Showing papers on "Cardiac cycle published in 2009"

Classification of supraventricular and ventricular cardiac rhythms using cross channel timing algorithm

Abstract: A system and method for classifying cardiac complexes sensed during a tachycardia episode. A first cardiac signal and a second cardiac signal are sensed, where the first cardiac signal has a voltage. A first cardiac complex and a second cardiac complex of a cardiac cycle are detected in the first and second cardiac signal, respectively. A predetermined alignment feature is identified in the second cardiac complex. A datum is defined, or positioned, at a specified interval from the predetermined alignment feature of the second cardiac complex. Voltage values are then measured from the first cardiac complex at each of two or more measurement intervals from the datum. The voltage values are then compared voltage values measured from NSR cardiac complexes to classify the first cardiac complex is either a ventricular tachycardia complex or a supraventricular tachycardiac complex.

Atrioventricular valve plane displacement in healthy persons. An echocardiographic study.

Abstract: A method of measuring the displacement of the atrioventricular (AV) of the left ventricle plane during the cardiac cycle in 71 healthy persons is described. An echocardiographic equipment with two cursors was used. Measurements were performed from four sites in the AV plane situated about 90 degrees apart and corresponding to the septal, anterior, lateral and posterior myocardial walls. The mean displacement during systole was 16 mm towards the apex. There was no significant difference in the recordings from the four sites. The study population was divided into three groups with mean ages 28, 42 and 60 years (group I, II and III). The displacement was significantly smaller in group III compared with groups I and II. Fractional shortening, however, could not demonstrate such a difference. The determination of displacement of the AV plane may imply the introduction of a new and simple method in assessment of left ventricular function.

Correlation between left ventricular end-diastolic pressure and peak left atrial wall strain during left ventricular systole.

Abstract: Objective Left atrial (LA) reservoir function is determined by integration of LA relaxation and left ventricular (LV) systolic function, and LV diastolic dysfunction increases LA volume at end systole. This study investigates the effect of LV end-diastolic pressure on LA wall tension during LV systole. Methods A total of 101 stable patients with sinus rhythm undergoing cardiac catheterization were studied. LA wall extension during LV systole was evaluated as LA wall strain in the longitudinal direction obtained using two-dimensional ultrasound speckle tracking imaging. LV end-diastolic pressure and LV end-systolic and end-diastolic volumes were obtained in cardiac catheterization, and LV ejection fraction was determined. Results Peak LA wall strain during LV systole had a significant inverse correlation with LV end-diastolic pressure ( r = − 0.76, P r = − 0.64, P Conclusion Elevated LV end-diastolic pressure is associated with a decrease of peak LA wall strain in the longitudinal direction during LV systole. In patients with peak LA wall strain during LV systole of less than 30%, the majority had elevated LV end-diastolic pressure, while most patients with peak LA wall strain during LV systole 45% or higher had normal LV end-diastolic pressures. In patients whose LV ejection fraction is 50% or more, when peak LA wall strain during LV systole is between 30% and 44%, it is not possible to predict LV end-diastolic pressure from peak LA wall strain measures.

A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography

Abstract: Background— Mitral and aortic valves are known to be coupled via fibrous tissue connecting the two annuli. Previous studies evaluating this coupling have been limited to experimental animals using invasive techniques. The new matrix array transesophageal transducer provides high-resolution real-time 3D images of both valves simultaneously. We sought to develop and test a technique for quantitative assessment of mitral and aortic valve dynamics and coupling. Methods and Results— Matrix array transesophageal (Philips iE33) imaging was performed in 24 patients with normal valves who underwent clinically indicated transesophageal echocardiography. Custom software was used to detect and track the mitral and aortic annuli in 3D space throughout the cardiac cycle, allowing automated measurement of changes in mitral and aortic valve morphology. Mitral annulus surface area and aortic annulus projected area changed reciprocally over time. Mitral annulus surface area was 8.0±2.1 cm2 at end-diastole and decreased to 7.7±2.1 cm2 in systole, reaching its maximum (10.0±2.2 cm2) at mitral valve opening. Aortic annulus projected area was 4.1±1.2 cm2 at end-diastole, then increased during isovolumic contraction reaching its maximum (4.8±1.3 cm2) in the first third of systole and its minimum (3.6±1.0 cm2) during isovolumic relaxation. The angle between the mitral and aortic annuli was maximum (136±13°) at end-diastole and decreased to its minimum value (129±11°) during systole. Conclusions— This is the first study to report quantitative 3D assessment of the mitral and aortic valve dynamics from matrix array transesophageal images and describe the mitral-aortic coupling in a beating human heart. This ability may have impact on patient evaluation for valvular surgical interventions and prosthesis design. Received May 19, 2008; accepted November 6, 2008. # CLINICAL PERSPECTIVE {#article-title-2}

