studies of a five-dimensional (5D) mathematical mouse phantom. Methods: Micro-CT data of eight mice, each administered with an x-ray dose of 500 mGy, were acquired, retrospectively gated for cardiac and respiratory motion and reconstructed using PCF, MKB, LDPC, and HDTV. Dose levels down to 50 mGy were simulated by using only a fraction of the projections. Contrast-to-noise ratio (CNR) was evaluated as a measure of image quality. Left ventricular volume was determined using different segmentation algorithms (Otsu, level sets, region growing). Forward projections of the 5D mouse phantom were performed to simulate a micro-CT scan. The simulated data were processed the same way as the real mouse data sets. Results: Compared to the conventional PCF reconstruction, the MKB, LDPC, and HDTV algorithm yield images of increased quality in terms of CNR. While the MKB reconstruction only provides small improvements, a significant increase of the CNR is observed in LDPC and HDTV reconstructions. The phantom studies demonstrate that left ventricular volumes can be determined accurately at 500 mGy. For lower dose levels which were simulated for real mouse data sets, the HDTV algorithm shows the best performance. At 50 mGy, the deviation from the reference obtained at 500 mGy were less than 4%. Also the LDPC algorithm provides reasonable results with deviation less than 10% at 50 mGy while PCF and MKB reconstruction show larger deviations even at higher dose levels. Conclusions: LDPC and HDTV increase CNR and allow for quantitative evaluations even at dose levels as low as 50 mGy. The left ventricular volumes exemplarily illustrate that cardiac parameters can be accurately estimated at lowest dose levels if sophisticated algorithms are used. This allows to reduce dose by a factor of 10 compared to today's gold standard and opens new options for longitudinal studies of the heart.

  14. N-Terminal Pro-B-Type Natriuretic Peptide Plasma Levels as a Potential Biomarker for Cardiac Damage After Radiotherapy in Patients With Left-Sided Breast Cancer

    SciTech Connect

    D'Errico, Maria P.; Grimaldi, Luca; Petruzzelli, Maria F.; Gianicolo, Emilio A.L.; Tramacere, Francesco; Monetti, Antonio; Placella, Roberto; Pili, Giorgio; Andreassi, Maria Grazia; Sicari, Rosa; Picano, Eugenio; Portaluri, Maurizio

    2012-02-01

    Purpose: Adjuvant radiotherapy (RT) after breast-conserving surgery has been associated with increased cardiovascular mortality. Cardiac biomarkers may aid in identifying patients with radiation-mediated cardiac dysfunction. We evaluated the correlation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin (TnI) and the dose of radiation to the heart in patients with left-sided breast cancer. Methods and Materials: NT-proBNP and TnI plasma concentrations were measured in 30 left-sided breast cancer patients (median age, 55.0 years) 5 to 22 months after RT (Group I) and in 30 left-sided breast cancer patients (median age, 57.0 years) before RT as control group (Group II). Dosimetric and geometric parameters of heart and left ventricle were determined in all patients of Group I. Seventeen patients underwent complete two-dimensional echocardiography. Results: NT-proBNP levels were significantly higher (p = 0.03) in Group I (median, 90.0 pg/ml; range, 16.7-333.1 pg/ml) than in Group II (median, 63.2 pg/ml; range, 11.0-172.5 pg/ml). TnI levels remained below the cutoff threshold of 0.07 ng/ml in both groups. In patients with NT-proBNP values above the upper limit of 125 pg/ml, there were significant correlations between plasma levels and V{sub 3Gy}(%) (p = 0.001), the ratios D{sub 15cm{sup 3}}(Gy)/D{sub mean}(Gy) (p = 0.01), the ratios D{sub 15cm}{sup 3}/D{sub 50%} (Gy) (p = 0.008) for the heart and correlations between plasma levels and V{sub 2Gy} (%) (p = 0.002), the ratios D{sub 1cm{sup 3}}(Gy)/D{sub mean}(Gy) (p = 0.03), and the ratios D{sub 0.5cm{sup 3}}(Gy)/D{sub 50%}(Gy) (p = 0.05) for the ventricle. Conclusions: Patients with left-sided breast cancer show higher values of NT-pro BNP after RT when compared with non-RT-treated matched patients, increasing in correlation with high doses in small volumes of heart and ventricle. The findings of this study show that the most important parameters are not the mean doses but instead the small percentage of organ volumes (heart or ventricle) receiving high dose levels, supporting the notion that the heart behaves as a serial organ.

  15. Sudden cardiac arrest associated with an anomalous aortic origin of the left coronary artery from the opposite sinus of valsalva.

    PubMed

    Shimizu, Takeshi; Iwaya, Shoji; Suzuki, Satoshi; Sakamoto, Nobuo; Sugimoto, Koichi; Nakazato, Kazuhiko; Suzuki, Hitoshi; Nishimura, Tomomi; Takahashi, Yukihiro; Saito, Shuichi; Takeishi, Yasuchika

    2014-01-01

    A 13-year-old boy was brought to our hospital after recovering from ventricular fibrillation that occurred after an episode of chest pain during training with his soccer team. Subsequent 64-slice multidetector computed tomography revealed the left coronary artery arising from the right sinus of Valsalva, which coursed between the ascending aorta and root of the main pulmonary artery. Surgical correction including unroofing of the left coronary ostium and pulmonary artery translocation was performed successfully. One year later, he remained asymptomatic and was back on his soccer team. PMID:25400182

  16. Transient left ventricular systolic dysfunction following surgical closure of large patent ductus arteriosus among children and adolescents operated at the cardiac centre, Ethiopia

    PubMed Central

    2013-01-01

    Background Patent ductus arteriosus (PDA) is one of the commonest congenital heart diseases that require closure within the first few months after birth. The residential area of patients affects the size of the PDA: living in highlands, like most places in Ethiopia, is a risk for having larger sized PDA. Closure of these congenital heart defects is usually performed at an early age in places where capable centers are available. In Ethiopia, closure of these defects is done on mission basis often at an older age. Recently, limited reports came about the occurrence of postoperative left ventricular systolic dysfunction (POLVD) following closure of PDA though full explanation is still lacking. Objective To determine the rate of and time to improvement of POLVD and the factors associated with it in children and adolescents who underwent surgical closure of PDA. Method All children and adolescents who underwent surgical closure of PDA at the Cardiac Center, Ethiopia (CCE) had postoperative follow up with echocardiography. Serial left ventricular ejection fraction (LVEF) and fiber shortening (FS) values were recorded for all of them. SPSS 20 was used to analyze the data. Results A total of 36 children and adolescents who underwent surgical closure of PDA from January 2009 to December 2012 and who fulfilled the inclusion criteria were studied. Their mean age at intervention was 8.52years (SD?=?5.23years), 77.80% were females. The mean duct size as determined by either echocardiography or intra-operative by the surgeon was 10.31mm (SD?=?3.20mm). They were followed for a mean duration of 24.80months (SD?=?12.36months) following surgical closure of PDA. The mean LVEF and FS decreased from 65.06% and 35.28% preoperatively to 54.83% and 28.40% post-operatively respectively. Fifteen (42.86%) of the patients had a post-operative LVEF of less than 55%. The mean time to normalization of systolic function was 5.11weeks (SD?=?3.30weeks). Having an associated cardiac lesion was an independent predictor of POLVD. Conclusions We conclude that there is a high rate of POLVD following surgical closure of large PDA in highlanders. We recommend a serial and systematic follow up of these children postoperatively. Those with a significant cardiac dysfunction may need cardiac medications like Angiotensin Converting Enzyme Inhibitors (ACEI). PMID:23721219

  17. INTRACORONARY ADMINISTRATION OF CARDIAC PROGENITOR CELLS ALLEVIATES LEFT VENTRICULAR DYSFUNCTION IN RATS WITH A 30-DAY OLD INFARCTION

    PubMed Central

    Tang, Xian-Liang; Rokosh, Gregg; Sanganalmath, Santosh K.; Yuan, Fangping; Sato, Hiroshi; Mu, Jianyao; Dai, Shujing; Li, Chengxin; Chen, Ning; Peng, Yong; Dawn, Buddhadeb; Hunt, Greg; Leri, Annarosa; Kajstura, Jan; Tiwari, Sumit; Shirk, Gregg; Anversa, Piero; Bolli, Roberto

    2010-01-01

    Background Administration of cardiac progenitor cells (CPCs) 4 h after reperfusion ameliorates LV function in rats with acute myocardial infarction (MI). Clinically, however, this approach is not feasible because expansion of autologous CPCs after acute MI requires several weeks. Therefore, we determined whether CPCs are beneficial in the more clinically relevant setting of an old MI (scar). Methods and Results One month after coronary occlusion/reperfusion, rats received vehicle or EGFP-labeled CPCs intracoronarily. Thirty-five days later, CPC-treated rats exhibited more viable myocardium in the risk region, less fibrosis in the noninfarcted region, and improved LV function. EGFPpos cells expressing cardiomyocyte, endothelial, and vascular smooth muscle cell markers were observed only in 7/17 treated rats and occupied only 2.6% and 1.1% of risk and noninfarcted regions, respectively. Transplantation of CPCs was associated with increased proliferation and expression of cardiac proteins by endogenous CPCs. Conclusions Intracoronary administration of CPCs in the setting of an old MI produces beneficial structural and functional effects. Although exogenous CPCs can differentiate into new cardiac cells, this mechanism is not sufficient to explain the benefits, suggesting paracrine effects; among these, our data identify activation of endogenous CPCs. This is the first report that CPCs are beneficial in the setting of an old MI when given intracoronarily – the most widely applicable therapeutic approach in patients. Furthermore, this is the first evidence that exogenous CPC administration activates endogenous CPCs. These results open new therapeutic applications for use of autologous CPCs in patients with old MI and chronic ischemic cardiomyopathy. PMID:20048209

  18. Chronic obstructive pulmonary disease and left ventricle.

    PubMed

    Portillo, Karina; Abad-Capa, Jorge; Ruiz-Manzano, Juan

    2015-05-01

    Several studies have shown that the interaction between chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidity is complex and bidirectional, since each of these diseases complicates the prognosis of the other. Recent advances in imaging technology have led to better characterization of cardiac chambers and allowed the relationship between certain cardiac function parameters and COPD clinical and functional variables to be explored. Although cardiac abnormalities in COPD have been mainly associated with the right ventricle, several studies have reported that the left ventricle may also be affected in this disease. A better understanding of the mechanisms involved and their clinical implications will establish diagnostic and therapeutic strategies for patients with both these conditions. PMID:24816034

  19. Finite element stress analysis of the human left ventricle whose irregular shape is developed from single plane cineangiocardiogram

    NASA Technical Reports Server (NTRS)

    Ghista, D. N.; Hamid, M. S.

    1977-01-01

    The three-dimensional left ventricular chamber geometrical model is developed from single plane cineangiocardiogram. This left ventricular model is loaded by an internal pressure monitored by cardiac catheterization. The resulting stresses in the left ventricular model chamber's wall are determined by computerized finite element procedure. For the discretization of this left ventricular model structure, a 20-node, isoparametric finite element is employed. The analysis and formulation of the computerised procedure is presented in the paper, along with the detailed algorithms and computer programs. The procedure is applied to determine the stresses in a left ventricle at an instant, during systole. Next, a portion (represented by a finite element) of this left ventricular chamber is simulated as being infarcted by making its active-state modulus value equal to its passive-state value; the neighbouring elements are shown to relieve the 'infarcted' element of stress by themselves taking on more stress.

  20. Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs.

    PubMed

    Xu, Da; Olivier, N Bari; Mukkamala, Ramakrishna

    2009-02-01

    We developed a technique to continuously (i.e., automatically) monitor cardiac output (CO) and left atrial pressure (LAP) by mathematical analysis of the pulmonary artery pressure (PAP) waveform. The technique is unique to the few previous related techniques in that it jointly estimates the two hemodynamic variables and analyzes the PAP waveform over time scales greater than a cardiac cycle wherein wave reflections and inertial effects cease to be major factors. First, a 6-min PAP waveform segment is analyzed so as to determine the pure exponential decay and equilibrium pressure that would eventually result if cardiac activity suddenly ceased (i.e., after the confounding wave reflections and inertial effects vanish). Then, the time constant of this exponential decay is computed and assumed to be proportional to the average pulmonary arterial resistance according to a Windkessel model, while the equilibrium pressure is regarded as average LAP. Finally, average proportional CO is determined similar to invoking Ohm's law and readily calibrated with one thermodilution measurement. To evaluate the technique, we performed experiments in five dogs in which the PAP waveform and accurate, but highly invasive, aortic flow probe CO and LAP catheter measurements were simultaneously recorded during common hemodynamic interventions. Our results showed overall calibrated CO and absolute LAP root-mean-squared errors of 15.2% and 1.7 mmHg, respectively. For comparison, the root-mean-squared error of classic end-diastolic PAP estimates of LAP was 4.7 mmHg. On future successful human testing, the technique may potentially be employed for continuous hemodynamic monitoring in critically ill patients with pulmonary artery catheters. PMID:19057003

  1. Circulating Endothelial Cells and Endothelial Function Predict Major Adverse Cardiac Events and Early Adverse Left Ventricular Remodeling in Patients With ST-Segment Elevation Myocardial Infarction.

    PubMed

    Abdel Hamid, Magdy; Bakhoum, Sameh Wg; Sharaf, Yasser; Sabry, Dina; El-Gengehe, Ahmed T; Abdel-Latif, Ahmed

    2016-02-01

    Endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) are mobilized from the bone marrow and increase in the early phase after ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the prognostic significance of CECs and indices of endothelial dysfunction in patients with STEMI. In 78 patients with acute STEMI, characterization of CD34+/VEGFR2+CECs, and indices of endothelial damage/dysfunction such as brachial artery flow mediated dilatation (FMD) were determined. Blood samples for CECs assessment and quantification were obtained within 24 hours of admission and FMD was assessed during the index hospitalization. At 30 days follow up, the primary composite end point of major adverse cardiac events (MACE) consisting of all-cause mortality, recurrent nonfatal MI, or heart failure and the secondary endpoint of early adverse left ventricular (LV) remodeling were analyzed. The 17 patients (22%) who developed MACE had significantly higher CEC level (P = 0.004), von Willebrand factor (vWF) level (P = 0.028), and significantly lower FMD (P = 0.006) compared to the remaining patients. Logistic regression analysis showed that CECs level and LV ejection fraction were independent predictors of MACE. The areas under the receiver operating characteristic curves (ROC) for CEC level, FMD, and the logistic model with both markers were 0.73, 0.75, and 0.82, respectively, for prediction of the MACE. The 16 patients who developed the secondary endpoint had significantly higher CEC level compared to remaining patients (P = 0.038). In conclusion, increased circulating endothelial cells and endothelial dysfunction predicted the occurrence of major adverse cardiac events and adverse cardiac remodeling in patients with STEMI. (J Interven Cardiol 2016;29:89-98). PMID:26864952

  2. Circulating Endothelial Cells and Endothelial Function predict Major Adverse Cardiac Events and Early Adverse Left Ventricular Remodeling in Patients with ST-Segment Elevation Myocardial Infarction

    PubMed Central

    Magdy, Abdel Hamid; Bakhoum, Sameh; Sharaf, Yasser; Sabry, Dina; El-Gengehe, Ahmed T; Abdel-Latif, Ahmed

    2016-01-01

    Endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) are mobilized from the bone marrow and increase in the early phase after ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the prognostic significance of CECs and indices of endothelial dysfunction in patients with STEMI. In 78 patients with acute STEMI, characterization of CD34+/VEGFR2+ CECs, and indices of endothelial damage/dysfunction such as brachial artery flow mediated dilatation (FMD) were determined. Blood samples for CECs assessment and quantification were obtained within 24 hours of admission and FMD was assessed during the index hospitalization. At 30 days follow up, the primary composite end point of major cardiac adverse events (MACE) consisting of all-cause mortality, recurrent non-fatal MI, or heart failure and the secondary endpoint of early adverse left ventricular (LV) remodeling were analyzed. The 17 patients (22%) who developed MACE had significantly higher CEC level (P = 0.004), vWF level (P =0.028), and significantly lower FMD (P = 0.006) compared to the remaining patients. Logistic regression analysis showed that CECs level and LV ejection fraction were independent predictors of MACE. The areas under the receiver operating characteristic curves (ROC) for CEC level, FMD, and the logistic model with both markers were 0.73, 0.75, and 0.82 respectively for prediction of the MACE. The 16 patients who developed the secondary endpoint had significantly higher CEC level compared to remaining patients (p =0.038). In conclusion, increased circulating endothelial cells and endothelial dysfunction predicted the occurrence of major adverse cardiac events and adverse cardiac remodeling in patients with STEMI. PMID:26864952

  3. Mismatch Between Cardiac Perfusion, Sympathetic Innervation, and Left Ventricular Electroanatomical Map in a Patient with Recurrent Ventricular Tachycardia.

    PubMed

    Jungen, Christiane; von Gogh, Gwendolyn; Schmitt, Christiane; Kuklik, Pawel; Hoffmann, Boris; Nakajima, Kenichi; Willems, Stephan; Mester, Janos; Meyer, Christian

    2016-01-01

    BACKGROUND Regional cardiac sympathetic denervation causes electrophysiological heterogeneity and has been found to be a predictor of potentially lethal VT. CASE REPORT We present the case of 69-year-old patient admitted with recurrent ventricular tachycardia and a history of anterior myocardial infarction. In line with Tc-99m-MIBI-SPECT perfusion imaging, electroanatomical mapping revealed extensive LV anterior scarring as detected by low-voltage areas. Surprisingly, I-123-MIBG-SPECT showed an extensive deficit of sympathetic innervation inferior (mismatch) and anterolateral (match). CONCLUSIONS Combination of electroanatomical mapping with tomographic imaging of innervation and perfusion might improve our understanding of the neural trigger of VT after myocardial infarction or substrate-based catheter ablation. PMID:27109542

  4. Mismatch Between Cardiac Perfusion, Sympathetic Innervation, and Left Ventricular Electroanatomical Map in a Patient with Recurrent Ventricular Tachycardia

    PubMed Central

    Jungen, Christiane; von Gogh, Gwendolyn; Schmitt, Christiane; Kuklik, Pawel; Hoffmann, Boris; Nakajima, Kenichi; Willems, Stephan; Mester, Janos; Meyer, Christian

    2016-01-01

    Patient: Male, 69 Final Diagnosis: Recurrent ventricular tachycardia Symptoms: Multiple ICD shocks Medication: — Clinical Procedure: Ventricular tachycardia ablation Specialty: Cardiology Objective: Rare co-existance of disease or pathology Background: Regional cardiac sympathetic denervation causes electrophysiological heterogeneity and has been found to be a predictor of potentially lethal VT. Case Report: We present the case of 69-year-old patient admitted with recurrent ventricular tachycardia and a history of anterior myocardial infarction. In line with Tc-99m-MIBI-SPECT perfusion imaging, electroanatomical mapping revealed extensive LV anterior scarring as detected by low-voltage areas. Surprisingly, I-123-MIBG-SPECT showed an extensive deficit of sympathetic innervation inferior (mismatch) and anterolateral (match). Conclusions: Combination of electroanatomical mapping with tomographic imaging of innervation and perfusion might improve our understanding of the neural trigger of VT after myocardial infarction or substrate-based catheter ablation. PMID:27109542

  5. Activated cranial cervical cord neurons affect left ventricular infarct size and the potential for sudden cardiac death

    PubMed Central

    Southerland, E. Marie; Gibbons, David D.; Smith, S. Brooks; Sipe, Adam; Williams, Carole Ann; Beaumont, Eric; Armour, J. Andrew; Foreman, Robert D.; Ardell, Jeffrey L.

    2012-01-01

    To evaluate whether cervical spinal neurons can influence cardiac indices and myocyte viability in the acutely ischemic heart, the hearts of anesthetized rabbits subjected to 30 min of LAD coronary arterial occlusion (CAO) were studied 3 hours after reperfusion. Control animals were compared to those exposed to pre-emptive high cervical cord stimulation (SCS; the dorsal aspect of the C1-C2 spinal cord was stimulated electrically at 50 Hz; 0.2 ms; 90% of motor threshold, starting 15 min prior to and continuing throughout CAO). Four groups of animals were so tested: 1) neuroaxis intact; 2) prior cervical vagotomy; 3) prior transection of the dorsal spinal columns at C6; and 4) following pharmacological treatment [muscarinic (atropine) or adrenergic (atenolol, prazosin or yohimbine) receptor blockade]. Infarct size (IS) was measured by tetrazolium, expressed as percentage of risk zone. C1-C2 SCS reduced acute ischemia induced IS by 43%, without changing the incidence of sudden cardiac death (SCD). While SCS-induced reduction in IS was unaffected by vagotomy, it was no longer evident following transection of C6 dorsal columns or atropinization. Beta-adrenoceptor blockade eliminated ischemia induced SCD, while alpha-receptor blockade doubled its incidence. During SCS, myocardial ischemia induced SCD was eliminated following vagotomy while remaining unaffected by atropinization. These data indicate that, in contrast to thoracic spinal neurons, i) cranial cervical spinal neurons affect both adrenergic and cholinergic motor outflows to the heart such that ii) their activation modifies ventricular infarct size and lethal arrhythmogenesis. PMID:22502863

  6. Comparison of cardiac power output and exercise performance in patients with left ventricular assist devices, explanted (recovered) patients, and those with moderate to severe heart failure.

    PubMed

    Jakovljevic, Djordje G; George, Robert S; Donovan, Gay; Nunan, David; Henderson, Keiran; Bougard, Robert S; Yacoub, Magdi H; Birks, Emma J; Brodie, David A

    2010-06-15

    Peak cardiac power output (CPO), as a direct measurement of overall cardiac function, has been shown to be a most powerful predictor of prognosis for patients with chronic heart failure. The present study assessed CPO and exercise performance in patients implanted with a left ventricular assist device (LVAD), those explanted due to myocardial recovery, and those with moderate to severe heart failure. Hemodynamic and respiratory gas exchange measurements were undertaken at rest and at peak graded exercise. These were performed in 54 patients-20 with moderate to severe heart failure, 18 with implanted LVADs, and 16 with explanted LVADs. At rest there was a nonsignificant difference in CPO among groups (p >0.05). Peak CPO was significantly higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 1.90 +/- 0.45 W, implanted LVAD 2.37 +/- 0.55 W, explanted LVAD 3.39 +/- 0.61 W, p <0.01) as was peak cardiac output (heart failure 9.1 +/- 2.1 L/min, implanted LVAD 12.4 +/- 2.2 L/min, explanted LVD 14.6 +/- 2.9 L/min, p <0.01). Peak oxygen consumption was higher in the explanted LVAD than in the heart failure and implanted LVAD groups (heart failure 15.8 +/- 4.1 ml/kg/min, implanted LVAD 19.8 +/- 5.8 ml/kg/min, explanted LVAD 28.2 +/- 5.0 ml/kg/min, p <0.05) as was anaerobic threshold (heart failure 11.2 +/- 1.9 ml/kg/min, implanted LVAD 14.7 +/- 4.9 ml/kg/min, explanted LVAD 21.4 +/- 5.0 ml/kg/min, p <0.05). In conclusion, peak CPO differentiates well during cardiac restoration using LVADs and emphasizes the benefits of this therapy. CPO has the potential to be a key physiologic marker of heart failure severity and can guide management of patients with LVAD. PMID:20538130

  7. Rapid Surface Cooling by ThermoSuit System Dramatically Reduces Scar Size, Prevents Post-Infarction Adverse Left Ventricular Remodeling, and Improves Cardiac Function in Rats

    PubMed Central

    Dai, Wangde; Herring, Michael J; Hale, Sharon L; Kloner, Robert A

    2015-01-01

    Background The long-term effects of transient hypothermia by the non-invasive ThermoSuit apparatus on myocardial infarct (MI) scar size, left ventricular (LV) remodeling, and LV function were assessed in rat MI model. Methods and Results Rats were randomized to normothermic or hypothermic groups (n=14 in each group) and subjected to 30 minutes coronary artery occlusion and 6 weeks of reperfusion. For hypothermia therapy, rats were placed into the ThermoSuit apparatus at 2 minutes after the onset of coronary artery occlusion, were taken out of the apparatus when the core body temperature reached 32°C (in ≈8 minutes), and were then allowed to rewarm. After 6 weeks of recovery, rats treated with hypothermia demonstrated markedly reduced scar size (expressed as % of left ventricular area: hypothermia, 6.5±1.1%; normothermia, 19.4±1.7%; P=1.3×10−6); and thicker anterior LV wall (hypothermia, 1.57±0.09 mm; normothermia, 1.07±0.05 mm; P=3.4×10−5); decreased postmortem left ventricular volume (hypothermia, 0.45±0.04 mL; normothermia, 0.6±0.03 mL; P=0.028); and better LV fractional shortening by echocardiography (hypothermia, 37.2±2.8%; normothermia, 18.9±2.3%; P=0.0002) and LV ejection fraction by LV contrast ventriculography (hypothermia, 66.8±2.3%; normothermia, 56.0±2.0%; P=0.0014). Conclusions Rapid, transient non-invasive surface cooling with the ThermoSuit apparatus in the acute phase of MI decreased scar size by 66.5%, attenuated adverse post-infarct left ventricular dilation and remodeling, and improved cardiac function in the chronic phase of experimental MI. PMID:26116692

  8. Albuminuria is Independently Associated with Cardiac Remodeling, Abnormal Right and Left Ventricular Function, and Worse Outcomes in Heart Failure with Preserved Ejection Fraction

    PubMed Central

    Katz, Daniel H.; Burns, Jacob A.; Aguilar, Frank G.; Beussink, Lauren; Shah, Sanjiv J.

    2014-01-01

    Objectives To determine the relationship between albuminuria and cardiac structure/function in heart failure with preserved ejection fraction (HFpEF). Background Albuminuria, a marker of endothelial dysfunction, has been associated with adverse cardiovascular outcomes in HFpEF. However, the relationship between albuminuria and cardiac structure/function in HFpEF has not been well studied. Methods We measured urinary albumin-to-creatinine ratio (UACR) and performed comprehensive echocardiography, including tissue Doppler imaging and right ventricular (RV) evaluation, in a prospective study of 144 patients with HFpEF. Multivariable-adjusted linear regression was used to determine the association between UACR and echocardiographic parameters. Cox proportional hazards analyses were used to determine the association between UACR and outcomes. Results The mean age was 6611 years, 62% were female, and 42% were African-American. Higher UACR was associated with greater left ventricular (LV) mass, lower preload-recruitable stroke work, and lower global longitudinal strain. Higher UACR was also significantly associated with RV remodeling (for each doubling of UACR, RV wall thickness was 0.9 mm higher [95% confidence interval (CI) 0.050.14 mm; P=0.001, adjusted P=0.01]) and worse RV systolic function (for each doubling of UACR, RV fractional area change was 0.56% lower [95% CI 0.140.98%; P=0.01, adjusted P=0.03]. The association between UACR and RV parameters persisted after excluding patients with macroalbuminuria (UACR > 300 mg/g). Increased UACR was also independently associated with worse outcomes. Conclusions In HFpEF, increased UACR is a prognostic marker and is associated with increased RV and LV remodeling, and longitudinal systolic dysfunction. PMID:25282032

  9. High-resolution numerical simulation of Left Ventricular Hemodynamics Guided by in-vivo Cardiac Magnetic Resonance Data

    NASA Astrophysics Data System (ADS)

    Le, Trung; Sotiropoulos, Fotis; Mirabella, Lucia; Chaffins, Brandon; Santhanakrishnan, Arvind; Oshinski, John; Yoganathan, Ajit; University of Minnesota Collaboration; Georgia Institute of Technology Collaboration

    2012-11-01

    We study the fluid dynamics within a patient-specific left ventricle (LV) during diastole using both numerical simulations and in-vivo data. The kinematics of the LV is reconstructed from high-resolution Magnetic Resonance Imaging (MRI) data acquired on a healthy volunteer, using image segmentation and a surface registration process. The flow velocity is acquired using phase-contrast MRI at the mitral orifice and at an additional parallel plane inside the ventricle. Numerical simulations are carried out using the CURVIB method (Ge et al., JCP, 2007) with the MRI reconstructed LV wall motion imposed as boundary condition. The numerical simulations show the highly dynamic environment of the flow field. The mitral vortex ring is formed during early diastolic filling and breaks down into small scale structures. The simulated hemodynamics are compared with phase-contrast MRI measurements and previous simulations in which the LV wall motion was obtained from a lumped parameter model (Le and Sotiropoulos, Eur. J. Mechanics B - Fluids, 2012). We acknowlege NIH Grant RO1-HL-07262 and the Minnesota Supercomputing Institute support.

  10. Radionuclide left ventricular dV/dt for the assessment of cardiac function in patients with coronary disease.

    PubMed

    Bianco, J A; Makey, D G; Laskey, W K; Shafer, R B

    1979-01-01

    To investigate potential uses of left-ventricular (LV) systolic ejection rate (LV dV/dt) in the evaluation of LV function, we examined the effect of exercise, angiotensin, and leg raising on LV ejection fraction and LV dV/dt in patients with coronary-artery disease. The following observations were made: a) LV ejection fraction and dV/dt changed proportionately, but in opposite directions, during supine exercise; b) LV ejection fraction and dV/dt decreased to a similar extent during angiotensin infusions; and c) LV ejection fraction and dV/dt were unchanged by leg raising. The changes in peak and mean LV dV/dt were similar. Regardless of the physiologic state, peak LV dV/dt occurred during the first third of systole. These data imply that in this population there were no specific advantages of LV dV/dt over LV ejection fraction in the evaluation of LV performance. PMID:430171

  11. Simulation of cardiac motion on non-Newtonian, pulsating flow development in the human left anterior descending coronary artery

    NASA Astrophysics Data System (ADS)

    Theodorakakos, A.; Gavaises, M.; Andriotis, A.; Zifan, A.; Liatsis, P.; Pantos, I.; Efstathopoulos, E. P.; Katritsis, D.

    2008-09-01

    This study aimed at investigating the effect of myocardial motion on pulsating blood flow distribution of the left anterior descending coronary artery in the presence of atheromatous stenosis. The moving 3D arterial tree geometry has been obtained from conventional x-ray angiograms obtained during the heart cycle and includes a number of major branches. The geometry reconstruction model has been validated against projection data from a virtual phantom arterial tree as well as with CT-based reconstruction data for the same patient investigated. Reconstructions have been obtained for a number of temporal points while linear interpolation has been used for all intermediate instances. Blood has been considered as a non-Newtonian fluid. Results have been obtained using the same pulse for the inlet blood flow rate but with fixed arterial tree geometry as well as under steady-state conditions corresponding to the mean flow rate. Predictions indicate that myocardial motion has only a minor effect on flow distribution within the arterial tree relative to the effect of the blood pressure pulse.

  12. Left atrial volume assessment in atrial fibrillation using multimodality imaging: a comparison of echocardiography, invasive three-dimensional CARTO and cardiac magnetic resonance imaging.

    PubMed

    Rabbat, Mark G; Wilber, David; Thomas, Kevin; Malick, Owais; Bashir, Atif; Agrawal, Anoop; Biswas, Santanu; Sanagala, Thriveni; Syed, Mushabbar A

    2015-06-01

    Left atrial size in atrial fibrillation is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance multislice method (CMR-MSM) is the current gold standard for left atrial volume (LAV) assessment but is time consuming. We investigated whether LAV with more rapid area-length method by echocardiography (Echo-AL) or cardiac magnetic resonance (CMR-AL) and invasive measurement by 3D-CARTO mapping during ablation correlate with the CMR-MSM. We studied 250 consecutive patients prior to atrial fibrillation ablation. CMR images were acquired on 3T scanner to measure LAV by MSM and biplane area-length method. Standard echocardiography views were used to calculate LAV by biplane area-length method. LAV during ablation was measured by 3D-CARTO mapping. LAV was compared using intra-class correlation (ICC), Pearson's correlation and Bland-Altman plots. CMR-MSM was used as the reference standard. Mean LAV using CMR-MSM was 112.7 ± 36.7 ml. CMR-AL method overestimated LAV by 13.3 ± 21.8 ml (11.2%, p < 0.005) whereas 3D-CARTO and Echo-AL underestimated LAV by 8.3 ± 22.6 and 24.0 ± 27.6 ml respectively (8.7% and 20.0% respectively, p < 0.005). There was no significant difference between paroxysmal and persistent atrial fibrillation. CMR-AL and 3D-CARTO correlated and agreed well with CMR-MSM (r = 0.87 and 0.74, ICC = 0.80 and 0.77 respectively). However, Echo-AL had poor correlation and agreement with CMR-MSM (r = 0.66 and ICC = 0.48). Bland-Altman plots confirmed these findings. CMR-AL method may be used as an alternative to CMR-MSM, as it is non-invasive, rapid, and correlates well with CMR-MSM. LAV by different modalities should not be used interchangeably. PMID:25761533

  13. Impact of septal flash and left ventricle contractile reserve on positive remodeling during 1 year cardiac resynchronization therapy: the multicenter ViaCRT study

    PubMed Central

    Gąsior, Zbigniew; Płońska-Gościniak, Edyta; Wita, Krystian; Mizia-Stec, Katarzyna; Szwed, Hanna; Kasprzak, Jarosław; Tomaszewski, Andrzej; Sinkiewicz, Władysław; Wojciechowska, Celina

    2016-01-01

    Introduction Cardiac resynchronization therapy (CRT) has been shown to improve outcomes in patients with systolic heart failure (HFREF). However, the relatively high non-responder rate results in a need for more precise qualification for CRT. The ViaCRT study was designed to determine the role of contractile reserve and dyssynchrony parameters in predicting CRT response. The purpose of this analysis was to determine the effect of baseline septal flash and contractile reserve (CR) on clinical and echocardiographic parameters of response to CRT in 12-month follow-up. Material and methods One hundred thirty-three guideline-selected CRT candidates (both ischemic and non-ischemic heart failure with reduced ejection fraction) were enrolled in the study. Baseline study population characteristics were: left ventricle ejection fraction (LVEF) 25 ±6%, QRS 165 ±25 ms, NYHA class III (90%) and IV (10%). Results In subjects with septal flash (SF) registered before CRT implantation improvement in LVEF (14 ±2% vs. 8 ±1%, p < 0.05) and left ventricle (LV) systolic (63 ±10 ml vs. 36 ±6 ml, p < 0.05) and diastolic (46 ±10 ml vs. 32 ±7, p < 0.05) volumes was more pronounced than in patients without SF. In patients with CR (defined as LVEF increase by 20% or 4 viable segments) improvement in echo parameters was not significantly different then in the CR– group. Neither SF nor CR was associated with improvement in NYHA class. Subgroup analysis revealed that only in non-ischemic HF patients is presence of septal flash associated with LV function improvement after CRT. Conclusions In non-ischemic HF patients septal flash is a helpful parameter in prediction of LV remodeling after 12 months of resynchronization therapy.

  14. Different patterns of left ventricular rotational mechanics in cardiac amyloidosis—results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

    PubMed Central

    Földeák, Dóra; Domsik, Péter; Kalapos, Anita; Sepp, Róbert; Borbényi, Zita; Forster, Tamás

    2015-01-01

    Cardiac amyloidosis (CA) is an infiltrative disease primarily caused by extracellular tissue deposition of amyloid fibrils in the myocardial interstitium. The aim of the present study was to examine left ventricular (LV) rotational mechanics in biopsy-proven CA by three-dimensional (3D) speckle-tracking echocardiography (STE). Ten patients (65.3±11.5 years, 6 males) with CA entered the study. The mean basal LV rotations were 0.3±3.8°, while mean apical LV rotations proved to be 7.0±3.3°. LV basal and apical rotations were in the same counterclockwise direction in 6 out of 10 CA patients demonstrating near absence of LV twist [LV rigid body rotation (RBR)]. Apico-basal difference was near 3 or less degrees in three patients with LV-RBR, and 6−10 degrees in the other three subjects with LV-RBR. One another patient showed normal rotational mechanics, while two patients had significant hyporotations and one had significant hyperrotations in normal directions. To conclude with, different patterns of LV rotational mechanics could be demonstrated in CA. LV RBR, the near absence of LV twist seems to be a frequent phenomenon in CA. PMID:26807368

  15. The R21C Mutation in Cardiac Troponin I Imposes Differences in Contractile Force Generation between the Left and Right Ventricles of Knock-In Mice

    PubMed Central

    Liang, Jingsheng; Kazmierczak, Katarzyna; Rojas, Ana I.; Wang, Yingcai

    2015-01-01

    We investigated the effect of the hypertrophic cardiomyopathy-linked R21C (arginine to cysteine) mutation in human cardiac troponin I (cTnI) on the contractile properties and myofilament protein phosphorylation in papillary muscle preparations from left (LV) and right (RV) ventricles of homozygous R21C+/+ knock-in mice. The maximal steady-state force was significantly reduced in skinned papillary muscle strips from the LV compared to RV, with the latter displaying the level of force observed in LV or RV from wild-type (WT) mice. There were no differences in the Ca2+ sensitivity between the RV and LV of R21C+/+ mice; however, the Ca2+ sensitivity of force was higher in RV-R21C+/+ compared with RV-WT and lower in LV- R21C+/+ compared with LV-WT. We also observed partial loss of Ca2+ regulation at low [Ca2+]. In addition, R21C+/+-KI hearts showed no Ser23/24-cTnI phosphorylation compared to LV or RV of WT mice. However, phosphorylation of the myosin regulatory light chain (RLC) was significantly higher in the RV versus LV of R21C+/+ mice and versus LV and RV of WT mice. The difference in RLC phosphorylation between the ventricles of R21C+/+ mice likely contributes to observed differences in contractile force and the lower tension monitored in the LV of HCM mice. PMID:25961037

  16. Four chamber pacing in dilated cardiomyopathy.

    PubMed

    Cazeau, S; Ritter, P; Bakdach, S; Lazarus, A; Limousin, M; Henao, L; Mundler, O; Daubert, J C; Mugica, J

    1994-11-01

    A 54-year-old man received a four chamber pacing system for severe congestive heart failure (NYHA functional Class IV). His ECG showed a left bundle branch block (200-msec QRS duration) with 200-msec PR interval, normal QRS axis, and 90-msec interatrial interval. An acute hemodynamic study with insertion of four temporary leads was performed prior to the implant, which demonstrated a significant increase in cardiac output and decrease of pulmonary capillary wedge pressure. A permanent pacemaker was implanted based on the encouraging results of the acute study. The right chamber leads were introduced by cephalic and subclavian approaches. The left atrium was paced with a coronary sinus lead, Medtronic SP 2188-58 model. An epicardial Medtronic 5071 lead was placed on the LV free wall. The four leads were connected to a standard bipolar DDD pacemaker, Chorus 6234. The two atrial leads were connected via a Y-connector to the atrial channel of the pacemaker with a bipolar pacing configuration. The two ventricular leads were connected in a similar fashion to the ventricular channel of the device. The right chamber leads were connected to the distal poles. The left chamber leads were connected to the proximal poles of the pacemaker. Six weeks later, the patient's clinical status improved markedly with a weight loss of 17 kg and disappearance of peripheral edema. His functional class was reduced to NYHA II. Four chamber pacing is technically feasible. In patients with evidence of interventricular dyssynchrony, this original pacing mode probably provides a mechanical activation sequence closer to the natural one.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7845801

  17. Early outcome of Coronary Artery Bypass Graft Surgery in patients with significant Left Main Stem stenosis at a tertiary cardiac care center

    PubMed Central

    Sher-i-Murtaza, Muhammad; Baig, Mirza Ahmad Raza; Raheel, Hafiz Muhammad Azam

    2015-01-01

    Objective: Primary objective of this study was to evaluate the impact of significant left main stem (LMS) stenosis on the early outcome of coronary artery bypass graft (CABG) surgery. Methods: A Retrospective non-randomized analytical study was conducted in Cardiac surgery department, Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan, Pakistan. The data of patients who underwent isolated CABG at our institution from February 2008 to March 2014 were analyzed. Two thousand six hundred two (2602) patients of isolated CABG were divided into 2 groups according to the LMS disease. Group I (n=2088): without significant LMS disease and Group II (n=514): with LMS disease. Data was analyzed using SPSS V16. The groups were compared using Student’s t-test for numeric variables. Chi-square test and Fishers Exact test were used for categorical variables. P-value ≤ 0.05 was considered as significant difference. Results: Out of two thousand six hundred two, 2088 patients were in Non.LMS group (Control Group) and five hundred fourteen were in LMS Group (Study Group). Patients with LMS disease were older. In both groups there was no statistically significant difference regarding gender distribution, risk factors of IHD, pre-operative renal function and preoperative CKMB levels. Significant number 50 (9.7%) of patients were unstable in LMS group and they needed urgent surgery (p-value <0.0001). Need and duration for inotropic support and intra-aortic balloon counter-pulsation support were significantly high in LMS group (p-value <0.0001, 0.002, 0.003 respectively). Similarly Mechanical ventilation time and hospital stay were higher in LMS group. Incidence of pulmonary complications and operative mortality were significantly higher in LMS group (p-value 0.005 and 0.001 respectively). Mortality of CABG patients with significant left main coronary stenosis was 13 out of five hundred fourteen (2.5%) as compared to just 17 out of two thousand eighty eight (0.8%) in control group. Conclusion: This study showed that significant LMS disease is an independent risk factor for early cardiopulmonary morbidity and mortality after CABG surgery. PMID:26430428

  18. Flow chamber

    DOEpatents

    Morozov, Victor

    2011-01-18

    A flow chamber having a vacuum chamber and a specimen chamber. The specimen chamber may have an opening through which a fluid may be introduced and an opening through which the fluid may exit. The vacuum chamber may have an opening through which contents of the vacuum chamber may be evacuated. A portion of the flow chamber may be flexible, and a vacuum may be used to hold the components of the flow chamber together.

  19. Variability in cardiac MR measurement of left ventricular ejection fraction, volumes and mass in healthy adults: defining a significant change at 1 year

    PubMed Central

    Edwards, N C; Chue, C D; Taylor, R J; Ferro, C J; Townend, J N; Steeds, R P

    2015-01-01

    Objective: Variability in the measurement of left ventricular (LV) parameters in cardiovascular imaging has typically been assessed over a short time interval, but clinicians most commonly compare results from studies performed a year apart. To account for variation in technical, procedural and biological factors over this time frame, we quantified the within-subject changes in LV volumes, LV mass (LVM) and LV ejection fraction (EF) in a well-defined cohort of healthy adults at 12 months. Methods: Cardiac MR (CMR) was performed in 42 healthy control subjects at baseline and at 1 year (1.5 T Magnetom® Avanto; Siemens Healthcare, Erlangen, Germany). Analysis of steady-state free precession images was performed manually offline (Argus software; Siemens Healthcare) for assessment of LV volumes, LVM and EF by a single blinded observer. A random subset of 10 participants also underwent repeat imaging within 7 days to determine short-term interstudy reproducibility. Results: There were no significant changes in any LV parameter on repeat CMR at 12 months. The short-term interstudy biases were not significantly different from the long-term changes observed at 1 year. The smallest detectable change (SDC) for LVEF, end-diastolic volume, end-systolic volume and LVM that could be recognized with 95% confidence were 6%, 13 ml, 7 ml and 6 g, respectively. Conclusion: The variability in CMR-derived LV measures arising from technical, procedural and biological factors remains minimal at 12 months. Thus, for patients undergoing repeat annual assessment by CMR, even small differences in LV function, size and LVM (which are greater than the SDC) may be attributed to disease-related factors. Advances in knowledge: The reproducibility and reliability of CMR data at 12 months is excellent allowing clinicians to be confident that even small changes in LV structure and function over this time frame are real. PMID:25710361

  20. Cardiac Health Risk Stratification System (CHRiSS): A Bayesian-Based Decision Support System for Left Ventricular Assist Device (LVAD) Therapy

    PubMed Central

    Loghmanpour, Natasha A.; Druzdzel, Marek J.; Antaki, James F.