Following One’s Heart: Cardiac Rhythms Gate Central Initiation of Sympathetic Reflexes

Abstract: Central nervous processing of environmental stimuli requires integration of sensory information with ongoing autonomic control of cardiovascular function. Rhythmic feedback of cardiac and baroreceptor activity contributes dynamically to homeostatic autonomic control. We examined how the processing of brief somatosensory stimuli is altered across the cardiac cycle to evoke differential changes in bodily state. Using functional magnetic resonance imaging of brain and noninvasive beat-to-beat cardiovascular monitoring, we show that stimuli presented before and during early cardiac systole elicited differential changes in neural activity within amygdala, anterior insula and pons, and engendered different effects on blood pressure. Stimulation delivered during early systole inhibited blood pressure increases. Individual differences in heart rate variability predicted magnitude of differential cardiac timing responses within periaqueductal gray, amygdala and insula. Our findings highlight integration of somatosensory and phasic baroreceptor information at cortical, limbic and brainstem levels, with relevance to mechanisms underlying pain control, hypertension and anxiety.

MR elastography of the human heart: noninvasive assessment of myocardial elasticity changes by shear wave amplitude variations.

Abstract: Many cardiovascular diseases and disorders are associated with hemodynamic dysfunction. The heart's ability to contract and pump blood through the vascular system primarily depends on the elasticity of the myocardium. This article introduces a magnetic resonance elastography (MRE) technique that allows noninvasive and time-resolved measurement of changes in myocardial elasticity over the cardiac cycle. To this end, low-frequency shear vibrations of 24.3 Hz were induced in the human heart via the anterior chest wall. An electrocardiograph (ECG)-triggered, steady-state MRE sequence was used to capture shear oscillations with a frame rate of eight images per vibration cycle. The time evolution of 2D-shear wave fields was observed in two imaging planes through the short axis of the heart in six healthy volunteers. Correlation analysis revealed that wave amplitudes were modulated in synchrony to the heartbeat with up to 2.45 ± 0.18 higher amplitudes during diastole than during systole (interindividual mean ± SD). The reduction of wave amplitudes started at 75 ± 9 ms prior to changes in left ventricular diameter occurring at the beginning of systole. Analysis of this wave amplitude alteration using a linear elastic constitutive model revealed a maximum change in the myocardial wall stiffness of a factor of 37.7 ± 10.6 during the cardiac cycle. Magn Reson Med, 2009. © 2008 Wiley-Liss, Inc.

The three‐dimensional arrangement of the myocytes in the ventricular walls

Abstract: The arrangement of the myocytes aggregated together within the ventricular walls has been the subject of anatomic investigation for more than four centuries. The dangers of analyzing the myocardium on the basis of arrangement of the skeletal myocytes have long been appreciated, yet some still described the ventricular myocardium in terms of a unique band extending from the pulmonary trunk to the aorta. Another current interpretation, with much support, is that the ventricular myocytes are compartmentalized in the form of sheets, albeit that the extent of division, and interrelations, of the sheets is less well explained. Histological examination, however, shows that the only muscular unit to be found within the myocardial walls is the cardiac myocyte itself. Our own investigations show that, rather than forming a continuous band, or being arranged as sheets, the myocytes are aggregated together as a three-dimensional mesh within a supporting matrix of fibrous tissue. Within the mesh of aggregated myocytes, it is then possible to recognize two populations, depending on the orientations of their long axes. The first population is aligned with the long axis of the aggregated myocytes tangential to the epicardial and endocardial borders, albeit with marked variation in the angulation relative to the ventricular equator. Correlation with measurements taken using force probes shows that these myocytes produce the major unloading of the blood during ventricular systole. The second population is aligned at angles of up to 40 degrees from the epicardium toward the endocardium. The correlation with measurements from force probes reveals that these intruding myocytes produce auxotonic forces during the cardiac cycle. The three-dimensional arrangement of the mesh also serves to account for the realignment of the myocytes that must take place during ventricular contraction so as to account for the extent of systolic mural thickening.

Analysing the pattern of pulse waves in arterial networks: a time-domain study

Abstract: The mechanisms underlying the shape of pulse waves in the systemic arterial network are studied using the time-domain, one-dimensional (1-D) equations of blood flow in compliant vessels. The pulse waveform at an arbitrarylocationinthenetworkisinitiallyseparatedintoaperipheralcomponentthatdependsonthecardiacoutput, total compliance and total peripheral resistance of the network, and a conduit component governed by reflections at the junctions of the large conduit arteries and at the aortic valve. The dynamics of the conduit component are then analysed using a new algorithm that describes all the waves generated in the linear 1-D model network by a single wavefront starting at the root. This algorithm allows one to systematically follow all the waves arriving at the measuring site and identify all the reflection sites that these waves have visited. Application of this method to the pulse waves simulated using a 1-D model of the largest 55 systemic arteries in the human demonstrates that peripheral components make a larger contribution to aortic pressure waveforms than do the conduit components. Conduit components are closely related to the outflow from the left ventricle in early systole. Later in the cardiac cycle, they are the result of reflections at the arterial junctions and aortic valve. The number of reflected waves increases approximately as 3 m , with m being the number of reflection sites encountered. The pressure changes associated with these waves can be positive or negative but their absolute values tend to decrease exponentially. As a result, wave activity is minimal during late diastole, when the peripheral components of pressure and the flow are dominant,andaorticpressurestendtoaspace-independentvaluedeterminedbythecardiacoutput,totalcompliance and total peripheral resistance. The results also suggest that pulse-wave propagation is the mechanism by which the arterial system reaches the mean pressure dictated by the cardiac output and total resistance that is required to perfuse the microcirculation. The total compliance determines the rate at which this pressure is restored when the system has departed from its equilibrium state of steady oscillation. This study provides valuable information on

Vascular endothelial ageing, heartbeat after heartbeat.

Abstract: The vascular endothelium starts to age at the first heartbeat There is no longer a need to demonstrate that an increased resting heart rate—above 70 bpm—is associated with the onset of cardiovascular events and reduces lifespan in humans Each cardiac cycle imposes a mechanical constraint on the arteries, and we would like to propose that this mechanical stress damages the vascular endothelium, its dysfunction being the prerequisite for atherogenesis Consequently, reducing heart rate could protect the endothelium and slow the onset of atherosclerosis The potential mechanisms by which reducing heart rate could be beneficial to the endothelium are likely a combination of a reduction in mechanical stress and tissue fatigue and a prolongation of the period of steady laminar flow, and thus sustained shear stress, between each systole With age, irreparable damage accumulates in endothelial cells and leads to senescence, which is characterized by a pro-atherogenic phenotype In the body, the highest mechanical stress occurs in the coronary vessels, where blood only flows during diastole and even reverses during systole; thus, coronary arteries are the prime site of atherosclerosis All classical risk factors for cardiovascular diseases add up, to accelerate atherogenesis, but hypertension, which further raises mechanical stress, is likely the most damaging By inducing flow through the arteries, the heart rate determines shear stress and its stability: mechanical stress and the associated damage induced by each systole are efficiently counteracted by the repair capacities of a healthy endothelium The maintenance of a physiological, low heart rate may be key to prolonging the endothelial healthy lifespan and thus, vascular health

Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies

Abstract: The aim of this study was to provide an insight into normative values of the ascending aorta in regards to novel endovascular procedures using ECG-gated multi-detector CT angiography. Seventy-seven adult patients without ascending aortic abnormalities were evaluated. Measurements at relevant levels of the aortic root and ascending aorta were obtained. Diameter variations of the ascending aorta during cardiac cycle were also considered. Mean diameters (mm) were as follows: LV outflow tract 20.3 ± 3.4, coronary sinus 34.2 ± 4.1, sino-tubular junction 29.7 ± 3.4 and mid ascending aorta 32.7 ± 3.8 with coefficients of variation (CV) ranging from 12 to 17%. Mean distances (mm) were: from the plane passing through the proximal insertions of the aortic valve cusps to the right brachio-cephalic artery (BCA) 92.6 ± 11.8, from the plane passing through the proximal insertions of the aortic valve cusps to the proximal coronary ostium 12.1 ± 3.7, and between both coronary ostia 7.2 ± 3.1, minimal arc of the ascending aorta from left coronary ostium to right BCA 52.9 ± 9.5, and the fibrous continuity between the aortic valve and the anterior leaflet of the mitral valve 14.6 ± 3.3, CV 13–43%. Mean aortic valve area was 582.0 ± 131.9 mm2. The variation of the antero-posterior and transverse diameters of the ascending aorta during the cardiac cycle were 8.4% and 7.3%, respectively. Results showed large inter-individual variations in diameters and distances but with limited intra-individual variations during the cardiac cycle. A personalized approach for planning endovascular devices must be considered.