    2014-01-01

    This study investigated the use of Bayesian Networks (BNs) for left ventricular assist device (LVAD) therapy; a treatment for end-stage heart failure that has been steadily growing in popularity over the past decade. Despite this growth, the number of LVAD implants performed annually remains a small fraction of the estimated population of patients who might benefit from this treatment. We believe that this demonstrates a need for an accurate stratification tool that can help identify LVAD candidates at the most appropriate point in the course of their disease. We derived BNs to predict mortality at five endpoints utilizing the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database: containing over 12,000 total enrolled patients from 153 hospital sites, collected since 2006 to the present day, and consisting of approximately 230 pre-implant clinical variables. Synthetic minority oversampling technique (SMOTE) was employed to address the uneven proportion of patients with negative outcomes and to improve the performance of the models. The resulting accuracy and area under the ROC curve (%) for predicted mortality were 30 day: 94.9 and 92.5; 90 day: 84.2 and 73.9; 6 month: 78.2 and 70.6; 1 year: 73.1 and 70.6; and 2 years: 71.4 and 70.8. To foster the translation of these models to clinical practice, they have been incorporated into a web-based application, the Cardiac Health Risk Stratification System (CHRiSS). As clinical experience with LVAD therapy continues to grow, and additional data is collected, we aim to continually update these BN models to improve their accuracy and maintain their relevance. Ongoing work also aims to extend the BN models to predict the risk of adverse events post-LVAD implant as additional factors for consideration in decision making. PMID:25397576

  1. Interaction between respiration and right versus left ventricular volumes at rest and during exercise: a real-time cardiac magnetic resonance study.

    PubMed

    Claessen, Guido; Claus, Piet; Delcroix, Marion; Bogaert, Jan; La Gerche, Andre; Heidbuchel, Hein

    2014-03-01

    Breathing-induced changes in intrathoracic pressures influence left ventricular (LV) and right ventricular (RV) volumes, the exact nature and extent of which have not previously been evaluated in humans. We sought to examine this "respiratory pump" using novel real-time cardiac magnetic resonance (CMR) imaging. Eight healthy subjects underwent serial multislice real-time CMR during normal breathing, breath holding, and the Valsalva maneuver. Subsequently, a separate cohort of nine subjects underwent real-time CMR at rest and during incremental exercise. LV and RV end-diastolic volume (EDV) and end-systolic volume (ESV) and diastolic and systolic eccentricity indexes were determined at peak inspiration and expiration. During normal breathing, inspiration resulted in an increase in RV volumes [RVEDV: +18 ± 8%, RVESV: +14 ± 12%, and RV stroke volume (SV): +21 ± 10%, P < 0.01] and an opposing decrease in LV volumes (P < 0.0001 for interaction). During end-inspiratory breath holding, RV SV decreased by 9 ± 10% (P = 0.046), whereas LV SV did not change. During the Valsalva maneuver, volumes decreased in both ventricles (RVEDV: -29 ± 11%, RVESV: -16 ± 14%, RV SV: -36 ± 14%, LVEDV: -22 ± 17%, and LV SV: -25 ± 17%, P < 0.01). The reciprocal effect of respiration on LV and RV volumes was maintained throughout exercise. The diastolic and systolic eccentricity indexes were greater during inspiration than during expiration, both at rest and during exercise (P < 0.0001 for both). In conclusion, ventricular volumes oscillate with respiratory phase such that RV and LV volumes are maximal at peak inspiration and expiration, respectively. Thus, interpretation of RV versus LV volumes requires careful definition of the exact respiratory time point for proper interpretation, both at rest and during exercise. PMID:24464754

  2. Evaluation of Heterogeneity in the Association between Congenital Heart Defects and Variants of Folate Metabolism Genes: Conotruncal and Left-Sided Cardiac Defects

    PubMed Central

    Long, Jin; Lupo, Philip J.; Goldmuntz, Elizabeth; Mitchell, Laura E.

    2011-01-01

    PURPOSE Genetic variation in the folate metabolic pathway may influence the risk of congenital heart defects. This study was undertaken to assess the associations between the inherited and maternal genotypes for variants in folate-related genes and the risk of a composite heart phenotype that included two component phenotypes: conotruncal heart defects (CTDs) and left-sided cardiac lesions (LSLs). METHODS Nine folate-related gene variants were evaluated using data from 692 case-parent triads (CTD, n=419; LSL, n=273). Log-linear analyses were used to test for heterogeneity of the genotype-phenotype association across the two component phenotypes (i.e. CTD and LSLS) and, when there was no evidence of heterogeneity, to assess the associations of the maternal and inherited genotypes with the composite phenotype. RESULTS There was little evidence of heterogeneity of the genotype-phenotype association across the two component phenotypes or of an association between the genotypes and the composite phenotype. There was evidence of heterogeneity in the association of the maternal MTR A2756G genotype (p = 0.01) with CTDs and LSLs. However, further analyses suggested that the observed associations with the maternal MTR A2756G genotype might be confounded by parental imprinting effects. CONCLUSIONS Our analyses of these data provide little evidence that the folate-related gene variants evaluated in this study influence the risk of this composite congenital heart defect phenotype. However, larger and more comprehensive studies that evaluate parent-of-origin effects, as well as additional folate-related genes, are required to more fully explore the relation between folate and congenital heart defects. PMID:21987465

  3. Not left ventricular lead position, but the extent of immediate asynchrony reduction predicts long-term response to cardiac resynchronization therapy.

    PubMed

    Poller, Wolfram C; Dreger, Henryk; Schwerg, Marius; Bondke, Hansjürgen; Melzer, Christoph

    2014-06-01

    Cardiac resynchronization therapy (CRT) is an effective treatment for a large subgroup of chronic heart failure patients. Various attempts to improve the high non-responder rate of 30 % by preoperative asynchrony assessment have failed. We hypothesized that superior response to CRT is correlated with greater acute reduction of asynchrony and that a concordant left ventricular (LV) lead is beneficial compared to a discordant lead. Hundred and eight consecutive CRT patients from our center were prospectively included. Clinical status and asynchrony parameters were assessed before, 1 day and 6 months after CRT implantation. Super-response was defined as an increase of the LV ejection fraction by ≥15 % and a decrease in LV end systolic volume (LVESV) by ≥30 %. When the criteria for super-response were not met, average response was given with a decrease of baseline LVESV ≥15 %. Sixty eight patients were classified as responders (63 %). Comparing super- (n = 19) and average (n = 49) responders, we found that greater acute reduction of LV asynchrony (change of asynchronous segments under CRT: -1.3 vs. -0.4, p < 0.05; decrease of LV intraventricular delay: -34 ms vs. -16 ms, p < 0.05) is associated with superior reverse remodeling after 6 months. Importantly, asynchrony parameters of super-, average and non-responders were almost identical at baseline. A concordant LV lead (n = 63) was not associated with improved LV reverse remodeling compared to a discordant lead (n = 28): LVEF: +8.6 % vs. +7.8 %, p = 0.91; LVESV: -30.5 ml vs. -23.8 mL, p = 0.84. A greater immediate reduction of LV asynchrony predicts superior response. Preoperative asynchrony parameters do not correlate with outcome. A concordant LV lead is not superior to a discordant lead. PMID:24468897

  4. Novel Left Ventricular Assist System®

    PubMed Central

    Liotta, Domingo

    2003-01-01

    We propose a Novel Left Ventricular Assist System® (Novel LVAS®) as a bridge to cardiac transplantation and to functional heart recovery in advanced heart failure. This report regards the principles that led to its development. It is our hope that the design of a high-peak-output pump of smaller size will lead to improved functional capacity, when compared with currently available left ventricular assist bridges to heart recovery. Several basic considerations went into the design of this system: 1) we did not want to cannulate the heart chambers; 2) in particular, we rejected the use of a left ventricular apical cannula for myocardial recovery, because it destroys the helical anatomy of the chamber; 3) we chose an atriostomy for blood inflow to the implanted pump; and 4) we synchronized the pump to the patient's electrocardiogram, to ensure blood pump ejection in diastole. The key to success is the atriostomy, which creates an opening larger than the patient's mitral valve. The atriostomy may be performed with the heart beating. Bleeding from the left ventricular apical anastomosis is a fairly common occurrence in currently available left ventricular assist systems; subsequent transfusion can exacerbate right heart dysfunction and sensitize the immune system. These complications are avoided with our system. The new system works either in partial mode or total mode, depending on whether partial or full left ventricular unloading is required. The Novel Left Ventricular Assist System is in its initial clinical trial stage, under the supervision of the author. (Tex Heart Inst J 2003;30:194–201) PMID:12959201

  5. Percutaneous fiber optic angioscopy of the left ventricle in patients with rheumatic valvular disease

    NASA Astrophysics Data System (ADS)

    Hirose, Junichi; Oshima, Tomomitsu; Fujimori, Yoshiharu; Uchida, Yasumi

    1993-05-01

    Recent advances in fiberoptic technology enabled us to observe percutaneously the cardiac chambers and valves. We examined left ventricular luminal and valvular changes by percutaneous fiberoptic angioscopy in patients with rheumatic valvular disease. Six patients with echocardiographic rheumatic changes in the mitral valves, underwent angioscopy during routine cardiac catheterization. The fiberscope 4.2 F in diameter, and the guiding catheter 9 F in external diameter with an inflatable balloon around the distal most tip were used for angioscopy. The left ventricular endocardial surface was diffusely white in color or white and brown in mosaic fashion. Echocardiography and angiography had low sensitivity for detecting the changes of the left ventricular luminal surface. Whitish changes which were observed by angioscopy were not related to the indices derived from echocardiography and angiography. The results indicate the possibility of percutaneous angioscopy in detecting left ventricular luminal changes in patients with rheumatic valvular disease.

  6. Higher sympathetic nerve activity during ventricular (VVI) than during dual-chamber (DDD) pacing

    NASA Technical Reports Server (NTRS)

    Taylor, J. A.; Morillo, C. A.; Eckberg, D. L.; Ellenbogen, K. A.

    1996-01-01

    OBJECTIVES: We determined the short-term effects of single-chamber ventricular pacing and dual-chamber atrioventricular (AV) pacing on directly measured sympathetic nerve activity. BACKGROUND: Dual-chamber AV cardiac pacing results in greater cardiac output and lower systemic vascular resistance than does single-chamber ventricular pacing. However, it is unclear whether these hemodynamic advantages result in less sympathetic nervous system outflow. METHODS: In 13 patients with a dual-chamber pacemaker, we recorded the electrocardiogram, noninvasive arterial pressure (Finapres), respiration and muscle sympathetic nerve activity (microneurography) during 3 min of underlying basal heart rate and 3 min of ventricular and AV pacing at rates of 60 and 100 beats/min. RESULTS: Arterial pressure was lowest and muscle sympathetic nerve activity was highest at the underlying basal heart rate. Arterial pressure increased with cardiac pacing and was greater with AV than with ventricular pacing (change in mean blood pressure +/- SE: 10 +/- 3 vs. 2 +/- 2 mm Hg at 60 beats/min; 21 +/- 5 vs. 14 +/- 2 mm Hg at 100 beats/min; p < 0.05). Sympathetic nerve activity decreased with cardiac pacing and the decline was greater with AV than with ventricular pacing (60 beats/min -40 +/- 11% vs. -17 +/- 7%; 100 beats/min -60 +/- 9% vs. -48 +/- 10%; p < 0.05). Although most patients showed a strong inverse relation between arterial pressure and muscle sympathetic nerve activity, three patients with severe left ventricular dysfunction (ejection fraction < or = 30%) showed no relation between arterial pressure and sympathetic activity. CONCLUSIONS: Short-term AV pacing results in lower sympathetic nerve activity and higher arterial pressure than does ventricular pacing, indicating that cardiac pacing mode may influence sympathetic outflow simply through arterial baroreflex mechanisms. We speculate that the greater incidence of adverse outcomes in patients treated with single-chamber ventricular rather than dual-chamber pacing may be due in part to increased sympathetic nervous outflow.

  7. Prevalence, Patterns, and Clinical Predictors of Left Ventricular Late Gadolinium Enhancement in Patients Undergoing Cardiac Magnetic Resonance Prior to Pulmonary Vein Antral Isolation for Atrial Fibrillation

    PubMed Central

    Nance, John W.; Khurram, Irfan M.; Nazarian, Saman; DeWire, Jane; Calkins, Hugh; Zimmerman, Stefan L.

    2015-01-01

    Abstract Cardiac magnetic resonance (CMR) imaging is increasingly used to evaluate patients with atrial fibrillation (AF) before pulmonary vein antral isolation (PVAI). The purpose of this study was to assess the incidence and pattern of left ventricular (LV) late gadolinium enhancement (LGE) in patients undergoing CMR before PVAI and compare the clinical and demographic differences of patients with and without LV LGE. Clinical and demographic data on 62 patients (mean age 61 ± 7.9, 69% male) undergoing CMR before PVAI for AF were collected. Two observers, masked to clinical histories, independently recorded the prevalence, extent (number of myocardial segments), and pattern (subendocardial, midmyocardial, or subepicardial) of LV LGE in each patient. Clinical and demographic predictors of LV LGE were determined using logistic regression. Twenty-three patients (37%) demonstrated LV LGE affecting a mean of 3.0 ± 2.1 myocardial segments. There was no difference in LV ejection fraction between patients with and without LGE, and most (65%) patients with LGE had normal wall motion. Only age (P = 0.04) and a history of congestive heart failure (P = .03) were statistically significant independent predictors of LGE. The most common LGE pattern was midmyocardial, seen in 17 of 23 (74%) patients. Only 4 of 23 (17%) patients had LGE in an “expected” pattern based on clinical history. Of the remaining 19 patients, 4 had known congestive heart failure, 5 nonischemic cardiomyopathy, 4 known coronary artery disease, and 2 prior aortic valve replacement. Six of 23 (26%) patients had no known coronary artery, valvular, or myocardial disease. There is a high prevalence of unexpected LV scar in patients undergoing CMR before PVAI for AF, with most patients demonstrating a nonischemic pattern of LV LGE and no wall motion abnormalities (ie, subclinical disease). The high prevalence of unexpected LGE in these patients may argue for CMR as the modality of choice for imaging integration before PVAI, especially given the demonstrated prognostic value of LGE in this and other patient populations. PMID:26376379

  8. Characterization of Respiratory and Cardiac Motion from Electro-Anatomical Mapping Data for Improved Fusion of MRI to Left Ventricular Electrograms

    PubMed Central

    Roujol, Sébastien; Anter, Elad; Josephson, Mark E.; Nezafat, Reza

    2013-01-01

    Accurate fusion of late gadolinium enhancement magnetic resonance imaging (MRI) and electro-anatomical voltage mapping (EAM) is required to evaluate the potential of MRI to identify the substrate of ventricular tachycardia. However, both datasets are not acquired at the same cardiac phase and EAM data is corrupted with respiratory motion limiting the accuracy of current rigid fusion techniques. Knowledge of cardiac and respiratory motion during EAM is thus required to enhance the fusion process. In this study, we propose a novel approach to characterize both cardiac and respiratory motion from EAM data using the temporal evolution of the 3D catheter location recorded from clinical EAM systems. Cardiac and respiratory motion components are extracted from the recorded catheter location using multi-band filters. Filters are calibrated for each EAM point using estimates of heart rate and respiratory rate. The method was first evaluated in numerical simulations using 3D models of cardiac and respiratory motions of the heart generated from real time MRI data acquired in 5 healthy subjects. An accuracy of 0.6–0.7 mm was found for both cardiac and respiratory motion estimates in numerical simulations. Cardiac and respiratory motions were then characterized in 27 patients who underwent LV mapping for treatment of ventricular tachycardia. Mean maximum amplitude of cardiac and respiratory motion was 10.2±2.7 mm (min = 5.5, max = 16.9) and 8.8±2.3 mm (min = 4.3, max = 14.8), respectively. 3D Cardiac and respiratory motions could be estimated from the recorded catheter location and the method does not rely on additional imaging modality such as X-ray fluoroscopy and can be used in conventional electrophysiology laboratory setting. PMID:24250815

  9. Bakeout Chamber Within Vacuum Chamber

    NASA Technical Reports Server (NTRS)

    Taylor, Daniel M.; Soules, David M.; Barengoltz, Jack B.

    1995-01-01

    Vacuum-bakeout apparatus for decontaminating and measuring outgassing from pieces of equipment constructed by mounting bakeout chamber within conventional vacuum chamber. Upgrade cost effective: fabrication and installation of bakeout chamber simple, installation performed quickly and without major changes in older vacuum chamber, and provides quantitative data on outgassing from pieces of equipment placed in bakeout chamber.

  10. Multi-Physics MRI-Based Two-Layer Fluid-Structure Interaction Anisotropic Models of Human Right and Left Ventricles with Different Patch Materials: Cardiac Function Assessment and Mechanical Stress Analysis

    PubMed Central

    Tang, Dalin; Yang, Chun; Geva, Tal; Gaudette, Glenn; del Nido, Pedro J.

    2011-01-01

    Multi-physics right and left ventricle (RV/LV) fluid-structure interaction (FSI) models were introduced to perform mechanical stress analysis and evaluate the effect of patch materials on RV function. The FSI models included three different patch materials (Dacron scaffold, treated pericardium, and contracting myocardium), two-layer construction, fiber orientation, and active anisotropic material properties. The models were constructed based on cardiac magnetic resonance (CMR) images acquired from a patient with severe RV dilatation and solved by ADINA. Our results indicate that the patch model with contracting myocardium leads to decreased stress level in the patch area, improved RV function and patch area contractility. PMID:21765559

  11. Multi-Physics MRI-Based Two-Layer Fluid-Structure Interaction Anisotropic Models of Human Right and Left Ventricles with Different Patch Materials: Cardiac Function Assessment and Mechanical Stress Analysis.

    PubMed

    Tang, Dalin; Yang, Chun; Geva, Tal; Gaudette, Glenn; Del Nido, Pedro J

    2011-06-01

    Multi-physics right and left ventricle (RV/LV) fluid-structure interaction (FSI) models were introduced to perform mechanical stress analysis and evaluate the effect of patch materials on RV function. The FSI models included three different patch materials (Dacron scaffold, treated pericardium, and contracting myocardium), two-layer construction, fiber orientation, and active anisotropic material properties. The models were constructed based on cardiac magnetic resonance (CMR) images acquired from a patient with severe RV dilatation and solved by ADINA. Our results indicate that the patch model with contracting myocardium leads to decreased stress level in the patch area, improved RV function and patch area contractility. PMID:21765559

  12. Ruptured Sinus of Valsalva Aneurysm into the Left Atrium with Multiple Fistulous Communications: A Rare Cause of Heart Failure

    PubMed Central

    Agrawal, Yashwant; Chandrashekhar, Rakshita; Pratt, Jerry W.; Cole, Maria D.; Kamath, Sreenivas; Kalavakunta, Jagadeesh K.

    2015-01-01

    Ruptured noncoronary sinus of valsalva aneurysm with fistulous connections to multiple cardiac chambers has not been reported previously. We report a 66-year-old man who presented with worsening cough and exertional dyspnea. Transesophageal echocardiogram confirmed a large aneurysm involving the noncoronary cusp of the aortic sinus with aneurysmal extension to the left atrium. There were also two fistulous communications with the left atrium and one small fistulous connection with the right atrium. Open-heart surgery with aortic root replacement and reimplantation of coronary arteries along with primary closure and repair of aorta to the left atrial fistula was performed. PMID:26819782

  13. Characterization of spinal afferent neurons projecting to different chambers of the rat heart.

    PubMed

    Guić, Maja Marinović; Kosta, Vana; Aljinović, Jure; Sapunar, Damir; Grković, Ivica

    2010-01-29

    The pattern of distribution of spinal afferent neurons (among dorsal root ganglia-DRGs) that project to anatomically and functionally different chambers of the rat heart, as well as their morphological and neurochemical characteristics were investigated. Retrograde tracing using a patch loaded with Fast blue (FB) was applied to all four chambers of the rat heart and labeled cardiac spinal afferents were characterized by using three neurochemical markers. The majority of cardiac projecting neurons were found from T1 to T4 DRGs, whereas the peak was at T2 DRG. There was no difference in the total number of FB-labeled neurons located in ipsilateral and contralateral DRGs regardless of the chambers marked with the patch. However, significantly more FB-labeled neurons projected to the ventricles compared to the atria (859 vs. 715). The proportion of isolectin B(4) binding in FB-labeled neurons was equal among all neurons projecting to different heart chambers (2.4%). Neurofilament 200 positivity was found in greater proportions in DRG neurons projecting to the left side of the heart, whereas calretinin-immunoreactivity was mostly represented in neurons projecting to the left atrium. Spinal afferent neurons projecting to different chambers of the rat heart exhibit a variety of neurochemical phenotypes depending on binding capacity for isolectin B(4) and immunoreactivity for neurofilament 200 and calretinin, and thus represent important baseline data for future studies. PMID:20018227

  14. Myoepithelial carcinoma in the mediastinum involving the left atrium.

    PubMed

    Briasoulis, Alexandros; Salem, Nagla; Siddiqui, Fayez; Rashed, Ahmed; Othman, Mahmoud

    2016-01-01

    We report a case of a 56-year-old male who presented with typical atrial flutter and was diagnosed with a large mediastinal mass, posterior to the ascending aorta, noted within the left atrium, compressing the superior vena cava and right superior pulmonary vein, and measuring >9.0 cm at its greatest diameter. Histopathological studies showed a myoepithelial carcinoma. The patient underwent tumor debulking and radiation therapy. This is the first report of a mediastinal myoepithelial carcinoma involving cardiac chambers. PMID:26429764

  15. Congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery: an interesting case report.

    PubMed

    Turker, Yasin; Tibilli, Hakan

    2014-01-01

    Intercoronary communication is a very rare coronary artery anomaly. It is defined as an open-ended circulation with bidirectional blood flow between two coronary arteries. Coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel. A 62-year-old man was admitted to our hospital with sudden development of general weakness, dizziness and a sensation of compression in his chest. At presentation his blood pressure was 80/40 mmHg and heart rate was 65 beats/min. The ECG revealed sinus rhythm and 1-2 mm ST elevation in the anterior leads. The patient was taken to the catheterization laboratory for percutaneous coronary intervention. The left main and left circumflex coronary arteries were normal. Coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium. The other coronary arteries were normal. Laboratory test results, including cardiac troponin I and creatine kinase-MB levels, were normal. The angina symptoms disappeared and the ST elevation resolved within four hours. We report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome. To the best of our knowledge, this is the first case in the literature involving a coronary artery fistula in an intercoronary communication. PMID:24411822

  16. A unique foetal case of left ventricular non-compaction associated with arrhythmia, structural cardiac anomalies, and agenesis of the ductus venosus.

    PubMed

    Thakur, Varsha; Jaeggi, Edgar T; Nield, Lynne E

    2016-02-01

    A 21-week gestational age foetus was diagnosed with left ventricular non-compaction, Ebstein's anomaly, sinus bradycardia, first-degree heart block, and agenesis of the ductus venosus. The prognosis was guarded given the constellation of findings, and the foetus was monitored closely. Despite a potentially poor outcome, the foetus survived. Prognosis in foetally diagnosed left ventricular non-compaction is usually poor; however, rarely, foetuses can survive postnatally. PMID:26095517

  17. A Rare Case of Left Ventricular Intramural Hemangioma Diagnosed Using 1.5-T Cardiac MRI with Histopathological Correlation and Successfully Treated by Surgery

    SciTech Connect

    Marrone, Gianluca; Sciacca, Sergio D'Ancona, Giuseppe Pilato, Michele; Luca, Angelo; Gridelli, Bruno

    2010-02-15

    Hemangiomas are vascular tumors composed of blood vessels, frequently localized in the skin and subcutaneous muscles; their localization in the heart is exceptional. The most common localizations are the lateral walls of the left ventricle, the anterior wall, and the septum. Mostly, these tumors grow intracavitarily, rarely intramurally. We describe a singular case of left ventricular intramural hemangioma, detected and diagnosed using newer magnetic resonance imaging (MRI) modalities, confirmed by histopathological results, and treated successfully by surgery.

  18. Cardiac-Specific Inhibition of Kinase Activity in Calcium/Calmodulin-Dependent Protein Kinase Kinase-β Leads to Accelerated Left Ventricular Remodeling and Heart Failure after Transverse Aortic Constriction in Mice

    PubMed Central

    Watanabe, Shin; Horie, Takahiro; Nagao, Kazuya; Kuwabara, Yasuhide; Baba, Osamu; Nishi, Hitoo; Sowa, Naoya; Narazaki, Michiko; Matsuda, Tetsuya; Takemura, Genzou; Wada, Hiromichi; Hasegawa, Koji; Kimura, Takeshi; Ono, Koh

    2014-01-01

    Background The mechanism of cardiac energy production against sustained pressure overload remains to be elucidated. Methods and Results We generated cardiac-specific kinase-dead (kd) calcium/calmodulin-dependent protein kinase kinase-β (CaMKKβ) transgenic (α-MHC CaMKKβkd TG) mice using α-myosin heavy chain (α-MHC) promoter. Although CaMKKβ activity was significantly reduced, these mice had normal cardiac function and morphology at baseline. Here, we show that transverse aortic binding (TAC) in α-MHC CaMKKβkd TG mice led to accelerated death and left ventricular (LV) dilatation and dysfunction, which was accompanied by significant clinical signs of heart failure. CaMKKβ downstream signaling molecules, including adenosine monophosphate-activated protein kinase (AMPK), were also suppressed in α-MHC CaMKKβkd TG mice compared with wild-type (WT) mice. The expression levels of peroxisome proliferator-activated receptor-γ coactivator (PGC)-1α, which is a downstream target of both of CaMKKβ and calcium/calmodulin kinases, were also significantly reduced in α-MHC CaMKKβkd TG mice compared with WT mice after TAC. In accordance with these findings, mitochondrial morphogenesis was damaged and creatine phosphate/β-ATP ratios assessed by magnetic resonance spectroscopy were suppressed in α-MHC CaMKKβkd TG mice compared with WT mice after TAC. Conclusions These data indicate that CaMKKβ exerts protective effects on cardiac adaptive energy pooling against pressure-overload possibly through phosphorylation of AMPK and by upregulation of PGC-1α. Thus, CaMKKβ may be a therapeutic target for the treatment of heart failure. PMID:25255457

  19. Blunt Cardiac Injury.

    PubMed

    Marcolini, Evie G; Keegan, Joshua

    2015-08-01

    Blunt cardiac injury encompasses multiple different injuries, including contusion, chamber rupture, and acute valvular disorders. Blunt cardiac injury is common and may cause significant morbidity and mortality; a high index of suspicion is needed for accurate diagnosis. Diagnostic work-up should always include electrocardiogram and cardiac enzymes, and may include echocardiography if specific disorders (ie, tamponade or valvular disorders) are suspected. Patients with myocardial contusion should be observed for 24 to 48 hours for arrhythmias. Many other significant forms of blunt cardiac injury require surgical intervention. PMID:26226863

  20. A case of cerebral embolism due to cardiac myxoma presenting with multiple cerebral microaneurysms detected on first MRI scans.

    PubMed

    Sato, Takahiro; Saji, Naoki; Kobayashi, Kazuto; Shibazaki, Kensaku; Kimura, Kazumi

    2016-03-01

    A 64-year-old man developed right arm weakness and dysarthria, and was admitted to our hospital. Diffusion-weighted magnetic resonance imaging of the brain showed a high intensity area in the frontal lobe. T2*-weighted images showed multiple spotty low intensity lesions in bilateral cerebral hemispheres, mimicking cerebral microbleeds. Cerebral angiography showed multiple aneurysms in the anterior, middle, posterior cerebral arteries and cerebellar arteries. Transthoracic echocardiography revealed a floating structure in the left atrial chamber, indicating cardiac myxoma. We diagnosed cardioembolic ischemic stroke due to left atrial myxoma. Cardiac surgery for excision of a left atrial myxoma was performed on the 3rd hospital day. Multiple aneurysms should be taken into account for differential diagnosis in patients with cardiac myxoma and with atypical spotty low intensity on T2*-weighted images. PMID:26797485

  1. Implantation of a left ventricular assist device as a destination therapy in Duchenne muscular dystrophy patients with end stage cardiac failure: management and lessons learned.

    PubMed

    Iodice, Francesca; Testa, Giuseppina; Averardi, Marco; Brancaccio, Gianluca; Amodeo, Antonio; Cogo, Paola

    2015-01-01

    Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder, characterized by progressive skeletal muscle weakness, loss of ambulation, and death secondary to cardiac or respiratory failure. End-stage dilated cardiomyopathy (DCM) is a frequent finding in DMD patients, they are rarely candidates for cardiac transplantation. Recently, the use of ventricular assist devices as a destination therapy (DT) as an alternative to cardiac transplantation in DMD patients has been described. Preoperative planning and patient selection play a significant role in the successful postoperative course of these patients. We describe the preoperative, intraoperative and postoperative management of Jarvik 2000 implantation in 4 DMD pediatric (age range 12-17 years) patients. We also describe the complications that may occur. The most frequent were bleeding and difficulty in weaning from mechanical ventilation. Our standard protocol includes: 1) preoperative multidisciplinary evaluation and selection, 2) preoperative and postoperative non-invasive ventilation and cough machine cycles, 3) intraoperative use of near infrared spectroscopy (NIRS) and transesophageal echocardiography, 4) attention on surgical blood loss, use of tranexamic acid and prothrombin complexes, 5) early extubation and 6) avoiding the use of nasogastric feeding tubes and nasal temperature probes. Our case reports describe the use of Jarvik 2000 as a destination therapy in young patients emphasizing the use of ventricular assist devices as a new therapeutic option in DMD. PMID:25444433

  2. Time Components of the Left Ventricle.

    ERIC Educational Resources Information Center

    Franks, B. Don

    The purpose of this study was to examine the relationship of the time components of the left ventricle. Since one of the ways to investigate cardiac function is to analyze the time intervals between particular events of the cardiac cycle, various time intervals of systole and diastole of the left ventricle were measured from simultaneous…

  3. Cardiac remodeling in the mouse model of Marfan syndrome develops into two distinctive phenotypes.

    PubMed

    Tae, Hyun-Jin; Petrashevskaya, Natalia; Marshall, Shannon; Krawczyk, Melissa; Talan, Mark

    2016-01-15

    Marfan syndrome (MFS) is a systemic disorder of connective tissue caused by mutations in fibrillin-1. Cardiac dysfunction in MFS has not been characterized halting the development of therapies of cardiac complication in MFS. We aimed to study the age-dependent cardiac remodeling in the mouse model of MFS FbnC1039G+/- mouse [Marfan heterozygous (HT) mouse] and its association with valvular regurgitation. Marfan HT mice of 2-4 mo demonstrated a mild hypertrophic cardiac remodeling with predominant decline of diastolic function and increased transforming growth factor-β canonical (p-SMAD2/3) and noncanonical (p-ERK1/2 and p-p38 MAPK) signaling and upregulation of hypertrophic markers natriuretic peptides atrium natriuretic peptide and brain natriuretic peptide. Among older HT mice (6-14 mo), cardiac remodeling was associated with two distinct phenotypes, manifesting either dilated or constricted left ventricular chamber. Dilatation of left ventricular chamber was accompanied by biochemical evidence of greater mechanical stress, including elevated ERK1/2 and p38 MAPK phosphorylation and higher brain natriuretic peptide expression. The aortic valve regurgitation was registered in 20% of the constricted group and 60% of the dilated group, whereas mitral insufficiency was observed in 40% of the constricted group and 100% of the dilated group. Cardiac dysfunction was not associated with the increase of interstitial fibrosis and nonmyocyte proliferation. In the mouse model fibrillin-1, haploinsufficiency results in the early onset of nonfibrotic hypertrophic cardiac remodeling and dysfunction, independently from valvular abnormalities. MFS heart is vulnerable to stress-induced cardiac dilatation in the face of valvular regurgitation, and stress-activated MAPK signals represent a potential target for cardiac management in MFS. PMID:26566724

  4. Four patients with Sillence type I osteogenesis imperfecta and mild bone fragility, complicated by left ventricular cardiac valvular disease and cardiac tissue fragility caused by type I collagen mutations.

    PubMed

    Vandersteen, Anthony M; Lund, Allan M; Ferguson, David J P; Sawle, Philip; Pollitt, Rebecca C; Holder, Susan E; Wakeling, Emma; Moat, Neil; Pope, F Michael

    2014-02-01

    Osteogenesis imperfecta (OI) type I is a hereditary disorder of connective tissue (HDCT) characterized by blue or gray sclerae, variable short stature, dentinogenesis imperfecta, hearing loss, and recurrent fractures from infancy. We present four examples of OI type I complicated by valvular heart disease and associated with tissue fragility. The diagnosis of a type I collagen disorder was confirmed by abnormal COL1A1 or COL1A2 gene sequencing. One patient was investigated with electrophoresis of collagens from cultured skin fibroblasts, showing structurally abnormal collagen type I, skin biopsy showed unusual histology and abnormal collagen fibril ultra-structure at electron microscopy. The combined clinical, surgical, histological, ultra-structural, and molecular genetic data suggest the type I collagen defect as contributory to cardiac valvular disease. The degree of tissue fragility experienced at cardiac surgery in these individuals, also reported in a small number of similar case reports, suggests that patients with OI type I need careful pre-operative assessment and consideration of the risks and benefits of cardiac surgery. PMID:24311407

  5. [Cardiac computed tomography in preoperative management of a congenital coronary anomaly].

    PubMed

    Davin, L; Gach, O; Martinez, C; Bruyère, P-J; Radermecker, M; Grenade, T; Piérard, L; Legrand, V

    2009-04-01

    We report the case of a 81-year-old man presenting with stable exercise angina pectoris. The stress test is positive and the coronaro-angiographic evaluation demonstrates a coronary fistula between the left anterior descending (LAD) artery and the pulmonary artery trunk. The mid LAD presents a significant lesion after the origin of the fistula. A cardiac computed tomography is used before surgical treatment. Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunt into a cardiac chamber, great vessel or other structure. Low-pressure structure is the most common site of drainage of the coronary fistula. The clinical presentation of coronary fistulas is mainly dependent on the severity of the left-to-right shunt. Various cardiac imaging modalities are used for diagnosis and anatomical exploration before surgical or percutaneous intervention if the closure of the fistula is indicated. PMID:18579115

  6. Dietary saturated fat and docosahexaenoic acid differentially effect cardiac mitochondrial phospholipid fatty acyl composition and Ca2+ uptake, without altering permeability transition or left ventricular function

    PubMed Central

    O'Connell, Kelly A; Dabkowski, Erinne R; de Fatima Galvao, Tatiana; Xu, Wenhong; Daneault, Caroline; de Rosiers, Christine; Stanley, William C

    2013-01-01

    High saturated fat diets improve cardiac function and survival in rodent models of heart failure, which may be mediated by changes in mitochondrial function. Dietary supplementation with the n3-polyunsaturated fatty acid docosahexaenoic acid (DHA, 22:6n3) is also beneficial in heart failure and can affect mitochondrial function. Saturated fatty acids and DHA likely have opposing effects on mitochondrial phospholipid fatty acyl side chain composition and mitochondrial membrane function, though a direct comparison has not been previously reported. We fed healthy adult rats a standard low-fat diet (11% of energy intake from fat), a low-fat diet supplemented with DHA (2.3% of energy intake) or a high-fat diet comprised of long chain saturated fatty acids (45% fat) for 6 weeks. There were no differences among the three diets in cardiac mass or function, mitochondrial respiration, or Ca2+-induced mitochondrial permeability transition. On the other hand, there were dramatic differences in mitochondrial phospholipid fatty acyl side chains. Dietary supplementation with DHA increased DHA from 7% to ∼25% of total phospholipid fatty acids in mitochondrial membranes, and caused a proportional depletion of arachidonic acid (20:4n6). The saturated fat diet increased saturated fat and DHA in mitochondria and decreased linoleate (18:2n6), which corresponded to a decrease in Ca2+ uptake by isolated mitochondria compared to the other diet groups. In conclusion, despite dramatic changes in mitochondrial phospholipid fatty acyl side chain composition by both the DHA and high saturated fat diets, there were no effects on mitochondrial respiration, permeability transition, or cardiac function. PMID:24303101

  7. Dietary saturated fat and docosahexaenoic acid differentially effect cardiac mitochondrial phospholipid fatty acyl composition and Ca(2+) uptake, without altering permeability transition or left ventricular function.

    PubMed

    O'Connell, Kelly A; Dabkowski, Erinne R; de Fatima Galvao, Tatiana; Xu, Wenhong; Daneault, Caroline; de Rosiers, Christine; Stanley, William C

    2013-06-01

    High saturated fat diets improve cardiac function and survival in rodent models of heart failure, which may be mediated by changes in mitochondrial function. Dietary supplementation with the n3-polyunsaturated fatty acid docosahexaenoic acid (DHA, 22:6n3) is also beneficial in heart failure and can affect mitochondrial function. Saturated fatty acids and DHA likely have opposing effects on mitochondrial phospholipid fatty acyl side chain composition and mitochondrial membrane function, though a direct comparison has not been previously reported. We fed healthy adult rats a standard low-fat diet (11% of energy intake from fat), a low-fat diet supplemented with DHA (2.3% of energy intake) or a high-fat diet comprised of long chain saturated fatty acids (45% fat) for 6 weeks. There were no differences among the three diets in cardiac mass or function, mitochondrial respiration, or Ca(2+)-induced mitochondrial permeability transition. On the other hand, there were dramatic differences in mitochondrial phospholipid fatty acyl side chains. Dietary supplementation with DHA increased DHA from 7% to ∼25% of total phospholipid fatty acids in mitochondrial membranes, and caused a proportional depletion of arachidonic acid (20:4n6). The saturated fat diet increased saturated fat and DHA in mitochondria and decreased linoleate (18:2n6), which corresponded to a decrease in Ca(2+) uptake by isolated mitochondria compared to the other diet groups. In conclusion, despite dramatic changes in mitochondrial phospholipid fatty acyl side chain composition by both the DHA and high saturated fat diets, there were no effects on mitochondrial respiration, permeability transition, or cardiac function. PMID:24303101

  8. Cardiac function adaptations in hibernating grizzly bears (Ursus arctos horribilis).

    PubMed

    Nelson, O Lynne; Robbins, Charles T

    2010-03-01

    Research on the cardiovascular physiology of hibernating mammals may provide insight into evolutionary adaptations; however, anesthesia used to handle wild animals may affect the cardiovascular parameters of interest. To overcome these potential biases, we investigated the functional cardiac phenotype of the hibernating grizzly bear (Ursus arctos horribilis) during the active, transitional and hibernating phases over a 4 year period in conscious rather than anesthetized bears. The bears were captive born and serially studied from the age of 5 months to 4 years. Heart rate was significantly different from active (82.6 +/- 7.7 beats/min) to hibernating states (17.8 +/- 2.8 beats/min). There was no difference from the active to the hibernating state in diastolic and stroke volume parameters or in left atrial area. Left ventricular volume:mass was significantly increased during hibernation indicating decreased ventricular mass. Ejection fraction of the left ventricle was not different between active and hibernating states. In contrast, total left atrial emptying fraction was significantly reduced during hibernation (17.8 +/- 2.8%) as compared to the active state (40.8 +/- 1.9%). Reduced atrial chamber function was also supported by reduced atrial contraction blood flow velocities and atrial contraction ejection fraction during hibernation; 7.1 +/- 2.8% as compared to 20.7 +/- 3% during the active state. Changes in the diastolic cardiac filling cycle, especially atrial chamber contribution to ventricular filling, appear to be the most prominent macroscopic functional change during hibernation. Thus, we propose that these changes in atrial chamber function constitute a major adaptation during hibernation which allows the myocardium to conserve energy, avoid chamber dilation and remain healthy during a period of extremely low heart rates. These findings will aid in rational approaches to identifying underlying molecular mechanisms. PMID:19940994

  9. Metal ring on 4th or 5th finger markedly increases both cardiac troponin I at left ventricle and cancer-related parameters such as oncogen C-fosAb2 & integrin α₅β₁[corrected] by 4-12 times. Thus these metal rings appear to promote both heart problems & cancer.

    PubMed

    Omura, Yoshiaki; Hines, Howard; Jones, Marilyn; O'Young, Brian; Duvvi, Harsha; Lu, Dominic P; Pallos, Andrew; Shimotsuura, Yasuhiro; Ohki, Motomu

    2010-01-01

    We examined patients wearing a metal ring on the left 4th finger with abnormally increased Cardiac Troponin I (which is known to increase in the presence of myocardial injury or left ventricular hypertrophy) of 5-14ng BDORT units (depending on the ring and individual) at left ventricle compared with normal value of 1ng BDORT units or less. Although shape of the ECG does not change significantly regardless of whether metal rings are on or not, when rings are on, the Bi-Digital O-Ring Test evaluation of trace of ECG revealed "Vulnerable Period of Rising Part of T-wave" of ECG waves (which correspond to the left ventricle and AV node) become abnormal with increased Cardiac Troponin I. DHEA in various parts of the body reduced significantly and maximum decrease in DHEA was found when metal ring was on the left 4th and 5th fingers. Telomere reduced with each of the 5 fingers, but the 2nd, 4th, and 5th fingers produced the maximum reduction of telomere. When metal ring was inserted onto the left 1st finger and left 2nd finger, Cardiac Troponin I did not change significantly. Additional abnormality was found when patients with cancer wore metal ring(s); namely both Cardiac Troponin I and cancer parameters, such as Integrin α₅β₁[corrected] and Oncogen C-fos Ab2, increase anywhere between 4-12 times. However, when the ring was cut, creating a 1mm or longer empty space, no increase in cancer markers and Cardiac Troponin I were observed. Similar findings were found with metal bracelets. PMID:20578646

  10. Postinfarct Left Ventricular Remodelling: A Prevailing Cause of Heart Failure

    PubMed Central

    Galli, Alessio; Lombardi, Federico

    2016-01-01

    Heart failure is a chronic disease with high morbidity and mortality, which represents a growing challenge in medicine. A major risk factor for heart failure with reduced ejection fraction is a history of myocardial infarction. The expansion of a large infarct scar and subsequent regional ventricular dilatation can cause postinfarct remodelling, leading to significant enlargement of the left ventricular chamber. It has a negative prognostic value, because it precedes the clinical manifestations of heart failure. The characteristics of the infarcted myocardium predicting postinfarct remodelling can be studied with cardiac magnetic resonance and experimental imaging modalities such as diffusion tensor imaging can identify the changes in the architecture of myocardial fibers. This review discusses all the aspects related to postinfarct left ventricular remodelling: definition, pathogenesis, diagnosis, consequences, and available therapies, together with experimental interventions that show promising results against postinfarct remodelling and heart failure. PMID:26989555

  11. Exposure chamber

    DOEpatents

    Moss, Owen R.

    1980-01-01

    A chamber for exposing animals, plants, or materials to air containing gases or aerosols is so constructed that catch pans for animal excrement, for example, serve to aid the uniform distribution of air throughout the chamber instead of constituting obstacles as has been the case in prior animal exposure chambers. The chamber comprises the usual imperforate top, bottom and side walls. Within the chamber, cages and their associated pans are arranged in two columns. The pans are spaced horizontally from the walls of the chamber in all directions. Corresponding pans of the two columns are also spaced horizontally from each other. Preferably the pans of one column are also spaced vertically from corresponding pans of the other column. Air is introduced into the top of the chamber and withdrawn from the bottom. The general flow of air is therefore vertical. The effect of the horizontal pans is based on the fact that a gas flowing past the edge of a flat plate that is perpendicular to the flow forms a wave on the upstream side of the plate. Air flows downwardly between the chamber walls and the outer edges of the pan. It also flows downwardly between the inner edges of the pans of the two columns. It has been found that when the air carries aerosol particles, these particles are substantially uniformly distributed throughout the chamber.

  12. Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

    PubMed Central

    2011-01-01

    Abtract Background In right ventricular failure (RVF), an interatrial shunt can relieve symptoms of severe pulmonary hypertension by reducing right ventricular preload and increasing systemic flow. Using a pig model to determine if a pulmonary artery - left atrium shunt (PA-LA) is better than a right atrial - left atrial shunt (RA-LA), we compared the hemodynamic effects and blood gases between the two shunts. Methods Thirty, male Large White pigs weighting in average 21.3 kg ± 0.7 (SEM) were divided into two groups (15 pigs per group): In group 1, banding of the pulmonary artery and a pulmonary artery to left atrium shunt with an 8 mm graft (PA-LA) was performed and in group 2 banding of the pulmonary artery and right atrial to left atrial shunt (RA-LA) with a similar graft was performed. Hemodynamic parameters and blood gases were measured from all cardiac chambers in 10 and 20 minutes, half and one hour interval from the baseline (30 min from the banding). Cardiac output and flow of at the left anterior descending artery was also monitored. Results In both groups, a stable RVF was generated. The PA-LA shunt compared to the RA-LA shunt has better hemodynamic performance concerning the decreased right ventricle afterload, the 4 fold higher mean pressure of the shunt, the better flow in left anterior descending artery and the decreased systemic vascular resistance. Favorable to the PA-LA shunt is also the tendency - although not statistically significant - in relation to central venous pressure, left atrial filling and cardiac output. Conclusion The PA-LA shunt can effectively reverse the catastrophic effects of acute RVF offering better hemodynamic characteristics than an interatrial shunt. PMID:22011551

  13. Mechanisms of cardiac pain.

    PubMed

    Foreman, Robert D; Garrett, Kennon M; Blair, Robert W

    2015-04-01

    Angina pectoris is cardiac pain that typically is manifested as referred pain to the chest and upper left arm. Atypical pain to describe localization of the perception, generally experienced more by women, is referred to the back, neck, and/or jaw. This article summarizes the neurophysiological and pharmacological mechanisms for referred cardiac pain. Spinal cardiac afferent fibers mediate typical anginal pain via pathways from the spinal cord to the thalamus and ultimately cerebral cortex. Spinal neurotransmission involves substance P, glutamate, and transient receptor potential vanilloid-1 (TRPV1) receptors; release of neurokinins such as nuclear factor kappa b (NF-kb) in the spinal cord can modulate neurotransmission. Vagal cardiac afferent fibers likely mediate atypical anginal pain and contribute to cardiac ischemia without accompanying pain via relays through the nucleus of the solitary tract and the C1-C2 spinal segments. The psychological state of an individual can modulate cardiac nociception via pathways involving the amygdala. Descending pathways originating from nucleus raphe magnus and the pons also can modulate cardiac nociception. Sensory input from other visceral organs can mimic cardiac pain due to convergence of this input with cardiac input onto spinothalamic tract neurons. Reduction of converging nociceptive input from the gallbladder and gastrointestinal tract can diminish cardiac pain. Much work remains to be performed to discern the interactions among complex neural pathways that ultimately produce or do not produce the sensations associated with cardiac pain. PMID:25880519

  14. Wire chamber

    DOEpatents

    Atac, Muzaffer

    1989-01-01

    A wire chamber or proportional counter device, such as Geiger-Mueller tube or drift chamber, improved with a gas mixture providing a stable drift velocity while eliminating wire aging caused by prior art gas mixtures. The new gas mixture is comprised of equal parts argon and ethane gas and having approximately 0.25% isopropyl alcohol vapor.

  15. L-Arginine ameliorates cardiac left ventricular oxidative stress by upregulating eNOS and Nrf2 target genes in alloxan-induced hyperglycemic rats

    SciTech Connect

    Ramprasath, Tharmarajan; Hamenth Kumar, Palani; Syed Mohamed Puhari, Shanavas; Senthil Murugan, Ponniah; Vasudevan, Varadaraj; Selvam, Govindan Sadasivam

    2012-11-23

    Highlights: Black-Right-Pointing-Pointer L-Arginine treatment reduced the metabolic disturbances in diabetic animals. Black-Right-Pointing-Pointer Antioxidant marker proteins were found high in myocardium by L-arginine treatment. Black-Right-Pointing-Pointer Elevated antioxidant status, mediates the reduced TBA-reactivity in left ventricle. Black-Right-Pointing-Pointer L-Arginine treatment enhanced the Nrf2 and eNOS signaling in left ventricle. Black-Right-Pointing-Pointer Improved cell survival signaling by arginine, offers a novel tactic for targeting. -- Abstract: Hyperglycemia is independently related with excessive morbidity and mortality in cardiovascular disorders. L-Arginine-nitric oxide (NO) pathway and the involvement of NO in modulating nuclear factor-E2-related factor-2 (Nrf2) signaling were well established. In the present study we investigated, whether L-arginine supplementation would improve the myocardial antioxidant defense under hyperglycemia through activation of Nrf2 signaling. Diabetes was induced by alloxan monohydrate (90 mg kg{sup -1} body weight) in rats. Both non-diabetic and diabetic group of rats were divided into three subgroups and they were administered either with L-arginine (2.25%) or L-NAME (0.01%) in drinking water for 12 days. Results showed that L-arginine treatment reduced the metabolic disturbances in diabetic rats. Antioxidant enzymes and glutathione levels were found to be increased in heart left ventricles, thereby reduction of lipid peroxidation by L-arginine treatment. Heart histopathological analysis further validates the reversal of typical diabetic characteristics consisting of alterations in myofibers and myofibrillary degeneration. qRT-PCR studies revealed that L-arginine treatment upregulated the transcription of Akt and downregulated NF-{kappa}B. Notably, transcription of eNOS and Nrf2 target genes was also upregulated, which were accompanied by enhanced expression of Nrf2 in left ventricular tissue from diabetic and control rats. Under these findings, we suggest that targeting of eNOS and Nrf2 signaling by L-arginine supplementation could be used as a potential treatment method to alleviate the late diabetic complications.

  16. Concurrent Left Ventricular Assist Device (LVAD) Implantation and Percutaneous Temporary RVAD Support via CardiacAssist Protek-Duo TandemHeart to Preempt Right Heart Failure.

    PubMed

    Schmack, Bastian; Weymann, Alexander; Popov, Aron-Frederik; Patil, Nikhil Prakash; Sabashnikov, Anton; Kremer, Jamila; Farag, Mina; Brcic, Andreas; Lichtenstern, Christoph; Karck, Matthias; Ruhparwar, Arjang

    2016-01-01

    Right ventricular failure (RVF) is an unfortunate complication that continues to limit outcomes following durable left ventricular assist device (LVAD) implantation. Despite several 'RVF risk scores' having been proposed, preoperative prediction of post-LVAD RVF remains a guesstimate at best. Current strategies for institution of temporary RVAD support are invasive, necessitate additional re-thoracotomy, restrict postoperative mobilization, and/or entail prolonged retention of prosthetic material in-situ. The authors propose a novel surgical strategy comprising simultaneous implantation of a permanent LVAD and percutaneous TandemHeart® plus ProtekDuo® to provide temporary RVAD support and preempt RVF in patients with impaired RV function. PMID:27145697

  17. Cardiac stem cells delivered intravascularly traverse the vessel barrier, regenerate infarcted myocardium, and improve cardiac function.

    PubMed

    Dawn, Buddhadeb; Stein, Adam B; Urbanek, Konrad; Rota, Marcello; Whang, Brian; Rastaldo, Raffaella; Torella, Daniele; Tang, Xian-Liang; Rezazadeh, Arash; Kajstura, Jan; Leri, Annarosa; Hunt, Greg; Varma, Jai; Prabhu, Sumanth D; Anversa, Piero; Bolli, Roberto

    2005-03-01

    The ability of cardiac stem cells (CSCs) to promote myocardial repair under clinically relevant conditions (i.e., when delivered intravascularly after reperfusion) is unknown. Thus, rats were subjected to a 90-min coronary occlusion; at 4 h after reperfusion, CSCs were delivered to the coronary arteries via a catheter positioned into the aortic root. Echocardiographic analysis showed that injection of CSCs attenuated the increase in left ventricular (LV) end-diastolic dimensions and impairment in LV systolic performance at 5 weeks after myocardial infarction. Pathologic analysis showed that treated hearts exhibited a smaller increase in LV chamber diameter and volume and a higher wall thickness-to-chamber radius ratio and LV mass-to-chamber volume ratio. CSCs induced myocardial regeneration, decreasing infarct size by 29%. A diploid DNA content and only two chromosomes 12 were found in new cardiomyocytes, indicating that cell fusion did not contribute to tissue reconstitution. In conclusion, intravascular injection of CSCs after reperfusion limits infarct size, attenuates LV remodeling, and ameliorates LV function. This study demonstrates that CSCs are effective when delivered in a clinically relevant manner, a clear prerequisite for clinical translation, and that these beneficial effects are independent of cell fusion. The results establish CSCs as candidates for cardiac regeneration and support an approach in which the heart's own stem cells could be collected, expanded, and stored for subsequent therapeutic repair. PMID:15734798

  18. Cardiac stem cells delivered intravascularly traverse the vessel barrier, regenerate infarcted myocardium, and improve cardiac function

    PubMed Central

    Dawn, Buddhadeb; Stein, Adam B.; Urbanek, Konrad; Rota, Marcello; Whang, Brian; Rastaldo, Raffaella; Torella, Daniele; Tang, Xian-Liang; Rezazadeh, Arash; Kajstura, Jan; Leri, Annarosa; Hunt, Greg; Varma, Jai; Prabhu, Sumanth D.; Anversa, Piero; Bolli, Roberto

    2005-01-01

    The ability of cardiac stem cells (CSCs) to promote myocardial repair under clinically relevant conditions (i.e., when delivered intravascularly after reperfusion) is unknown. Thus, rats were subjected to a 90-min coronary occlusion; at 4 h after reperfusion, CSCs were delivered to the coronary arteries via a catheter positioned into the aortic root. Echocardiographic analysis showed that injection of CSCs attenuated the increase in left ventricular (LV) end-diastolic dimensions and impairment in LV systolic performance at 5 weeks after myocardial infarction. Pathologic analysis showed that treated hearts exhibited a smaller increase in LV chamber diameter and volume and a higher wall thickness-to-chamber radius ratio and LV mass-to-chamber volume ratio. CSCs induced myocardial regeneration, decreasing infarct size by 29%. A diploid DNA content and only two chromosomes 12 were found in new cardiomyocytes, indicating that cell fusion did not contribute to tissue reconstitution. In conclusion, intravascular injection of CSCs after reperfusion limits infarct size, attenuates LV remodeling, and ameliorates LV function. This study demonstrates that CSCs are effective when delivered in a clinically relevant manner, a clear prerequisite for clinical translation, and that these beneficial effects are independent of cell fusion. The results establish CSCs as candidates for cardiac regeneration and support an approach in which the heart's own stem cells could be collected, expanded, and stored for subsequent therapeutic repair. PMID:15734798

  19. Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass

    PubMed Central

    Levin, Ricardo; Degrange, Marcela; Del Mazo, Carlos; Tanus, Eduardo; Porcile, Rafael

    2012-01-01

    BACKGROUND: The calcium sensitizer levosimendan has been used in cardiac surgery for the treatment of postoperative low cardiac output syndrome (LCOS) and difficult weaning from cardiopulmonary bypass (CPB). OBJECTIVES: To evaluate the effects of preoperative treatment with levosimendan on 30-day mortality, the risk of developing LCOS and the requirement for inotropes, vasopressors and intra-aortic balloon pumps in patients with severe left ventricular dysfunction. METHODS: Patient with severe left ventricular dysfunction and an ejection fraction <25% undergoing coronary artery bypass grafting with CPB were admitted 24 h before surgery and were randomly assigned to receive levosimendan (loading dose 10 μg/kg followed by a 23 h continuous infusion of 0.1μg/kg/min) or a placebo. RESULTS: From December 1, 2002 to June 1, 2008, a total of 252 patients were enrolled (127 in the levosimendan group and 125 in the control group). Individuals treated with levosimendan exhibited a lower incidence of complicated weaning from CPB (2.4% versus 9.6%; P<0.05), decreased mortality (3.9% versus 12.8%; P<0.05) and a lower incidence of LCOS (7.1% versus 20.8%; P<0.05) compared with the control group. The levosimendan group also had a lower requirement for inotropes (7.9% versus 58.4%; P<0.05), vasopressors (14.2% versus 45.6%; P<0.05) and intra-aortic balloon pumps (6.3% versus 30.4%; P<0.05). CONCLUSION: Patients with severe left ventricle dysfunction (ejection fraction <25%) undergoing coronary artery bypass grafting with CPB who were pretreated with levosimendan exhibited lower mortality, a decreased risk for developing LCOS and a reduced requirement for inotropes, vasopressors and intra-aortic balloon pumps. Studies with a larger number of patients are required to confirm whether these findings represent a new strategy to reduce the operative risk in this high-risk patient population. PMID:23620700

  20. Comparison of the effects of continuous and pulsatile left ventricular-assist devices on ventricular unloading using a cardiac electromechanics model

    PubMed Central

    Lim, Ki Moo; Constantino, Jason; Gurev, Viatcheslav; Zhu, Renjun; Trayanova, Natalia A.

    2012-01-01

    Left ventricular-assist devices (LVADs) are used to supply blood to the body of patients with heart failure. Pressure unloading is greater for counter-pulsating LVADs than for continuous LVADs. However, several clinical trials have demonstrated that myocardial recovery is similar for both types of LVAD. This study examined the contractile energy consumption of the myocardium with continuous and counter-pulsating LVAD support to ascertain the effect of the different LVADs on myocardial recovery. We used a three-dimensional electromechanical model of canine ventricles, with models of the circulatory system and an LVAD. We compared the left ventricular peak pressure (LVPP) and contractile ATP consumption between pulsatile and continuous LVADs. With the continuous and counter-pulsating LVAD, the LVPP decreased to 46 and 10%, respectively, and contractile ATP consumption decreased to 60 and 50%. The small difference between the contractile ATP consumption of these two types of LVAD may explain the comparable effects of the two types on myocardial recovery. PMID:22076841

  1. Biomechanics of Early Cardiac Development

    PubMed Central

    Goenezen, Sevan; Rennie, Monique Y.

    2012-01-01

    Biomechanics affect early cardiac development, from looping to the development of chambers and valves. Hemodynamic forces are essential for proper cardiac development, and their disruption leads to congenital heart defects. A wealth of information already exists on early cardiac adaptations to hemodynamic loading, and new technologies, including high resolution imaging modalities and computational modeling, are enabling a more thorough understanding of relationships between hemodynamics and cardiac development. Imaging and modeling approaches, used in combination with biological data on cell behavior and adaptation, are paving the road for new discoveries on links between biomechanics and biology and their effect on cardiac development and fetal programming. PMID:22760547

  2. Combination of a Giant Dissected Ascending Aortic Aneurysm with Multiple Fistulae into the Cardiac Chambers Caused by Prosthetic Aortic Valve Endocarditis

    PubMed Central

    Sabzi, Feridoun; Faraji, Reza

    2016-01-01

    The combination of a dissected ascending aortic aneurysm (AA) with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium and pulmonary artery and a paravalvular leak in a 47-year-old woman with a history of an aortic valve replacement. The patient had presented to the Imam Ali Hospital, Kermanshah, Iran, in January 2015 with clinical features of heart failure. After initially being treated for congestive heart failure, she underwent open-heart surgery via a classic Bentall procedure and double fistula closure. She was discharged 23 days after the operation in good condition. A six-month follow-up showed normal functioning of the composite conduit prosthetic valve and no fistulae recurrence. PMID:26909200

  3. IONIZATION CHAMBER

    DOEpatents

    Redman, W.C.; Shonka, F.R.

    1958-02-18

    This patent describes a novel ionization chamber which is well suited to measuring the radioactivity of the various portions of a wire as the wire is moved at a uniform speed, in order to produce the neutron flux traverse pattern of a reactor in which the wire was previously exposed to neutron radiation. The ionization chamber of the present invention is characterized by the construction wherein the wire is passed through a tubular, straight electrode and radiation shielding material is disposed along the wire except at an intermediate, narrow area where the second electrode of the chamber is located.

  4. Effectiveness and Safety of the Impella 5.0 as a Bridge to Cardiac Transplantation or Durable Left Ventricular Assist Device.

    PubMed

    Lima, Brian; Kale, Parag; Gonzalez-Stawinski, Gonzalo V; Kuiper, Johannes J; Carey, Sandra; Hall, Shelley A

    2016-05-15

    Many patients with end-stage heart failure require mechanical circulatory support as a temporizing measure to enable multidisciplinary assessment for the most suitable therapeutic strategy. Impella 5.0 can be used as a bridge to decision to evaluate patients for potential recovery or bridge to next therapy (bridge to heart transplantation [BTHT] or bridge to durable left ventricular assist device or VAD [BLVAD]. Our goal was to examine single-center outcomes with the Impella 5.0 device as a bridge to next therapy (BTHT or BTLVAD). Forty patients underwent Impella 5.0 support from December 2009 to December 2015 with the intent of BTHT (n = 20) or BTLVAD (n = 20). The primary end point was survival to next therapy. Secondary end points included hemodynamic assessments and in-hospital/30-day complications. All patients were inotrope-dependent, with severely depressed left ventricular ejection fraction (12%) and renal insufficiency (creatinine 2.0 mg/dl). Most were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 2 (66%) with biventricular failure (65%). Thirty patients (75%) survived to next therapy, including transplant (n = 13), durable LVAD (n = 15), and recovery of native heart function (n = 2). No strokes or major bleeding events requiring surgery were observed. Acute renal dysfunction, bleeding requiring transfusion, hemolysis, device malfunction, limb ischemia occurred in 13 (33%), 11 (28%), 3 (8%), 4 (10%), and 1 (3%) patients, respectively. Survival rate to discharge and/or 30 days was 68% (27 of 40). Temporary support with the Impella 5.0 allows for an effective bridge to decision strategy for hemodynamic stabilization and multidisciplinary heart team assessment of critically ill patients with heart failure. In conclusion, many of these patients can be subsequently bridged to the next therapy with favorable outcomes. PMID:27061705

  5. A biplane roentgen videometry system for dynamic /60 per second/ studies of the shape and size of circulatory structures, particularly the left ventricle.

    NASA Technical Reports Server (NTRS)

    Ritman, E. L.; Sturm, E.; Wood, E. H.; Heintzen, P. H.

    1971-01-01

    A roentgen-television digital-computer technique and a display system developed for dynamic circulatory structure studies are described. Details are given for a videoroentgenographic setup which is used for obtaining biplane roentgen silhouettes of a left ventricle. A 60 per sec measurement of the shape and volume of angiographically outlined cardiac chambers can be made by this technique along with simultaneous ECG, pressure, and flow measurements accessible for real-time digital computer processing and analysis.

  6. Heart rate reduction for 36 months with ivabradine reduces left ventricular mass in cardiac allograft recipients: a long-term follow-up study

    PubMed Central

    Doesch, Andreas O; Mueller, Susanne; Erbel, Christian; Gleissner, Christian A; Frankenstein, Lutz; Hardt, Stefan; Ruhparwar, Arjang; Ehlermann, Philipp; Dengler, Thomas; Katus, Hugo A

    2013-01-01

    Background Due to graft denervation, sinus tachycardia is a common problem after heart transplantation, underlining the importance of heart rate control without peripheral effects. However, long-term data regarding the effects of ivabradine, a novel If channel antagonist, are limited in patients after heart transplantation. Methods In this follow-up analysis, the resting heart rate, left ventricular mass indexed to body surface area (LVMI), tolerability, and safety of ivabradine therapy were evaluated at baseline and after 36 months in 30 heart transplant recipients with symptomatic sinus tachycardia versus a matched control group. Results During the study period, ivabradine medication was stopped in three patients (10% of total). Further analysis was based on 27 patients with 36 months of drug intake. The mean patient age was 53.3±11.3 years and mean time after heart transplantation was 5.0±4.8 years. After 36 months, the mean ivabradine dose was 12.0±3.4 mg/day. Resting heart rate was reduced from 91.0±10.7 beats per minute before initiation of ivabradine therapy (ie, baseline) to 81.2±9.8 beats per minute at follow-up (P=0.0006). After 36 months of ivabradine therapy, a statistically significant reduction of LVMI was observed (104.3±22.7 g at baseline versus 93.4±18.4 g at follow-up, P=0.002). Hematologic, renal, and liver function parameters remained stable during ivabradine therapy. Except for a lower mycophenolate mofetil dose at follow-up (P=0.02), no statistically significant changes in immunosuppressive drug dosage or blood levels were detected. No phosphenes were observed during 36 months of ivabradine intake despite active inquiry. Conclusion In line with previously published 12-month data, heart rate reduction with ivabradine remained effective and safe in chronic stable patients after heart transplantation, and also during 36-month long-term follow-up. Further, a significant reduction of LVMI was observed only during ivabradine therapy. Therefore, ivabradine may have a sustained long-term beneficial effect with regard to left ventricular remodeling in heart transplant patients. PMID:24235815

  7. Left Ventricular Hypertrophy in Mild and Moderate Chronic Kidney Disease Determined Using Cardiac Magnetic Resonance Imaging and Cystatin C: the Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Moran, Andrew; Katz, Ronit; Jenny, Nancy Swords; Astor, Brad; Bluemke, David A.; Lima, João A.C.; Siscovick, David; Bertoni, Alain G.; Shlipak, Michael G.

    2008-01-01

    Background: Left Ventricular Hypertrophy (LVH) is associated with end-stage renal disease and chronic kidney disease, but the association of LVH with mild impairment in kidney function is not known. We hypothesized that mild and moderate reductions in kidney function, reflected in higher serum cystatin C concentrations, would be linearly associated with a higher prevalence of LVH. Study Design: Cross-sectional observational study. Settings and Participants: 4,971 participants participating in baseline examinations in the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study with several sites in the U.S. Predictor: Cystatin C-based estimated glomerular filtration rate (eGFRcysC) Outcomes: LVH and left ventricular (LV) mass index. Measurements: Serum cystatin C and creatinine, LV mass obtained by magnetic resonance imaging (MRI). LVH cutoffs for males and females were defined by the upper 95th percentile of LV mass index of all MESA participants without hypertension. Results: LVH was distinctly more prevalent (>12%) only in the lowest two deciles of eGFRcysC (<75 ml/min/1.73 m2). When participants with stage III or higher chronic kidney disease (creatinine eGFR <60 ml/min/1.73 m2) were excluded, the odds for LVH increased for each lower category of eGFRcysC below 75 ml/min/1.73 m2: 1.6 the odds for LVH with an eGFRcysC between 60-75 ml/min/1.73 m2 (95% confidence interval 1.20-2.07, P = 0.001), and 2.0 the odds for an eGFRcysC <60 ml/min/1.73 m2 (1.03-3.75, P = 0.04), after adjustment for demographic factors, study site, diabetes, and smoking. The association of the a lower eGFRcysC with LVH was attenuated after further adjustment for hypertension. Limitations: Cross-sectional, rather than longitudinal design, lack of participants with more advanced kidney disease, lack of a direct measurement of glomerular filtration rate. Conclusions: Among subjects without CKD, eGFRcysC ≤ 75 ml/min/1.73 m2 was associated with a higher odds of LVH. PMID:18845370

  8. 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 ...

  9. New design for an endo-esophageal probe intended for the ablation of cardiac muscle in the left-atrium: A parametric simulation study

    NASA Astrophysics Data System (ADS)

    Pichardo, Samuel; Hynynen, Kullervo

    2009-04-01

    A parametric simulation study was carried out to establish optimal dimensions of endo-esophageal devices intended to treat the atrial fibrillation (AF). The devices are spherical-surface sections truncated at 15 mm (depth of 4 mm) and cut in concentric-rings each composed of independently driven sectors. The number of independent elements (N) was minimized for different values of ratio of amplitude of secondary lobe over main lobe (E) of 0.35, 0.4, 0.45 and 0.5 and for a volume of interest (VOI) of 24×27×28 mm3 (located at 23.5 mm from the center of the device), which is large enough to contain all the targets identified in the Visible Human Project Male specimen. Operating at 1 MHz, E and N were calculated in function of the element size and focal length (F). After keeping values of F and normalized dimensions of the independent elements in terms of wavelength, higher frequencies were considered: 1.25 and 1.5 MHz. Lesion formation in the heart chamber showed that the twelve configurations were able to produce the typical lesion used to treat the AF while preserving surrounding structures. For an exposure of 5 s and maximal temperature of 70 řC, the average (s.d.) acoustical intensity at transducer surface varied from 22.3(5.8)W/cm2 for a device with F = 98 mm at 1 MHz to 9.2(2.1)W/cm2 for a device with F = 186 mm at 1.5 MHz, while requiring 319 and 1158 elements, respectively, and achieving values of E of 0.5 and 0.41, respectively.

  10. Platelet Endothelial Cell Adhesion Molecule‐1 Mediates Endothelial‐Cardiomyocyte Communication and Regulates Cardiac Function

    PubMed Central

    McCormick, Margaret E.; Collins, Caitlin; Makarewich, Catherine A.; Chen, Zhongming; Rojas, Mauricio; Willis, Monte S.; Houser, Steven R.; Tzima, Ellie

    2015-01-01

    Background Dilated cardiomyopathy is characterized by impaired contractility of cardiomyocytes, ventricular chamber dilatation, and systolic dysfunction. Although mutations in genes expressed in the cardiomyocyte are the best described causes of reduced contractility, the importance of endothelial‐cardiomyocyte communication for proper cardiac function is increasingly appreciated. In the present study, we investigate the role of the endothelial adhesion molecule platelet endothelial cell adhesion molecule (PECAM‐1) in the regulation of cardiac function. Methods and Results Using cell culture and animal models, we show that PECAM‐1 expressed in endothelial cells (ECs) regulates cardiomyocyte contractility and cardiac function via the neuregulin‐ErbB signaling pathway. Conscious echocardiography revealed left ventricular (LV) chamber dilation and systolic dysfunction in PECAM‐1−/− mice in the absence of histological abnormalities or defects in cardiac capillary density. Despite deficits in global cardiac function, cardiomyocytes isolated from PECAM‐1−/− hearts displayed normal baseline and isoproterenol‐stimulated contractility. Mechanistically, absence of PECAM‐1 resulted in elevated NO/ROS signaling and NRG‐1 release from ECs, which resulted in augmented phosphorylation of its receptor ErbB2. Treatment of cardiomyocytes with conditioned media from PECAM‐1−/− ECs resulted in enhanced ErbB2 activation, which was normalized by pre‐treatment with an NRG‐1 blocking antibody. To determine whether normalization of increased NRG‐1 levels could correct cardiac function, PECAM‐1−/− mice were treated with the NRG‐1 blocking antibody. Echocardiography showed that treatment significantly improved cardiac function of PECAM‐1−/− mice, as revealed by increased ejection fraction and fractional shortening. Conclusions We identify a novel role for PECAM‐1 in regulating cardiac function via a paracrine NRG1‐ErbB pathway. These data highlight the importance of tightly regulated cellular communication for proper cardiac function. PMID:25600142

  11. Tomato (Lycopersicon esculentum) Supplementation Induces Changes in Cardiac miRNA Expression, Reduces Oxidative Stress and Left Ventricular Mass, and Improves Diastolic Function

    PubMed Central

    Pereira, Bruna L. B.; Arruda, Fernanda C. O.; Reis, Patrícia P.; Felix, Tainara F.; Santos, Priscila P.; Rafacho, Bruna P.; Gonçalves, Andrea F.; Claro, Renan T.; Azevedo, Paula S.; Polegato, Bertha F.; Okoshi, Katashi; Fernandes, Ana A. H.; Paiva, Sergio A. R.; Zornoff, Leonardo A. M.; Minicucci, Marcos F.

    2015-01-01

    The aim of this study was to evaluate the effects of tomato supplementation on the normal rat heart and the role of oxidative stress in this scenario. Male Wistar rats were assigned to two groups: a control group (C; n = 16), in which animals received a control diet + 0.5 mL of corn oil/kg body weight/day, and a tomato group (T; n = 16), in which animals received a control diet supplemented with tomato +0.5 mL of corn oil/kg body weight/day. After three months, morphological, functional, and biochemical analyses were performed. Animals supplemented with tomato had a smaller left atrium diameter and myocyte cross-sectional area (CSA) compared to the control group (C group: 474 (415–539); T group: 273 (258–297) µm2; p = 0.004). Diastolic function was improved in rats supplemented with tomato. In addition, lipid hydroperoxide was lower (C group: 267 ± 46.7; T group: 219 ± 23.0 nmol/g; p = 0.039) in the myocardium of rats supplemented with tomato. Tomato intake was also associated with up-regulation of miR-107 and miR-486 and down-regulation of miR-350 and miR-872. In conclusion, tomato supplementation induces changes in miRNA expression and reduces oxidative stress. In addition, these alterations may be responsible for CSA reduction and diastolic function improvement. PMID:26610560

  12. Tomato (Lycopersicon esculentum) Supplementation Induces Changes in Cardiac miRNA Expression, Reduces Oxidative Stress and Left Ventricular Mass, and Improves Diastolic Function.

    PubMed

    Pereira, Bruna L B; Arruda, Fernanda C O; Reis, Patrícia P; Felix, Tainara F; Santos, Priscila P; Rafacho, Bruna P; Gonçalves, Andrea F; Claro, Renan T; Azevedo, Paula S; Polegato, Bertha F; Okoshi, Katashi; Fernandes, Ana A H; Paiva, Sergio A R; Zornoff, Leonardo A M; Minicucci, Marcos F

    2015-11-01

    The aim of this study was to evaluate the effects of tomato supplementation on the normal rat heart and the role of oxidative stress in this scenario. Male Wistar rats were assigned to two groups: a control group (C; n = 16), in which animals received a control diet + 0.5 mL of corn oil/kg body weight/day, and a tomato group (T; n = 16), in which animals received a control diet supplemented with tomato +0.5 mL of corn oil/kg body weight/day. After three months, morphological, functional, and biochemical analyses were performed. Animals supplemented with tomato had a smaller left atrium diameter and myocyte cross-sectional area (CSA) compared to the control group (C group: 474 (415-539); T group: 273 (258-297) µm²; p = 0.004). Diastolic function was improved in rats supplemented with tomato. In addition, lipid hydroperoxide was lower (C group: 267 ± 46.7; T group: 219 ± 23.0 nmol/g; p = 0.039) in the myocardium of rats supplemented with tomato. Tomato intake was also associated with up-regulation of miR-107 and miR-486 and down-regulation of miR-350 and miR-872. In conclusion, tomato supplementation induces changes in miRNA expression and reduces oxidative stress. In addition, these alterations may be responsible for CSA reduction and diastolic function improvement. PMID:26610560

  13. Automatic classification of scar tissue in late gadolinium enhancement cardiac MRI for the assessment of left-atrial wall injury after radiofrequency ablation

    NASA Astrophysics Data System (ADS)

    Perry, Daniel; Morris, Alan; Burgon, Nathan; McGann, Christopher; MacLeod, Robert; Cates, Joshua

    2012-03-01

    Radiofrequency ablation is a promising procedure for treating atrial fibrillation (AF) that relies on accurate lesion delivery in the left atrial (LA) wall for success. Late Gadolinium Enhancement MRI (LGE MRI) at three months post-ablation has proven effective for noninvasive assessment of the location and extent of scar formation, which are important factors for predicting patient outcome and planning of redo ablation procedures. We have developed an algorithm for automatic classification in LGE MRI of scar tissue in the LA wall and have evaluated accuracy and consistency compared to manual scar classifications by expert observers. Our approach clusters voxels based on normalized intensity and was chosen through a systematic comparison of the performance of multivariate clustering on many combinations of image texture. Algorithm performance was determined by overlap with ground truth, using multiple overlap measures, and the accuracy of the estimation of the total amount of scar in the LA. Ground truth was determined using the STAPLE algorithm, which produces a probabilistic estimate of the true scar classification from multiple expert manual segmentations. Evaluation of the ground truth data set was based on both inter- and intra-observer agreement, with variation among expert classifiers indicating the difficulty of scar classification for a given a dataset. Our proposed automatic scar classification algorithm performs well for both scar localization and estimation of scar volume: for ground truth datasets considered easy, variability from the ground truth was low; for those considered difficult, variability from ground truth was on par with the variability across experts.

  14. Cardiac temperature and cardioplegic volume during cardiopulmonary bypass.

    PubMed

    Baile, E M; Ling, H; Miyagishima, R T; Kronhardt, H; Par, P D

    1986-10-01

    This study was designed to compare two methods of cardiac drainage on the rate of change of cardiac temperature and volume of cardioplegic solution required to maintain the cardiac temperature less than or equal to 12 degrees C in patients undergoing coronary artery bypass surgery. Two groups of 10 patients were studied who were comparable in age, sex, and smoking history. In Group 1, cardiac drainage was achieved by using single-port drainage cannulae in the superior and inferior vena cava with caval tapes. Group 2 patients had a caval atrial cannula to drain the noncoronary collateral flow from the right atrium as well as that from the venae cavae. Both groups had a sump line in the left ventricle to drain the bronchopulmonary anastomotic blood flow. Results from the study showed that there was no difference between groups in the initial amount of cold cardioplegic solution required to arrest and cool the heart or the initial recording of ventricular temperatures. However, the volume of cardioplegic solution required to maintain the cardiac temperature at less than or equal to 12 degrees C after administration of the initial volume was less (P less than 0.05) for Group 2 than Group 1. Group 2 also had a slower rate of increase in cardiac temperature than Group 1 (P less than 0.01). Results from this study indicate that the constant removal of blood from both cardiac chambers during coronary artery bypass surgery significantly reduces the rate of myocardial rewarming and decreases the amount of cardioplegic solution required to maintain a given cardiac temperature. PMID:3773498

  15. Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation

    NASA Technical Reports Server (NTRS)

    Makikallio, T. H.; Hoiber, S.; Kober, L.; Torp-Pedersen, C.; Peng, C. K.; Goldberger, A. L.; Huikuri, H. V.

    1999-01-01

    A number of new methods have been recently developed to quantify complex heart rate (HR) dynamics based on nonlinear and fractal analysis, but their value in risk stratification has not been evaluated. This study was designed to determine whether selected new dynamic analysis methods of HR variability predict mortality in patients with depressed left ventricular (LV) function after acute myocardial infarction (AMI). Traditional time- and frequency-domain HR variability indexes along with short-term fractal-like correlation properties of RR intervals (exponent alpha) and power-law scaling (exponent beta) were studied in 159 patients with depressed LV function (ejection fraction <35%) after an AMI. By the end of 4-year follow-up, 72 patients (45%) had died and 87 (55%) were still alive. Short-term scaling exponent alpha (1.07 +/- 0.26 vs 0.90 +/- 0.26, p <0.001) and power-law slope beta (-1.35 +/- 0.23 vs -1.44 +/- 0.25, p <0.05) differed between survivors and those who died, but none of the traditional HR variability measures differed between these groups. Among all analyzed variables, reduced scaling exponent alpha (<0.85) was the best univariable predictor of mortality (relative risk 3.17, 95% confidence interval 1.96 to 5.15, p <0.0001), with positive and negative predictive accuracies of 65% and 86%, respectively. In the multivariable Cox proportional hazards analysis, mortality was independently predicted by the reduced exponent alpha (p <0.001) after adjustment for several clinical variables and LV function. A short-term fractal-like scaling exponent was the most powerful HR variability index in predicting mortality in patients with depressed LV function. Reduction in fractal correlation properties implies more random short-term HR dynamics in patients with increased risk of death after AMI.

  16. 11. Second floor, northwest chamber, south wall. Former passage to ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. Second floor, northwest chamber, south wall. Former passage to southwest chamber (door blocked off on far side) on left; closet on right. - Conner Homestead, House, Epping Road (State Route 101), Exeter, Rockingham County, NH

  17. Comparison of methods for determining absolute left ventricular volumes from radionuclide ventriculography

    SciTech Connect

    Warren, S.E.; McKay, R.G.; Aroesty, J.M.; Heller, G.V.; Kolodny, G.M.; Royal, H.D.

    1987-01-01

    Several radionuclide techniques have been used in routine clinical nuclear medicine practice as a means of quantitating left ventricular chamber volumes in man. Despite wide use and availability of the different techniques, however, there has not been a thorough comparison of radionuclide and contrast angiographic measurements performed in the same patients in close temporal proximity. Accordingly, in order to validate traditional methods of ventricular volume measurement, we have performed contrast ventriculography followed immediately (upon return of baseline hemodynamics) by gated radionuclide ventriculography in 34 patients undergoing diagnostic cardiac catheterization. Absolute left ventricular end-diastolic volumes were determined from single-plane, right anterior oblique, end-diastolic contrast silhouettes using a standard area-length method. Radionuclide ventriculographic volumes were determined by three methods: planimetry (32 patients), counts-based (19 patients), and thermodilution stroke volume/radionuclide ejection fraction (32 patients). With planimetry, an area-length method was used in which the modified left anterior oblique left ventricular image was assumed to be a prolate ellipsoid whose volume can be determined by measuring surface area and the ventricular long axis. With the counts-based technique, a blood sample was drawn at the midpoint of the radionuclide ventriculogram acquisition and counted with a gamma camera with appropriate attenuation factor correction. With the thermodilution stroke volume/radionuclide ejection fraction technique, the left ventricular stroke volume was determined by dividing thermodilution cardiac output by the heart rate.

  18. Association of Late Gadolinium Enhancement and Degree of Left Ventricular Hypertrophy Assessed on Cardiac Magnetic Resonance Imaging With Ventricular Tachycardia in Children With Hypertrophic Cardiomyopathy.

    PubMed

    Spinner, Joseph A; Noel, Cory V; Denfield, Susan W; Krishnamurthy, Rajesh; Jeewa, Aamir; Dreyer, William J; Maskatia, Shiraz A

    2016-04-15

    There are limited data on the clinical significance of left ventricular (LV) mass and late gadolinium enhancement (LGE) in pediatric hypertrophic cardiomyopathy (HC). We reviewed cardiovascular magnetic resonance (CMR) studies of children with HC to investigate the associations between the extent and distribution of LGE and LV mass with ventricular tachycardia (VT) in children with HC. A blinded observer reviewed CMR studies for the presence and distribution of LV hypertrophy and LGE using a 17-segment model. The primary outcome was VT. LGE was present 17 of 33 subjects (52%). VT was present on outpatient Holter monitor or exercise stress test in 7 patients, of which 5 patients (71%) had LGE. Each additional segment of LGE was associated with an increase in the odds of VT (odds ratio [OR] 1.4, 95% CI 1.1 to 1.9) and fewer than 5 segments with LGE had 93% specificity for the presence or absence of VT (OR 0.06, 95% CI 0.01 to 0.5). VT was more common in patients with LGE in the apical septal (p = 0.03), basal inferoseptal (p <0.01), and basal inferior (p = 0.04) segments, whereas LGE in more commonly involved segments (midanteroseptal and midinferoseptal) was not associated with VT (p = 0.13, 0.26). Patients with VT had greater LV mass index (76.4 ± 40.4 g/m(2.7) vs 50.9 ± 24.3 g/m(2.7); p = 0.03). Each centimeter of increased maximum LV thickness was associated with increased likelihood of VT (OR 2.9, 95% CI 1.2 to 6.8). In conclusion, in pediatric HC, CMR to evaluate the extent and pattern of LGE, LV mass index, and maximum LV thickness may help to identify children with HC at risk of VT. PMID:26892450

  19. Ionization chamber

    DOEpatents

    Walenta, Albert H.

    1981-01-01

    An ionization chamber has separate drift and detection regions electrically isolated from each other by a fine wire grid. A relatively weak electric field can be maintained in the drift region when the grid and another electrode in the chamber are connected to a high voltage source. A much stronger electric field can be provided in the detection region by connecting wire electrodes therein to another high voltage source. The detection region can thus be operated in a proportional mode when a suitable gas is contained in the chamber. High resolution output pulse waveforms are provided across a resistor connected to the detection region anode, after ionizing radiation enters the drift region and ionize the gas.

  20. Ionization chamber

    DOEpatents

    Walenta, A.H.

    An ionization chamber is described which has separate drift and detection regions electrically isolated from each other by a fine wire grid. A relatively weak electric field can be maintained in the drift region when the grid and another electrode in the chamber are connected to a high voltage source. A much stronger electric field can be provided in the detection region by connecting wire electrodes therein to another high voltage source. The detection region can thus be operated in a proportional mode when a suitable gas is contained in the chamber. High resolution output pulse waveforms are provided across a resistor connected to the detection region anode, after ionizing radiation enters the drift region and ionizes the gas.

  1. Visualization of cardiac dynamics using physics-based deformable model

    NASA Astrophysics Data System (ADS)

    Lin, Wei-te; Robb, Richard A.

    2000-04-01

    Modeling of moving anatomic structures is complicated by the complexity of motion intrinsic and extrinsic to the structures. However when motion is cyclical, such as in heart, effective dynamic modeling can be approached using modern fast imaging techniques, which provide 3D structural data. Data may be acquired as a sequence of 3D volume images throughout the cardiac cycle. To model the intricate non- linear motion of the heart, we created a physics-based surface model which can realistically deform between successive time points in the cardiac cycle, yielding a dynamic 4D model of cardiac motion. Sequences of fifteen 3D volume images of intact canine beating hearts were acquired during compete cardiac cycles using the Dynamic Spatial Reconstructor and the Electron Beam CT. The chambers of the heart were segmented at successive time points, typically at 1/15-second intervals. The left ventricle of the first item point was reconstructed as an initial triangular mesh. A mass-spring physics-based deformable model, which can expand and shrink with local contraction and stretching forces distributed in an anatomically accurate simulation of cardiac motion, was applied to the initial mesh and allowed the initial mesh to deform to fit the left ventricle in successive time increments of the sequence. The resultant 4D model can be interactively transformed and displayed with associated regional electrical activity mapped onto the anatomic surfaces, producing a 5D mode, which faithfully exhibits regional cardiac contraction and relaxation patterns over the entire heart. For acquisition systems that may provide only limited 4D data, the model can provide interpolated anatomic shape between time points. This physics-based deformable model accurately represents dynamic cardiac structural changes throughout the cardiac cycle. Such models provides the framework for minimizing the number of time points required to usefully depict regional motion of myocardium and allowing quantitative assessment of regional myocardial dynamics. The electrical activation mapping provides spatial and temporal correlation within the cardiac cycle. In procedures such as intra-cardiac catheter ablation, visualization of the dynamic mole can be used to accurately localize the foci of myocardial arrhythmias and guide positioning of catheters for effective ablation.

  2. Echocardiography of the normal camel (Camelus dromedaries) heart: technique and cardiac dimensions

    PubMed Central

    2012-01-01

    Background Echocardiography and intra-cardiac dimensions have not previously been reported in adult camels despite its potential application for medical purpose. The aim of this study was to describe the results of a prospective study, aiming to report normal cardiac appearance and normal chamber dimensions in adult camels (Camelus dromedarius). Results On the right side, when the probe was placed in the 5th or 4th intercostal space (ICS), the caudal long-axis four-chamber view of the ventricles, atria, and the interventricular septum was obtained. Placing the probe slightly more cranially in the 4th ICS, the caudal long-axis four-chamber view and the caudal long-axis view of the left ventricular outflow tract (LVOT) were imaged. In 7 camels, a hybrid view between a “four-chamber” and “LVOT view” was imaged from the same position. The short-axis view of the ventricles was obtained in the 4th ICS where the transducer was rotated between 0° and 25°. Placement of the transducer in the 3rd ICS allowed visualisation of the right ventricular outflow tract (RVOT). On the left side, when the probe was placed in the 5th or 4th ICS, a four-chamber view was obtained. The LVOT is imaged in the 4th ICS and the RVOT was seen from the 3rd ICS. Conclusions This study showed that it is possible to obtain good-quality echocardiograms in adult camels and provide normal cardiac dimensions. This study could be used as a reference for further studies concerning camels with cardiac diseases. PMID:22862855

  3. Chamber Specific Gene Expression Landscape of the Zebrafish Heart

    PubMed Central

    Singh, Angom Ramcharan; Sivadas, Ambily; Sabharwal, Ankit; Vellarikal, Shamsudheen Karuthedath; Jayarajan, Rijith; Verma, Ankit; Kapoor, Shruti; Joshi, Adita; Scaria, Vinod; Sivasubbu, Sridhar

    2016-01-01

    The organization of structure and function of cardiac chambers in vertebrates is defined by chamber-specific distinct gene expression. This peculiarity and uniqueness of the genetic signatures demonstrates functional resolution attributed to the different chambers of the heart. Altered expression of the cardiac chamber genes can lead to individual chamber related dysfunctions and disease patho-physiologies. Information on transcriptional repertoire of cardiac compartments is important to understand the spectrum of chamber specific anomalies. We have carried out a genome wide transcriptome profiling study of the three cardiac chambers in the zebrafish heart using RNA sequencing. We have captured the gene expression patterns of 13,396 protein coding genes in the three cardiac chambers—atrium, ventricle and bulbus arteriosus. Of these, 7,260 known protein coding genes are highly expressed (≥10 FPKM) in the zebrafish heart. Thus, this study represents nearly an all-inclusive information on the zebrafish cardiac transcriptome. In this study, a total of 96 differentially expressed genes across the three cardiac chambers in zebrafish were identified. The atrium, ventricle and bulbus arteriosus displayed 20, 32 and 44 uniquely expressing genes respectively. We validated the expression of predicted chamber-restricted genes using independent semi-quantitative and qualitative experimental techniques. In addition, we identified 23 putative novel protein coding genes that are specifically restricted to the ventricle and not in the atrium or bulbus arteriosus. In our knowledge, these 23 novel genes have either not been investigated in detail or are sparsely studied. The transcriptome identified in this study includes 68 differentially expressing zebrafish cardiac chamber genes that have a human ortholog. We also carried out spatiotemporal gene expression profiling of the 96 differentially expressed genes throughout the three cardiac chambers in 11 developmental stages and 6 tissue types of zebrafish. We hypothesize that clustering the differentially expressed genes with both known and unknown functions will deliver detailed insights on fundamental gene networks that are important for the development and specification of the cardiac chambers. It is also postulated that this transcriptome atlas will help utilize zebrafish in a better way as a model for studying cardiac development and to explore functional role of gene networks in cardiac disease pathogenesis. PMID:26815362

  4. Surgical resection of a giant cardiac fibroma.

    PubMed

    Stamp, Nikki L; Larbalestier, Robert I

    2016-05-01

    A 42-year-old woman presented to a regional hospital emergency room with palpitations and was found to be in ventricular tachycardia. Chest radiography demonstrated a massively enlarged cardiac silhouette. Echocardiography and cardiac magnetic resonance imaging demonstrated a mass within the left ventricular free wall, consistent with a cardiac fibroma. The patient proceeded to have surgical resection of the mass. Left ventricular function was preserved postoperatively. PMID:25690433

  5. Digital cardiac imaging

    SciTech Connect

    Buda, A.J.; Delp, E.J.

    1985-01-01

    This book contains 16 papers. Some of the titles are: The analysis of left ventricular function with digital subtraction angiography; Digital radiographic assessment of coronary flow reserve; Clinical application of cardiac CT; Digital two-dimensional echocardiography; and Magnetic resonance imaging of the heart.

  6. 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 ...

  7. Optimal atrioventricular delay at rest and during exercise in patients with dual chamber pacemakers: a non-invasive assessment by continuous wave Doppler.

    PubMed Central

    Mehta, D; Gilmour, S; Ward, D E; Camm, A J

    1989-01-01

    The optimal atrioventricular delay at rest and during exercise was investigated in nine patients with heart block and implanted dual chamber pacemakers. All patients studied had normal left ventricular function and a normal sinus node rate response to exercise. Cardiac output was measured by continuous wave Doppler and was calculated as the product of stroke distance measured by Doppler at the left ventricular outflow, aortic root area measured by M mode echocardiography, and heart rate. Pacemakers were programmed in the DDD mode. Cardiac output was measured with the patient at rest while supine and while erect and at the peak of submaximal exercise (the end of stage 1 of the Bruce protocol) with the pacemakers programmed to the following atrioventricular intervals: 75-80 ms, 100-110 ms, 140-150 ms, and 200 ms. During exercise the basic pacing rate was programmed to 70 beats/min. Cardiac output at rest while supine and erect was greatest with an atrioventricular delay of 140-150 ms and it was significantly higher than that with an atrioventricular delay of 75-80 ms. On average there was a 31% decrease in cardiac output when patients stood up. During treadmill exercise, however, cardiac output was greatest when the atrioventricular delay was 75-80 ms, and this was significantly higher than the cardiac output with atrioventricular delays of 150 and 200 ms. During exercise 1:1 atrioventricular relations were maintained in patients at all atrioventricular intervals. In patients with atrioventricular sequential pacemakers cardiac output at rest is greatest with an atrioventricular delay of 140-150 ms but during exercise the optimal atrioventricular delay is shorter. Rate modulation of the atrioventricular interval may improve the haemodynamic response and possibly exercise tolerance in patients with dual chamber pacemakers. PMID:2923753

  8. Beat‐to‐Beat Spatiotemporal Variability in the T Vector Is Associated With Sudden Cardiac Death in Participants Without Left Ventricular Hypertrophy: The Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Waks, Jonathan W.; Soliman, Elsayed Z.; Henrikson, Charles A.; Sotoodehnia, Nona; Han, Lichy; Agarwal, Sunil K.; Arking, Dan E.; Siscovick, David S.; Solomon, Scott D.; Post, Wendy S.; Josephson, Mark E.; Coresh, Josef; Tereshchenko, Larisa G.

    2015-01-01

    Background Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed. Methods and Results Beat‐to‐beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T‐wave vectors (mean TT′ angle) on standard 12‐lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT′ angle was 5.21±3.55°. During a median of 14 years of follow‐up, 235 SCDs occurred (1.24 per 1000 person‐years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT′ angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT′ angle >90th percentile (>9.57°) was associated with a 2‐fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T‐vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT′ angle and age was found: TT′ angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (Pinteraction=0.009). Conclusions In a large, prospective, community‐based cohort of left ventricular hypertrophy–free participants, increased beat‐to‐beat spatiotemporal variability in the T vector, as assessed by increasing TT′ angle, was associated with SCD. PMID:25600143

  9. Separation of afterload reduction and a direct beneficial cardiac effect of nifedipine in congestive cardiomyopathy.

    PubMed

    Percy, R F; Bass, T A; Conetta, D A; Miller, A B

    1989-08-01

    To assess whether the calcium antagonist nifedipine has a specific, direct effect on left ventricular diastolic function separate from its vasodilatory action, we studied 10 patients with idiopathic congestive cardiomyopathy (ages 28-69, New York Heart Association Class III or IV) at 30 min, 2 h, and 6 h after administration of 10 mg of sublingual nifedipine. Hemodynamic parameters were assessed with Swan-Ganz catheter and two-dimensional echo images were processed with computer-assisted analysis (Quantic 1200) to obtain left ventricular chamber areas and an index of rapid diastolic filling. Indices of left ventricular systolic performance (cardiac index and left ventricular area change fraction) improved during the early (30 min and 2 h) observation periods as afterload (estimated by systolic blood pressure and systemic vascular resistance) was reduced (p less than .05 vs. baseline). Pulmonary capillary wedge pressure fell from 17 mmHg to 11 mmHg and rapid diastolic filling index increased from .28 (% area change/ms) to .37 (% area change/ms) (p less than .05 vs. baseline) during the early observation periods. Indices of left ventricular systolic performance and afterload had returned to baseline at the late (6 h) observation period. However, pulmonary capillary wedge pressure remained reduced significantly at 10 mmHg after 6 h (p less than .05 vs. baseline). Preload (estimated by left ventricular end-diastolic chamber area) did not vary throughout the study period. Reduction of pulmonary capillary wedge pressure at 6 h, despite return of afterload reduction to baseline and no change in preload, suggests improved left ventricular chamber compliance after sublingual nifedipine, not related to alteration of left ventricular loading conditions. PMID:2766589

  10. Segmentation of the endocardial wall of the left atrium using local region-based active contours and statistical shape learning

    NASA Astrophysics Data System (ADS)

    Gao, Yi; Gholami, Behnood; MacLeod, Robert S.; Blauer, Joshua; Haddad, Wassim M.; Tannenbaum, Allen R.

    2010-03-01

    Atrial fibrillation, a cardiac arrhythmia characterized by unsynchronized electrical activity in the atrial chambers of the heart, is a rapidly growing problem in modern societies. One treatment, referred to as catheter ablation, targets specific parts of the left atrium for radio frequency ablation using an intracardiac catheter. Magnetic resonance imaging has been used for both pre- and and post-ablation assessment of the atrial wall. Magnetic resonance imaging can aid in selecting the right candidate for the ablation procedure and assessing post-ablation scar formations. Image processing techniques can be used for automatic segmentation of the atrial wall, which facilitates an accurate statistical assessment of the region. As a first step towards the general solution to the computer-assisted segmentation of the left atrial wall, in this paper we use shape learning and shape-based image segmentation to identify the endocardial wall of the left atrium in the delayed-enhancement magnetic resonance images.

  11. [Cardiac neuroses].

    PubMed

    Simson, U; Martin, K; Janssen, P L

    2001-09-01

    Cardiac neurosis is defined as heart complaints for which no organic cause can be found. Other common terms are "cardiac anxiety neurosis", "cardiac anxiety disorder", "cardiac phobia", "functional heart complaints" and "somatoform autonomous functional disorders of the cardiovascular system" (ICD-10). Although cardiac neurosis is rarely diagnosed, it is estimated that approximately 30 bis 40% of patients with cardiovascular disorders are actually suffering from functional complaints. Predisposing to the development of cardiac neurosis are insufficient internalization processes during childhood, leading to an insoluble autonomy dependency conflict. Cardiac neurosis is treated with drugs and psychotherapy. PMID:11554103

  12. Cardiac Magnetic Resonance Imaging Findings in 20-year Survivors of Mediastinal Radiotherapy for Hodgkin's Disease

    SciTech Connect

    Machann, Wolfram; Beer, Meinrad; Breunig, Margret; Stoerk, Stefan; Angermann, Christiane; Seufert, Ines; Schwab, Franz; Koelbl, Oliver; Flentje, Michael; Vordermark, Dirk

    2011-03-15

    Purpose: The recognition of the true prevalence of cardiac toxicity after mediastinal radiotherapy requires very long follow-up and a precise diagnostic procedure. Cardiac magnetic resonance imaging (MRI) permits excellent quantification of cardiac function and identification of localized myocardial defects and has now been applied to a group of 20-year Hodgkin's disease survivors. Methods and materials: Of 143 patients treated with anterior mediastinal radiotherapy (cobalt-60, median prescribed dose 40 Gy) for Hodgkin's disease between 1978 and 1985, all 53 survivors were invited for cardiac MRI. Of those, 36 patients (68%) presented for MRI, and in 31 patients (58%) MRI could be performed 20-28 years (median, 24) after radiotherapy. The following sequences were acquired on a 1.5-T MRI: transversal T1-weighted TSE and T2-weighted half-fourier acquisition single-shot turbo-spin-echo sequences, a steady-state free precession (SSFP) cine sequence in the short heart axis and in the four-chamber view, SSFP perfusion sequences under rest and adenosine stress, and a SSFP inversion recovery sequence for late enhancement. The MRI findings were correlated with previously reconstructed doses to cardiac structures. Results: Clinical characteristics and reconstructed doses were not significantly different between survivors undergoing and not undergoing MRI. Pathologic findings were reduced left ventricular function (ejection fraction <55%) in 7 (23%) patients, hemodynamically relevant valvular dysfunction in 13 (42%), late myocardial enhancement in 9 (29%), and any perfusion deficit in 21 (68%). An association of regional pathologic changes and reconstructed dose to cardiac structures could not be established. Conclusions: In 20-year survivors of Hodgkin's disease, cardiac MRI detects pathologic findings in approximately 70% of patients. Cardiac MRI has a potential role in cardiac imaging of Hodgkin's disease patients after mediastinal radiotherapy.

  13. Cardiac mechanics: Physiological, clinical, and mathematical considerations

    NASA Technical Reports Server (NTRS)

    Mirsky, I. (Editor); Ghista, D. N.; Sandler, H.

    1974-01-01

    Recent studies concerning the basic physiological and biochemical principles underlying cardiac muscle contraction, methods for the assessment of cardiac function in the clinical situation, and mathematical approaches to cardiac mechanics are presented. Some of the topics covered include: cardiac ultrastructure and function in the normal and failing heart, myocardial energetics, clinical applications of angiocardiography, use of echocardiography for evaluating cardiac performance, systolic time intervals in the noninvasive assessment of left ventricular performance in man, evaluation of passive elastic stiffness for the left ventricle and isolated heart muscle, a conceptual model of myocardial infarction and cardiogenic shock, application of Huxley's sliding-filament theory to the mechanics of normal and hypertrophied cardiac muscle, and a rheological modeling of the intact left ventricle. Individual items are announced in this issue.

  14. Chamber transport

    SciTech Connect

    OLSON,CRAIG L.

    2000-05-17

    Heavy ion beam transport through the containment chamber plays a crucial role in all heavy ion fusion (HIF) scenarios. Here, several parameters are used to characterize the operating space for HIF beams; transport modes are assessed in relation to evolving target/accelerator requirements; results of recent relevant experiments and simulations of HIF transport are summarized; and relevant instabilities are reviewed. All transport options still exist, including (1) vacuum ballistic transport, (2) neutralized ballistic transport, and (3) channel-like transport. Presently, the European HIF program favors vacuum ballistic transport, while the US HIF program favors neutralized ballistic transport with channel-like transport as an alternate approach. Further transport research is needed to clearly guide selection of the most attractive, integrated HIF system.

  15. Nongated cardiac magnetic resonance imaging: preliminary experience at 0. 12 T

    SciTech Connect

    Choyke, P.L.; Kressel, H.Y.; Reichek, N.; Axel, L.; Gefter, W.; Mamourian, A.C.; Thickman, D.

    1984-12-01

    Nongated cardiac magnetic resonance imaging (MRI) has been reported previously to be inadequate for obtaining diagnostic information. This study explored the role of pulse sequence in the degradation of the nongated cardiac image. Images of diagnostic quality were obtained by using single spin-echo sequences with a very short echo time (10-20 msec TE) on a 0.12-T development MR unit. Marked degradation of the image was noted with longer TEs. Short-TE technique was used to examine 34 patients with a variety of cardiac diseases. Eleven patients had ventricular aneurysms. Twenty patients had left ventricular hypertrophy that was concentric in 11. Six patients had extrinsic masses displacing the heart and distorting the chamber contour. One patient with ventricular septal defect (VSD) and corrected transposition was scanned. In addition to identifying the VSD and chamber hypertrophy, the malposition of the great vessels at the base of the heart was seen. Four postoperative patients were scanned; wire suture artifact did not preclude imaging. In conclusion, diagnostic information can be obtained from nongated cardiac images provided that the TE is very short (10-20 msec). Although quantitative functional data are not available from nongated images, qualitative and diagnostic information is possible and may suffice in certain circumstances.

  16. Titin isoform switching is a major cardiac adaptive response in hibernating grizzly bears.

    PubMed

    Nelson, O Lynne; Robbins, Charles T; Wu, Yiming; Granzier, Henk

    2008-07-01

    The hibernation phenomenon captures biological as well as clinical interests to understand how organs adapt. Here we studied how hibernating grizzly bears (Ursus arctos horribilis) tolerate extremely low heart rates without developing cardiac chamber dilation. We evaluated cardiac filling function in unanesthetized grizzly bears by echocardiography during the active and hibernating period. Because both collagen and titin are involved in altering diastolic function, we investigated both in the myocardium of active and hibernating grizzly bears. Heart rates were reduced from 84 beats/min in active bears to 19 beats/min in hibernating bears. Diastolic volume, stroke volume, and left ventricular ejection fraction were not different. However, left ventricular muscle mass was significantly lower (300 +/- 12 compared with 402 +/- 14 g; P = 0.003) in the hibernating bears, and as a result the diastolic volume-to-left ventricular muscle mass ratio was significantly greater. Early ventricular filling deceleration times (106.4 +/- 14 compared with 143.2 +/- 20 ms; P = 0.002) were shorter during hibernation, suggesting increased ventricular stiffness. Restrictive pulmonary venous flow patterns supported this conclusion. Collagen type I and III comparisons did not reveal differences between the two groups of bears. In contrast, the expression of titin was altered by a significant upregulation of the stiffer N2B isoform at the expense of the more compliant N2BA isoform. The mean ratio of N2BA to N2B titin was 0.73 +/- 0.07 in the active bears and decreased to 0.42 +/- 0.03 (P = 0.006) in the hibernating bears. The upregulation of stiff N2B cardiac titin is a likely explanation for the increased ventricular stiffness that was revealed by echocardiography, and we propose that it plays a role in preventing chamber dilation in hibernating grizzly bears. Thus our work identified changes in the alternative splicing of cardiac titin as a major adaptive response in hibernating grizzly bears. PMID:18502907

  17. Using a human cardiovascular-respiratory model to characterize cardiac tamponade and pulsus paradoxus

    PubMed Central

    Ramachandran, Deepa; Luo, Chuan; Ma, Tony S; Clark, John W

    2009-01-01

    Background Cardiac tamponade is a condition whereby fluid accumulation in the pericardial sac surrounding the heart causes elevation and equilibration of pericardial and cardiac chamber pressures, reduced cardiac output, changes in hemodynamics, partial chamber collapse, pulsus paradoxus, and arterio-venous acid-base disparity. Our large-scale model of the human cardiovascular-respiratory system (H-CRS) is employed to study mechanisms underlying cardiac tamponade and pulsus paradoxus. The model integrates hemodynamics, whole-body gas exchange, and autonomic nervous system control to simulate pressure, volume, and blood flow. Methods We integrate a new pericardial model into our previously developed H-CRS model based on a fit to patient pressure data. Virtual experiments are designed to simulate pericardial effusion and study mechanisms of pulsus paradoxus, focusing particularly on the role of the interventricular septum. Model differential equations programmed in C are solved using a 5th-order Runge-Kutta numerical integration scheme. MATLAB is employed for waveform analysis. Results The H-CRS model simulates hemodynamic and respiratory changes associated with tamponade clinically. Our model predicts effects of effusion-generated pericardial constraint on chamber and septal mechanics, such as altered right atrial filling, delayed leftward septal motion, and prolonged left ventricular pre-ejection period, causing atrioventricular interaction and ventricular desynchronization. We demonstrate pericardial constraint to markedly accentuate normal ventricular interactions associated with respiratory effort, which we show to be the distinct mechanisms of pulsus paradoxus, namely, series and parallel ventricular interaction. Series ventricular interaction represents respiratory variation in right ventricular stroke volume carried over to the left ventricle via the pulmonary vasculature, whereas parallel interaction (via the septum and pericardium) is a result of competition for fixed filling space. We find that simulating active septal contraction is important in modeling ventricular interaction. The model predicts increased arterio-venous CO2 due to hypoperfusion, and we explore implications of respiratory pattern in tamponade. Conclusion Our modeling study of cardiac tamponade dissects the roles played by septal motion, atrioventricular and right-left ventricular interactions, pulmonary blood pooling, and the depth of respiration. The study fully describes the physiological basis of pulsus paradoxus. Our detailed analysis provides biophysically-based insights helpful for future experimental and clinical study of cardiac tamponade and related pericardial diseases. PMID:19656411

  18. Cardiac-specific overexpression of RhoA results in sinus and atrioventricular nodal dysfunction and contractile failure

    PubMed Central

    Sah, Valerie P.; Minamisawa, Susumu; Tam, Steven P.; Wu, Thomas H.; Dorn, Gerald W.; Ross, John; Chien, Kenneth R.; Brown, Joan Heller

    1999-01-01

    RhoA is a low-molecular-weight GTPase that has been implicated in the regulation of hypertrophic cardiac muscle cell growth. To study the role of RhoA in control of cardiac function in vivo, transgenic mice expressing wild-type and constitutively activated forms of RhoA under the control of the cardiac-specific α-myosin heavy chain promoter were generated. Transgene-positive mice expressing high levels of either wild-type or activated RhoA showed pronounced atrial enlargement and manifested a lethal phenotype, often preceded by generalized edema, with most animals dying over the course of a few weeks. Echocardiographic analysis of visibly healthy wild-type RhoA transgenic mice revealed no significant change in left ventricular function. As their condition deteriorated, significant dilation of the left ventricular chamber and associated decreases in left ventricular contractility were detected. Heart rate was grossly depressed in both wild-type and activated RhoA-expressing mice, even prior to the onset of ventricular failure. Electrocardiography showed evidence of atrial fibrillation and atrioventricular block. Interestingly, muscarinic receptor blockade with atropine did not elicit a positive chronotropic response in the transgenic mice. We suggest that RhoA regulates cardiac sinus and atrioventricular nodal function and that its overexpression results in bradycardia and development of ventricular failure. J. Clin. Invest. 103:1627–1634 (1999) PMID:10377168

  19. Pseudoaneurysm of the left ventricle.

    PubMed Central

    Mackenzie, J W; Lemole, G M

    1994-01-01

    Pseudoaneurysm of the left ventricle most often occurs after transmural myocardial infarction but may also follow cardiac operations, trauma, inflammation, or infection. In contrast to patients with true ventricular aneurysm, those with false aneurysm most commonly die of hemorrhage. Review of the reported surgical experience and of our 14 cases confirms that standard chest radiographs with an abnormal cardiac silhouette and rapidly expanding size may alert the physician to this sometimes overlooked diagnosis. Noninvasive tests such as color-flow Doppler echocardiography, 2-dimensional echocardiography, cineangiographic computed tomography, and transesophageal echocardiography allow relatively easy recognition of these apparently rare lesions with increasing frequency. Cardiac catheterization, however, is usually still necessary for a clear picture of the location and anatomy of the aneurysm and the state of the coronary arteries. Finally, a new classification is proposed, consisting of true aneurysm, false aneurysm, pseudo-false aneurysm, and mixed aneurysm. Images PMID:7888805

  20. Cardiac arrest

    MedlinePlus

    Sudden cardiac arrest, SCA; Cardiopulmonary arrest; Circulatory arrest ... While some people refer to a heart attack as a cardiac arrest, they are not the same thing. A heart attack occurs when a blocked artery stops the flow ...

  1. Cardiac rehabilitation

    MedlinePlus

    Cardiac rehabilitation (rehab) is a program that helps you live better with heart disease. It is often prescribed to ... Ades PA, et al. Core Components of Cardiac Rehabilitation/Secondary Prevention Programs: 2007 Update: A Scientific Statement ...

  2. [A case of primary cardiac angiosarcoma associated with cardiac tamponade].

    PubMed

    Nakaya, Naoki; Sato, Itaru; Shimasaki, Takeo; Nakajima, Hideo; Kurose, Nozomu; Nojima, Takayuki; Motoo, Yoshiharu

    2011-08-01

    A 72-year-old man came to our hospital due to edema, malaise, and poor appetite in May 200X. He was diagnosed as cardiac tamponade, and open surgery revealed tumors in the right atrium and the left ventricule. Tumor tissue was revealed to be angiosarcoma by the pathological findings. Metastases to the brain, lungs, liver, and adrenal glands were found. The patient was treated with interleukin-2(IL-2)for 7 weeks. However, there was no anti-tumor effect, and the patient died in September, 200X. We reported a very rare case of cardiac angiosarcoma associated with cardiac tamponade, who was treated with IL-2 monotherapy. PMID:21829080

  3. Neuromodulation for cardiac arrhythmia.

    PubMed

    Hou, Yuemei; Zhou, Qina; Po, Sunny S

    2016-02-01

    The autonomic nervous system is known to play a significant role in the genesis and maintenance of arrhythmias. Neuromodulation, mostly designed to increase the parasympathetic tone and suppress the sympathetic tone, has become an emerging therapeutic strategy for the treatment of arrhythmias. Emerging therapeutic approaches include cervical vagal stimulation, transcutaneous auricular vagal stimulation, baroreceptor activation therapy spinal cord stimulation, ganglionated plexi ablation, renal sympathetic denervation, and left cardiac sympathetic denervation. PMID:26440550

  4. Overlapping left ventricular restoration.

    PubMed

    Matsui, Yoshiro

    2009-06-01

    Cardiac transplantation, a final option of treatment for refractory heart failure, has not been a standard procedure in Japan especially, mainly because of the shortage of donors. However, surgical methods to restore native heart function, such as surgical ventricular restoration (SVR), are often effective for these cases. The Dor procedure has been used for ischemic cardiomyopathy cases presenting with broad akinetic segments. This is a fine method to exclude the scarred septum and to reduce the intraventricular cavity by encircling purse-string suture, but it may produce a postoperative spherical ventricular shape as a result of endoventricular patch repair. Also, partial left ventriculectomy is not recommended for non-ischemic dilated cardiomyopathy cases for now. A modification of these SVR and surgical approaches to functional mitral regurgitation has been named "overlapping ventriculoplasty" without endoventricular patch and resection of viable cardiac muscle, and "mitral complex reconstruction", which consists of mitral annuloplasty, papillary muscle approximation, and suspension. Although the long-term prognosis of these procedures is undetermined, they could be an important option, at least as an alternative bridge to transplantation. This review will describe the concepts and some technical aspects of these procedures for the end-stage heart. PMID:19474505

  5. [Hypoplastic left heart syndrome].

    PubMed

    Yoshizumi, Ko; Sano, Shunji

    2004-07-01

    Hypoplastic left heart syndrome (HLHS) is one of the last remaining problems in pediatric cardiac surgery, which necessitates a search for new solutions and continues to be a challenge for cardiologists and cardiac surgeons. The identification of HLHS in utero is extremely helpful for prompt, appropriate preoperative management. In addition, infants with prenatal diagnosis had an improvement operative mortality on Norwood operation compared to infants diagnosed postnatally. Outcome following Norwood procedure has improved significantly secondary to modifications in the surgical technique for protection of multiorgans, improved perioperative care, and improved anesthetic management. In particular right ventricular (RV)-pulmonary artery (PA) shunt using non-valved polytetrafluoroethylene (PTFE) graft was applied as a first stage palliation of HLHS to prevent hemodynamic instability associated with a classic Norwood procedure. In the modified Norwood (RV-PA shunt), higher diastolic blood pressures and lower Qp/Qs ratios that are associated with a more stable and efficient systemic circulation. In fact, patients who received a RV-PA shunt, rarely received ventilatory manipulations. PMID:15362550

  6. Luteolin alleviates post-infarction cardiac dysfunction by up-regulating autophagy through Mst1 inhibition.

    PubMed

    Hu, Jianqiang; Man, Wanrong; Shen, Min; Zhang, Mingming; Lin, Jie; Wang, Tingting; Duan, Yu; Li, Congye; Zhang, Rongqing; Gao, Erhe; Wang, Haichang; Sun, Dongdong

    2016-01-01

    Myocardial infarction (MI), which is characterized by chamber dilation and LV dysfunction, is associated with substantially higher mortality. We investigated the effects and underlying mechanisms of Luteolin on post-infarction cardiac dysfunction. Myocardial infarction was constructed by left anterior descending coronary artery ligation. In vitro, cultured neonatal cardiomyocytes subjected to simulated MI were used to probe mechanism. Luteolin significantly improved cardiac function, decreased cardiac enzyme and inflammatory cytokines release after MI. Enhanced autophagic flux as indicated by more autophagosomes puncta, less accumulation of aggresomes and P62 in the neonatal cardiomyocytes after hypoxia was observed in the Luteolin pre-treatment group. Western blot analysis also demonstrated that Luteolin up-regulated autophagy in the cardiomyocytes subjected to simulated MI injury. Furthermore, Luteolin increased mitochondrial membrane potential, adenosine triphosphate content, citrate synthase activity and complexes I/II/III/IV/V activities in the cardiomyocytes subjected to simulated MI injury. Interestingly, mammalian sterile 20-like kinase 1 (Mst1) knockout abolished the protective effects of Luteolin administration. Luteolin enhances cardiac function, reduces cardiac enzyme and inflammatory markers release after MI. The protective effects of Luteolin are associated with up-regulation of autophagy and improvement of mitochondrial biogenesis through Mst1 inhibition. PMID:26538370

  7. Cardiac Involvement in Ankylosing Spondylitis

    PubMed Central

    Ozkan, Yasemin

    2016-01-01

    Ankylosing spondylitis is one of the subgroup of diseases called “seronegative spondyloarthropathy”. Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed. PMID:27222669

  8. Videoscope-assisted cardiac surgery

    PubMed Central

    Chen, Robert Jeen-Chen

    2014-01-01

    Videoscope-assisted cardiac surgery (VACS) offers a minimally invasive platform for most cardiac operations such as coronary and valve procedures. It includes robotic and thoracoscopic approaches and each has strengths and weaknesses. The success depends on appropriate hardware setup, staff training, and troubleshooting efficiency. In our institution, we often use VACS for robotic left-internal-mammary-artery takedown, mitral valve repair, and various intra-cardiac operations such as tricuspid valve repair, combined Maze procedure, atrial septal defect repair, ventricular septal defect repair, etc. Hands-on reminders and updated references are provided for reader’s further understanding of the topic. PMID:24455172

  9. Cardiac abnormalities in young women with anorexia nervosa.

    PubMed Central

    de Simone, G.; Scalfi, L.; Galderisi, M.; Celentano, A.; Di Biase, G.; Tammaro, P.; Garofalo, M.; Mureddu, G. F.; de Divitiis, O.; Contaldo, F.

    1994-01-01

    OBJECTIVE--To identify the characteristics of cardiac involvement in the self-induced starvation phase of anorexia nervosa. METHODS--Doppler echocardiographic indices of left ventricular geometry, function, and filling were examined in 21 white women (mean (SD) 22 (5) years) with anorexia nervosa according to the DSMIII (Diagnostic and Statistical Manual of Mental Disorders) criteria, 19 women (23 (2) years) of normal weight, and 22 constitutionally thin women (21 (4) years) with body mass index < 20. RESULTS--13 patients (62%) had abnormalities of mitral valve motion compared with one normal weight woman and two thin women (p < 0.001) v both control groups). Left ventricular chamber dimension and mass were significantly less in women with anorexia nervosa than in either the women of normal weight or the thin women, even after standardisation for body size or after controlling for blood pressure. There were no substantial changes in left ventricular shape. Midwall shortening as a percentage of the values predicted from end systolic stress was significantly lower in the starving patients than in women of normal weight: when endocardial shortening was used as the index this difference was overestimated. The cardiac index was also significantly reduced in anorexia nervosa because of a low stroke index and heart rate. The total peripheral resistance was significantly higher in starving patients than in both control groups. The left atrial dimension was significantly smaller in anorexia than in the women of normal weight and the thin women, independently of body size. The transmitral flow velocity E/A ratio was significantly higher in anorexia than in both the control groups because of the reduction of peak velocity A. When data from all three groups were pooled the flow velocity E/A ratio was inversely related to left atrial dimension (r = -0.43, p < 0.0001) and cardiac output (r = -0.64, p < 0.0001) independently of body size. CONCLUSIONS--Anorexia nervosa caused demonstrable abnormalities of mitral valve motion and reduced left ventricular mass and filling associated with systolic dysfunction. PMID:8142200

  10. Portable Hyperbaric Chamber

    NASA Technical Reports Server (NTRS)

    Schneider, William C. (Inventor); Locke, James P. (Inventor); DeLaFuente, Horacio (Inventor)

    2001-01-01

    A portable, collapsible hyperbaric chamber was developed. A toroidal inflatable skeleton provides initial structural support for the chamber, allowing the attendant and/or patient to enter the chamber. Oval hatches mate against bulkhead rings, and the hyperbaric chamber is pressurized. The hatches seal against an o-ring, and the internal pressure of the chamber provides the required pressure against the hatch to maintain an airtight seal. In the preferred embodiment, the hyperbaric chamber has an airlock to allow the attendant to enter and exit the patient chamber during treatment. Visual communication is provided through portholes in the patient and/or airlock chamber. Life monitoring and support systems are in communication with the interior of the hyperbaric chamber and/or airlock chamber through conduits and/or sealed feed-through connectors into the hyperbaric chamber.

  11. Cardiac Fibrosis: The Fibroblast Awakens.

    PubMed

    Travers, Joshua G; Kamal, Fadia A; Robbins, Jeffrey; Yutzey, Katherine E; Blaxall, Burns C

    2016-03-18

    Myocardial fibrosis is a significant global health problem associated with nearly all forms of heart disease. Cardiac fibroblasts comprise an essential cell type in the heart that is responsible for the homeostasis of the extracellular matrix; however, upon injury, these cells transform to a myofibroblast phenotype and contribute to cardiac fibrosis. This remodeling involves pathological changes that include chamber dilation, cardiomyocyte hypertrophy and apoptosis, and ultimately leads to the progression to heart failure. Despite the critical importance of fibrosis in cardiovascular disease, our limited understanding of the cardiac fibroblast impedes the development of potential therapies that effectively target this cell type and its pathological contribution to disease progression. This review summarizes current knowledge regarding the origins and roles of fibroblasts, mediators and signaling pathways known to influence fibroblast function after myocardial injury, as well as novel therapeutic strategies under investigation to attenuate cardiac fibrosis. PMID:26987915

  12. [Cardiac amyloidosis. General review].

    PubMed

    Laraki, R

    1994-04-01

    Cardiac amyloidosis, most often of AL type, is a non-exceptional disease as it represents 5 to 10% of non-ischemic cardiomyopathies. It realizes typically a restrictive cardiomyopathy. Nevertheless the wide diversity of possible presentation makes it a "big shammer" which must be evoked in front of every unexplained cardiopathy after the age of forty. If some associated manifestations can rapidly suggest the diagnosis, as a peripheric neuropathy especially a carpal tunnel syndrome or palpebral ecchymosis, cardiac involvement can also evolve in an apparently isolated way. The most suggestive paraclinic elements for the diagnosis are, in one hand, the increased myocardial echogenicity with a "granular sparkling" appearance seen throughout all walls of the left ventricle and, in the other hand, the association of a thickened left ventricle and a low voltage (electrocardiogram could also show pseudo-infarct Q waves). In front of such aspects, the proof of amyloidosis is brought by an extra-cardiac biopsy or by scintigraphy with labelled serum amyloid P component, so that the indications of endomyocardial biopsy are very limited today. The identification of the amyloid nature of a cardiopathy has an direct therapeutic implication: it contra-indicates the use of digitalis, calcium channel blockers and beta-blockers. The treatment of AL amyloidosis (chemotherapy with alkylant agents) remains very unsatisfactory especially in the cardiac involvement which is the most frequent cause of death (in AL amyloidosis). Last, cardiac amyloidosis is a bad indication for transplantation which results are burden by rapid progression of deposits especially in the gastro-intestinal tract and the nervous system. PMID:8059146

  13. Unbiased stratification of left ventricles.

    PubMed

    Srinivasan, Rajagopalan; Shriram, K S; Suryanarayanan, Srikanth

    2008-01-01

    Image based quantitative stratification of the Left Ventricles (LV) across a population helps in unraveling the structure-function symbiosis of the heart. An unbiased, reference less grouping scheme that automatically determines the number of clusters and a physioanatomically relevant strategy that aligns the intra cluster LV shapes would enable the robust construction of pathology stratified cardiac atlas. This paper achieves this hitherto elusive stratification and alignment by adapting the conventional strategies routinely followed by clinicians. The individual LV shape models (N=127) are independently oriented to an "attitudinally consistent orientation" that captures the physioanatomic variations of the LV morphology. Affinity propagation technique based on the automatically identified inter-LV_landmark distances is used to group the LV shapes. The proposed algorithm is computationally efficient and, if the inter cluster variations are linked to pathology, could provide a clinically relevant cardiac atlas. PMID:18979790

  14. 1. OVERFLOW CHAMBER. VIEW IS NORTH (DOWNSTREAM). NOTE DELGANY SEWER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. OVERFLOW CHAMBER. VIEW IS NORTH (DOWNSTREAM). NOTE DELGANY SEWER ON RIGHT SIDE OF NEGATIVE AND OVERFLOW CHANNEL ON LEFT SIDE OF IMAGE. - Thirty-first Street Overflow Structure, Thirty-first Street, Denver, Denver County, CO

  15. 5. DETAIL OF ARCH INSIDE OVERFLOW CHAMBER ON THE SOUTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. DETAIL OF ARCH INSIDE OVERFLOW CHAMBER ON THE SOUTH (UPSTREAM) END. NOTE DELGANY SEWER ON THE LEFT SIDE OF THE NEGATIVE. - Thirty-first Street Overflow Structure, Thirty-first Street, Denver, Denver County, CO

  16. 18. SECOND FLOOR, CITY COMMISSION CHAMBERS, DETAIL OF ARCH WITH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. SECOND FLOOR, CITY COMMISSION CHAMBERS, DETAIL OF ARCH WITH MURAL ON LEFT OF BENCH, SHOWING SEAMEN,SCIENTIST,SPORTSMEN AND STATE SEAL - City Hall, Atlantic & Tennessee Avenues, Atlantic City, Atlantic County, NJ

  17. 8. EMPTY LOCK CHAMBER FROM DOWNSTREAM (WEST) END, WITH VISITORS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. EMPTY LOCK CHAMBER FROM DOWNSTREAM (WEST) END, WITH VISITORS CENTER (LEFT) AND LOCKMASTER'S HOUSE ON NORTH BANK. VIEW TO NORTHEAST. - Starved Rock Locks & Dam, Illinois Waterway River mile 231, Peru, La Salle County, IL

  18. Dose to the cardiac vascular and conduction systems in primary breast irradiation

    SciTech Connect

    Janjan, N.A.; Gillin, M.T.; Prows, J.; Arnold, S.; Haasler, G.; Thorsen, M.K.; Wilson, J.F. )

    1989-01-01

    Using computerized tomography (CT) in which cardiac anatomy was defined, doses delivered to the cardiac compartments, vascular and conduction systems were assessed for various standard techniques of primary breast irradiation. Included in the analysis were 6 MV photon tangents (T) alone, or in conjunction with a separate internal mammary field (IMF). Beams evaluated in the IMF were 6 MV photons, 12 MeV electron beam, and mixed photon/electron beam; Cobalt 60 was also analyzed as an alternate photon beam. Treatment of the IMF with photons, either alone or in combination with electron beam, delivered doses ranging between 30 Gy to 50 Gy to all chambers of the heart, coronary arteries and branches of the conduction system. Complete sparing of the posterior cardiac structures and volume is accomplished with treatment plans using tangents alone or in combination with 12 MeV electron beam irradiation to the IMF. Sparing of the anterior wall of the left ventricle, Bundle of His and left anterior descending coronary artery is also achieved in treatment with tangents and 12 MeV electron beam IMF. Doses to this region with tangents alone ranged from 20 Gy to 45 Gy compared to 0 to 30 Gy with tangents and 12 MeV electron beam IMF. Clinical significance of these findings will be discussed.

  19. Biomechanics of Cardiac Function.

    PubMed

    Voorhees, Andrew P; Han, Hai-Chao

    2015-10-01

    The heart pumps blood to maintain circulation and ensure the delivery of oxygenated blood to all the organs of the body. Mechanics play a critical role in governing and regulating heart function under both normal and pathological conditions. Biological processes and mechanical stress are coupled together in regulating myocyte function and extracellular matrix structure thus controlling heart function. Here, we offer a brief introduction to the biomechanics of left ventricular function and then summarize recent progress in the study of the effects of mechanical stress on ventricular wall remodeling and cardiac function as well as the effects of wall mechanical properties on cardiac function in normal and dysfunctional hearts. Various mechanical models to determine wall stress and cardiac function in normal and diseased hearts with both systolic and diastolic dysfunction are discussed. The results of these studies have enhanced our understanding of the biomechanical mechanism in the development and remodeling of normal and dysfunctional hearts. Biomechanics provide a tool to understand the mechanism of left ventricular remodeling in diastolic and systolic dysfunction and guidance in designing and developing new treatments. PMID:26426462

  20. Left Main Coronary Artery Hypoplasia in Elderly

    PubMed Central

    Kenar Tiryakioglu, Selma; Bahadir, Hakan

    2016-01-01

    Congenital anomalies of the coronary artery causing coronary occlusive disease may be of many different types. A 67-year-old woman with no coronary risk factors was referred for coronary angiography with few months' history of angina. The patient underwent coronary angiography due to ischemic cardiac symptoms with nondiagnostic exercising test. In coronary angiography, the left main coronary artery was arising from normal anatomical position; however, left anterior descending artery and circumflex artery were hypoplastic. The treatment of patient was discussed in cardiology-cardiovascular surgery council and coronary surgery was found inappropriate due to the hypoplasia of the left coronary system entirely.

  1. Focused Cardiac Ultrasound Using a Pocket-Size Device in the Emergency Room

    PubMed Central

    Mancuso, Frederico José Neves; Siqueira, Vicente Nicoliello; Moisés, Valdir Ambrósio; Gois, Aécio Flavio Teixeira; de Paola, Angelo Amato Vincenzo; Carvalho, Antonio Carlos Camargo; Campos, Orlando

    2014-01-01

    Background Cardiovascular urgencies are frequent reasons for seeking medical care. Prompt and accurate medical diagnosis is critical to reduce the morbidity and mortality of these conditions. Objective To evaluate the use of a pocket-size echocardiography in addition to clinical history and physical exam in a tertiary medical emergency care. Methods One hundred adult patients without known cardiac or lung diseases who sought emergency care with cardiac complaints were included. Patients with ischemic changes in the electrocardiography or fever were excluded. A focused echocardiography with GE Vscan equipment was performed after the initial evaluation in the emergency room. Cardiac chambers dimensions, left and right ventricular systolic function, intracardiac flows with color, pericardium, and aorta were evaluated. Results The mean age was 61 ± 17 years old. The patient complaint was chest pain in 51 patients, dyspnea in 32 patients, arrhythmia to evaluate the left ventricular function in ten patients, hypotension/dizziness in five patients and edema in one patient. In 28 patients, the focused echocardiography allowed to confirm the initial diagnosis: 19 patients with heart failure, five with acute coronary syndrome, two with pulmonary embolism and two patients with cardiac tamponade. In 17 patients, the echocardiography changed the diagnosis: ten with suspicious of heart failure, two with pulmonary embolism suspicious, two with hypotension without cause, one suspicious of acute coronary syndrome, one of cardiac tamponade and one of aortic dissection. Conclusion The focused echocardiography with pocket-size equipment in the emergency care may allow a prompt diagnosis and, consequently, an earlier initiation of the therapy. PMID:25590933

  2. An integrated platform for image-guided cardiac resynchronization therapy

    NASA Astrophysics Data System (ADS)

    Ma, Ying Liang; Shetty, Anoop K.; Duckett, Simon; Etyngier, Patrick; Gijsbers, Geert; Bullens, Roland; Schaeffter, Tobias; Razavi, Reza; Rinaldi, Christopher A.; Rhode, Kawal S.

    2012-05-01

    Cardiac resynchronization therapy (CRT) is an effective procedure for patients with heart failure but 30% of patients do not respond. This may be due to sub-optimal placement of the left ventricular (LV) lead. It is hypothesized that the use of cardiac anatomy, myocardial scar distribution and dyssynchrony information, derived from cardiac magnetic resonance imaging (MRI), may improve outcome by guiding the physician for optimal LV lead positioning. Whole heart MR data can be processed to yield detailed anatomical models including the coronary veins. Cine MR data can be used to measure the motion of the LV to determine which regions are late-activating. Finally, delayed Gadolinium enhancement imaging can be used to detect regions of scarring. This paper presents a complete platform for the guidance of CRT using pre-procedural MR data combined with live x-ray fluoroscopy. The platform was used for 21 patients undergoing CRT in a standard catheterization laboratory. The patients underwent cardiac MRI prior to their procedure. For each patient, a MRI-derived cardiac model, showing the LV lead targets, was registered to x-ray fluoroscopy using multiple views of a catheter looped in the right atrium. Registration was maintained throughout the procedure by a combination of C-arm/x-ray table tracking and respiratory motion compensation. Validation of the registration between the three-dimensional (3D) roadmap and the 2D x-ray images was performed using balloon occlusion coronary venograms. A 2D registration error of 1.2 ± 0.7 mm was achieved. In addition, a novel navigation technique was developed, called Cardiac Unfold, where an entire cardiac chamber is unfolded from 3D to 2D along with all relevant anatomical and functional information and coupled to real-time device detection. This allowed more intuitive navigation as the entire 3D scene was displayed simultaneously on a 2D plot. The accuracy of the unfold navigation was assessed off-line using 13 patient data sets by computing the registration error of the LV pacing lead electrodes which was found to be 2.2 ± 0.9 mm. Furthermore, the use of Unfold Navigation was demonstrated in real-time for four clinical cases.

  3. 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

  4. A novel passive left heart platform for device testing and research.

    PubMed

    Leopaldi, A M; Vismara, R; van Tuijl, S; Redaelli, A; van de Vosse, F N; Fiore, G B; Rutten, M C M

    2015-04-01

    Integration of biological samples into in vitro mock loops is fundamental to simulate real device's operating conditions. We developed an in vitro platform capable of simulating the pumping function of the heart through the external pressurization of the ventricle. The system consists of a fluid-filled chamber, in which the ventricles are housed and sealed to exclude the atria from external loads. The chamber is connected to a pump that drives the motion of the ventricular walls. The aorta is connected to a systemic impedance simulator, and the left atrium to an adjustable preload. The platform reproduced physiologic hemodynamics, i.e. aortic pressures of 120/80 mmHg with 5 L/min of cardiac output, and allowed for intracardiac endoscopy. A pilot study with a left ventricular assist device (LVAD) was also performed. The LVAD was connected to the heart to investigate aortic valve functioning at different levels of support. Results were consistent with the literature, and high speed video recordings of the aortic valve allowed for the visualization of the transition between a fully opening valve and a permanently closed configuration. In conclusion, the system showed to be an effective tool for the hemodynamic assessment of devices, the simulation of surgical or transcatheter procedures and for visualization studies. PMID:25666402

  5. 7. SEDIMENTATION CHAMBER AT 520', CONSTRUCTED 19371938, VIEWED FROM DOWNSTREAM. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. SEDIMENTATION CHAMBER AT 520', CONSTRUCTED 1937-1938, VIEWED FROM DOWNSTREAM. DEBRIS REMOVED FROM TOP PLANKS FOR CLARITY. ONE OF TWO SPILLWAYS SEEN AT RIGHT. FLUSH VALVE SEEN AT LOWER LEFT AND WRENCH FOR VALVES IS PROPPED AGAINST CHAMBER. - Kalaupapa Water Supply System, Waikolu Valley to Kalaupapa Settlement, Island of Molokai, Kalaupapa, Kalawao County, HI

  6. 8. SEDIMENTATION CHAMBER, VIEW UPSTREAM (PLANK COVER REMOVED FOR CLARITY). ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. SEDIMENTATION CHAMBER, VIEW UPSTREAM (PLANK COVER REMOVED FOR CLARITY). BOX FLUME DROPS SLIGHTLY INTO CHAMBER ON LEFT SIDE. CHAMBER IS A SERIES OF BAFFLES DESIGNED TO SLOW THE FLOW OF WATER. FLOW IS REDUCED TO ALLOW PARTICULATES TO SETTLE TO THE BOTTOM. TWO SCREENS (NOT SHOWN) FILTER LARGER DEBRIS. - Kalaupapa Water Supply System, Waikolu Valley to Kalaupapa Settlement, Island of Molokai, Kalaupapa, Kalawao County, HI

  7. Cardiac nuclear medicine

    SciTech Connect

    Gerson, M.C.

    1987-01-01

    The book begins with a review of the radionuclide methods available for evaluating cardiac perfusion and function. The authors discuss planar and tomographic thallium myocardial imaging, first-pass and equilibrium radionuclide angiography, and imaging with infarct-avid tracers. Several common but more specialized procedures are then reviewed: nonogemetric measurement of left ventricular volume, phase (Fourier) analysis, stroke volume ratio, right ventricular function, and diastolic function. A separate chapter is devoted to drug interventions and in particular the use of radionuclide ventriculography to monitor doxorubicin toxicity and therapy of congestive heart failure. The subsequent chapters provide a comprehensive guide to test selection, accuracy, and results in acute myocardial infarction, in postmyocardial infarction, in chronic coronary artery disease, before and after medical or surgical revascularization, in valvular heart disease, in cardiomyopathies, and in cardiac trauma.

  8. A multimodal (MRI/ultrasound) cardiac phantom for imaging experiments

    NASA Astrophysics Data System (ADS)

    Tavakoli, Vahid; Kendrick, Michael; Shakeri, Mostafa; Alshaher, Motaz; Stoddard, Marcus F.; Amini, Amir

    2013-03-01

    A dynamic cardiac phantom can play a significant role in the evaluation and development of ultrasound and cardiac magnetic resonance (MR) motion tracking and registration methods. A four chamber multimodal cardiac phantom has been designed and built to simulate normal and pathologic hearts with different degrees of "infarction" and "scar tissues". In this set up, cardiac valves have been designed and modeled as well. The four-chamber structure can simulate the asymmetric ventricular, atrial and valve motions. Poly Vinyl Alcohol (PVA) is used as the principal material since it can simulate the shape, elasticity, and MR and ultrasound properties of the heart. The cardiac shape is simulated using a four-chamber mold made of polymer clay. An additional pathologic heart phantom containing stiff inclusions has been manufactured in order to simulate an infracted heart. The stiff inclusions are of different shapes and different degrees of elasticity and are able to simulate abnormal cardiac segments. The cardiac elasticity is adjusted based on freeze-thaw cycles of the PVA cryogel for normal and scarred regions. Ultrasound and MRI markers were inserted in the cardiac phantom as landmarks for validations. To the best of our knowledge, this is the first multimodal phantom that models a dynamic four-chamber human heart including the cardiac valve.

  9. Absent right and persistent left superior vena cava: troubleshooting during a challenging pacemaker implant: a case report

    PubMed Central

    2014-01-01

    Background Venous anomalies of the thorax can occur in isolation or in association with complex congenital heart disease. The incidence of an absent right superior vena cava in the setting of a persistent left superior vena cava is very rare in the general population with only a dozen cases documented in the medical literature. Such venous anomalies can make for very challenging electronic cardiac device implantation. We report our challenging dual chamber pacemaker implant in a patient with such complex anatomy and focus on our implantation technique that helped achieve adequate lead positioning. Case presentation A 73-year-old Caucasian female with degenerative complete heart block presented for dual chamber permanent pacemaker implant. Lead implantation was very challenging due to abnormal and rare vena cava anatomy; a persistent left superior vena cava drained directly into the coronary sinus and the right brachiocephalic vein drained directly into the left persistent superior vena cava as the patient had an absent right superior vena cava . Adequate right ventricular lead positioning was achieved following numerous lead-stylet manipulations and careful looping in the atria to redirect its trajectory to the ventricular apex. Conclusion Abnormal superior vena cava development is uncommon and can lead to technical challenges when venous access is required during various interventional procedures. Pre-operative imaging can help identify such challenging anatomy allowing appropriate operative planning; careful patient selection is warranted for venography given the risk of contrast nephrotoxicity. PMID:25047923

  10. Old Riverdale Cotton Mill office building on left. The old ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Old Riverdale Cotton Mill office building on left. The old office building has also been used as a starch mixing house. Note entrance to new office building on right - Riverdale Cotton Mill, Office Building, Old, Valley, Chambers County, AL

  11. 12. VIEW, LOOKING SOUTH FROM LEFT TO RIGHT, SHOWING DRESSING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. VIEW, LOOKING SOUTH FROM LEFT TO RIGHT, SHOWING DRESSING FROM AND WORK/CHAMBER ROOM - U.S. Naval Submarine Base, New London Submarine Escape Training Tank, Albacore & Darter Roads, Groton, New London County, CT

  12. [Cardiac involvement in systemic sclerosis].

    PubMed

    Silveira-Torre, Luis H

    2006-11-01

    Systemic sclerosis (SS) can involve the pericardium, myocardium, conduction system, and cardiac valves. The presence of overt clinical signs of cardiac disease is a poor prognostic sign. Clinical manifestations include dyspnea, palpitations, chest pain, syncope, and symptoms of right heart failure. Prevalence of clinically symptomatic pericardial disease is 5-16%. However, ecocardiographic prevalence is 5.4- 41% and at autopsy is 33-77.5%. Patchy fibrosis is the characteristic myocardial finding in SS. Contraction band necrosis is the typical pathological finding. Important complications of fibrosis include left ventricular hypertrophy, as well as systolic and diastolic dysfunction of both ventricles. Early detection of these abnormalities is very important, mainly of the diastolic dysfunction, since it occurs before the systolic dysfunction and can predict important cardiac damage. Association of skeletal myositis with myocardial disease has been described. Patients with skeletal myositis are more likely to develop congestive heart failure, sustained symptomatic arrythmias, and cardiac sudden death. Coronary arteries are normal in systemic sclerosis, but there is no endomyocardial vessel involvement. There is an increased prevalence of arrhytmias, mainly premature atrial and ventricular contractions, as well as conduction system disease. Cardiac valvular involvement is minor in systemic sclerosis; mitral valve is the most frequently affected. Other abnormalities described in this disease include peripheral large vessels stiffness and secondary cardiac involvement due to pulmonary and systemic arterial hypertension. Cardiac involvement confers a high morbi-mortality risk in systemic sclerosis. PMID:21794385

  13. A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation in Patients With Moderately Reduced Left Ventricular Ejection Fraction and a Narrow QRS Duration: Study Rationale and Design

    PubMed Central

    ABRAHAM, WILLIAM T.; LINDENFELD, JOANN; REDDY, VIVEK Y.; HASENFUSS, GERD; KUCK, KARL-HEINZ; BOSCARDIN, JOHN; GIBBONS, ROBERT; BURKHOFF, DANIEL

    2015-01-01

    Cardiac contractility modulation (CCM) signals are nonexcitatory electrical signals delivered during the cardiac absolute refractory period that enhance the strength of cardiac muscular contraction. The FIX-HF-5 study was a prospective randomized study comparing CCM plus optimal medical therapy (OMT) to OMT alone that included 428 New York Heart Association (NYHA) functional class III or IV heart failure patients with ejection fraction (EF) ≤45% according to core laboratory assessment. The study met its primary safety end point, but did not reach its primary efficacy end point: a responders analysis of changes in ventilatory anaerobic threshold (VAT). However, in a prespecified subgroup analysis, significant improvements in primary and secondary end points, including the responder VAT end point, were observed in patients with EFs ranging from 25% to 45%, who constituted about one-half of the study subjects. We therefore designed a new study to prospectively confirm the efficacy of CCM in this population. A hierarchic bayesian statistical analysis plan was developed to take advantage of the data already available from the first study. In addition, based on technical difficulties encountered in reliably quantifying VAT and the relatively large amount of nonquantifiable studies, the primary efficacy end point was changed to peak VO2, with significant measures incorporated to minimize the influence of placebo effect. In this paper, we provide the details and rationale of the FIX-HF-5C study design to study CCM plus OMT compared with OMT alone in subjects with normal QRS duration, NYHA functional class III or IV, and EF 25%–45%. This study is registered on www.clinicaltrials.gov with identifier no. NCT01381172. PMID:25285748

  14. CONTINUOUS ROTATION SCATTERING CHAMBER

    DOEpatents

    Verba, J.W.; Hawrylak, R.A.

    1963-08-01

    An evacuated scattering chamber for use in observing nuclear reaction products produced therein over a wide range of scattering angles from an incoming horizontal beam that bombards a target in the chamber is described. A helically moving member that couples the chamber to a detector permits a rapid and broad change of observation angles without breaching the vacuum in the chamber. Also, small inlet and outlet openings are provided whose size remains substantially constant. (auth)

  15. Graphite transmission ionization chamber

    SciTech Connect

    Austerlitz, C.; Sibata, C.H.; de Almeida, C.E.

    1987-11-01

    A pancake-type transmission chamber made of high-purity graphite and open to the atmosphere has been designed and constructed at the Secondary Standard Dosimetry Laboratory (SSDL-Rio de Janeiro). Tests performed on the chamber following the International Electrotechnical Commission recommendations indicate that its performance characteristics are comparable to those expected from a secondary standard ionization chamber.

  16. Two chamber reaction furnace

    DOEpatents

    Blaugher, Richard D.

    1998-05-05

    A vertical two chamber reaction furnace. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium-copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700.degree. and 800.degree. C.) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800.degree. to 950.degree. C. to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product.

  17. Two chamber reaction furnace

    DOEpatents

    Blaugher, R.D.

    1998-05-05

    A vertical two chamber reaction furnace is described. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium-copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700 C and 800 C) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800 to 950 C to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product. 2 figs.

  18. Left ventricular guidewire pacing for transcatheter aortic valve implantation.

    PubMed

    Guérios, Enio E; Wenaweser, Peter; Meier, Bernhard

    2013-12-01

    Previous reports prove the safety and efficacy of cardiac pacing employing a guidewire in the left ventricle as unipolar pacing electrode. We describe the use of left ventricular guidewire pacing as an alternative to conventional transvenous temporary right ventricular pacing in the context of transcatheter aortic valve implantation. PMID:22581741

  19. Cardiac Rehabilitation

    MedlinePlus

    Cardiac rehabilitation (rehab) is a medically supervised program to help people who have A heart attack Angioplasty or coronary artery bypass grafting for coronary heart disease A heart valve repair or replacement A ...

  20. Cardiac Sarcoidosis

    MedlinePlus

    ... do at National Jewish Health? We provide comprehensive cardiology evaluation and consultation and non-invasive cardiac testing. ... the whole person, not just the disease. Our cardiology team works with healthcare providers from all areas ...

  1. Cardiac CT

    MedlinePlus

    ... type of CT scan is called a coronary CT angiography (an-je-OG-rah-fee), or CTA. Overview ... called atrial fibrillation (AF). The pictures that cardiac CT creates of the pulmonary veins can help guide procedures used to treat ...

  2. Cardiac Catheterization

    MedlinePlus

    ... done during a cardiac catheterization include: closing small holes inside the heart repairing leaky or narrow heart ... bandage. It's normal for the site to be black and blue, red, or slightly swollen for a ...

  3. Cardiac MRI

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Cardiac MRI? Magnetic resonance imaging (MRI) is a safe, noninvasive test that creates detailed ... and no instruments are inserted into your body. MRI uses radio waves, magnets, and a computer to ...

  4. Evaluation of Known or Suspected Cardiac Sarcoidosis.

    PubMed

    Blankstein, Ron; Waller, Alfonso H

    2016-03-01

    Sarcoidosis is a multisystem disorder of unknown cause, and cardiac sarcoidosis affects at least 25% of patients and accounts for substantial mortality and morbidity from this disease. Cardiac sarcoidosis may present with heart failure, left ventricular systolic dysfunction, AV block, atrial or ventricular arrhythmias, and sudden cardiac death. Cardiac involvement can be challenging to detect and diagnose because of the focal nature of the disease, as well as the fact that clinical criteria have limited diagnostic accuracy. Nevertheless, the diagnosis of cardiac sarcoidosis can be enhanced by integrating both clinical and imaging findings. This article reviews the various roles that different imaging modalities provide in the evaluation and management of patients with known or suspected cardiac sarcoidosis. PMID:26926267

  5. Cardiac cephalgia.

    PubMed

    Torres-Yaghi, Yasar; Salerian, Justin; Dougherty, Carrie

    2015-04-01

    "Cardiac cephalgia" is a type of secondary headache disorder, usually initiated by exertion that is related to myocardial ischemia. Primary exertional headaches such as sex-, cough-, or exercise-induced headaches are typically benign. Cardiac cephalgia, on the other hand, can have life-threatening complications. Due to overlapping features and similarities in presentation, cardiac cephalgia can be misdiagnosed as a primary headache disorder such as migraine. However, the management of these conditions is unique, and treatment of cardiac cephalgia with vasoconstrictors intended for migraine can potentially worsen myocardial ischemia. Thus, it is important to make the correct diagnosis by evaluating cardiac function with an electrocardiogram and/or stress testing. In this review, we examine reported cases of cardiac cephalgia from the past 5 years to highlight the importance of this condition in the differential diagnosis of a headache in a patient with a history of cardiovascular risk factors, as well as to discuss the appropriate approach to diagnosis and the proposed pathogenic mechanisms of this condition. PMID:25819974

  6. Fetal cardiac function in intrauterine growth retardation.

    PubMed

    Rizzo, G; Arduini, D

    1991-10-01

    Blood-flow velocity waveforms are altered in several peripheral vascular beds of fetuses whose intrauterine growth is retarded because of placental insufficiency. We investigated these concomitant changes in cardiac function. Color and pulsed Doppler echocardiographic recordings were performed in 124 fetuses with intrauterine growth retardation. These fetuses were free of structural and chromosomal abnormalities and were characterized by increased umbilical artery resistance and reduced middle cerebral artery resistance. Twenty-four of these fetuses were also studied at weekly intervals until the onset of antepartum late heart rate decelerations. Blood-flow velocity waveforms were obtained from the aortic and pulmonary valves, and the following variables were measured: peak systolic velocity, time to peak velocity, the product of time velocity integral multiplied by heart rate, left and right cardiac output, and the right/left ratios of the product of time velocity integrals multiplied by heart rate and cardiac output. When compared with previously established norms, both aortic and pulmonary peak systolic velocities and pulmonary time to peak velocity were reduced; aortic time to peak velocity increased. Left cardiac output and the product of the aortic time velocity integral multiplied by the heart rate increased and right cardiac output and the product of the pulmonary time velocity integral multiplied by the heart rate decreased, resulting in reduced right/left ratios. In the 24 fetuses studied longitudinally, time to peak velocities and the right/left flow ratios remained stable. However, aortic and pulmonary peak velocities and cardiac output declined significantly in contrast to an expected rise with advancing gestation. The fall in cardiac output and aortic and pulmonary peak velocities was directly related to umbilical artery pH at birth. This study provides evidence of a modified cardiac function that seems to deteriorate progressively with the advancing gestation of fetuses with intrauterine growth retardation. PMID:1951546

  7. Evaluation of Carbon Dioxide Dissipation within a Euthanasia Chamber

    PubMed Central

    Djoufack-Momo, Shelly M; Amparan, Ashlee A; Grunden, Beverly; Boivin, Gregory P

    2014-01-01

    CO2 euthanasia is used widely for small laboratory animals, such as rodents. A common necessity in many animal research facilities is to euthanize mice in sequential batches. We assessed the effects of several variables on the time it took for CO2 to dissipate within a chamber. Using standard euthanasia time, changes in flow rate were compared between a slow 15% fill rate for 7 min, and a slow 15% followed by a rapid 50% filling for a total of 5 min. Additional variables assessed included the effects of opening the lid after the completion of chamber filling, turning the chamber over after completion of filling, and the use and removal of a cage from within the chamber. For all trials, CO2 levels in the chambers peaked between 50% and 80%. After the gas was turned off, the concentration of CO2 dropped to below 10% CO2 within 2 min, except when the lid was left on the chamber, where concentration levels remained above 10% after 20 min. CO2 dissipation was significantly faster when the chamber was turned upside down after filling. Significant interaction effects occurred among the factors of cage presence within the chamber, flow rate, and chamber position. Only leaving the lid on the chamber had any practical implication for delaying CO2 dissipation. We recommend that users allow 2 min for CO2 to clear from the chamber before subsequent euthanasia procedures, unless the chamber is manipulated to increase the dissipation rate. PMID:25199098

  8. Cardiac arrest in kearns-sayre syndrome.

    PubMed

    van Beynum, Ingrid; Morava, Eva; Taher, Marjan; Rodenburg, Richard J; Karteszi, Judit; Toth, Kalman; Szabados, Eszter

    2012-01-01

    The prognosis of progressive ophthalmoplegia in patients with large-scale mitochondrial DNA deletions is highly variable and almost unpredictable. The risk to develop cardiac involvement and sudden cardiac death is strikingly high, especially in patients with Kearns-Sayre syndrome (KSS). The most typical cardiac complications of the disease are conduction defects, which usually begin with left anterior fascicular block with or without right bundle branch block (RBBB), progressing sometimes rapidly to complete atrioventricular block. Other cardiac manifestations reported are first or second degree of AV block, QT prolongation, torsades de pointes ventricular tachycardia, and rarely dilated cardiomyopathy. Most frequently syncope, sometimes even sudden cardiac death, is the first clinical sign of the cardiac disease in KSS. Due to these life-threatening cardiac conditions, patients should be carefully monitored for cardiac signs and symptoms and pacemaker implantation should be suggested early to avoid sudden cardiac arrest in KSS.Here, we present two cases of KSS with life-threatening syncope due to complete atrioventricular block. To emphasize the importance of an early pacemaker implantation, we review the literature on cardiac complications in KSS in the last 20 years. In almost all of the reviewed cases, ophthalmoplegia or ptosis was present before the cardiac manifestations. In most of the cases, syncope was the first symptom of the cardiac involvement. There was no correlation between the age of the onset of the disease and the onset of cardiac manifestations.With our current report, we increase awareness for life-threatening cardiac complications in patients with KSS. PMID:23430846

  9. Management of a Left Internal Thoracic Artery Graft Injury during Left Thoracotomy for Thoracic Surgery.

    PubMed

    Oates, Matthew; Yadav, Sumit; Saxena, Pankaj

    2016-07-01

    There have been some recent reports on the surgical treatment of lung cancer in patients following previous coronary artery bypass graft surgery. Use of internal thoracic artery graft is a gold standard in cardiac surgery with superior long-term patency. Left internal thoracic artery graft is usually patent during left lung resection in patients who present to the surgeon with an operable lung cancer. We have presented our institutional experience with left-sided thoracic surgery in patients who have had previous coronary artery surgery with a patent internal thoracic artery graft. PMID:26907619

  10. Cardiac Regeneration and Stem Cells.

    PubMed

    Zhang, Yiqiang; Mignone, John; MacLellan, W Robb

    2015-10-01

    After decades of believing the heart loses the ability to regenerate soon after birth, numerous studies are now reporting that the adult heart may indeed be capable of regeneration, although the magnitude of new cardiac myocyte formation varies greatly. While this debate has energized the field of cardiac regeneration and led to a dramatic increase in our understanding of cardiac growth and repair, it has left much confusion in the field as to the prospects of regenerating the heart. Studies applying modern techniques of genetic lineage tracing and carbon-14 dating have begun to establish limits on the amount of endogenous regeneration after cardiac injury, but the underlying cellular mechanisms of this regeneration remained unclear. These same studies have also revealed an astonishing capacity for cardiac repair early in life that is largely lost with adult differentiation and maturation. Regardless, this renewed focus on cardiac regeneration as a therapeutic goal holds great promise as a novel strategy to address the leading cause of death in the developed world. PMID:26269526

  11. Photocopy of drawing. ALTITUDE CHAMBER LIGHTING MODS., O&C BUILDING. NASA, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of drawing. ALTITUDE CHAMBER LIGHTING MODS., O&C BUILDING. NASA, John F. Kennedy Space Center, Florida. Drawing 203-644, U.S. Army Corps of Engineers, May, 1967. LIGHTING LAYOUT, LEFT CHAMBER. Sheet 5 - Cape Canaveral Air Force Station, Launch Complex 39, Altitude Chambers, First Street, between Avenue D and Avenue E, Cape Canaveral, Brevard County, FL

  12. Relationship of Exercise Capacity and Left Ventricular Dimensions in Patients with a Normal Ejection Fraction. An Exploratory Study

    PubMed Central

    Nyotowidjojo, Iwan; Chu, Guoxiang; LeWinter, Martin M.

    2015-01-01

    Objectives Extreme endurance exercise is known to be associated with an enlargement of the left ventricular (LV) chamber, whereas inactivity results in inverse changes. It is unknown if these dimensional relationships exist in patients. Methods We analyzed the relationship of exercise capacity and LV dimension in a cohort of sequential patients with a normal ejection fraction undergoing stress echocardiography. In a total of 137 studies the following questions were addressed: (a) is there a difference in LV dimensions of patients with an excellent exercise capacity versus patients with a poor exercise capacity, (b) how is LV dimension and exercise capacity affected by LV wall thickness and (c) how do LV dimensions of patients who are unable to walk on a treadmill compare to the above groups. Results Patients with a poor exercise capacity or who are unable to physically exercise have a 34 percent smaller LV cavity size when compared to patients with an excellent exercise capacity (p<0.001). This reduction in LV chamber size is associated with concentric LV hypertrophy and a reciprocal increase in resting heart rate. In addition, cardiac output reserve is further blunted by chronotropic incompetence and a tachycardia-induced LV volume reduction. In conclusion the relationship of exercise capacity and cardiac dimensions described in extreme athletes also applies to patients. Our exploratory analysis suggests that patients who cannot sufficiently exercise have small LV cavities. PMID:25756359

  13. Sildenafil ameliorates left ventricular T-tubule remodeling in a pressure overload-induced murine heart failure model

    PubMed Central

    Huang, Chun-kai; Chen, Bi-yi; Guo, Ang; Chen, Rong; Zhu, Yan-qi; Kutschke, William; Hong, Jiang; Song, Long-sheng

    2016-01-01

    Aim: Sildenafil, a phosphodiesterase 5 (PDE5) inhibitor, has been shown to exert beneficial effects in heart failure. The purpose of this study was to test whether sildenafil suppressed transverse-tubule (T-tubule) remodeling in left ventricular (LV) failure and thereby providing the therapeutic benefits. Methods: A pressure overload-induced murine heart failure model was established in mice by thoracic aortic banding (TAB). One day after TAB, the mice received sildenafil (100 mg·kg−1·d−1, sc) or saline for 5 weeks. At the end of treatment, echocardiography was used to examine LV function. Then the intact hearts were dissected out and placed in Langendorff-perfusion chamber for in situ confocal imaging of T-tubule ultrastructure from epicardial myocytes. Results: TAB surgery resulted in heart failure accompanied by remarkable T-tubule remodeling. Sildenafil treatment significantly attenuated TAB-induced cardiac hypertrophy and congestive heart failure, improved LV contractile function, and preserved T-tubule integrity in LV cardiomyocytes. But sildenafil treatment did not significantly affect the chamber dilation. The integrity of LV T-tubule structure was correlated with cardiac hypertrophy (R2=0.74, P<0.01) and global LV function (R2=0.47, P<0.01). Conclusion: Sildenafil effectively ameliorates LV T-tubule remodeling in TAB mice, revealing a novel mechanism underlying the therapeutic benefits of sildenafil in heart failure. PMID:26972492

  14. Coronary haemodynamics in left ventricular hypertrophy.

    PubMed Central

    Wallbridge, D. R.; Cobbe, S. M.

    1996-01-01

    BACKGROUND: Left ventricular hypertrophy is associated with an increased risk of cardiovascular morbidity and mortality. Previous studies have shown that patients with left ventricular hypertrophy develop electrocardiographic changes and left ventricular dysfunction during acute hypotension, and suggest that the lower end of autoregulation may be shifted upwards. AIM: To measure coronary blood flow (velocity) and flow reserve during acute hypotension in patients with left ventricular hypertrophy. PATIENTS: Eight patients with atypical chest pain and seven with hypertensive left ventricular hypertrophy; all with angiographically normal epicardial vessels. SETTING: Tertiary referral centre. METHODS: The physiological range of blood pressure was determined by previous ambulatory monitoring. Left ventricular mass was determined by echocardiography. At cardiac catheterisation, left coronary blood flow velocity was measured using a Judkins style Doppler tipped catheter. During acute hypotension with sodium nitroprusside, coronary blood flow velocity was recorded at rest and during maximal hyperaemia induced by intracoronary injection of adenosine. Quantitative coronary angiography was performed manually. RESULTS: For both groups coronary blood flow velocity remained relatively constant over a range of physiological diastolic blood pressures and showed a steep relation with diastolic blood pressure during maximal hyperaemia with intracoronary adenosine. Absolute coronary blood flow (calculated from quantitative angiographic data), standardised for left ventricular mass, showed reduced flow in the hypertensive group at rest and during maximal vasodilatation. CONCLUSION: The results are consistent with an inadequate blood supply to the hypertrophied heart, but no upward shift of the lower end of the autoregulatory range was observed. PMID:8705764

  15. Differentiation of cardiac thrombus from cardiac tumor combining cardiac MRI and 18F-FDG-PET/CT Imaging.

    PubMed

    Rinuncini, Massimo; Zuin, Marco; Scaranello, Fiorenzo; Fejzo, Majlinda; Rampin, Lucia; Rubello, Domenico; Faggian, Giuseppe; Roncon, Loris

    2016-06-01

    Radiological differentiation of an unknown cardiac masse is often a challenging issue. 18F-FDG-PET/CT imaging was performed to evaluate a left ventricle mass visualized on transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) in a patient with an history of ischemic heart disease. The metabolically inert area on the PET/CT, corresponding to the relatively homogenous hypodensity in the LV, was thought to represent an old organized LV thrombus. Histopathological examination confirmed the imaging diagnosis. PMID:27038712

  16. 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

  17. Long-term trajectory of two unique cardiac biomarkers and subsequent left ventricular structural pathology and risk of incident heart failure in community dwelling older adults at low baseline risk

    PubMed Central

    Glick, Danielle; de Filippi, Christopher R.; Christenson, Robert; Gottdiener, John S.; Seliger, Stephen L.

    2013-01-01

    Background Initial low levels of hs cTnT and NT-proBNP identify older adults at lower risk for CV events. Objective To determine whether the combined trajectories of cardiac biomarkers identify those older adults with initial low levels who have an increased risk for structural heart disease, incident HF, and CV death. Methods Observational study among older adults without prevalent HF in the Cardiovascular Health Study. NT-proBNP and hs cTnT were measured at baseline and after 2-3 years. In those with low baseline levels, significant increase was defined as: cTnT >50%; NT-proBNP >25% increase to >190 pg/mL. LVEF and LV mass were measured by echocardiography at baseline and 5 years. Cox regression was used to estimate the association of change in biomarkers with HF and CV mortality. Results Among 2,008 participants with initially low biomarker concentrations, significant increases occurred in 14.8% for cTnT only, 13.2% for NT-proBNP only and 6.1% for both. After 10 years, cumulative HF incidence was 50.4% vs. 12.2% among those with both vs. neither biomarkers increased. The adjusted relative risk comparing those with increases in both vs. neither biomarkers was 3.56 for incident HF (95% confidence interval [CI]: 2.56-4.97) and 2.98 for CV mortality (95% CI: 2.98-4.26). Among 1340 participants with serial echocardiography, the frequency of new abnormal LVEF was 11.8% vs. 4.0% for those with increases in both vs. neither biomarkers (p=0.007). Conclusions Among older adults without HF with initially low cTnT and NT-proBNP, the long-term trajectory of both biomarkers predicts systolic dysfunction, incident HF, and CV death. PMID:24621939

  18. Static diffusion cloud chambers

    NASA Technical Reports Server (NTRS)

    Ayers, G.

    1981-01-01

    The chamber geometry and optical arrangement are described. The supersaturation range is given and consists of readings taken at five fixed points: 0.25%, 0.5%, 0.75%, 1.0%, and 1.25%. The detection system is described including light source, cameras, and photocell detectors. The temperature control and the calibration of the chamber are discussed.

  19. The Mobile Chamber

    NASA Technical Reports Server (NTRS)

    Scharfstein, Gregory; Cox, Russell

    2012-01-01

    A document discusses a simulation chamber that represents a shift from the thermal-vacuum chamber stereotype. This innovation, currently in development, combines the capabilities of space simulation chambers, the user-friendliness of modern-day electronics, and the modularity of plug-and-play computing. The Mobile Chamber is a customized test chamber that can be deployed with great ease, and is capable of bringing payloads at temperatures down to 20 K, in high vacuum, and with the desired metrology instruments integrated to the systems control. Flexure plans to lease Mobile Chambers, making them affordable for smaller budgets and available to a larger customer base. A key feature of this design will be an Apple iPad-like user interface that allows someone with minimal training to control the environment inside the chamber, and to simulate the required extreme environments. The feedback of thermal, pressure, and other measurements is delivered in a 3D CAD model of the chamber's payload and support hardware. This GUI will provide the user with a better understanding of the payload than any existing thermal-vacuum system.

  20. High resolution drift chambers

    SciTech Connect

    Va'vra, J.

    1985-07-01

    High precision drift chambers capable of achieving less than or equal to 50 ..mu..m resolutions are discussed. In particular, we compare so called cool and hot gases, various charge collection geometries, several timing techniques and we also discuss some systematic problems. We also present what we would consider an ''ultimate'' design of the vertex chamber. 50 refs., 36 figs., 6 tabs.

  1. [Cardiac amyloidosis].

    PubMed

    Hoyer, Caroline; Angermann, Christiane E; Knop, Stefan; Ertl, Georg; Störk, Stefan

    2008-03-15

    Amyloidoses are a heterogeneous group of multisystem disorders, which are characterized by an extracellular deposition of amyloid fibrils. Typically affected are the heart, liver, kidneys, and nervous system. More than half of the patients die due to cardiac involvement. Clinical signs of cardiac amyloidosis are edema of the lower limbs, hepatomegaly, ascites and elevated jugular vein pressure, frequently in combination with dyspnea. There can also be chest pain, probably due to microvessel disease. Dysfunction of the autonomous nervous system or arrhythmias may cause low blood pressure, dizziness, or recurrent syncope. The AL amyloidosis caused by the deposition of immunoglobulin light chains is the most common form. It can be performed by monoclonal gammopathy. The desirable treatment therapy consists of high-dose melphalan therapy twice followed by autologous stem cell transplantation. Due to the high peritransplantation mortality, selection of appropriate patients is mandatory. The ATTR amyloidosis is an autosomal dominant disorder caused by the amyloidogenic form of transthyretin, a plasmaprotein that is synthesized in the liver. Therefore, liver transplantation is the only curative therapy. The symptomatic treatment of cardiac amyloidosis is based on the current guidelines for chronic heart failure according to the patient's New York Heart Association (NYHA) state. Further types of amyloidosis with possible cardiac involvement comprise the senile systemic amyloidosis caused by the wild-type transthyretin, secondary amyloidosis after chronic systemic inflammation, and the beta(2)-microglobulin amyloidosis after long-term dialysis treatment. PMID:18344065

  2. Myocardial Dysfunction and Shock after Cardiac Arrest

    PubMed Central

    Jentzer, Jacob C.; Chonde, Meshe D.; Dezfulian, Cameron

    2015-01-01

    Postarrest myocardial dysfunction includes the development of low cardiac output or ventricular systolic or diastolic dysfunction after cardiac arrest. Impaired left ventricular systolic function is reported in nearly two-thirds of patients resuscitated after cardiac arrest. Hypotension and shock requiring vasopressor support are similarly common after cardiac arrest. Whereas shock requiring vasopressor support is consistently associated with an adverse outcome after cardiac arrest, the association between myocardial dysfunction and outcomes is less clear. Myocardial dysfunction and shock after cardiac arrest develop as the result of preexisting cardiac pathology with multiple superimposed insults from resuscitation. The pathophysiology involves cardiovascular ischemia/reperfusion injury and cardiovascular toxicity from excessive levels of inflammatory cytokine activation and catecholamines, among other contributing factors. Similar mechanisms occur in myocardial dysfunction after cardiopulmonary bypass, in sepsis, and in stress-induced cardiomyopathy. Hemodynamic stabilization after resuscitation from cardiac arrest involves restoration of preload, vasopressors to support arterial pressure, and inotropic support if needed to reverse the effects of myocardial dysfunction and improve systemic perfusion. Further research is needed to define the role of postarrest myocardial dysfunction on cardiac arrest outcomes and identify therapeutic strategies. PMID:26421284

  3. [Rhythm disorders and cardiac crypto-malformations].

    PubMed

    Davy, J M; Raczka, F; Cung, T T; Combes, N; Bortone, A; Gaty, D

    2005-12-01

    Faced with a cardiac arrhythmia occuring in an apparently healthy heart, it is necessary to perform an anatomical investigation to detect any unsuspected anomalies. Congenital cardiopathy must certainly be excluded, as this is often responsible for rhythm disorders and/or cardiac conduction defects. Similarly, any acquired conditions, cardiomyopathy, or cardiac tumour must be sought. However, the possibility should always be considered of a minimal congenital malformation, which could be repsonsible for: any type of cardiac arrhythmia: rhythm disorder or conduction defect at the atrial, junctional or ventricular level, with a benign or serious prognosis. Unexpected therapeutic difficulties during radiofrequency ablation procedures or at implantation of pacemakers or defibrillators. Together with rhythm studies, the investigation of choice is high quality imaging, either the classic left or right angiography or the more modern cardiac CT or intracardiac mapping. PMID:16433240

  4. MicroRNA Induced Cardiac Reprogramming In Vivo: Evidence for Mature Cardiac Myocytes and Improved Cardiac Function

    PubMed Central

    Jayawardena, Tilanthi M.; Finch, Elizabeth A.; Zhang, Lunan; Zhang, Hengtao; Hodgkinson, Conrad P.; Pratt, Richard E.; Rosenberg, Paul B.; Mirotsou, Maria; Dzau, Victor J.

    2014-01-01

    Rationale A major goal for the treatment of heart tissue damaged by cardiac injury is to develop strategies for restoring healthy heart muscle through the regeneration and repair of damaged myocardium. We recently demonstrated that administration of a specific combination of micro-RNAs (miR combo) into the infarcted myocardium leads to direct in vivo reprogramming of non-cardiac myocytes to cardiac myocytes. However, the biologic and functional consequences of such reprogramming are not yet known. Objective The aim of this study was to determine whether non-cardiac myocytes directly reprogrammed using miRNAs in vivo develop into mature functional cardiac myocytes in situ, and whether reprogramming leads to improvement of cardiac function. Methods and Results We subjected FSP1-Cre mice/tdTomato mice to cardiac injury by permanent ligation of the left anterior descending coronary artery (LAD) and injected lentiviruses encoding miR combo or a control nontargeting miRNA. miR combo significantly increased the number of reprogramming events in vivo. Five-to-six weeks following injury, morphological and physiological properties of tdTomato− and tdTomato+ cardiac myocyte-like cells were analyzed ex vivo. tdTomato+ cells expressed cardiac myocyte markers, sarcomeric organization, excitation-contraction coupling, and action potentials characteristic of mature ventricular cardiac myocytes (tdTomato− cells). Reprogramming was associated with improvement of cardiac function, as analyzed by serial echocardiography. There was a time delayed and progressive improvement in fractional shortening and other measures of ventricular function, indicating that miR combo promotes functional recovery of damaged myocardium. Conclusions The findings from this study further validate the potential utility of miRNA-mediated reprogramming as a therapeutic approach to promote cardiac regeneration following myocardial injury. PMID:25351576

  5. Proven cardiac changes during death-feigning (tonic immobility) in rabbits (Oryctolagus cuniculus).

    PubMed

    Giannico, Amália Turner; Lima, Leandro; Lange, Rogério Ribas; Froes, Tilde Rodrigues; Montiani-Ferreira, Fabiano

    2014-04-01

    Tonic immobility (TI) is a response to fear or threat by remaining motionless, principally when attacked by predators from which there is no possibility of escape. Thus, here we demonstrate a way of easily reproducing this phenomenon in a laboratory setting and characterize the cardiac electromechanical alterations during TI. We observed a significant decrease in heart rate (HR) and changes of rhythm in electrocardiogram during TI in rabbits. Echocardiogram showed a significant increase in the left ventricle chamber diameter during systole and a consequent decrease in fractional shortening and ejection fraction, in addition to the HR and rhythm changes. There was also a significant decrease in aortic and pulmonary artery blood flow. Diastolic functional changes included a significant decrease of the peak atrial contraction velocity (A peak) and consequent increase in the ratio of peak early diastolic velocity to A peak and increased isovolumetric relaxation time. We were able to prove that TI changes the cardiac function considerably. Although the "fight-or-flight" response is the most common response to fear, which is characterized by the action of sympathetic nervous system with tachycardia and increased physical activity, TI is an alternative anti-predator behavior causing cardiac changes opposite to the "fight-or-flight" phenomenon. PMID:24515628

  6. 45. AUXILIARY CHAMBER BETWEEN CHAMBER AND CONCRETE ENCLOSURE (LOCATION DDD), ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    45. AUXILIARY CHAMBER BETWEEN CHAMBER AND CONCRETE ENCLOSURE (LOCATION DDD), VIEW LOOKING EAST. LEAD ENCLOSED PIPING IS DRAIN FROM BOILER CHAMBER No. 1 - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  7. Cardiac resynchronisation therapy after percutaneous mitral annuloplasty

    PubMed Central

    Swampillai, Janice

    2016-01-01

    Percutaneous approaches to reduce mitral regurgitation in ischemic cardiomyopathy have stirred interest recently. Patients with ischemic cardiomyopathy and functional mitral regurgitation often meet criteria for cardiac resynchronisation therapy to improve left ventricular function as well as mitral regurgitation, and alleviate symptoms. This case shows that implantation of a pacing lead in the coronary sinus to restore synchronous left and right ventricular contraction is feasible, despite the presence of a remodeling device in the coronary sinus. PMID:27182527

  8. A new approach to assessment of the left ventricle

    PubMed Central

    Poppe, Katrina K.; Doughty, Rob N.; Whalley, Gillian A.; Triggs, Christopher M.

    2016-01-01

    Cardiac motion is a continuous process; however most measurements to assess cardiac function are taken at brief moments in the cardiac cycle. Using functional data analysis, repeated measurements of left ventricular volume recorded at each frame of a continuous image measured with cardiac ultrasound (echocardiography) were turned into a function of volume over time. The first derivative of the displacement of volume with respect to time is velocity; the second derivative is acceleration. Plotting volume, velocity, and acceleration against each other in a 3-dimensional plot results in a closed loop. The area within the loop is defined by the kinematics of volume change and so may represent ventricular function. • We have developed an approach to analyzing images of the left ventricle that incorporates information from throughout the cardiac cycle. • Comparing systolic and diastolic areas within a loop defined by volume, velocity, and acceleration of left ventricular volume highlights imbalances in the kinematics of the two phases, potentially indicating early sub-clinical disease. • Substantially more information about left ventricular function may be derived from a non-invasive clinically available tool such as echocardiography. PMID:27104150

  9. The cost-utility of left ventricular assist devices for end-stage heart failure patients ineligible for cardiac transplantation: a systematic review and critical appraisal of economic evaluations

    PubMed Central

    Van den Bruel, Ann; Smit, Yolba; De Jonge, Nicolaas; Vlayen, Joan

    2014-01-01

    Background A health technology assessment (HTA) of left ventricular assist devices (LVADs) as destination therapy in patients with end-stage heart failure was commissioned by the Dutch Health Care Insurance Board [College voor Zorgverzekeringen (CVZ)]. In this context, a systematic review of the economic literature was performed to assess the procedure’s value for money. Methods A systematic search (updated in December 2013) for economic evaluations was performed by consulting various databases: the HTA database produced by the Centre for Reviews and Dissemination (CRD HTA), websites of HTA institutes, CRD’s National Health Service Economic Evaluation Database (NHS EED), Medline (OVID) and EMBASE. No time or language restrictions were imposed and pre-defined selection criteria were used. The two-step selection procedure was performed by two people. References of the selected studies were checked for additional relevant citations. Results Six relevant studies were selected. Four economic evaluations relied on the results of the REMATCH trial to compare a pulsatile-flow LVAD with optimal medical therapy (OMT). These evaluations were performed before the publication of the HeartMate II (HM-II) Destination Therapy Trial which compared a pulsatile-flow with a continuous-flow LVAD. Two more recent economic evaluations combined the results of both trials to make an indirect comparison of a continuous-flow LVAD with OMT. In all studies, the largest part of the incremental cost was due to the reimplantation cost of an LVAD, with a device cost of €58,000-€75,000 and about €55,000 for the surgical procedure. The survival gain was highest with a continuous-flow LVAD, up to about three life-years gained (LYG) versus OMT in the most optimistic study. Quality of life (QoL) was improved but measures with a generic utility instrument were lacking, making estimates on quality-adjusted life-years (QALYs) gained more uncertain. Incremental cost-effectiveness ratios of the two most recent studies were on average €107,600 and $198,184 (ca.€145,800) per QALY gained. Conclusions Although LVAD destination therapy improves survival and QoL, it remains questionable as to whether it offers value for money. This conclusion may alter if the price of the device/procedure decreases sufficiently, in combination with further improved outcomes for mortality, adverse events and QoL. PMID:25452904

  10. 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

  11. 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

  12. Large hemangioma in a persistent left superior vena cava.

    PubMed

    Hu, Wen; Wang, Xiang; Tan, Sichuang; Fan, Songqing; Liu, Jun; Yu, Fenglei; Tang, Jingqun

    2012-12-01

    Cardiac hemangiomas represent 1 to 2% of all detected benign heart tumors. Tumors in the coronary sinus have been reported; however, to our knowledge, there have been no reports of masses in a persistent left superior vena cava. We report here the first case of a 58-year-old man with a rare huge unicamerate cardiac hemangiomas in a persistent left superior vena cava. A communication vein between the coronary sinus and hemangiomas could be identified, and thrombus formation was found in the hemangiomas as well. PMID:23180384

  13. Ion Chamber Compensation Tests

    SciTech Connect

    Mallard, R.L. Jr.

    2003-02-14

    The purpose of this report is to present the results of a series of tests performed to determine the need for gamma compensation of the ion chambers used to monitor the neutron flux in the 100 Area reactors.

  14. Respiratory acoustic impedance in left ventricular failure.

    PubMed

    Depeursinge, F B; Feihl, F; Depeursinge, C; Perret, C H

    1989-12-01

    The measurement of respiratory acoustic impedance (Zrs) by forced pseudorandom noise provides a simple means of assessing respiratory mechanics in nonintubated intensive care patients. To characterize the lung mechanical alterations induced by acute vascular congestion of the lung, Zrs was measured in 14 spontaneously breathing patients hospitalized for acute left ventricular failure. The Zrs data in the cardiac patients were compared with those of 48 semirecumbent normal subjects and those of 23 sitting asthmatic patients during allergen-induced bronchospasm. In the patients with acute left ventricular failure, the Zrs abnormalities noted were an excessive frequency dependence of resistance from 10 to 20 Hz and an abnormally low reactance at all frequencies, abnormalities qualitatively similar to those observed in the asthmatic patients but of lesser magnitude. Acute lung vascular congestion modifies the acoustic impedance of the respiratory system. Reflex-induced bronchospasm might be the main mechanism altering respiratory acoustic impedance in acute left ventricular failure. PMID:2582846

  15. Sleeve reaction chamber system

    DOEpatents

    Northrup, M. Allen; Beeman, Barton V.; Benett, William J.; Hadley, Dean R.; Landre, Phoebe; Lehew, Stacy L.; Krulevitch, Peter A.

    2009-08-25

    A chemical reaction chamber system that combines devices such as doped polysilicon for heating, bulk silicon for convective cooling, and thermoelectric (TE) coolers to augment the heating and cooling rates of the reaction chamber or chambers. In addition the system includes non-silicon-based reaction chambers such as any high thermal conductivity material used in combination with a thermoelectric cooling mechanism (i.e., Peltier device). The heat contained in the thermally conductive part of the system can be used/reused to heat the device, thereby conserving energy and expediting the heating/cooling rates. The system combines a micromachined silicon reaction chamber, for example, with an additional module/device for augmented heating/cooling using the Peltier effect. This additional module is particularly useful in extreme environments (very hot or extremely cold) where augmented heating/cooling would be useful to speed up the thermal cycling rates. The chemical reaction chamber system has various applications for synthesis or processing of organic, inorganic, or biochemical reactions, including the polymerase chain reaction (PCR) and/or other DNA reactions, such as the ligase chain reaction.

  16. Mitral stenosis with high left ventricular diastolic pressure.

    PubMed Central

    Traill, T A; St John Sutton, M G; Gibson, D G

    1979-01-01

    Three patients with mitral stenosis are described, in whom the haemodynamic findings at cardiac catheterisation were more suggestive of left ventricular myocardial disease, in that the left ventricular diastolic pressure was high and the mitral valve gradient small. However, their echocardiograms showed abnormal wall movement during diastole characteristic of severe inflow obstruction, with slow and protracted filling, and at operation mitral stenosis was confirmed. Left ventricular wall stress was estimated throughout the cardiac cycle in one patient, and the diastolic stress-strain relation shown to be abnormal. The effects of mitral stenosis on left ventricular function are complex, and are not explicable simply by reduction in size of the mitral orifice. Images PMID:465208

  17. Isolated congenital left ventricular diverticulum in an elderly patient that was identified because of an incidental finding during a complete medical checkup.

    PubMed

    Sakabe, Koichi; Fukuda, Nobuo; Fukuda, Yamato; Wakayama, Katsunori; Nada, Teru; Morishita, Satofumi; Shinohara, Hisanori; Tamura, Yoshiyuki

    2008-04-10

    Congenital left ventricular diverticulum is a rare cardiac malformation in an elderly patient. It frequently is associated with other cardiac or non-cardiac congenital malformations. We present an asymptomatic elderly patient, evaluated because of an incidental finding of a left ventricular anatomic change on chest computed tomography during a complete medical checkup. The diagnosis of isolated congenital left ventricular diverticulum was confirmed by echocardiography and cardiac catheterization. With the general use of a complete medical checkup, the incidental findings of patients with isolated congenital left ventricular diverticulum might increase, which might allow for a valid estimation of the morbidity and mortality of these patients. PMID:17707090

  18. Determinants of kinetic energy of blood flow in the four-chambered heart in athletes and sedentary controls.

    PubMed

    Steding-Ehrenborg, K; Arvidsson, P M; Töger, J; Rydberg, M; Heiberg, E; Carlsson, M; Arheden, H

    2016-01-01

    The kinetic energy (KE) of intracardiac blood may play an important role in cardiac function. The aims of the present study were to 1) quantify and investigate the determinants of KE, 2) compare the KE expenditure of intracardiac blood between athletes and control subjects, and 3) quantify the amount of KE inside and outside the diastolic vortex. Fourteen athletes and fourteen volunteers underwent cardiac MRI, including four-dimensional phase-contrast sequences. KE was quantified in four chambers, and energy expenditure was calculated by determining the mean KE/cardiac index. Left ventricular (LV) mass was an independent predictor of diastolic LVKE (R(2) = 0.66, P < 0.001), whereas right ventricular (RV) end-diastolic volume was important for diastolic RVKE (R(2) = 0.76, P < 0.001). The mean KE/cardiac index did not differ between groups (control subjects: 0.53 ± 0.14 mJ·l(-1)·min·m(2) and athletes: 0.56 ± 0.21 mJ·l(-1)·min·m(2), P = 0.98). Mean LV diastolic vortex KE made up 70 ± 1% and 73 ± 2% of total LV diastolic KE in athletes and control subjects (P = 0.18). In conclusion, the characteristics of the LV as a pressure pump and the RV as a volume pump are demonstrated as an association between LVKE and LV mass and between RVKE and end-diastolic volume. This also suggests different filling mechanisms where the LV is dependent on diastolic suction, whereas the RV fills with a basal movement of the atrioventricular plane over "stationary" blood. Both groups had similar energy expenditure for intracardiac blood flow, indicating similar pumping efficiency, likely explained by the lower heart rate that cancels the higher KE per heart beat in athletes. The majority of LVKE is found within the LV diastolic vortex, in contrast to earlier findings. PMID:26497965

  19. Increase in cardiac myosin heavy-chain (MyHC) alpha protein isoform in hibernating ground squirrels, with echocardiographic visualization of ventricular wall hypertrophy and prolonged contraction

    PubMed Central

    Nelson, O. Lynne; Rourke, Bryan C.

    2013-01-01

    SUMMARY Deep hibernators such as golden-mantled ground squirrels (Callospermophilus lateralis) have multiple challenges to cardiac function during low temperature torpor and subsequent arousals. As heart rates fall from over 300 beats min−1 to less than 10, chamber dilation and reduced cardiac output could lead to congestive myopathy. We performed echocardiography on a cohort of individuals prior to and after several months of hibernation. The left ventricular chamber exhibited eccentric and concentric hypertrophy during hibernation and thus calculated ventricular mass was ~30% greater. Ventricular ejection fraction was mildly reduced during hibernation but stroke volumes were greater due to the eccentric hypertrophy and dramatically increased diastolic filling volumes. Globally, the systolic phase in hibernation was ~9.5 times longer, and the diastolic phase was 28× longer. Left atrial ejection generally was not observed during hibernation. Atrial ejection returned weakly during early arousal. Strain echocardiography assessed the velocity and total movement distance of contraction and relaxation for regional ventricular segments in active and early arousal states. Myocardial systolic strain during early arousal was significantly greater than the active state, indicating greater total contractile movement. This mirrored the increased ventricular ejection fraction noted with early arousal. However, strain rates were slower during early arousal than during the active period, particularly systolic strain, which was 33% of active, compared with the rate of diastolic strain, which was 67% of active. As heart rate rose during the arousal period, myocardial velocities and strain rates also increased; this was matched closely by cardiac output. Curiously, though heart rates were only 26% of active heart rates during early arousal, the cardiac output was nearly 40% of the active state, suggesting an efficient pumping system. We further analyzed proportions of cardiac myosin heavy-chain (MyHC) isoforms in a separate cohort of squirrels over 5 months, including time points before hibernation, during hibernation and just prior to emergence. Hibernating individuals were maintained in both a 4°C cold room and a 20°C warm room. Measured by SDS-PAGE, relative percentages of cardiac MyHC alpha were increased during hibernation, at both hibernacula temperatures. A potential increase in contractile speed, and power, from more abundant MyHC alpha may aid force generation at low temperature and at low heart rates. Unlike many models of cardiomyopathies where the alpha isoform is replaced by the beta isoform in order to reduce oxygen consumption, ground squirrels demonstrate a potential cardioprotective mechanism to maintain cardiac output during torpor. PMID:24072796

  20. Effect of rate-dependent left bundle branch block on global and regional left ventricular function

    SciTech Connect

    Bramlet, D.A.; Morris, K.G.; Coleman, R.E.; Albert, D.; Cobb, F.R.

    1983-05-01

    Seven subjects with rate-dependent left bundle branch block (RDLBBB) and 13 subjects with normal conduction (control group) underwent upright bicycle exercise radionuclide angiography to determine the effects of the development of RDLBBB on global and regional left ventricular function. Six of the seven subjects with RDLBBB had atypical chest pain syndromes; none had evidence of cardiac disease based on clinical examination and either normal cardiac catheterization or exercise thallium-201 scintigraphy. Radionuclide angiograms were recorded at rest and immediately before and after RDLBBB in the test group, and at rest and during intermediate and maximal exercise in the control group. The development of RDLBBB was associated with an abrupt decrease in left ventricular ejection fraction (LVEF) in six of seven patients (mean decrease 6 +/- 5%) and no overall increase in LVEF between rest and maximal exercise (65 +/- 9% and 65 +/- 12%, respectively). In contrast, LVEF in the control group was 62 +/- 8% at rest and increased to 72 +/- 8% at intermediate and 78 +/- 7% at maximal exercise. The onset of RDLBBB was associated with the development of asynchronous left ventricular contraction in each patient and hypokinesis in four of seven patients. All patients in the control group had normal wall motion at rest and exercise. These data indicate that the development of RDLBBB is associated with changes in global and regional ventricular function that may be confused with development of left ventricular ischemia during exercise.

  1. Cardiac hypertrophy: useful adaptation or pathologic process?

    PubMed

    Grossman, W

    1980-10-01

    An extensive body of evidence supports the concept that cardiac hypertrophy and normal cardiac growth develop in response to increased hemodynamic loading and abnormal systolic and diastolic stresses at the myocardial fiber level. The pattern of hypertrophy reflects the nature of the inciting stress. Experimental studies indicate that if the stress is moderate, gradually applied, and the animal young and healthy, physiologic hypertrophy of muscle with normal contractility develops. In this circumstance, cardiac hypertrophy may be regarded as a useful adaptation to increased hemodynamic loading. When the inciting stress is severe, abruptly applied, or the animal old or debilitated, pathologic hypertrophy develops: in this circumstance, the cardiac muscle produced is abnormal and exhibits depressed contractility. Of particular clinical relevance is the intermediate situation which seems to develop in many patients with chronic left ventricular pressure-overload and perhaps also in left ventricular volume-overload. In this situation, chronic left ventricular pressure or volume overload is initially matched by adequate hypertrophy in the appropriate pattern. Eventually, in some patients, hypertrophy fails to keep pace with the hemodynamic overload so that a systolic stress imbalance occurs at the myocardial fiber level and left ventricular pump failure ensues. If this situation persists uncorrected, it is possible that the increasingly high wall stresses will convert physiologic to pathologic hypertrophy. The task of the clinician is to identify this intermediate stage and to correct the abnormal hemodynamic loading before the transition to pathologic hypertrophy becomes complete. PMID:6448546

  2. Automatic slice-alignment method in cardiac magnetic resonance imaging for evaluation of the right ventricle in patients with pulmonary hypertension

    NASA Astrophysics Data System (ADS)

    Yokoyama, Kenichi; Nitta, Shuhei; Kuhara, Shigehide; Ishimura, Rieko; Kariyasu, Toshiya; Imai, Masamichi; Nitatori, Toshiaki; Takeguchi, Tomoyuki; Shiodera, Taichiro

    2015-09-01

    We propose a new automatic slice-alignment method, which enables right ventricular scan planning in addition to the left ventricular scan planning developed in our previous work, to simplify right ventricular cardiac scan planning and assess its accuracy and the clinical acceptability of the acquired imaging planes in the evaluation of patients with pulmonary hypertension. Steady-state free precession (SSFP) sequences covering the whole heart in the end-diastolic phase with ECG gating were used to acquire 2D axial multislice images. To realize right ventricular scan planning, two morphological feature points are added to be detected and a total of eight morphological features of the heart were extracted from these series of images, and six left ventricular planes and four right ventricular planes were calculated simultaneously based on the extracted features. The subjects were 33 patients (25 with chronic thromboembolic pulmonary hypertension and 8 with idiopathic pulmonary arterial hypertension). The four right ventricular reference planes including right ventricular short-axis, 4-chamber, 2-chamber, and 3-chamber images were evaluated. The acceptability of the acquired imaging planes was visually evaluated using a 4-point scale, and the angular differences between the results obtained by this method and by conventional manual annotation were measured for each view. The average visual scores were 3.9±0.4 for short-axis images, 3.8±0.4 for 4-chamber images, 3.8±0.4 for 2-chamber images, and 3.5±0.6 for 3-chamber images. The average angular differences were 8.7±5.3, 8.3±4.9, 8.1±4.8, and 7.9±5.3 degrees, respectively. The processing time was less than 2.5 seconds in all subjects. The proposed method, which enables right ventricular scan planning in addition to the left ventricular scan planning developed in our previous work, can provide clinically acceptable planes in a short time and is useful because special proficiency in performing cardiac MR for patients with right ventricles of various sizes and shapes is not required.

  3. Using the Nova target chamber for high-yield targets

    SciTech Connect

    Pitts, J.H.

    1987-09-28

    The existing 2.2-m-radius Nova aluminum target chamber, coated and lined with boron-seeded carbon shields, is proposed for use with 1000-MJ-yield targets in the next laser facility. The laser beam and diagnostic holes in the target chamber are left open and the desired 10/sup -2/ Torr vacuum is maintained both inside and outside the target chamber; a larger target chamber room is the vacuum barrier to the atmosphere. The hole area available is three times that necessary to maintain a maximum fluence below 12 J/cm/sup 2/ on optics placed at a radius of 10 m. Maximum stress in the target chamber wall is 73 MPa, which complies with the intent of the ASME Pressure Vessel Code. However, shock waves passing through the inner carbon shield could cause it to comminute. We propose tests and analyses to ensure that the inner carbon shield survives the environment. 13 refs.

  4. Left ventricular mechanics in Behcet’s disease: A speckle tracking echocardiographic study

    PubMed Central

    Demirelli, Selami; Degirmenci, Hüsnü; Bilen, Handan; Ermis, Emrah; Duman, Hakan; Arisoy, Arif; Bakirci, Eftal Murat; Ipek, Emrah; Askin, Lutfu

    2014-01-01

    Although cardiac involvement is rarely seen in Behcet’s disease (BD), it is essential to detect subclinical left ventricular (LV) dysfunction for prognostic purposes. Herein we aimed to show the role of two dimensional (2D) speckle tracking echocardiography (STE) in determination of subclinical LV dysfunction in patients with BD. 30 patients diagnosed as BD due to International Study Group Behcet’s diagnostic criteria and 25 control subjects underwent Doppler echocardiography including pulsed tissue Doppler of the mitral annulus and speckle-tracking echocardiography. LV peak longitudinal strain and strain rate (SR) was calculated in four-chamber (4C), apical long-axis (LAX), and two-chamber (2C) views, and values of the three views were averaged LV global longitudinal strain (LV-GLS) and SR. LV torsion was determined as the net difference in the mean rotation between the apical and basal levels. There was not any significant difference in age and gender between groups. Patients with BD had significantly lower LV longitudinal strain and Sr measurements than the control group. Although LV basal rotation (LVR) basal values were similar in both groups, LVR-apical and LV torsion (LVTR) values were significantly higher in patient group. LVR-apical and LV-GLS were found to have a good positive corelation (r: 0.44, p<0.001) (r: -0.56, r: -0.65, respectively. p<0.001). There was a weak positive correlation between LVTR and LV-GLS (r: 0.29, p<0.05). We demonstrated that combined assessment of LV-GLS, LV-GLSR, LVTR and LVR-apical values detected by STE can be useful in determination of subclinical left ventricular dysfunction in BD. PMID:25172976

  5. Cardiac torsion and electromagnetic fields: the cardiac bioinformation hypothesis.

    PubMed

    Burleson, Katharine O; Schwartz, Gary E

    2005-01-01

    Although in physiology the heart is often referred to as a simple piston pump, there are in fact two additional features that are integral to cardiac physiology and function. First, the heart as it contracts in systole, also rotates and produces torsion due to the structure of the myocardium. Second, the heart produces a significant electromagnetic field with each contraction due to the coordinated depolarization of myocytes producing a current flow. Unlike the electrocardiogram, the magnetic field is not limited to volume conduction and extends outside the body. The therapeutic potential for interaction of this cardioelectromagnetic field both within and outside the body is largely unexplored. It is our hypothesis that the heart functions as a generator of bioinformation that is central to normative functioning of body. The source of this bioinformation is based on: (1) vortex blood flow in the left ventricle; (2) a cardiac electromagnetic field and both; (3) heart sounds; and (4) pulse pressure which produce frequency and amplitude information. Thus, there is a multidimensional role for the heart in physiology and biopsychosocial dynamics. Recognition of these cardiac properties may result in significant implications for new therapies for cardiovascular disease based on increasing cardiac energy efficiency (coherence) and bioinformation from the cardioelectromagnetic field. Research studies to test this hypothesis are suggested. PMID:15823696

  6. Structural basis for pathologic left ventricular hypertrophy.

    PubMed

    Weber, K T; Brilla, C G

    1993-05-01

    Left ventricular hypertrophy (LVH) is a major risk factor associated with the emergence of symptomatic congestive heart failure. Cardiac myocyte excitation-contraction coupling has been the biochemical focus in the search for insights into the impaired contractility, relaxation, and stiffness of the hypertrophied myocardium. Although hypertrophied myocytes are the hallmark of LVH, other aspects of myocardial structure may be altered to impair pump function--specifically an abnormal accumulation of connective tissue (interstitial fibrosis). Cardiac fibroblasts, which are nonmyocyte cells of the cardiac interstitium, synthesize and degrade collagen and, therefore, represent an important determinant of pathologic LVH. Significantly, this reactive fibrosis has been found not only in the pressure-overloaded hypertrophied left ventricle but also in the normotensive, nonhypertrophied right ventricle of animals with experimental hypertension. These findings suggest the involvement of a circulating substance that has access to the coronary circulation common to both ventricles. Based on in vivo studies that examined this hypothesis, it can be concluded that chronic elevation of circulating aldosterone, relative to sodium intake, is associated with myocardial fibrosis, which initially adversely alters diastolic function and ultimately systolic ventricular function. The mechanisms by which fibroblast collagen metabolism is invoked in this setting are under investigation. Elucidation of these mechanisms may prepare the way to the prevention as well as the reversal of myocardial fibrosis and, in turn, of pathologic LVH. PMID:8504584

  7. Target Chamber Manipulator

    NASA Astrophysics Data System (ADS)

    Tantillo, Anthony; Watson, Matthew

    2015-11-01

    A system has been developed to allow remote actuation of sensors in a high vacuum target chamber used with a particle accelerator. Typically, sensors of various types are placed into the target chamber at specific radial and angular positions relative to the beam line and target. The chamber is then evacuated and the experiments are performed for those sensor positions. Then, the chamber is opened, the sensors are repositioned to new angles or radii, and the process is repeated, with a separate pump-down cycle for each set of sensor positions. The new sensor positioning system allows scientists to pre-set the radii of up to a dozen sensors, and then remotely actuate their angular positions without breaking the vacuum of the target chamber. This reduces the time required to reposition sensors from 6 hours to 1 minute. The sensors are placed into one of two tracks that are separately actuated using vacuum-grade stepping motors. The positions of the sensors are verified using absolute optical rotary encoders, and the positions are accurate to 0.5 degrees. The positions of the sensors are electronically recorded and time-stamped after every change. User control is through a GUI using LabVIEW.

  8. Improved Rhenium Thrust Chambers

    NASA Technical Reports Server (NTRS)

    O'Dell, John Scott

    2015-01-01

    Radiation-cooled bipropellant thrust chambers are being considered for ascent/ descent engines and reaction control systems on various NASA missions and spacecraft, such as the Mars Sample Return and Orion Multi-Purpose Crew Vehicle (MPCV). Currently, iridium (Ir)-lined rhenium (Re) combustion chambers are the state of the art for in-space engines. NASA's Advanced Materials Bipropellant Rocket (AMBR) engine, a 150-lbf Ir-Re chamber produced by Plasma Processes and Aerojet Rocketdyne, recently set a hydrazine specific impulse record of 333.5 seconds. To withstand the high loads during terrestrial launch, Re chambers with improved mechanical properties are needed. Recent electrochemical forming (EL-Form"TM") results have shown considerable promise for improving Re's mechanical properties by producing a multilayered deposit composed of a tailored microstructure (i.e., Engineered Re). The Engineered Re processing techniques were optimized, and detailed characterization and mechanical properties tests were performed. The most promising techniques were selected and used to produce an Engineered Re AMBR-sized combustion chamber for testing at Aerojet Rocketdyne.

  9. PATHOLOGY IMAGE OF THE MONTH: Sudden Cardiac Death Caused by an Uncommon Disease.

    PubMed

    Li, Julie Y; Mcgoey, Robin R

    2015-01-01

    A 57-year-old female, found dead lying supine in bed, was transferred to the autopsy service for an unrestricted autopsy to be performed under the authorization by the coroner. Medical history was unknown. At the time of autopsy, an implantable cardioverter-defibrillator (ICD) was identified in the subcutaneous tissues of the left subclavicular chest, with distal leads terminating in a small amount of fibrous tissue within the right auricular appendage and along the medial wall of the right ventricle. The heart was enlarged at 430gm (312 ±78) and cross sections were notable for left ventricular hypertrophy at 1.9cm (1.0-1.5cm) and for dilatation of the right ventricular chamber on initial apical cross section. All cross sections, from cardiac apex to subvalvular base, showed broad patches of white-yellow myocardial discoloration, without obvious hemorrhage, along the free wall of the left ventricle, the free wall of the right ventricle, and within the anterior interventricular septum (Figure 1). Additional notable findings at autopsy included a vena caval filter devoid of thromboembolic material, a patent foramen ovale (0.7cm) and microscopic plexogenic arteriopathy, low grade, consistent with pulmonary hypertension within the intrapulmonary vasculature. Histology from the discolored patches of myocardium is seen in Figure 2. Special stains for microorgansims (periodic acid-Schiff, Gomori methanamine silver, and Fite) were all negative. PMID:25978060

  10. Non-invasive quick diagnosis of cardiovascular problems from visible and invisible abnormal changes with increased cardiac troponin I appearing on cardiovascular representation areas of the eyebrows, left upper lip, etc. of the face & hands: beneficial manual stimulation of hands for acute anginal chest pain, and important factors in safe, effective treatment.

    PubMed

    Omura, Yoshiaki; Jones, Marilyn K; Duvvi, Harsha; Shimotsuura, Yasuhiro; Ohki, Motomu; Rodriques, Aaron

    2014-01-01

    Our previous study indicated that there are at least 7 cardiovascular representation areas on the face, including the "Eyebrows", both sides of the "Nose", "Lelt Upper Lip" and the "Outside of the corner of both sides of the mouth," in addition to 2 areas in each hand. When there are cardiovascular problems, some of the heart representation areas of these areas often show the following changes: 1) Most distinctive visible changes such as the initial whitening with or without long white hair, then hair loss and complete disappearance of the hairs of the heart representation area of "Eyebrows" 2) Invisible biochemical changes that happen in heart representation areas at the "Left Upper Lips", 3) "Nose" below eye level as well as 4) "3rd segment of Middle Finger of Hands." Most distinctive visible & invisible changes are found in heart representation areas on the "Eyebrow", located nearest to the midline of face, where the color of the hairs becomes white compared with the rest of the Eyebrow. Then the cardiovascular problem advances, and hair starts disappearing. When there are no hairs at the heart representation areas of the Eyebrow, usually Cardiac Troponin I is increased to a very serious, abnormal high value. Most of the cardiovascular representation areas of the face show, regardless of presence or absence of visible change. When there is a cardiovascular problem, not only simple Bi-Digital O-Ring Test can detect without using any instrument in several minutes but also, corresponding biochemical changes of abnormally increased Cardiac Troponin I level can often be detected non-invasively from these Organ Representation Areas of Face & Hands, although changes in Eyebrows, L-Upper Lip & 3rd segment of middle fingers are clinically the most reliable changes & easy to identify the locations. Manual Stimulation of Hand's heart representation areas often eliminated acute anginal chest pain before medical help became available. Important factors for safe, effective treatment of heart disease & cancer were also presented. Significant beneficial effect of optimal dose of Vitamin D3 400 I.U. for average adult on heart, brain and cancer, and harmful effect of widely used 2000 I.U., was emphasized. PMID:25219029

  11. Left ventricular non-compaction cardiomyopathy.

    PubMed

    Towbin, Jeffrey A; Lorts, Angela; Jefferies, John Lynn

    2015-08-22

    Left ventricular non-compaction, the most recently classified form of cardiomyopathy, is characterised by abnormal trabeculations in the left ventricle, most frequently at the apex. It can be associated with left ventricular dilation or hypertrophy, systolic or diastolic dysfunction, or both, or various forms of congenital heart disease. Affected individuals are at risk of left or right ventricular failure, or both. Heart failure symptoms can be induced by exercise or be persistent at rest, but many patients are asymptomatic. Patients on chronic treatment for compensated heart failure sometimes present acutely with decompensated heart failure. Other life-threatening risks of left ventricular non-compaction are ventricular arrhythmias or complete atrioventricular block, presenting clinically as syncope, and sudden death. Genetic inheritance arises in at least 30-50% of patients, and several genes that cause left ventricular non-compaction have been identified. These genes seem generally to encode sarcomeric (contractile apparatus) or cytoskeletal proteins, although, in the case of left ventricular non-compaction with congenital heart disease, disturbance of the NOTCH signalling pathway seems part of a final common pathway for this form of the disease. Disrupted mitochondrial function and metabolic abnormalities have a causal role too. Treatments focus on improvement of cardiac efficiency and reduction of mechanical stress in patients with systolic dysfunction. Further, treatment of arrhythmia and implantation of an automatic implantable cardioverter-defibrillator for prevention of sudden death are mainstays of therapy when deemed necessary and appropriate. Patients with left ventricular non-compaction and congenital heart disease often need surgical or catheter-based interventions. Despite progress in diagnosis and treatment in the past 10 years, understanding of the disorder and outcomes need to be improved. PMID:25865865

  12. Variability in the Cardiac Venous System of Wistar Rats

    PubMed Central

    Krešáková, Lenka; Purzyc, Halina; Schusterová, Ingrid; Fulton, Benjamin; Maloveská, Marcela; Vdoviaková, Katarina; Kravcová, Zuzanna; Boldižár, Martin

    2015-01-01

    Rats are often used as animal models in experimental cardiology for studying myocardial infarctions and various cardiologic procedures. Currently the cardiac venous system is a target for the delivery of drugs, gene vectors, angiogenetic growth factors, stem cells, and cardioprotective reagents. The purpose of this study was to describe the anatomic configuration and variability of the cardiac venous system in Wistar rats, by using the corrosion cast method and perfusion of colored latex. The distribution of veins in the rat heart disagrees with prior descriptions for other mammals, except mice, which have a similar pattern. Coronary venous drainage in the 36 rats examined consistently involved the left cardiac, left conal, major caudal, right cardiac, and right conal veins. Other veins involved inconsistently included the cranial cardiac vein (58.3% of cases), minor caudal veins (16.7%), conoanastomotic vein (66.7%), and left atrial vein (75%). In 4 cases (11.1%), the collateral veins were located between the left conal and left cardiac veins. In this study, high morphologic variability between cases was manifested by differences in the arrangement, size, mode of opening, and formation of the common root and affected all regions of the heart but primarily the right ventricle. PMID:25651085

  13. Automated Electrostatics Environmental Chamber

    NASA Technical Reports Server (NTRS)

    Calle, Carlos; Lewis, Dean C.; Buchanan, Randy K.; Buchanan, Aubri

    2005-01-01

    The Mars Electrostatics Chamber (MEC) is an environmental chamber designed primarily to create atmospheric conditions like those at the surface of Mars to support experiments on electrostatic effects in the Martian environment. The chamber is equipped with a vacuum system, a cryogenic cooling system, an atmospheric-gas replenishing and analysis system, and a computerized control system that can be programmed by the user and that provides both automation and options for manual control. The control system can be set to maintain steady Mars-like conditions or to impose temperature and pressure variations of a Mars diurnal cycle at any given season and latitude. In addition, the MEC can be used in other areas of research because it can create steady or varying atmospheric conditions anywhere within the wide temperature, pressure, and composition ranges between the extremes of Mars-like and Earth-like conditions.

  14. A three-dimensional analytical (rheological) model of the human left ventricle in passive-active states. Nontraumatic determination of the in vivo values of the rheological parameters.

    PubMed

    Ghista, D N; Brady, A J; Radhakrishnan, S

    1973-08-01

    In this paper a three-dimensional continuum model of a mammalian left ventricle is formulated. The stresses in the model satisfy the conditions of zero stress on the outer (epicardial surface-representing) boundary. The strains of the model are obtained from the actual dynamic geometry measurements (obtained from cineangiocardiography). Since the left ventricular muscle is incompressible, the dilatational strain is zero and hence the (three-dimensional) deviatric stress components are related to the corresponding strain components by Maxwell and Voigt rheological model analogues of one-dimensional systems; the parameters of the model are series and parallel elastic (SE, PE) elements and the contractile element (CE) (representing the sarcomere). The incorporation of the rheological features of the cardiac muscle into the three-dimensional constitutive equations (for the three-dimensional continuum model of the left ventricle) is a feature of this paper. A procedure is presented to determine the parameters of the constitutive equations (i.e., the SE, PE, and the parameters of the force-velocity relation for the CE) for the left ventricle of a subject from data on the dimensions and chamber pressure of the left ventricle. The values of these parameters characterize the rheology of the left ventricular muscle of the subject. In order to demonstrate clinical application of the analyses, in vivo data of the subjects' left ventricular pressure and dimensions are obtained, and the analyses are applied to the data to determine (for each subject) the values and characteristics of the elastic elements and CEs. PMID:4726883

  15. [Cardiac transplantation. Indications, delays, surveillance].

    PubMed

    Merlet, P; Benvenuti, C; Deleuze, P; Dubois-Randé, J L; Loisance, D; Castaigne, A; Cachera, J P

    1990-11-01

    The number cardiac transplantation has been dramatically increasing for the last year and the results are satisfactory regarding survival or functional capacity. The observed increase of cardiac transplantation may tend to vulgarize it. However, this intervention should be only considered in a selected group of patients who have no other option. Many reports concerned various technical approach for a clearcut determination of high and low risk population of patients with congestive heart failure. But, considering individual patients, the value of each prognostic parameter remains unresolved. Nevertheless the more discriminant parameters for the prognosis assessment are: the left ventricular ejection fraction, the NYHA class, right heart catheterization data, the functional capacity, the cardiothoracic ratio on chest X ray, the ischemic etiology of the disease. The role of neuro-hormonal determinant such as norepinephrine circulating concentration or cardiac uptake on MIBG imaging should be further investigated, especially for patients treated by ACE inhibitors or beta blockers. Contraindications for cardiac transplantation are less restrictive, nowadays. Concerning patients selected, and waiting for heart transplantation or patients non primary selected survival can be improved by adjusting medical therapy on objective efficacy criteria. PMID:2125416

  16. [Changes in cardiac function during recreational diving].

    PubMed

    Boussuges, A; Lafay, V

    1997-02-01

    Underwater diving is a widely practised leisure activity. As cardiac patients may wish to participate, cardiologists should be aware of potential changes of cardiac function during diving. Multiple factors may affect haemodynamics. Firstly, changes in pressure, secondary to ventilation of a high density gas mixture which increases afterload. Hyperoxia is the principal factor which slows the heart rate, a commonly observed phenomenon. Excitability and conduction speed may be modified by the increase in hydrostatic pressure. During decompression, gaseous pulmonary embolism may increase right heart pressures and cause a paradoxical embolism may increase right heart pressures and cause a paradoxical embolism in patients with a right-to-left shunt. Immersion increases the preload. Exposure to cold also plays a role increasing afterload and slowing the heart rate. These factors may disturb cardiac function and expose cardiac patients to accidents during underwater diving. PMID:9181036

  17. Surgical treatment of cardiac pheochromocytomas

    SciTech Connect

    Orringer, M.B.; Sisson, J.C.; Glazer, G.; Shapiro, B.; Francis, I.; Behrendt, D.M.; Thompson, N.W.; Lloyd, R.V.

    1985-05-01

    The development at our institution of the radiopharmaceutical /sup 131/-I-metaiodobenzylguanidine has permitted for the first time scintigraphic localization of pheochromocytomas. By the use of this scan in combination with contrast-enhanced computed tomography, intrapericardial pheochromocytomas have been demonstrated in eight patients at our hospital during the past 2 years. Four of these patients have been operated upon by us, and each was found to have a pheochromocytoma arising from the heart (left atrium in three and interventricular groove at the aortic root in one). While in one patient it was possible to shell the tumor away from the left atrial wall without cardiopulmonary bypass, in the remaining patients, bypass and cardioplegia were required to resect the pheochromocytomas without inducing life-threatening intraoperative hypertension and cardiac arrhythmias. One patient required coronary artery reconstruction and two, excision of the posterior left atrial wall with pericardial replacement. One of these latter two patients died intraoperatively of uncontrollable hemorrhage. The three remaining patients are well and normotensive after more than 1 year of follow-up. Cardiac pheochromocytomas should not be approached as typical posterior mediastinal tumors, or as they are in the abdomen, with the expectation that they will shell away from contiguous structures. Cardiopulmonary bypass should be available, and resection of involved myocardium may be necessary for complete removal.

  18. Automated soil gas monitoring chamber

    DOEpatents

    Edwards, Nelson T.; Riggs, Jeffery S.

    2003-07-29

    A chamber for trapping soil gases as they evolve from the soil without disturbance to the soil and to the natural microclimate within the chamber has been invented. The chamber opens between measurements and therefore does not alter the metabolic processes that influence soil gas efflux rates. A multiple chamber system provides for repetitive multi-point sampling, undisturbed metabolic soil processes between sampling, and an essentially airtight sampling chamber operating at ambient pressure.

  19. Filament wound rocket motor chambers

    NASA Technical Reports Server (NTRS)

    1976-01-01

    The design, analysis, fabrication and testing of a Kevlar-49/HBRF-55A filament wound chamber is reported. The chamber was fabricated and successfully tested to 80% of the design burst pressure. Results of the data reduction and analysis from the hydrotest indicate that the chamber design and fabrication techniques used for the chamber were adequate and the chamber should perform adequately in a static test.

  20. Left ventricular function in chronic aortic regurgitation

    SciTech Connect

    Iskandrian, A.S.; Hakki, A.H.; Manno, B.; Amenta, A.; Kane, S.A.

    1983-06-01

    Left ventricular performance was determined in 42 patients with moderate or severe aortic regurgitation during upright exercise by measuring left ventricular ejection fraction and volume with radionuclide ventriculography. Classification of the patients according to exercise tolerance showed that patients with normal exercise tolerance (greater than or equal to 7.0 minutes) had a significantly higher ejection fraction at rest (probability (p) . 0.02) and during exercise (p . 0.0002), higher cardiac index at exercise (p . 0.0008) and lower exercise end-systolic volume (p . 0.01) than did patients with limited exercise tolerance. Similar significant differences were noted in younger patients compared with older patients in ejection fraction at rest and exercise (both p . 0.001) and cardiac index at rest (p . 0.03) and exercise (p . 0.0005). The end-diastolic volume decreased during exercise in 60% of the patients. The patients with a decrease in volume were significantly younger and had better exercise tolerance and a larger end-diastolic volume at rest than did patients who showed an increase in volume. The mean corrected left ventricular end-diastolic radius/wall thickness ratio was significantly greater in patients with abnormal than in those with normal exercise reserve (mean +/- standard deviation 476 +/- 146 versus 377 +/- 92 mm Hg, p less than 0.05). Thus, in patients with chronic aortic regurgitation: 1) left ventricular systolic function during exercise was related to age, exercise tolerance and corrected left ventricular end-diastolic radius/wall thickness ratio, and 2) the end-diastolic volume decreased during exercise, especially in younger patients and patients with normal exercise tolerance or a large volume at rest.

  1. Left ventricular pseudoaneurysm found after mitral valve replacement performed 30 years earlier.

    PubMed

    Castilla, Elena; Gato, Manuel; Ruiz, José Ramón

    2010-03-01

    Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery. Because patients frequently present with nonspecific symptoms, a high index of suspicion is needed to make the diagnosis. This report describes an unusual case demonstrating a large LV pseudoaneurysm after mitral valve replacement performed 30 years earlier. PMID:20197588

  2. Quantitative coronary and left ventricular cineangiography

    SciTech Connect

    Reiber, J.H.C.; Serruys, P.W.; Slager, C.J.

    1986-01-01

    The first section, with 12 chapters, deals with the detailed methods of computer analysis of images obtained from coronary vessels and the left ventricle. Basic principles of x-ray image formation are described, followed by details of the computer-based Cardiovascular Angiography Analysis system (CAAs) and the left-ventricular angioprocessing system (Contouromat), with their degree of validity. Other chapters discuss contour analysis, edge detection, densitometry, digital image processing, three-dimensional reconstruction, and the current status of structural analysis of the entire coronary tree. The second edition section contains 11 chapters, each exemplifying the application of these computer-based systems to almost the entire sphere of interventional cardiac imaging. Applications include intracoronary effects of nifedipine on coronary motility, left-ventricular function and myocardial oxygen consumption, various aspects of percutaneous transluminal coronary angioplasty (including left-ventricular wall stiffness), adjuvant thrombolysis, comparison of contour versus densitometric area measurements of coronary obstructions before and after percutaneous transluminal coronary angioplasty, and left-ventricular performance including lactate metabolism during vessel occlusion.

  3. Flame-Test Chamber

    NASA Technical Reports Server (NTRS)

    Bjorklund, R. A.

    1984-01-01

    Experimental chamber provides controlled environment for observation and measurement of flames propagating in expanding plume of flammable air/fuel mixture under atmospheric conditions. Designed to evaluate quenching capability of screen-type flame arresters in atmospheric vents of fuel cargo tanks aboard marine cargo vessels.

  4. A vacuum chamber feedthrough

    NASA Technical Reports Server (NTRS)

    Brown, V. D.

    1973-01-01

    Simple and inexpensive microwave feedthrough has been designed which transfers 130 ns, 5kV pulse into vacuum chamber. Feedthrough may be used over wide range and is adaptable to most coaxial cables, since either multistrand or single strand center conductor cable can be used.

  5. Ultrasonic Drying Processing Chamber

    NASA Astrophysics Data System (ADS)

    Acosta, V.; Bon, J.; Riera, E.; Pinto, A.

    The design of a high intensity ultrasonic chamber for drying process was investigated. The acoustic pressure distribution in the ultrasonic drying chamber was simulated solving linear elastic models with attenuation for the acoustic-structure interaction. Together with the government equations, the selection of appropriate boundary conditions, mesh refinement, and configuration parameters of the calculation methods, which is of great importance to simulate adequately the process, were considered. Numerical solution, applying the finite element method (FEM), of acoustic-structure interactions involves to couple structural and fluid elements (with different degrees of freedom), whose solution implies several problems of hardware requirements and software configuration, which were solved. To design the drying chamber, the influence of the directivity of the drying open camera and the staggered reflectors over the acoustic pressure distribution was analyzed. Furthermore, to optimize the influence of the acoustic energy on the drying process, the average value of the acoustic energy distribution in the drying chamber was studied. This would determine the adequate position of the food samples to be dried. For this purpose, the acoustic power absorbed by the samples will be analyzed in later studies.

  6. Liquid Wall Chambers

    SciTech Connect

    Meier, W R

    2011-02-24

    The key feature of liquid wall chambers is the use of a renewable liquid layer to protect chamber structures from target emissions. Two primary options have been proposed and studied: wetted wall chambers and thick liquid wall (TLW) chambers. With wetted wall designs, a thin layer of liquid shields the structural first wall from short ranged target emissions (x-rays, ions and debris) but not neutrons. Various schemes have been proposed to establish and renew the liquid layer between shots including flow-guiding porous fabrics (e.g., Osiris, HIBALL), porous rigid structures (Prometheus) and thin film flows (KOYO). The thin liquid layer can be the tritium breeding material (e.g., flibe, PbLi, or Li) or another liquid metal such as Pb. TLWs use liquid jets injected by stationary or oscillating nozzles to form a neutronically thick layer (typically with an effective thickness of {approx}50 cm) of liquid between the target and first structural wall. In addition to absorbing short ranged emissions, the thick liquid layer degrades the neutron flux and energy reaching the first wall, typically by {approx}10 x x, so that steel walls can survive for the life of the plant ({approx}30-60 yrs). The thick liquid serves as the primary coolant and tritium breeding material (most recent designs use flibe, but the earliest concepts used Li). In essence, the TLW places the fusion blanket inside the first wall instead of behind the first wall.

  7. Improved wire chamber

    DOEpatents

    Atac, M.

    1987-05-12

    An improved gas mixture for use with proportional counter devices, such as Geiger-Mueller tubes and drift chambers. The improved gas mixture provides a stable drift velocity while eliminating wire aging caused by prior art gas mixtures. The new gas mixture is comprised of equal parts argon and ethane gas and having approximately 0.25% isopropyl alcohol vapor. 2 figs.

  8. Computational modeling and analysis for left ventricle motion using CT/Echo image fusion

    NASA Astrophysics Data System (ADS)

    Kim, Ji-Yeon; Kang, Nahyup; Lee, Hyoung-Euk; Kim, James D. K.

    2014-03-01

    In order to diagnose heart disease such as myocardial infarction, 2D strain through the speckle tracking echocardiography (STE) or the tagged MRI is often used. However out-of-plane strain measurement using STE or tagged MRI is inaccurate. Therefore, strain for whole organ which are analyzed by simulation of 3D cardiac model can be applied in clinical diagnosis. To simulate cardiac contraction in a cycle, cardiac physical properties should be reflected in cardiac model. The myocardial wall in left ventricle is represented as a transversely orthotropic hyperelastic material, with the fiber orientation varying sequentially from the epicardial surface, through about 0° at the midwall, to the endocardial surface. A time-varying elastance model is simulated to contract myocardial fiber, and physiological intraventricular systolic pressure curves are employed for the cardiac dynamics simulation in a cycle. And an exact description of the cardiac motion should be acquired in order that essential boundary conditions for cardiac simulation are obtained effectively. Real time cardiac motion can be acquired by using echocardiography and exact cardiac geometrical 3D model can be reconstructed using 3D CT data. In this research, image fusion technology from CT and echocardiography is employed in order to consider patient-specific left ventricle movement. Finally, longitudinal strain from speckle tracking echocardiography which is known to fit actual left ventricle deformation relatively well is used to verify these results.

  9. Cardiac pacing and aviation.

    PubMed

    Toff, W D; Edhag, O K; Camm, A J

    1992-12-01

    Certain applicants with stable disturbances of rhythm or conduction requiring cardiac pacing, in whom no other disqualifying condition is present, may be considered fit for medical certification restricted to multi-crew operations. The reliability of modern pacing systems appears adequate to permit restricted certification even in pacemaker dependent subjects except for certain models of pacemakers and leads known to be at increased risk of failure. These are to be avoided. There is little evidence to suggest that newer devices are any more reliable than their predecessors. Single and dual chamber systems appear to have similar reliability up to 4 years, after which time significant attrition of dual chamber devices occurs, principally due to battery depletion. All devices require increased scrutiny as they approach their end of life as predicted from longevity data and pacing characteristics. Unipolar and bipolar leads are of similar reliability, apart from a number of specific bipolar polyurethane leads which have been identified. Atrial leads, particularly those without active fixation, are less secure than ventricular leads and applicants who are dependent on atrial sensing or pacing should be denied certification. Bipolar leads are to be preferred due to the lower risk of myopotential and exogenous EMI. Sensor-driven adaptive-rate pacing systems using active sensors may have reduced longevity and require close scrutiny. Activity-sensing devices using piezoelectric crystal sensors may be subject to significant rate rises in rotary wing aircraft. The impracticality of restricted certification in helicopters will, in any event, preclude certification. Such devices would best be avoided in hovercraft (air cushioned vehicle) pilots. Only minor rate rises are likely in fixed-wing aircraft which are unlikely to be of significance. Anti-tachycardia devices and implanted defibrillators are inconsistent with any form of certification to fly. PMID:1493823

  10. Transseptal fine needle aspiration of a large left atrial tumour.

    PubMed

    Wong, Chi Wing; Ruygrok, Peter; Sutton, Timothy; Ding, Patricia; van Vliet, Chris; Occleshaw, Christopher; Smith, Warren

    2010-07-01

    The diagnosis of cardiac tumours is often based on images without tissue diagnosis or tissue obtained at surgery. Percutaneous myocardial biopsy via a transvenous approach has been described in literatures but this technique is not feasible with left atrial tumours. We report a patient presenting with heart failure and left atrial tumour. The diagnosis of spindle cell neoplasm was established pre-operatively via successful transseptal fine needle aspiration of cells from a left atrial tumour. We believe this technique worth consideration to aid pre-surgery diagnosis. PMID:19656723

  11. An Isolated Congenital Left Ventricular Diverticulum with Mitral Valve Endocarditis.

    PubMed

    Jiang, Bo; Yang, Yi-Feng; Wang, Xi; Xiong, Lian; Huang, Can; Gong, Liang-Hui

    2016-03-01

    Congenital left ventricular diverticulum is a rare cardiac malformation, which could result in rupture, thrombosis, congestive heart failure, infective endocarditis, ventricular arrhythmia and aortic insufficiency. Most authors propose that patients who are symptomatic and have a higher risk for major complications should undergo surgical treatment. We present a case of isolated congenital left ventricular diverticulum with mitral valve infective endocarditis and anomalous single coronary artery observed intra-operatively. The patient underwent successful surgical repair of the diverticulum by continuous suture of the internal opening inside the left ventricle. PMID:26572256

  12. Magnetic Resonance Elastography as a Method for the Assessment of Effective Myocardial Stiffness throughout the Cardiac Cycle

    PubMed Central

    Kolipaka, Arunark; Araoz, Philip A.; McGee, Kiaran P.; Manduca, Armando; Ehman, Richard L.

    2011-01-01

    Magnetic resonance elastography (MRE) is a noninvasive technique in which images of externally generated waves propagating in tissue are used to measure stiffness. The first aim is to determine, from a range of driver configurations the optimal driver for the purpose of generating waves within the heart in vivo. The second aim is to quantify the shear stiffness of normal myocardium throughout the cardiac cycle using MRE and to compare MRE stiffness to left ventricular (LV) chamber pressure in an in vivo pig model. MRE was performed in 6-pigs with 6-different driver setups including no motion, 3-noninvasive drivers and 2-invasive drivers. MRE wave displacement amplitudes were calculated for each driver. During the same MRI examination, LV pressure and MRI-measured LV volume were obtained, and MRE myocardial stiffness was calculated for 20 phases of the cardiac cycle. No discernible waves were imaged when no external motion was applied, and a single pneumatic drum driver produced higher amplitude waves than the other noninvasive drivers (P <0.05). Pressure-volume loops overlaid onto stiffness-volume loops showed good visual agreement. Pressure and MRE-measured effective stiffness showed good correlation (R2 = 0.84). MRE shows potential as a noninvasive method for estimating effective myocardial stiffness throughout the cardiac cycle. PMID:20578052

  13. 78. (Credit JTL) Mixing chambers (19241926) in foreground, looking west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    78. (Credit JTL) Mixing chambers (1924-1926) in foreground, looking west along south facade of station. Settling basins to left, new filter house (1942) in background. Aerators added in 1930-31 to remove carbon dioxide from water. - McNeil Street Pumping Station, McNeil Street & Cross Bayou, Shreveport, Caddo Parish, LA

  14. 11. GENERAL VIEW IN SENATE CHAMBER, FROM WEST; PAINTED GLASS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. GENERAL VIEW IN SENATE CHAMBER, FROM WEST; PAINTED GLASS WINDOW BEHIND COLUMNS DEPICTS 'THE LANDING OF DE SOTO;' MURAL TO LEFT SHOWS 'THOMAS HART BENTON'S SPEECH AT ST. LOUIS 1849;' MURAL TO RIGHT SHOWS 'PRESIDENT JEFFERSON GREETING LEWIS AND CLARK' - Missouri State Capitol, High Street between Broadway & Jefferson Streets, Jefferson City, Cole County, MO

  15. 36. MACHINERY CHAMBER FOR SLUICE GATE OUTLET WORKS ON GALLERY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    36. MACHINERY CHAMBER FOR SLUICE GATE OUTLET WORKS ON GALLERY 1 (LOCATED AT A ON SITE PLAN), SHOWING HYDRAULIC GATE HOIST (SIX, TOTAL, MANUFACTURED BY JOSHUA HENDRY IRON WORKS, SAN FRANCISCO) ON LEFT AND INSPECTION GALLERY ON RIGHT. VIEW TO NORTHEAST. - Owyhee Dam, Across Owyhee River, Nyssa, Malheur County, OR

  16. INTERIOR VIEW, NORTHWEST ATTIC CHAMBER FROM THE CENTRAL PASSAGE. (NOTE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    INTERIOR VIEW, NORTHWEST ATTIC CHAMBER FROM THE CENTRAL PASSAGE. (NOTE THE LEFT JAMB OF THE ARCHITRVE MOLDING AROUND THE DOOR. ALL OF THE SERVICE SPACES THROUGHOUT THE WOODLANDS INCLUDED THIS DEGREE OF REFINEMENT - The Woodlands, 4000 Woodlands Avenue, Philadelphia, Philadelphia County, PA

  17. Echocardiographic assessment of cardiac disease

    NASA Technical Reports Server (NTRS)

    Popp, R. L.

    1976-01-01

    The physical principles and current applications of echocardiography in assessment of heart diseases are reviewed. Technical considerations and unresolved points relative to the use of echocardiography in various disease states are stressed. The discussion covers normal mitral valve motion, mitral stenosis, aortic regurgitation, atrial masses, mitral valve prolapse, and idiopathic hypertrophic subaortic stenosis. Other topics concern tricuspic valve abnormalities, aortic valve disease, pulmonic valve, pericardial effusion, intraventricular septal motion, and left ventricular function. The application of echocardiography to congenital heart disease diagnosis is discussed along with promising ultrasonic imaging systems. The utility of echocardiography in quantitative evaluation of cardiac disease is demonstrated.

  18. Echocardiographic abnormalities following cardiac radiation

    SciTech Connect

    Perrault, D.J.; Levy, M.; Herman, J.D.; Burns, R.J.; Bar Shlomo, B.Z.; Druck, M.N.; Wu, W.Q.; McLaughlin, P.R.; Gilbert, B.W.

    1985-04-01

    Five years or more after receiving cardiac radiation, 41 patients with Hodgkin's disease and seminoma in remission were subjected to echocardiography. The abnormalities detected included pericardial thickening in 70%, thickening of the aortic and/or mitral valves in 28%, right ventricular dilatation or hypokinesis in 39%, and left ventricular dysfunction in 39%. In the 23 patients treated by an upper mantle technique with shielding, the incidence of right ventricular abnormalities and valvular thickening was significantly lower than in patients treated with modified techniques. Although no symptoms were attributable to the observed abnormalities, longer follow-up time may reveal important functional implications.

  19. Cardiac Monitoring Using Laser Speckle

    NASA Astrophysics Data System (ADS)

    Periasamy, A.; Sivaram, B. M.; Singh, M.

    1980-05-01

    Laser speckle is an interference phenomena which is always present when a laser is used. Time-average speckle interferograms of the left and right side of the chest of a normal healthy subject were recorded at the Fourier transform plane on a fine grain photographic plate, while the subject held his breath. The interferogram was analysed by the point wise method and a graph was drawn between the position and the displacements at corresponding points on the chest wall. The associated displacements of the chest wall due to heart action are correlated with cardiac function.

  20. [Left juxtaposition of the heart atrial appendages].

    PubMed

    González Ramos, Luis Antonio; López Cervantes, Guillermo; Castillo Aldaco, Juan; Rascón Alcántar, Adela; Pérez Medina, Tupac; Ruíz Bustamante, Norma Patricia

    2007-01-01

    We present the first case of left juxtaposition of the right atrial appendages that has been seen at the Children's Hospital of the state of Sonora. This anomaly was associated with a complex congenital heart defect, i.e. absence of the right atrioventricular connection and transposition of the great arteries. The two-dimensional echocardiogram is the usual study to reach a clinical diagnoses, but it may also be an incidental of finding during surgery or during autopsy, in ocurred in our case. Its timely diagnosis may have implications in the surgical treatment and in therapeutic cardiac catheterization. PMID:18050936

  1. Myocardial ischemia with left ventricular outflow obstruction

    PubMed Central

    Popov, Aron F; Bireta, Christian; Schmitto, Jan D; Zenker, Dieter; Friedrich, Martin; Coskun, Kasim O; Seipelt, Ralf; Hanekop, Gerd G; Schoendube, Friedrich A

    2009-01-01

    We report an unusual case of a 32-year old man who was treated for a hypertrophic obstructive cardiomyopathy (HOCM) with a DDD pacing with short AV delay reduction in the past. Without prior notice the patient developed ventricular fibrillation and an invasive cardiac diagnostic was performed, which revealed a myocardial bridging around of the left anterior descending artery (LAD). We suspected ischemia that could be either related to LAD artery compression or perfusion abnormalities due to AV delay reduction with related to diastolic dysfunction. PMID:19761610

  2. Multi-chamber deposition system

    DOEpatents

    Jacobson, Richard L.; Jeffrey, Frank R.; Westerberg, Roger K.

    1989-06-27

    A system for the simultaneous deposition of different coatings onto a thin web within a large volume vacuum chamber is disclosed which chamber is provided with a plurality of deposition chambers in which the different layers are deposited onto the film as its moves from a supply roll to a finished take-up roll of coated web. The deposition chambers provided within the large vacuum chamber are provided with separate seals which minimize back diffusion of any dopant gas from adjacent deposition chambers.

  3. Multi-chamber deposition system

    DOEpatents

    Jacobson, Richard L.; Jeffrey, Frank R.; Westerberg, Roger K.

    1989-10-17

    A system for the simultaneous deposition of different coatings onto a thin web within a large volume vacuum chamber is disclosed which chamber is provided with a plurality of deposition chambers in which the different layers are deposited onto the film as its moves from a supply roll to a finished take-up roll of coated web. The deposition chambers provided within the large vacuum chamber are provided with separate seals which minimize back diffusion of any dopant gas from adjacent deposition chambers.

  4. Combustor with fuel preparation chambers

    NASA Technical Reports Server (NTRS)

    Zelina, Joseph (Inventor); Myers, Geoffrey D. (Inventor); Srinivasan, Ram (Inventor); Reynolds, Robert S. (Inventor)

    2001-01-01

    An annular combustor having fuel preparation chambers mounted in the dome of the combustor. The fuel preparation chamber comprises an annular wall extending axially from an inlet to an exit that defines a mixing chamber. Mounted to the inlet are an air swirler and a fuel atomizer. The air swirler provides swirled air to the mixing chamber while the atomizer provides a fuel spray. On the downstream side of the exit, the fuel preparation chamber has an inwardly extending conical wall that compresses the swirling mixture of fuel and air exiting the mixing chamber.

  5. 72. VISITOR'S CENTER, MODEL OF BOILER CHAMBER, AUXILIARY CHAMBER, REACTOR ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    72. VISITOR'S CENTER, MODEL OF BOILER CHAMBER, AUXILIARY CHAMBER, REACTOR AND CANAL (LOCATION T) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  6. 61. BOILER CHAMBER No. 2, LOOKING SOUTHWEST BETWEEN CHAMBER AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    61. BOILER CHAMBER No. 2, LOOKING SOUTHWEST BETWEEN CHAMBER AND CONCRETE ENCLOSURE (LOCATION PPP) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  7. 41. AUXILIARY CHAMBER, CONCRETE ENCLOSURE CHAMBER AIR LOCK (EXTERIOR), LOOKING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    41. AUXILIARY CHAMBER, CONCRETE ENCLOSURE CHAMBER AIR LOCK (EXTERIOR), LOOKING NORTHEAST FROM SOUTHWEST CORNER (LOCATION AAA) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  8. 44. AUXILIARY CHAMBER BETWEEN CHAMBER AND CONCRETE ENCLOSURE (LOCATION CCC), ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    44. AUXILIARY CHAMBER BETWEEN CHAMBER AND CONCRETE ENCLOSURE (LOCATION CCC), LOOKING NORTHEAST SHOWING DRAIN PIPE FROM SUMP - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  9. 50. BOILER CHAMBER No. 1, LOOKING SOUTHEAST BETWEEN CHAMBER AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    50. BOILER CHAMBER No. 1, LOOKING SOUTHEAST BETWEEN CHAMBER AND ENCLOSURE (LOCATION III) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

  10. Developments in Cardiac Resynchronisation Therapy

    PubMed Central

    Lewis, Geoffrey F; Gold, Michael R

    2015-01-01

    Cardiac resynchronisation therapy (CRT) is an important therapy for patients with heart failure with a reduced ejection fraction and interventricular conduction delay. Large trials have established the role of CRT in reducing heart failure hospitalisations and improving symptoms, left ventricular (LV) function and mortality. Guidelines from major medical societies are consistent in support of CRT for patients with New York Health Association (NYHA) class II, III and ambulatory class IV heart failure, reduced LV ejection fraction and QRS prolongation, particularly left bundle branch block. The current challenge facing practitioners is to maximise the rate of patients who respond to CRT and the magnitude of that response. Current areas of interest for achieving these goals include tailoring patient selection, individualising LV lead placement and application of new technologies and techniques for CRT delivery. PMID:26835113

  11. Paradoxical carbon dioxide embolism during laparoscopic cholecystectomy as a cause of cardiac arrest and neurologic sequelae: a case report

    PubMed Central

    Shin, Hye Young; Kim, Dong Wook; Kim, Ju Deok; Yu, Soo Bong; Kim, Doo Sik; Kim, Kyung Han

    2014-01-01

    An 81-year-old male patient was scheduled for a laparoscopic cholecystectomy due to acute cholecystitis. About 50 minutes into the operation, the arterial blood pressure suddenly decreased and ventricular fibrillation appeared on the electrocardiography. The patient received cardiopulmonary resuscitation and recovered a normal vital sign. We suspected a carbon dioxide embolism as the middle hepatic vein had been injured during the surgery. We performed a transesophageal echocardiography and were able to confirm the presence of multiple gas bubbles in all of the cardiac chambers. After the operation, the patient presented a stable hemodynamic state, but showed weaknesses in the left arm and leg. There were no acute lesions except for a chronic cerebral cortical atrophy and chronic microvascular encephalopathy on the postoperative brain-computed tomography, 3D angiography and magnetic resonance image. Fortunately, three days after the operation, the patient's hemiparesis had entirely subsided and he was discharged without any neurologic sequelae. PMID:25558345

  12. Three chamber negative ion source

    DOEpatents

    Leung, Ka-Ngo; Ehlers, Kenneth W.; Hiskes, John R.

    1985-01-01

    A negative ion vessel is divided into an excitation chamber, a negative ionization chamber and an extraction chamber by two magnetic filters. Input means introduces neutral molecules into a first chamber where a first electron discharge means vibrationally excites the molecules which migrate to a second chamber. In the second chamber a second electron discharge means ionizes the molecules, producing negative ions which are extracted into or by a third chamber. A first magnetic filter prevents high energy electrons from entering the negative ionization chamber from the excitation chamber. A second magnetic filter prevents high energy electrons from entering the extraction chamber from the negative ionizing chamber. An extraction grid at the end of the negative ion vessel attracts negative ions into the third chamber and accelerates them. Another grid, located adjacent to the extraction grid, carries a small positive voltage in order to inhibit positive ions from migrating into the extraction chamber and contour the plasma potential. Additional electrons can be suppressed from the output flux using ExB forces provided by magnetic field means and the extractor grid electric potential.

  13. Streetscape view looking southeast of 3010 23rd St. (left foreground) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Streetscape view looking southeast of 3010 23rd St. (left foreground) in Shawmut Mill village section of Valley - 3010 Twenty-third Street (House), 3010 Twenty-third Street, Valley, Chambers County, AL

  14. Cardiac regeneration therapy: connections to cardiac physiology.

    PubMed

    Takehara, Naofumi; Matsubara, Hiroaki

    2011-12-01

    Without heart transplantation, a large number of patients with failing hearts worldwide face poor outcomes. By means of cardiomyocyte regeneration, cardiac regeneration therapy is emerging with great promise as a means for restoring loss of cardiac function. However, the limited success of clinical trials using bone marrow-derived cells and myoblasts with heterogeneous constituents, transplanted at a wide range of cell doses, has led to disagreement on the efficacy of cell therapy. It is therefore essential to reevaluate the evidence for the efficacy of cell-based cardiac regeneration therapy, focusing on targets, materials, and methodologies. Meanwhile, the revolutionary innovation of cardiac regeneration therapy is sorely needed to help the millions of people who suffer heart failure from acquired loss of cardiomyocytes. Cardiac regeneration has been used only in limited species or as a developing process in the rodent heart; now, the possibility of cardiomyocyte turnover in the human heart is being revisited. In the pursuit of this concept, the use of cardiac stem/progenitor stem cells in the cardiac niche must be focused to usher in a second era of cardiac regeneration therapy for the severely injured heart. In addition, tissue engineering and cellular reprogramming will advance the next era of treatment that will enable current cell-based therapy to progress to "real" cardiac regeneration therapy. Although many barriers remain, the prevention of refractory heart failure through cardiac regeneration is now becoming a realistic possibility. PMID:21963835

  15. Electrical stimulation systems for cardiac tissue engineering

    PubMed Central

    Tandon, Nina; Cannizzaro, Christopher; Chao, Pen-Hsiu Grace; Maidhof, Robert; Marsano, Anna; Au, Hoi Ting Heidi; Radisic, Milica; Vunjak-Novakovic, Gordana

    2009-01-01

    We describe a protocol for tissue engineering of synchronously contractile cardiac constructs by culturing cardiac cells with the application of pulsatile electrical fields designed to mimic those present in the native heart. Tissue culture is conducted in a customized chamber built to allow for cultivation of (i) engineered three-dimensional (3D) cardiac tissue constructs, (ii) cell monolayers on flat substrates or (iii) cells on patterned substrates. This also allows for analysis of the individual and interactive effects of pulsatile electrical field stimulation and substrate topography on cell differentiation and assembly. The protocol is designed to allow for delivery of predictable electrical field stimuli to cells, monitoring environmental parameters, and assessment of cell and tissue responses. The duration of the protocol is 5 d for two-dimensional cultures and 10 d for 3D cultures. PMID:19180087

  16. Electrical stimulation systems for cardiac tissue engineering.

    PubMed

    Tandon, Nina; Cannizzaro, Christopher; Chao, Pen-Hsiu Grace; Maidhof, Robert; Marsano, Anna; Au, Hoi Ting Heidi; Radisic, Milica; Vunjak-Novakovic, Gordana

    2009-01-01

    We describe a protocol for tissue engineering of synchronously contractile cardiac constructs by culturing cardiac cells with the application of pulsatile electrical fields designed to mimic those present in the native heart. Tissue culture is conducted in a customized chamber built to allow for cultivation of (i) engineered three-dimensional (3D) cardiac tissue constructs, (ii) cell monolayers on flat substrates or (iii) cells on patterned substrates. This also allows for analysis of the individual and interactive effects of pulsatile electrical field stimulation and substrate topography on cell differentiation and assembly. The protocol is designed to allow for delivery of predictable electrical field stimuli to cells, monitoring environmental parameters, and assessment of cell and tissue responses. The duration of the protocol is 5 d for two-dimensional cultures and 10 d for 3D cultures. PMID:19180087

  17. Multiwire proportional chamber development

    NASA Technical Reports Server (NTRS)

    Doolittle, R. F.; Pollvogt, U.; Eskovitz, A. J.

    1973-01-01

    The development of large area multiwire proportional chambers, to be used as high resolution spatial detectors in cosmic ray experiments is described. A readout system was developed which uses a directly coupled, lumped element delay-line whose characteristics are independent of the MWPC design. A complete analysis of the delay-line and the readout electronic system shows that a spatial resolution of about 0.1 mm can be reached with the MWPC operating in the strictly proportional region. This was confirmed by measurements with a small MWPC and Fe-55 X-rays. A simplified analysis was carried out to estimate the theoretical limit of spatial resolution due to delta-rays, spread of the discharge along the anode wire, and inclined trajectories. To calculate the gas gain of MWPC's of different geometrical configurations a method was developed which is based on the knowledge of the first Townsend coefficient of the chamber gas.

  18. CONTINUOUSLY SENSITIVE BUBBLE CHAMBER

    DOEpatents

    Good, R.H.

    1959-08-18

    A radiation detector of the bubble chamber class is described which is continuously sensitive and which does not require the complex pressure cycling equipment characteristic of prior forms of the chamber. The radiation sensitive element is a gas-saturated liquid and means are provided for establishing a thermal gradient across a region of the liquid. The gradient has a temperature range including both the saturation temperature of the liquid and more elevated temperatures. Thus a supersaturated zone is created in which ionizing radiations may give rise to visible gas bubbles indicative of the passage of the radiation through the liquid. Additional means are provided for replenishing the supply of gas-saturated liquid to maintaincontinuous sensitivity.

  19. Crystals in magma chambers

    NASA Astrophysics Data System (ADS)

    Higgins, M.

    2011-12-01

    Differentiation processes in igneous systems are one way in which the diversity of igneous rocks is produced. Traditionally, magmatic diversity is considered as variations in the overall chemical composition, such as basalt and rhyolite, but I want to extend this definition to include textural diversity. Such textural variations can be manifested as differences in the amount of crystalline (and immiscible liquid) phases and in the origin and identity of such phases. One important differentiation process is crystal-liquid separation by floatation or decantation, which clearly necessitates crystals in the magma. Hence, it is important to determine if magmas in chambers (sensu lato) have crystals. The following discussion is framed in generalities - many exceptions occur. Diabase (dolerite) dykes are a common, widespread result of regional mafic magmatism. The rims of most diabase dykes have few or no phenocrysts and crystals in the cores are commonly thought to have crystallized in place. Hence, this major mafic magmatic source did not have crystals, although compositional diversity of these dykes is commonly explained by crystal-liquid separation. This can be resolved if crystallisation was on the walls on the magma chamber. Similarly, most flood basalts are low in crystals and separation of those that are present cannot always explain the observed compositional diversity. Crystal-rich flows do occur, for example the 'Giant Plagioclase Basalts' of the Deccan series, but the crystals are thought to form or accumulate in a crystal-rich zone beneath the roof of the chamber - the rest of the chamber probably has few crystals. Some magmas from Hawaii contain significant amounts of olivine crystals, but most of these are deformed and cannot have crystallised in the chamber. In this case the crystals are thought to grow as the magma passes through a decollement zone. They may have grown on the walls or been trapped by filters. Basaltic andesite ignimbrites generally have few crystals, in contrast to lavas from the same volcanoes. Hence, crystallisation must be a high-level process before eruption. Layering in mafic intrusions has many different origins, but some appears to be the result of crystal settling. If such mineralogical layering is present then so must crystals have been present in the magma. However, it is only necessary that crystals are present in local regions, such as along the floor, walls or roof. All this suggests that most mafic or intermediate magmas in chambers do not have substantial quantities of crystals, except at the peripheries. Felsic (sensu lato) rocks present a rather different story: Although there are many examples of low-crystallinity felsic tuffs and lavas, there are also large ignimbrites with high crystal contents, such as the Fish Canyon tuff. Indeed a 'typical' andesite or dacite is loaded with crystals, generally with long and complex histories. The widespread occurrence of megacrysts in felsic plutonic, and some volcanic, rocks also suggests that crystals are present in magma chambers and can exist for extended periods of time. This would suggest that it is possible, and indeed common, for a felsic magma chamber to have crystals throughout. The difficulty here for differentiation is the high viscosity of such magmas.

  20. Crypto-magma chambers beneath Mt. Fuji

    NASA Astrophysics Data System (ADS)

    Kaneko, Takayuki; Yasuda, Atsushi; Fujii, Toshitsugu; Yoshimoto, Mitsuhiro

    2010-06-01

    Mt. Fuji consists dominantly of basalt. A study of olivine-hosted melt-inclusions from layers of air-fall scoria, however, shows clear evidence of andesitic liquids. Whole rock compositions show a narrow range of SiO 2, but a wide range of FeO*/MgO and incompatible elements. Phenocrystic plagioclase generally shows bi-modal distributions in compositional frequency, while most olivine phenocrysts show uni-modal distribution with reverse zoning and often contain andesitic melt-inclusions. These suggest that magmas erupted from Fuji are generated through mixing between basaltic and more SiO 2-rich (often andesitic) end-members. We propose that Fuji's magmatic plumbing system consists of at least two magma chambers: a relatively deep (˜20 km) basaltic one and a relatively shallow (˜ 8-9 km) and more SiO 2-rich one. Evolved basalts with wide compositional ranges of incompatible elements are generated in the deep basaltic magma chamber by prevalent fractional crystallization of pyroxenes with olivine and calcic plagioclase at high pressure. Meanwhile basaltic magma left behind by the previous eruption in the conduit accumulates in a shallow magma chamber, and is differentiated to more SiO 2-rich composition by fractional crystallization of olivine, less-calcic plagioclase, and clinopyroxene. Shortly before a new eruption, a large amount of evolved basaltic magma containing calcic plagioclase rises from the deeper magma chamber and is mixed with the more SiO 2-rich magma in the shallow chamber, to generate the hybrid basaltic magma.

  1. Digital optical spark chambers

    NASA Technical Reports Server (NTRS)

    Evenson, Paul; Tuska, Evelyn

    1989-01-01

    The authors constructed and tested a prototype digital readout system for optical spark chambers using a linear, solid-state charge-coupled-device detector array. Position resolution of 0.013 mm (sigma) over a 25-cm field of view has been demonstrated. It is concluded that this technique should permit the construction of economical, lightweight and low-power trajectory hodoscopes for use in cosmic-ray instrumentation on balloons and in spacecraft.

  2. Advanced thrust chamber designs

    NASA Technical Reports Server (NTRS)

    Dietrich, F. J.; Leach, A. E.

    1971-01-01

    A regeneratively cooled thrust chamber has been designed and fabricated, consisting of an inner TD nickel liner which was spin formed, welded, and machined and an outer shell of electroformed nickel. Coolant channels were produced in the outer surface of the inner liner by the electric discharge machining process before electroforming the shell. Accessory manifolds and piping were attached by welding. Manufacturing processes employed are described.

  3. Left ventricular mechanoreceptors: a haemodynamic study

    PubMed Central

    Fox, I. J.; Gerasch, D. A.; Leonard, J. J.

    1977-01-01

    1. To study the function of the left ventricular mechanoreceptors, a working left ventricle preparation was devised in dogs which permitted control of pressure and flow of the isolated perfused coronary circulation and of the flow of the isolated, separately perfused systemic circulation. The systemic circulation was perfused at a constant rate so that changes in systemic pressure reflected changes in systemic resistance. 2. Increases in myocardial contractility produced by injection of catecholamines into the isolated, perfused coronary circulation produced a fall in the pressure (resistance) of the isolated, separately perfused (at a constant rate) systemic circulation. 3. Completeness of isolation of the coronary and systemic circulations was shown by the marked difference in appearance times between the reflex hypotensive responses from catecholamine injections into the isolated coronary circulation and the direct hypertensive response from a similar injection when the circulations were connected as well as by the marked difference between the pressure pulses recorded simultaneously on both sides of the aortic balloon separating the two circulations. 4. Myocardial β receptor blockade produced by injection of propranolol into the isolated coronary circulation abolished or attenuated the changes in left ventricular myocardial contractility as well as the subsequent hypotensive responses following the similar injection of catecholamines. 5. Electrical stimulation of a sympathetic nerve innervating the heart resulted in increases in left ventricular myocardial contractility and subsequent systemic hypotensive responses indistinguishable from those following injection of catecholamines. 6. That distortion of the mechano- or stretch receptors in the left ventricular myocardium was the cause of the hypotensive responses was demonstrated by increasing left ventricular myocardial contractility by mechanically obstructing the left ventricular outflow which produced hypotensive responses similar to those following the injection of catecholamines or nerve stimulation. 7. Bilateral high cervical vagotomy abolished the hypotensive responses following injection of catecholamines into the isolated coronary circulation or following left ventricular outflow obstruction in all but one instance, indicating the importance of vagal fibres to the afferent arm of the reflex. 8. It is suggested that the left ventricular mechanoreceptors function normally to reduce the peripheral resistance in order to prepare the systemic circulation to receive the left ventricular output and, especially during exercise, to prepare the systemic circulation to receive the augmented cardiac output with a minimum alteration in the systemic blood pressure and to distribute this augmented output preferentially to the skeletal muscles. PMID:599444

  4. [Giant left atrial myxoma].

    PubMed

    Cruz, J F; Dias, L B; Rodrigues Neto, J O; de Oliveira, S A

    1998-11-01

    A 65 year-old man with dilated cardiomyopathy and long history of high blood pressure and a previous cerebral vascular accident had a giant left atrial myxoma as an echocardiographic finding. PMID:10347957

  5. Left heart catheterization

    MedlinePlus

    Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye will be injected into your ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

  6. FBG sensor for contact level monitoring and prediction of perforation in cardiac ablation.

    PubMed

    Ho, Siu Chun Michael; Razavi, Mehdi; Nazeri, Alireza; Song, Gangbing

    2012-01-01

    Atrial fibrillation (AF) is the most common type of arrhythmia, and is characterized by a disordered contractile activity of the atria (top chambers of the heart). A popular treatment for AF is radiofrequency (RF) ablation. In about 2.4% of cardiac RF ablation procedures, the catheter is accidently pushed through the heart wall due to the application of excessive force. Despite the various capabilities of currently available technology, there has yet to be any data establishing how cardiac perforation can be reliably predicted. Thus, two new FBG based sensor prototypes were developed to monitor contact levels and predict perforation. Two live sheep were utilized during the study. It was observed during operation that peaks appeared in rhythm with the heart rate whenever firm contact was made between the sensor and the endocardial wall. The magnitude of these peaks varied with pressure applied by the operator. Lastly, transmural perforation of the left atrial wall was characterized by a visible loading phase and a rapid signal drop-off correlating to perforation. A possible pre-perforation signal was observed for the epoxy-based sensor in the form of a slight signal reversal (12-26% of loading phase magnitude) prior to perforation (occurring over 8 s). PMID:22368507

  7. Incidental left atrial and ventricular thrombi on routine CT: outcome and influence on subsequent management at an urban tertiary care referral center.

    PubMed

    Cox, Mougnyan; Balasubramanya, Rashmi; Hou, Angela; Deshmukh, Sandeep; Needleman, Laurence

    2015-12-01

    Incidental left-sided cardiac thrombi are occasionally encountered on CT. This study examined clinical findings and outcome in patients with incidental cardiac thrombi on CT. Our image database was reviewed for incidental left-sided cardiac thrombi on CT. These patients' charts were retrospectively reviewed. Thirty-five patients had incidental left-sided cardiac thrombi on CT, 26 of which were ventricular and 9 atrial. Thirty-two thrombi were unknown prior to the CT, and the radiologist interpretation triggered echocardiography or anticoagulation in most cases. Embolic complications occurred in 14 patients, 4 of which were fatal. Twelve patients had concomitant cancer, 6 of which were newly discovered. Incidental left-sided cardiac thrombi on CT appeared to confer substantial morbidity and mortality in our study. In many cases, the cardiac thrombi were new and led to changes in management. A high rate of malignancy was also noted, which may be related to the hypercoagulable state of malignancy. PMID:26324823

  8. A graphite transmission ionization chamber.

    PubMed

    Austerlitz, C; Sibata, C H; de Almeida, C E

    1987-01-01

    A pancake-type transmission chamber made of high-purity graphite and open to the atmosphere has been designed and constructed at the Secondary Standard Dosimetry Laboratory (SSDL-Rio de Janeiro). Tests performed on the chamber following the International Electrotechnical Commission recommendations indicate that its performance characteristics are comparable to those expected from a secondary standard ionization chamber. PMID:3696071

  9. Vertical two chamber reaction furnace

    DOEpatents

    Blaugher, Richard D.

    1999-03-16

    A vertical two chamber reaction furnace. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium-copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700.degree. and 800.degree. C.) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800.degree. to 950.degree. C. to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product.

  10. Vertical two chamber reaction furnace

    DOEpatents

    Blaugher, R.D.

    1999-03-16

    A vertical two chamber reaction furnace is disclosed. The furnace comprises a lower chamber having an independently operable first heating means for heating the lower chamber and a gas inlet means for admitting a gas to create an ambient atmosphere, and an upper chamber disposed above the lower chamber and having an independently operable second heating means for heating the upper chamber. Disposed between the lower chamber and the upper chamber is a vapor permeable diffusion partition. The upper chamber has a conveyor means for conveying a reactant there through. Of particular importance is the thallinating of long-length thallium-barium-calcium copper oxide (TBCCO) or barium-calcium-copper oxide (BCCO) precursor tapes or wires conveyed through the upper chamber to thereby effectuate the deposition of vaporized thallium (being so vaporized as the first reactant in the lower chamber at a temperature between about 700 and 800 C) on TBCCO or BCCO tape or wire (the second reactant) at its simultaneous annealing temperature in the upper chamber of about 800 to 950 C to thereby replace thallium oxide lost from TBCCO tape or wire because of the high annealing temperature or to deposit thallium on BCCO tape or wire. Continuously moving the tape or wire provides a single-step process that effectuates production of long-length TBCCO superconducting product. 2 figs.

  11. Alteration in myocardial prostaglandin D synthase expression in pressure overload-induced left ventricular remodeling in rats.

    PubMed

    Nagalla, Krishna T; Gole, Monica; Claudino, Mario A; Gardner, Jason D; Murray, David B

    2012-01-01

    We hypothesized that acute pharmacological blockade of cyclooxygenase-2 (COX-2) using nimesulide (Nime) would prevent maladaptive changes in left ventricular (LV) structure and function secondary to abdominal aortic coarctation-induced pressure overload (PO). In vivo LV chamber dimension and function were assessed by pressure/volume admittance catheter at 14 days' postsurgery in three groups (n ≥ 6/group): sham-operated (Sham); untreated PO; and selective COX-2 inhibitor nimesulide-treated PO (PO + Nime; 25 mg/kg/d). Treatment was initiated 24 h prior to surgical induction of PO. Relative to Sham, there was a marked increase in LV mass index in the PO groups (2.2 ± 0.01 mg/g versus 2.9 ± 0.10 mg/g Sham versus PO, PO+Nime: 2.5 ± 0.03 mg/g). End diastolic volume, an indicator of chamber size, was significantly decreased in the PO animals compared with Sham (202 ± 17μL versus 143 ± 16 μL Sham versus PO, PO + Nime: 226 ± 9 μL). Collagen levels in PO rats assessed by hydroxyproline analysis were significantly elevated relative to Sham values. Nimesulide treatment attenuated: (1) the increase in LV mass index; (2) the reduction in end diastolic volume; and (3) the PO-induced increase in myocardial collagen. In summary, acute COX-2 inhibition with nimesulide attenuated the maladaptive changes in the LV after PO. Acknowledging the clinical failure of chronic COX-2 inhibitor use, we propose that acute treatment with COX-2 inhibition during the initial stages of cardiac remodeling can be beneficial in maintaining the normal cardiac structure and function during PO. PMID:22228706

  12. IMPACT OF ISOPRENALINE AND CAFFEINE ON DEVELOPMENT OF LEFT VENTRICULAR HYPERTROPHY AND RENAL HEMODYNAMIC IN WISTAR KYOTO RATS.

    PubMed

    Ahmad, Ashfaq; Sattar, Munavvar Z A; Rathore, Hassaan A; Khan, Safia Akhtar; Lazhari, Mohammed A; Hashmi, Fayaz; Abdullah, Nor A; Johns, Edward J

    2015-01-01

    Left ventricular hypertrophy (LVH) is a compensatory mechanism in response to an increased work load on the heart. This study investigated the impact of chronic isoprenaline and caffeine (I/C model) administration on cardiac geometry, systemic hemodynamic and physiological data in rats as LVH develops. LVH was induced by administering isoprenaline (5 mg/kg s.c. every 72 h) and caffeine (62 mg/L) in drinking water for 14 days to Wistar Kyoto (WKY) rats. Mean arterial pressure (MAP), systolic blood pressure (SBP), heart weight, LV weight, LV chamber diameter and thickness of myocardium were observed as LVH indicators. MAP was significantly higher (142 ± 13 vs. 119 ± 2 mmHg, respectively) while heart rate (HR) in LVH was lower (314 ± 9 vs. 264 ± 18 BPM) compared to control WKY. Heart weight, LV weight and kidney weight were 31%, 38% and 7%, respectively, greater in the LVH group as compared to the control WKY (all p < 0.05).The myocardium thickness was 101% greater while LV chamber diameter was 44% smaller in the LVH group as compared to the control WKY (p < 0.05). The superoxide dismutase (SOD), glutathione reductase (GSH) and total antioxidant capacity (T-AOC) levels were significantly reduced while malonodialdehyde (MDA) level increased in LVH as compared to control WKY (all p < 0.05). In conclusion, isoprenaline and caffeine (I/C) induces LVH and cardiac hypertrophy with increases in blood pressure, fluid excretion and reduced renal hemodynamics. Prooxidant mechanism of the body and arterial stiffness are dominant in this disease model. This model of LVH is easily generated and associated with low mortality. PMID:26665409

  13. [Absence of right and left atrioventricular connexion].

    PubMed

    Muñoz-Castellanos, L; Kuri Nivon, M; Vázquez Antona, C A; Salinas Sánchez, H C

    2000-01-01

    Fifty seven hearts with absence of atrioventricular (A-V) connection were studied morphologically to specify their types of ventriculoarterial connection and their associated anomalies; the anatomic features of the hearts were correlated with their echocardiographic and cardioangiographic images in order to establish their mutual correspondence. Fifty six hearts had situs solitus; fifty specimens had right absent A-V connection and six had left absent A-V connection. One had situs inversus. All the specimens had: A deep A-V sulcus at the site of the absent A-V connection, a dimple in the muscular floor of the involved atrium connected with the dilated and hypertrophic left ventricle, incomplete right ventricle without inlet portion, ventricular septal defect of variable dimensions (it was obliterated in two), atrial septal defect, the ventricular septum deviated from the crux cordis. The left absent A-V connection had ventricular inversion and discordant ventriculoarterial connection. In the right absent A-V connection the ventriculoarterial connections were concordant in thirty eight hearts, from which thirty four had pulmonary stenosis both infundibular and valvular (five had the tetrad of Fallot), two had pulmonary valve atresia and two had a dilated pulmonary artery; discordant in nine hearts, one with aortic atresia; double outlet, from the right ventricle in two, (one with the tetrad of Fallot) and from the left ventricle in one. The heart in situs inversus had ventricular inversion, right absent A-V connection (left-sided), single (right) ventricle and atresia of the left ventricle. The correlations between cardiac morphology and imaging were precise. Developmentally, this cardiopathy is the result of an ectopic unequally lateralized septation of the common atrioventricular canal, which separates two canals, one stenotic leading to atresia and the other which develops too wide. PMID:11255713

  14. Successful launch of cardiac transplantation in Japan. Osaka University Cardiac Transplant Program.

    PubMed

    Hori, M; Yamamoto, K; Kodama, K; Takashima, S; Sato, H; Koretsune, Y; Kuzuya, T; Yutani, C; Fukushima, N; Ohtake, S; Shirakura, R; Matsuda, H

    2000-05-01

    Cardiac transplantation has been established as a therapeutic strategy for patients with end-stage heart failure. In Japan, however, cardiac transplantation has not been performed since the first case in 1968, and even now, after legislation for the approval of brain death was passed in 1997, it is still not performed regularly. Following long and steady efforts to enlighten Japanese society about the concept of brain death and the importance of organ transplantation, the first cardiac transplantation under the new legislation was successfully performed at Osaka University Hospital on February 1999. The patient was 47-year-old male in the dilated phase of hypertrophic cardiomyopathy who had been supported with an implantable left ventricular assist device. This article briefly reviews the situation prior to the first case of cardiac transplantation under the new legislation and discusses the current status of the therapy in Japan. PMID:10834446

  15. Thrombosed cor triatriatum sinistrum mimicking left atrial mass and causing unilateral pulmonary edema.

    PubMed

    Gonzalez Lengua, Carlos A; Kumar, Pirkash; Cham, Matthew; Sanz, Javier

    2016-01-01

    46 year old female with history of progressive shortness of breath for 3 years associated with recurrent right lung infiltrates and hemoptisis. A computed tomography of the chest showed a left atrial mass suggestive of atrial myxoma confirmed with transesophageal echocardiogram. Contrary with findings from a dedicated EKG gated cardiac computed tomography suggestive of cor triatriatum with associated thrombus and less likely a neoplasm; findings later on confirmed during surgery. Cardiac CT offers superior spatial resolution and multi-planar image reconstructions, allowing improved characterization of cardiac structures and cardiac masses compared to other traditional cardiovascular imaging modalities. PMID:26537098

  16. Multi-anode ionization chamber

    SciTech Connect

    Bolotnikov, Aleksey E.; Smith, Graham; Mahler, George J.; Vanier, Peter E.

    2010-12-28

    The present invention includes a high-energy detector having a cathode chamber, a support member, and anode segments. The cathode chamber extends along a longitudinal axis. The support member is fixed within the cathode chamber and extends from the first end of the cathode chamber to the second end of the cathode chamber. The anode segments are supported by the support member and are spaced along the longitudinal surface of the support member. The anode segments are configured to generate at least a first electrical signal in response to electrons impinging thereon.

  17. Biventricular Pacing (Cardiac Resynchronization Therapy)

    PubMed Central

    2005-01-01

    Executive Summary Issue In 2002, (before the establishment of the Ontario Health Technology Advisory Committee), the Medical Advisory Secretariat conducted a health technology policy assessment on biventricular (BiV) pacing, also called cardiac resynchronization therapy (CRT). The goal of treatment with BiV pacing is to improve cardiac output for people in heart failure (HF) with conduction defect on ECG (wide QRS interval) by synchronizing ventricular contraction. The Medical Advisory Secretariat concluded that there was evidence of short (6 months) and longer-term (12 months) effectiveness in terms of cardiac function and quality of life (QoL). More recently, a hospital submitted an application to the Ontario Health Technology Advisory Committee to review CRT, and the Medical Advisory Secretariat subsequently updated its health technology assessment. Background Chronic HF results from any structural or functional cardiac disorder that impairs the ability of the heart to act as a pump. It is estimated that 1% to 5% of the general population (all ages) in Europe have chronic HF. (1;2) About one-half of the patients with HF are women, and about 40% of men and 60% of women with this condition are aged older than 75 years. The incidence (i.e., the number of new cases in a specified period) of chronic HF is age dependent: from 1 to 5 per 1,000 people each year in the total population, to as high as 30 to 40 per 1,000 people each year in those aged 75 years and older. Hence, in an aging society, the prevalence (i.e., the number of people with a given disease or condition at any time) of HF is increasing, despite a reduction in cardiovascular mortality. A recent study revealed 28,702 patients were hospitalized for first-time HF in Ontario between April 1994 and March 1997. (3) Women comprised 51% of the cohort. Eighty-five percent were aged 65 years or older, and 58% were aged 75 years or older. Patients with chronic HF experience shortness of breath, a limited capacity for exercise, high rates of hospitalization and rehospitalization, and die prematurely. (2;4) The New York Heart Association (NYHA) has provided a commonly used functional classification for the severity of HF (2;5): Class I: No limitation of physical activity. No symptoms with ordinary exertion. Class II: Slight limitations of physical activity. Ordinary activity causes symptoms. Class III: Marked limitation of physical activity. Less than ordinary activity causes symptoms. Asymptomatic at rest. Class IV: Inability to carry out any physical activity without discomfort. Symptoms at rest. The National Heart, Lung, and Blood Institute estimates that 35% of patients with HF are in functional NYHA class I; 35% are in class II; 25%, class III; and 5%, class IV. (5) Surveys (2) suggest that from 5% to 15% of patients with HF have persistent severe symptoms, and that the remainder of patients with HF is evenly divided between those with mild and moderately severe symptoms. Overall, patients with chronic, stable HF have an annual mortality rate of about 10%. (2) One-third of patients with new-onset HF will die within 6 months of diagnosis. These patients do not survive to enter the pool of those with “chronic” HF. About 60% of patients with incident HF will die within 3 years, and there is limited evidence that the overall prognosis has improved in the last 15 years. To date, the diagnosis and management of chronic HF has concentrated on patients with the clinical syndrome of HF accompanied by severe left ventricular systolic dysfunction. Major changes in treatment have resulted from a better understanding of the pathophysiology of HF and the results of large clinical trials. Treatment for chronic HF includes lifestyle management, drugs, cardiac surgery, or implantable pacemakers and defibrillators. Despite pharmacologic advances, which include diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, spironolactone, and digoxin, many patients remain symptomatic on maximally tolerated doses. The Technology Owing to the limitations of drug therapy, cardiac transplantation and device therapies have been used to try to improve QoL and survival of patients with chronic HF. Ventricular pacing is an emerging treatment option for patients with severe HF that does not respond well to medical therapy. Traditionally, indications for pacing include bradyarrhythmia, sick sinus syndrome, atrioventricular block, and other indications, including combined sick sinus syndrome with atrioventricular block and neurocardiogenic syncope. Recently, BiV pacing as a new, adjuvant therapy for patients with chronic HF and mechanical dyssynchrony has been investigated. Ventricular dysfunction is a sign of HF; and, if associated with severe intraventricular conduction delay, it can cause dyssynchronous ventricular contractions resulting in decreased ventricular filling. The therapeutic intent is to activate both ventricles simultaneously, thereby improving the mechanical efficiency of the ventricles. About 30% of patients with chronic HF have intraventricular conduction defects. (6) These conduction abnormalities progress over time and lead to discoordinated contraction of an already hemodynamically compromised ventricle. Intraventricular conduction delay has been associated with clinical instability and an increased risk of death in patients with HF. (7) Hence, BiV pacing, which involves pacing left and right ventricles simultaneously, may provide a more coordinated pattern of ventricular contraction and thereby potentially reduce QRS duration, and intraventricular and interventricular asynchrony. People with advanced chronic HF, a wide QRS complex (i.e., the portion of the electrocardiogram comprising the Q, R, and S waves, together representing ventricular depolarization), low left ventricular ejection fraction and contraction dyssynchrony in a viable myocardium and normal sinus rhythm, are the target patients group for BiV pacing. One-half of all deaths in HF patients are sudden, and the mode of death is arrhythmic in most cases. Internal cardioverter defibrillators (ICDs) combined with BiV pacemakers are therefore being increasingly considered for patients with HF who are at high risk of sudden death. Current Implantation Technique for Cardiac Resynchronization Conventional dual-chamber pacemakers have only 2 leads: 1 placed in the right atrium and the other in the right ventricle. The technique used for BiV pacemaker implantation also uses right atrial and ventricular pacing leads, in addition to a left ventricle lead advanced through the coronary sinus into a vein that runs along the ventricular free wall. This permits simultaneous pacing of both ventricles to allow resynchronization of the left ventricle septum and free wall. Mode of Operation Permanent pacing systems consist of an implantable pulse generator that contains a battery and electronic circuitry, together with 1 (single-chamber pacemaker) or 2 (dual-chamber pacemaker) leads. Leads conduct intrinsic atrial or ventricular signals to the sensing circuitry and deliver the pulse generator charge to the myocardium (muscle of the heart). Complications of Biventricular Pacemaker Implantation The complications that may arise when a BiV pacemaker is implanted are similar to those that occur with standard pacemaker implantation, including pneumothorax, perforation of the great vessels or the myocardium, air embolus, infection, bleeding, and arrhythmias. Moreover, left ventricular pacing through the coronary sinus can be associated with rupture of the sinus as another complication. Conclusion of 2003 Review of Biventricular Pacemakers by the Medical Advisory Secretariat The randomized controlled trials (RCTs) the Medical Advisory Secretariat retrieved analyzed chronic HF patients that were assessed for up to 6 months. Other studies have been prospective, but nonrandomized, not double-blinded, uncontrolled and/or have had a limited or uncalculated sample size. Short-term studies have focused on acute hemodynamic analyses. The authors of the RCTs reported improved cardiac function and QoL up to 6 months after BiV pacemaker implantation; therefore, there is level 1 evidence that patients in ventricular dyssynchrony who remain symptomatic after medication might benefit from this technology. Based on evidence made available to the Medical Advisory Secretariat by a manufacturer, (8) it appears that these 6-month improvements are maintained at 12-month follow-up. To date, however, there is insufficient evidence to support the routine use of combined ICD/BiV devices in patients with chronic HF with prolonged QRS intervals. Summary of Updated Findings Since the 2003 Review Since the Medical Advisory Secretariat’s review in 2003 of biventricular pacemakers, 2 large RCTs have been published: COMPANION (9) and CARE-HF. (10) The characteristics of each trial are shown in Table 1. The COMPANION trial had a number of major methodological limitations compared with the CARE-HF trial. Table 1: Characteristics of the COMPANION and CARE-HF Trials* COMPANION, 2004 CARE-HF, 2005 Optimal Therapy vs. BiV Pacing vs. BiV Pacing/ICD† Optimal Therapy vs. BiV Pacing Population New York Heart Association class III/IV heart failure EF† ≤ 0.35 QRS† ≥ 120 ms N 1,520(optimal therapy, n = 308; BiV pacing, n = 617; BiV pacing/ICD, n = 595) 813 Follow-up (months) Median, 16 Mean, 29 Comment - Definition of “hospitalization” in primary outcome changed 3 times during trial w/o documentation in protocol and FDA† not notified (dominant outcome for composite endpoint).- Dropouts/withdrawals/crossovers not clearly described.- Study terminated early.- No direct comparison between BiV pacing vs. BiV pacing/ICD.- High number of patients withdrew from optimal therapy to device arms.- Not blinded. Not blinded * COMPANION; (9) CARE-HF. (10) † BiV indicates biventricular; ICD, implantable cardioverter defibrillator; EF, ejection fraction; QRS, the interval representing the Q, R and S waves on an electrocardiogram; FDA, United States Food and Drug Administration. Overall, CARE-HF showed that BiV pacing significantly improves mortality, QoL, and NYHA class in patients with severe HF and a wide QRS interval (Tables 2 and 3). Table 2: CARE-HF Results: Primary and Secondary Endpoints* Outcome Medical Therapy Alone(N = 404) Medical Therapy and BiV† Pacing†(N = 409) Hazard Ratio (95% CI) P NNT† No. (%) Patients No. (%) Patients Primary (Combined Endpoint) Death (any cause) or unplanned hospitalization for major cardiovascular event. 224 (55) 159 (39) 0.63 (0.51–0.77) < .001 6 Secondary Death (any cause) at 29 months 120 (30) 82 (20) 0.64 (0.48–0.85) < .002 10 0.60 (0.47–0.77) (at 36 months – grey literature) (11) 154 (38) 101 (25) < .0001 7 Death from any cause or unplanned hospitalization with worsening HF 191 (47) 118 (29) 0.54 (0.43–0.68) < .001 6 † BiV indicates biventricular; NNT, number needed to treat. * Cleland JGF, Daubert J, Erdmann E, Freemantle N, Gras D, Kappenberger L et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure (CARE-HF). New England Journal of Medicine 2005; 352:1539-1549; Copyright 2003 Massachusettes Medical Society. All rights reserved. (10) Table 3: CARE H-F Results: NYHA Class and Quality of Life Scores* Outcome Medical Therapy Alone(N = 404) Medical Therapy and BiV Pacing(N = 409) Difference in Means P (95% CI) Mean (SD) at 90 days Mean (SD) at 90 days NYHA class 2.7 (0.9) 2.1 (1.0) 0.6 < .001 (0.4–0.7) Minnesota Living with Heart 40 (22) 31 (22) -10 < .001 Failure score† (-8 to -12) EuroQoL EQ-5D score‡ 0.63 (0.29) 0.70 (0.28) 0.08 < .001 (0.04–0.12) † Minnesota Living with Heart Failure scores range from 0 to 105; higher scores reflect poorer QoL. ‡ European Quality of Life–5 Dimensions scores range from -0.594 to 1.000; 1.000 indicates fully healthy; 0, dead * Cleland JGF, Daubert J, Erdmann E, Freemantle N, Gras D, Kappenberger L et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure (CARE-HF). New England Journal of Medicine 2005; 352:1539-1549; Copyright 2005 Massachusettes Medical Society. All rights reserved.(10) GRADE Quality of Evidence The quality of these 3 trials was examined according to the GRADE Working Group criteria, (12) (Table 4). Quality refers to criteria such as the adequacy of allocation concealment, blinding, and follow-up. Consistency refers to the similarity of estimates of effect across studies. If there is an important unexplained inconsistency in the results, confidence in the estimate of effect for that outcome decreases. Differences in the direction of effect, the size of the differences in effect, and the significance of the differences guide the decision about whether important inconsistency exists. Directness refers to the extent to which the people interventions and outcome measures are similar to those of interest. For example, there may be uncertainty about the directness of the evidence if the people of interest are older, sicker, or have more comorbid conditions than do the people in the studies. As stated by the GRADE Working Group, (12) the following definitions were used in grading the quality of the evidence: High: Further research is very unlikely to change our confidence on the estimate of effect. Moderate: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low: Any estimate of effect is very uncertain. Table 4: Quality of Evidence: CARE-HF and COMPANION Trial Design Quality Consistency Directness Quality Grade CARE-HF RCT Not blinded. No important inconsistency. Direct. Moderate/High (BiV pacing only vs. medical therapy) Consistent with COMPANION in terms of mortality results.Consistent with previous studies regarding QoL and functional status results. COMPANION(BiV pacing only vs. combined BiV pacing/ICD vs. medical therapy) RCT Definition of “hospitalization” in primary outcome changed 3 times during trial without documentation in protocol and FDA not notified (dominant outcome for composite endpoint).Dropouts/withdrawals/crossovers not clearly described.Study terminated early.No direct comparison between BiV pacing vs. BiV pacing/ICD.High number of patients withdrew from optimal therapy to device arms.Not blinded. No important inconsistency for BiV pacing only.No other RCT prospectively examined the combined BiV pacing/ICD device in patients with NYHA III/IV HF and QRS > 120 ms and EF < 0.35 and refractory to drugs.No other RCT prospectively examined the prophylactic use of ICDs in patients with NYHA IV HF. Direct for BiV pacing only.No other RCT examined the prophylactic use of ICDs in patients with NYHA IV HF. Low Conclusions Overall, there is evidence that BiV pacemakers are effective for improving mortality, QoL, and functional status in patients with NYHA class III/IV HF, an EF less than 0.35, a QRS interval greater than 120 ms, who are refractory to drug therapy. As per the GRADE Working Group, recommendations considered the following 4 main factors: The tradeoffs, taking into account the estimated size of the effect for the main outcome, the confidence limits around those estimates, and the relative value placed on the outcome The quality of the evidence (Table 4) Translation of the evidence into practice in a specific setting, taking into consideration important factors that could be expected to modify the size of the expected effects such as proximity to a hospital or availability of necessary expertise Uncertainty about the baseline risk for the population of interest The GRADE Working Group also recommends that incremental costs of health care alternatives should be considered explicitly alongside the expected health benefits and harms. Recommendations rely on judgments about the value of the incremental health benefits in relation to the incremental costs. The last column in Table 5 shows the overall trade-off between benefits and harms and incorporates any risk/uncertainty. For BiV pacing, the overall GRADE and strength of the recommendation is moderate: the quality of the evidence is moderate/high (because of some uncertainty due to methodological limitations in the study design, e.g., no blinding), but there is also some risk/uncertainty in terms of the estimated prevalence and wide cost-effectiveness estimates (Table 5). For the combination BiV pacing/ICD, the overall GRADE and strength of the recommendation is weak—the quality of the evidence is low (because of uncertainty due to methodological limitations in the study design), but there is also some risk/uncertainty in terms of the estimated prevalence, high cost, and high budget impact (Table 5). There are indirect, low-quality comparisons of the effectiveness of BiV pacemakers compared with the combination BiV/ICD devices. A stronger recommendation can be made for BiV pacing only compared with the combination BiV/ICD device for patients with an EF less than or equal to 0.35, and a QRS interval over or equal to 120 ms, and NYHA III/IV symptoms, and refractory to optimal medical therapy (Table 5). There is moderate/high-quality evidence that BiV pacemakers significantly improve mortality, QoL, and functional status. There is low-quality evidence that combined BiV/ICD devices significantly improve mortality, QoL, and functional status. To date, there are no direct comparisons of the effectiveness of BiV pacemakers compared with the combined BiV/ICD devices in terms of mortality, QoL, and functional status. Table 5: Overall GRADE and Strength of Recommendation Quality Estimated Prevalence, Ontario NNT*Death (Any Cause) Cost-Effectiveness Cost in Ontario$(Millions) Overall Grade & Strength of Recommendation (Including Uncertainty) BiV* Pacing Moderate/high ~2,560 7 $7,000 to $59,000/QALY* 38–46~14–16/year over 4 years Moderate BiV Pacing/ICD* LowMajor study limitations ~2,560 14 ?Low quality data 74–82~27–29/year over 4 years Weak * BiV refers to biventricular; ICD, implantable cardioverter defibrillator; NNT, number needed to treat. PMID:23074464

  18. Left ventricle of mammalian hearts optimzed for high hydrodynamic efficiency

    NASA Astrophysics Data System (ADS)

    Ge, Liang; Azadani, Ali; Tseng, Elaine

    2009-11-01

    Mammalian hearts have four chambers: two atria (left and right) and two ventricles (left and right). The left ventricle (LV) is the primary pumping engine that pumps blood to all end organs of the body. The energetic efficiency of LV is therefore crucial for life. An important factor that contributes to the overall LV pumping efficiency is the hydrodynamic cost of blood flow within the LV chamber. LV blood flow is created by the cyclical expansion/contraction motion of LV wall and its hydrodynamic cost is certainly affected by the geometry and motion of LV wall. In this work we investigated the relationship between the hydrodynamic cost of LV filling/ejecting and LV geometry/motion and showed that the geometry and motion of mammalian hearts were optimized to minimize the hydrodynamic cost of LV blood flow.

  19. Determinants of Right Ventricular Muscle Mass in Idiopathic Dilated Cardiomyopathy: Impact of Left Ventricular Muscle Mass and Pulmonary Hypertension

    PubMed Central

    Vormbrock, Julia; Liebeton, Jeanette; Wirdeier, Sophia; Meissner, Axel; Butz, Thomas; Trappe, Hans-Joachim; Plehn, Gunnar

    2014-01-01

    Introduction: Although chronic pulmonary hypertension and right ventricular (RV) function carry important functional and prognostic implications in idiopathic dilated cardiomyopathy (IDC), little information on RV muscle mass (RVMM) and its determinants has been published. Methods: Our study comprised thirty-five consecutive patients with IDC, left ventricular (LV) ejection fraction <40% and NYHA class ≥2. Hemodynamic data and parameters on LV and RV geometry were derived from right heart catheterisation and cardiac magnetic resonance imaging. Results: RVMM was normalized to body size using a common linear, body surface area based approach (RVMMI) and by an allometric index (RVMM-AI) incorporating adjustment for age, height and weight. Stepwise multiple regression analysis revealed that pulmonary artery pressure and left ventricular muscle mass were independent predictors of RVMM-AI. The interventricular mass ratio of RV and LV mass (IVRM) was closely related to RVMM (r = 0.79, p < 0.001) and total muscle mass (r = 0.39, p < 0.02). However, there was no significant relationship between LVMM and IVMR (r = 0.17, p = 0.32). Conclusion: Our data suggest that an increase in RV mass in IDC may be explained by two mechanisms: First, as a consequence of the myopathic process itself resulting in a balanced hypertrophy of both ventricles. Second, due to the chamber specific burden of pulmonary artery pressure rise, resulting in unbalanced RV hypertrophy. PMID:24936147

  20. Left ventricular Doppler filling pattern in dilated cardiomyopathy: relation to hemodynamics and left atrial function.

    PubMed

    Ito, T; Suwa, M; Otake, Y; Moriguchi, A; Hirota, Y; Kawamura, K

    1997-06-01

    This study attempted to examine the relation of left ventricular filling patterns to hemodynamic status and left atrial function in dilated cardiomyopathy. Transesophageal echocardiography and cardiac catheterization were performed in 41 patients with dilated cardiomyopathy (six with an ischemic origin). Transmitral, left atrial appendage, and pulmonary venous flow velocities were recorded with the pulsed Doppler method. Left atrial systolic function was assessed by the peak velocity of the left atrial appendage emptying wave and pulmonary venous flow reversal during atrial systole. Patients were classified into three groups according to their left ventricular filling patterns. Group 1 showed an abnormal relaxation pattern (E wave/A wave ratio <1, n = 17), group 2 had a normal or pseudonormal pattern (1 < or = E/A < 2, n = 11), and group 3 had a restrictive pattern (E/A > or = 2, n = 13). No differences were found among the groups with regard to age, gender, heart rate, and M-mode echocardiographic indices of left ventricular function. Compared with patients in group 1, those in groups 2 and 3 had more symptoms (New York Heart Association functional class III or IV) and had higher left ventricular filling pressures. The sensitivity of an E/A ratio > or = 1 for predicting a pulmonary capillary wedge pressure > or = 15 mm Hg was 75% and the specificity was 94%. Despite a similar increase of filling pressures, group 3 patients had a lower left atrial appendage emptying velocity, pulmonary venous flow reversal velocity, and mitral A velocity than did group 2 patients. The sensitivity and specificity of an E/A ratio > or = 22 for detecting left atrial dysfunction (left atrial appendage emptying velocity < or = 40 cm/sec) was 85% and 86%, respectively. In conclusion, among patients with dilated cardiomyopathy, those who had a restrictive or pseudonormal filling pattern were in a higher functional class and had higher filling pressures. Further studies are needed to determine the therapeutic and prognostic significance of left atrial dysfunction, which was common in patients with a restrictive pattern. PMID:9203491

  1. Ionization chamber dosimeter

    DOEpatents

    Renner, Tim R.; Nyman, Mark A.; Stradtner, Ronald

    1991-01-01

    A method for fabricating an ion chamber dosimeter collecting array of the type utilizing plural discrete elements formed on a uniform collecting surface which includes forming a thin insulating layer over an aperture in a frame having surfaces, forming a predetermined pattern of through holes in the layer, plating both surfaces of the layer and simultaneously tilting and rotating the frame for uniform plate-through of the holes between surfaces. Aligned masking and patterned etching of the surfaces provides interconnects between the through holes and copper leads provided to external circuitry.

  2. Anterior chamber keratinous horn.

    PubMed

    Abrishami, Mojtaba; Ghassemi, Fariba; Vahedian, Zakieh

    2014-06-01

    A 14-year-old boy presented with a 6-month history of small white masses in his right eye. Examination revealed a white floating fluffy lesion and 2 vegetative hornlike white lesions originating at the periphery of the iris. On ultrasound biomicroscopy, a normal echogenic mass was detected on the inferior iris root and angle, with no posterior chamber or cilliary body involvement. Histopathology following an excisional biopsy revealed keratinous material. There was no recurrence during 10 months of follow-up. PMID:24797250

  3. Clinical Assessment and Implication of Left Ventricular Mechanical Dyssynchrony in Patients with Heart Failure

    PubMed Central

    Chan, Yi-Hsin; Wang, Chun-Li; Kuo, Chi-Tai; Yeh, Yung-Hsin; Wu, Chia-Tung; Wu, Lung-Sheng

    2013-01-01

    There have been numerous studies focusing on the assessment of left ventricular mechanical dyssynchrony. These studies are diverse in their purposes, which include more effectively predicting the response to cardiac resynchronization therapy, improving the guidance of the left ventricular lead position, and better prediction of outcome in patients with heart failure. This article reviews the current assessment methods, clinical applications and limitations of left ventricular dyssynchrony indices derived from echocardiography, magnetic resonance imaging and radionuclide imaging in patients with heart failure. PMID:27122751

  4. Prompt Recognition of Left Ventricular Free-Wall Rupture Aided by the Use of Contrast Echocardiography

    PubMed Central

    Okabe, Toshimasa; Julien, Howard M.; Kaliyadan, Antony G.; Siu, Henry

    2015-01-01

    In the modern period of reperfusion, left ventricular free-wall rupture occurs in less than 1% of myocardial infarctions. Typically, acute left ventricular free-wall rupture leads to sudden death from immediate cardiac tamponade. We present the case of a 59-year-old woman who sustained a posterior-wall myocardial infarction and subsequent cardiac arrest with pulseless electrical activity. A bedside transthoracic echocardiogram showed pericardial effusion with cardiac tamponade. Emergency pericardiocentesis yielded 500 mL of blood, and spontaneous circulation returned. Contrast-enhanced echocardiograms revealed inferolateral akinesis and a new, small myocardial slit with systolic extrusion of contrast medium, consistent with left ventricular free-wall rupture. During immediate open-heart surgery, a small hole in an area of necrotic tissue was discovered and repaired. This case highlights the usefulness of bedside contrast-enhanced echocardiography in confirming acute left ventricular free-wall rupture and enabling rapid surgical treatment. PMID:26504446

  5. Review of wire chamber aging

    SciTech Connect

    Va'Vra, J.

    1986-02-01

    This paper makes an overview of the wire chamber aging problems as a function of various chamber design parameters. It emphasizes the chemistry point of view and many examples are drawn from the plasma chemistry field as a guidance for a possible effort in the wire chamber field. The paper emphasizes the necessity of variable tuning, the importance of purity of the wire chamber environment, as well as it provides a practical list of presently known recommendations. In addition, several models of the wire chamber aging are qualitatively discussed. The paper is based on a summary talk given at the Wire Chamber Aging Workshop held at LBL, Berkeley on January 16-17, 1986. Presented also at Wire Chamber Conference, Vienna, February 25-28, 1986. 74 refs., 18 figs., 11 tabs.

  6. Rotational X-ray angiography: a method for intra-operative volume imaging of the left-atrium and pulmonary veins for atrial fibrillation ablation guidance

    NASA Astrophysics Data System (ADS)

    Manzke, R.; Zagorchev, L.; d'Avila, A.; Thiagalingam, A.; Reddy, V. Y.; Chan, R. C.

    2007-03-01

    Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired imaging data and can be of sufficient quality for intra-operative guidance.

  7. Cardiac atrophy after bed-rest deconditioning: a nonneural mechanism for orthostatic intolerance

    NASA Technical Reports Server (NTRS)

    Levine, B. D.; Zuckerman, J. H.; Pawelczyk, J. A.; Blomqvist, C. G. (Principal Investigator)

    1997-01-01

    BACKGROUND: The cardiovascular adaptation to bed rest leads to orthostatic intolerance, characterized by an excessive fall in stroke volume (SV) in the upright position. We hypothesized that this large fall in SV is due to a change in cardiac mechanics. METHODS AND RESULTS: We measured pulmonary capillary wedge pressure (PCWP), SV, left ventricular end-diastolic volume (LVEDV), and left ventricular mass (by echocardiography) at rest, during lower-body negative pressure, and after saline infusion before and after 2 weeks of bed rest with -6 degrees head-down tilt (n=12 subjects aged 24+/-5 years). Pressure (P)-volume (V) curves were modeled exponentially by P=ae(kV)+b and logarithmically by P=-Sln[(Vm-V)/(Vm-V0)], where V0 indicates volume at P=0, and the constants k and S were used as indices of normalized chamber stiffness. Dynamic stiffness (dP/dV) was calculated at baseline LVEDV. The slope of the line relating SV to PCWP during lower-body negative pressure characterized the steepness of the Starling curve. We also measured plasma volume (with Evans blue dye) and maximal orthostatic tolerance. Bed rest led to a reduction in plasma volume (17%), baseline PCWP (18%), SV (12%), LVEDV (16%), V0 (33%), and orthostatic tolerance (24%) (all P<.05). The slope of the SV/PCWP curve increased from 4.6+/-0.4 to 8.8+/-0.9 mL/mm Hg (P<.01) owing to a parallel leftward shift in the P-V curve. Normalized chamber stiffness was unchanged, but dP/dV was reduced by 50% at baseline LVEDV, and cardiac mass tended to be reduced by 5% (P<.10). CONCLUSIONS: Two weeks of head-down-tilt bed rest leads to a smaller, less distensible left ventricle but a shift to a more compliant portion of the P-V curve. This results in a steeper Starling relationship, which contributes to orthostatic intolerance by causing an excessive reduction in SV during orthostasis.

  8. Heart failure due to tension hydrothorax after left pneumonectomy.

    PubMed

    Maguire, Kim; Leung, Calvin; Kodali, Visali; Taylor, Brice; Fontaine, Jacques-Pierre; Rojas, Carlos A; Guglin, Maya

    2013-12-01

    Tension hydrothorax is a rare complication of pneumonectomy for pleural mesothelioma and an exceptionally rare cause of heart failure. We describe a patient who had undergone extrapleural pneumonectomy, chemotherapy, and radiation for pleural mesothelioma and who developed heart failure symptoms within months of the completion of treatment. Investigation showed a massive left pleural effusion resulting in tension hydrothorax, mediastinal shift, and evidence of right heart failure with constrictive physiology and low cardiac output. Therapeutic thoracentesis resulted in increase in cardiac output and symptomatic improvement. PMID:24370800

  9. Left Ventricular Non-compaction in Holt-Oram Syndrome.

    PubMed

    Kapadia, Renuka; Choudhary, Preeti; Collins, Nicholas; Celermajer, David; Puranik, Rajesh

    2016-06-01

    Holt-Oram Syndrome is an autosomal dominant condition with complete penetrance and which involves upper limb skeletal and cardiac abnormalities. The latter can be structural defects or involve the conduction system. This report details the occurrence of left ventricular non-compaction in multiple family members with Holt-Oram Syndrome. It is recommended that patients with the Holt-Oram Syndrome be considered for comprehensive cardiac evaluation to exclude non-compaction cardiomyopathy as this may have significant prognostic implications. PMID:26874791

  10. Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation.

    PubMed

    Menting, Myrthe E; van Grootel, Roderick W J; van den Bosch, Annemien E; Eindhoven, Jannet A; McGhie, Jackie S; Cuypers, Judith A A E; Witsenburg, Maarten; Helbing, Willem A; Roos-Hesselink, Jolien W

    2016-05-01

    Despite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with patient and echocardiographic characteristics. In this cross-sectional study, patients with repaired CoA and healthy controls were recruited prospectively. All subjects underwent echocardiography, ECG and blood sampling within 1 day. With speckle-tracking echocardiography, we assessed LV GLS on the apical four-, three- and two-chamber views. We included 150 subjects: 75 patients (57 % male, age 33.4 ± 12.8 years, age at repair 2.5 [IQR: 0.1-11.1] years) and 75 healthy controls of similar sex and age. LV GLS was lower in patients than in controls (-17.1 ± 2.3 vs. -20.2 ± 1.6 %, P < 0.001). Eighty percent of the patients had a normal LV ejection fraction, but GLS was still lower than in controls (P < 0.001). In patients, GLS correlated with systolic and diastolic blood pressure (r = 0.32, P = 0.009; r = 0.31, P = 0.009), QRS duration (r = 0.34, P = 0.005), left atrial dimension (r = 0.27, P = 0.029), LV mass (r = 0.30, P = 0.014) and LV ejection fraction (r = -0.48, P < 0.001). Patients with either associated cardiac lesions, multiple cardiac interventions or aortic valve replacement had lower GLS than patients without. Although the majority of adults with repaired CoA seem to have a normal systolic LV function, LV GLS was decreased. Higher blood pressure, associated cardiac lesions, and larger left atrial dimension are related with lower GLS. Therefore, LV GLS may be used as objective criterion for early detection of ventricular dysfunction. PMID:26780661

  11. Cardiac Risk Assessment

    MedlinePlus

    ... helpful? Formal name: Cardiac Risk Assessment Related tests: Lipid Profile , VLDL Cholesterol , hs-CRP , Lp(a) Overview | Common ... on Coronary artery disease: Tests and diagnosis .) The lipid profile is the most important blood test for cardiac ...

  12. 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 ...

  13. Cardiac biomarkers in cats.

    PubMed

    Borgeat, K; Connolly, D J; Luis Fuentes, V

    2015-12-01

    Cardiac biomarkers have been used in cats as part of the clinical assessment of heart disease for over a decade. They are widely available to practitioners through commercial reference laboratories. The evidence base for the use of cardiac biomarkers (primarily N-terminal pro-B type natriuretic peptide and cardiac troponin I) in cats is comprehensively reviewed in this article, focusing on each of six specific areas: distinguishing cardiac from non-cardiac causes of respiratory distress; measurement of cardiac biomarkers in urine and pleural fluid; identification of occult cardiomyopathy; effects of systemic disease on circulating concentrations of cardiac biomarkers; point-of-care biomarker testing, and the possible prognostic utility of cardiac biomarker measurement. PMID:26776596

  14. Three-dimensional left ventricular segmentation from magnetic resonance imaging for patient-specific modelling purposes

    PubMed Central

    Caiani, Enrico G.; Colombo, Andrea; Pepi, Mauro; Piazzese, Concetta; Maffessanti, Francesco; Lang, Roberto M.; Carminati, Maria Chiara

    2014-01-01

    Aims To propose a nearly automated left ventricular (LV) three-dimensional (3D) surface segmentation procedure, based on active shape modelling (ASM) and built on a database of 3D echocardiographic (3DE) LV surfaces, for cardiac magnetic resonance (CMR) images, and to test its accuracy for LV volumes computation compared with ‘gold standard’ manual tracings and discs-summation method. Methods and results The ASM was created based on segmented LV surfaces (4D LV analysis, Tomtec) from 3DE datasets of 205 patients. Then, it was applied to the cardiac magnetic resonance imaging short-axis (SAX) images stack of 12 consecutive patients. After proper realignment using two- and four-chambers CMR long-axis views both as reference and for initializing LV apex and base (six points in total), the ASM was iteratively and automatically updated to match the information of all the SAX planes contemporaneously, resulting in an endocardial LV 3D mesh from which volume was directly derived. The same CMR images were analysed by an experienced cardiologist to derive end-diastolic and end-systolic volumes. Linear correlation and Bland–Altman analyses were applied vs. the manual ‘gold standard’. Active shape modelling results showed high correlations with manual values both for LV volumes (r2 > 0.98) and ejection fraction (EF) (r2 > 0.90), non-significant biases and narrow limits of agreement. Conclusion The proposed method resulted in accurate detection of 3D LV endocardial surfaces, which lead to fast and reliable measurements of LV volumes and EF when compared with manual tracing of CMR SAX images. The segmented 3D mesh, including a realistic LV apex and base, could constitute a novel starting point for more realistic patient-specific finite element modelling. PMID:25362176

  15. CARDIAC COMPLICATIONS OF CHEMOTHERAPY: ROLE OF IMAGING

    PubMed Central

    Tan, Timothy C.; Scherrer-Crosbie, Marielle

    2014-01-01

    Opinion Statement New advances in cancer diagnosis and treatment have increased survival rates in patients with cancer. In parallel with the increase in the number of cancer survivors is an increasing prevalence of cardiac complications from cancer treatment. Chemotherapy-induced cardiac dysfunction is a major contributor to adverse morbidity and mortality rates in cancer patients. Evidence suggests that both clinical symptoms and the traditional left ventricular ejection fraction (LVEF) may lack sensitivity as measures of cardiotoxicity. The early identification of subclinical LV dysfunction is becoming increasingly important, as this may allow cancer patients and their physicians to make informed decisions about therapeutic options. The features of echocardiography make it a useful tool in the diagnosis and monitoring of cardiotoxicity. This review will examine the role of cardiac imaging in detecting cardiotoxicity, focusing primarily on the conventional and more recent echocardiographic approaches for assessing subclinical cardiotoxicity. PMID:24519487

  16. Malignant pericardial effusion and cardiac tamponade.

    PubMed

    Pinto, M M

    1986-01-01

    Cardiac tamponade due to malignant effusion, though rarely the initial manifestation of malignancy, is usually secondary to adenocarcinoma of the lung. Two cases are reported. One patient presented with cardiac tamponade; the other had diffuse cutaneous involvement of the left neck and shoulder two months before he presented with cardiac tamponade. Cytologic examination of both fluids revealed adenocarcinoma. Ultrastructural examination showed poorly differentiated adenocarcinoma in the first patient and bronchioloalveolar carcinoma in the second; carcinoembryonic antigen levels in the fluids were 9.4 ng/mL and over 60 ng/mL, respectively. The computed tomographic (CT) scans of both patients revealed mediastinal fullness with no lung involvement. Even in the absence of a pulmonary mass, lung carcinoma may be the likely primary in patients with malignant pericardial effusions. PMID:3024432

  17. Cardiac surgery in the parturient.

    PubMed

    Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D

    2009-03-01

    Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management. PMID:19224782

  18. Circulating angiotensin II deteriorates left ventricular function with sympathoexcitation via brain angiotensin II receptor

    PubMed Central

    Shinohara, Keisuke; Kishi, Takuya; Hirooka, Yoshitaka; Sunagawa, Kenji

    2015-01-01

    Sympathoexcitation contributes to the progression of heart failure. Activation of brain angiotensin II type 1 receptors (AT1R) causes central sympathoexcitation. Thus, we assessed the hypothesis that the increase in circulating angiotensin II comparable to that reported in heart failure model affects cardiac function through the central sympathoexcitation via activating AT1R in the brain. In Sprague-Dawley rats, the subcutaneous infusion of angiotensin II for 14 days increased the circulating angiotensin II level comparable to that reported in heart failure model rats after myocardial infarction. In comparison with the control, angiotensin II infusion increased 24 hours urinary norepinephrine excretion, and systolic blood pressure. Angiotensin II infusion hypertrophied left ventricular (LV) without changing chamber dimensions while increased end-diastolic pressure. The LV pressure–volume relationship indicated that angiotensin II did not impact on the end-systolic elastance, whereas significantly increased end-diastolic elastance. Chronic intracerebroventricular infusion of AT1R blocker, losartan, attenuated these angiotensin II-induced changes. In conclusion, circulating angiotensin II in heart failure is capable of inducing sympathoexcitation via in part AT1R in the brain, subsequently leading to LV diastolic dysfunction. PMID:26290529

  19. The Clinical Benefits of Adding a Third Dimension to Assess the Left Ventricle with Echocardiography

    PubMed Central

    Badano, Luigi P.

    2014-01-01

    Three-dimensional echocardiography is a novel imaging technique based on acquisition and display of volumetric data sets in the beating heart. This permits a comprehensive evaluation of left ventricular (LV) anatomy and function from a single acquisition and expands the diagnostic possibilities of noninvasive cardiology. It provides the possibility of quantitating geometry and function of LV without preestablished assumptions regarding cardiac chamber shape and allows an echocardiographic assessment of the LV that is less operator-dependent and therefore more reproducible. Further developments and improvements for widespread routine applications include higher spatial and temporal resolution to improve image quality, faster acquisition, processing and reconstruction, and fully automated quantitative analysis. At present, three-dimensional echocardiography complements routine 2DE in clinical practice, overcoming some of its limitations and offering additional valuable information that has led to recommending its use for routine assessment of the LV of patients in whom information about LV size and function is critical for their clinical management. PMID:24959374

  20. Left ventricular endocardial surface detection based on real-time 3D echocardiographic data

    NASA Technical Reports Server (NTRS)

    Corsi, C.; Borsari, M.; Consegnati, F.; Sarti, A.; Lamberti, C.; Travaglini, A.; Shiota, T.; Thomas, J. D.

    2001-01-01

    OBJECTIVE: A new computerized semi-automatic method for left ventricular (LV) chamber segmentation is presented. METHODS: The LV is imaged by real-time three-dimensional echocardiography (RT3DE). The surface detection model, based on level set techniques, is applied to RT3DE data for image analysis. The modified level set partial differential equation we use is solved by applying numerical methods for conservation laws. The initial conditions are manually established on some slices of the entire volume. The solution obtained for each slice is a contour line corresponding with the boundary between LV cavity and LV endocardium. RESULTS: The mathematical model has been applied to sequences of frames of human hearts (volume range: 34-109 ml) imaged by 2D and reconstructed off-line and RT3DE data. Volume estimation obtained by this new semi-automatic method shows an excellent correlation with those obtained by manual tracing (r = 0.992). Dynamic change of LV volume during the cardiac cycle is also obtained. CONCLUSION: The volume estimation method is accurate; edge based segmentation, image completion and volume reconstruction can be accomplished. The visualization technique also allows to navigate into the reconstructed volume and to display any section of the volume.

  1. Astronaut Story Musgrave in EMU in thermal vacuum chamber

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Astronaut F. Story Musgrave, wearing a training version of the extravehicular activity unit (EMU), particpates in a dry run for tests in thermal vacuum chamber. The test, conducted in Chamber B ofthe Space Environment and Simulation Laboratory at JSC, verified that the tools being designed for the mission will work in the cold vacuum of space. Others pictured, from the left, are Andrea Tullar and Donna Fender, test directors; Leonard S. Nicholson, acting Director of engineering; and Astronauts Thomas D. Akers and Kathryn C. Thornton, STS-61 mission specialists, along with Musgrave.

  2. Effect of Depression and Sertraline Treatment on Cardiac Function in Female Nonhuman Primates

    PubMed Central

    Groban, Leanne; Kitzman, Dalane W.; Register, Thomas C.; Shively, Carol A.

    2014-01-01

    Objective Depression is a proposed risk factor for heart failure based largely on epidemiological data; little experimental data is available addressing this hypothesis. Methods Depression was evaluated in relation to cardiac structural and functional phenotypes assessed by transthoracic echocardiography in 42 adult female cynomolgus monkeys that consumed a Western-like diet for 3 years. Half of the monkeys were treated with the SSRI sertraline HCl for 18 months and depressive behavior was assessed for 12 months prior to echocardiography. Results Depressed monkeys (the 19/42 with depressive behavior rates above the mean rate) had higher HRs (171±4.1 vs 152±6.1), and smaller BSA (0.13±0.003 vs 0.15±0.004). Cardiac measures showed lower LV end systolic dimension (0.75±0.05 vs 0.89±0.04), LV systolic (0.76±0.08 vs 1.2±0.11) and diastolic (2.4±0.23 vs 3.4±0.26) volumes, and left atrial volumes (1.15±0.14 vs 1.75±0.12) in depressed versus nondepressed monkeys (p’s <0.05). Doppler profiles of depressed monkeys indicated greater myocardial relaxation (higher e′ and higher e′/a′ ratio) and lower filling pressures (lower E/e′) compared to nondepressed monkeys (p’s<0.05). Although treatment with sertraline reduced HR (150±5.8 vs 171±4.8) and modestly increased chamber dimensions (left ventricular end systolic dimension: 0.91±0.05 vs 0.74±0.03; left ventricular end diastolic dimension, BSA adjusted 1.69±0.05 vs 1.47±0.06) (p’s<0.05), it did not overtly affect systolic or diastolic function (p’s >0.10). Conclusions These data suggest that behavioral depression in female primates is accompanied by differences in cardiac function, although not in ways classically associated with subclinical heart failure. SSRIs show promise in supporting heart function by reducing HR and perhaps improving LV filling, however further investigation is needed to confirm this hypothesis. PMID:24470133

  3. Carotid-cardiac baroreflex response and LBNP tolerance following resistance training

    NASA Technical Reports Server (NTRS)

    Tatro, D. L.; Dudley, G. A.; Convertino, V. A.

    1992-01-01

    The purpose of this study was to examine the effect of lower body resistance training on cardiovascular control mechanisms and blood pressure maintenance during an orthostatic challenge. Lower body negative pressure (LBNP) tolerance, carotid-cardiac baroreflex function (using neck chamber pressure), and calf compliance were measured in eight healthy males before and after 19 wk of knee extension and leg press training. Resistance training sessions consisted of four or five sets of 6-12 repetitions of each exercise, performed two times per week. Training increased strength 25 +/- 3 (SE) percent (P = 0.0003) and 31 +/- 6 percent (P = 0.0004), respectively, for the leg press and knee extension exercises. Average fiber size in biopsy samples of m. vastus lateralis increased 21 +/- 5 percent (P = 0.0014). Resistance training had no significant effect on LBNP tolerance. However, calf compliance decreased in five of the seven subjects measured, with the group average changing from 4.4 +/- 0.6 ml.mm Hg-1 to 3.9 +/- 0.3 ml.mm Hg-1 (P = 0.3826). The stimulus-response relationship of the carotid-cardiac baroreflex response shifted to the left on the carotid pressure axis as indicated by a reduction of 6 mm Hg in baseline systolic blood pressure (P = 0.0471). In addition, maximum slope increased from 5.4 +/- 1.3 ms.mm Hg-1 before training to 6.6 +/- 1.6 ms.mm Hg-1 after training (P = 0.0141). Our results suggest the possibility that high resistance, lower extremity exercise training can cause a chronic increase in sensitivity and resetting of the carotid-cardiac baroreflex.

  4. Endostatin inhibits bradykinin-induced cardiac contraction.

    PubMed

    Yasuda, Jumpei; Takada, Lila; Kajiwara, Yuka; Okada, Muneyosi; Yamawaki, Hideyuki

    2015-11-01

    Endogenous fragments of extracellular matrix are known to possess various biological effects. Levels of endostatin, a fragment of collagen type XVIII, increase in certain cardiac diseases, such as cardiac hypertrophy and myocardial infarction. However, the influence of endostatin on cardiac contraction has not been clarified. In the present study, we investigated the effects of endostatin on bradykinin-induced atrial contraction. Isometric contractile force of mouse isolated left atria induced by electrical current pulse was measured. Voltage-dependent calcium current of guinea pig ventricular myocytes was measured by a whole-cell patch-clamp technique. Endostatin (100-1,000 ng/ml) alone treatment had no influence on left atrial contraction. On the other hand, pretreatment with endostatin (300 ng/ml) significantly inhibited bradykinin (1 µM)-induced contraction and voltage-dependent calcium current. These data suggest that endostatin may decrease bradykinin-induced cardiac contraction perhaps through the inhibition of voltage-dependent calcium channel. PMID:26050753

  5. Cardiac magnetic resonance imaging in Alstrm syndrome

    PubMed Central

    Loudon, Margaret A; Bellenger, Nicholas G; Carey, Catherine M; Paisey, Richard B

    2009-01-01

    Background A case series of the cardiac magnetic resonance imaging findings in seven adult Alstrm patients. Methods Seven patients from the National Specialist Commissioning Group Centre for Alstrm Disease, Torbay, England, UK, completed the cardiac magnetic resonance imaging protocol to assess cardiac structure and function in Alstrm cardiomyopathy. Results All patients had some degree of left and right ventricular dysfunction. Patchy mid wall gadolinium delayed enhancement was demonstrated, suggesting an underlying fibrotic process. Some degree of cardiomyopathy was universal. No evidence of myocardial infarction or fatty infiltration was demonstrated, but coronary artery disease cannot be completely excluded. Repeat scanning after 18 months in one subject showed progression of fibrosis and decreased left ventricular function. Conclusion Adult Alstrm cardiomyopathy appears to be a fibrotic process causing impairment of both ventricles. Serial cardiac magnetic resonance scanning has helped clarify the underlying disease progression and responses to treatment. Confirmation of significant mutations in the ALMS1 gene should lead to advice to screen the subject for cardiomyopathy, and metabolic disorders. PMID:19515241

  6. A new algorithm for segmentation of cardiac quiescent phases and cardiac time intervals using seismocardiography<