Cardiac Flow Analysis Applied to Phase Contrast Magnetic Resonance Imaging of the Heart

Abstract: Phase contrast magnetic resonance imaging is performed to produce flow fields of blood in the heart. The aim of this study is to demonstrate the state of change in swirling blood flow within cardiac chambers and to quantify it for clinical analysis. Velocity fields based on the projection of the three dimensional blood flow onto multiple planes are scanned. The flow patterns can be illustrated using streamlines and vector plots to show the blood dynamical behavior at every cardiac phase. Large-scale vortices can be observed in the heart chambers, and we have developed a technique for characterizing their locations and strength. From our results, we are able to acquire an indication of the changes in blood swirls over one cardiac cycle by using temporal vorticity fields of the cardiac flow. This can improve our understanding of blood dynamics within the heart that may have implications in blood circulation efficiency. The results presented in this paper can establish a set of reference data to compare with unusual flow patterns due to cardiac abnormalities. The calibration of other flow-imaging modalities can also be achieved using this well-established velocity-encoding standard.

Cardiac MR Elastography: Comparison with left ventricular pressure measurement

Abstract: To compare magnetic resonance elastography (MRE) with ventricular pressure changes in an animal model. Three pigs of different cardiac physiology (weight, 25 to 53 kg; heart rate, 61 to 93 bpm; left ventricular [LV] end-diastolic volume, 35 to 70 ml) were subjected to invasive LV pressure measurement by catheter and noninvasive cardiac MRE. Cardiac MRE was performed in a short-axis view of the heart and applying a 48.3-Hz shear-wave stimulus. Relative changes in LV-shear wave amplitudes during the cardiac cycle were analyzed. Correlation coefficients between wave amplitudes and LV pressure as well as between wave amplitudes and LV diameter were determined. A relationship between MRE and LV pressure was observed in all three animals (R2 ≥ 0.76). No correlation was observed between MRE and LV diameter (R2 ≤ 0.15). Instead, shear wave amplitudes decreased 102 ± 58 ms earlier than LV diameters at systole and amplitudes increased 175 ± 40 ms before LV dilatation at diastole. Amplitude ratios between diastole and systole ranged from 2.0 to 2.8, corresponding to LV pressure differences of 60 to 73 mmHg. Externally induced shear waves provide information reflecting intraventricular pressure changes which, if substantiated in further experiments, has potential to make cardiac MRE a unique noninvasive imaging modality for measuring pressure-volume function of the heart.

Cardiac target tracking

Abstract: Systems and methods for tracking cardiac targets are disclosed. The cardiac targets may be tracked dynamically. The process may include registering a cardiac target at different phases of a cardiac cycle. Movement of the cardiac target can be determined by correlating respiratory motion and cardiac pumping motion. Radiation treatment can then be delivered to the cardiac target taking into account the movement of the cardiac target.

In vivo imaging of the cyclic changes in cross-sectional shape of the ventricular segment of pulsating embryonic chick hearts at stages 14 to 17: a contribution to the understanding of the ontogenesis of cardiac pumping function.

Abstract: The cardiac cycle-related deformations of tubular embryonic hearts were traditionally described as concentric narrowing and widening of a tube of circular cross-section. Using optical coherence tomography (OCT), we have recently shown that, during the cardiac cycle, only the myocardial tube undergoes concentric narrowing and widening while the endocardial tube undergoes eccentric narrowing and widening, having an elliptic cross-section at end-diastole and a slit-shaped cross-section at end-systole. Due to technical limitations, these analyses were confined to early stages of ventricular development (chick embryos, stages 10‐13). Using a modified OCT-system, we now document, for the first time, the cyclic changes in cross-sectional shape of beating embryonic ventricles at stages 14 to 17. We show that during these stages (1) a large area of diminished cardiac jelly appears at the outer curvature of the ventricular region associated with formation of endocardial pouches; (2) the ventricular endocardial lumen acquires a bell-shaped cross-section at end-diastole and becomes compressed like a fireplace bellows during systole; (3) the contracting portions of the embryonic ventricles display stretching along its baso-apical axis at end-systole. The functional significance of our data is discussed with respect to early cardiac pumping function. Developmental Dynamics 238:3273‐3284, 2009. V C 2009 Wiley-Liss, Inc.

Doppler flow velocity waveforms in the embryonic chicken heart at developmental stages corresponding to 5-8 weeks of human gestation.

Abstract: OBJECTIVES: To obtain Doppler velocity waveforms from the early embryonic chicken heart by means of ultrasound biomicroscopy and to compare these waveforms at different stages of embryonic development. METHODS: We collected cardiac waveforms using high-frequency Doppler ultrasound with a 55-MHz transducer at Hamburger-Hamilton (HH) stages 18, 21 and 23, which are comparable to humans at 5 to 8 weeks of gestation. Waveforms were obtained at the inflow tract, the primitive left ventricle, the primitive right ventricle and at the outflow tract in 10 different embryos per stage. M-mode recordings were collected to study opening and closure of the cushions. By exploring the temporal relationship between the waveforms, using a secondary Doppler device, cardiac cycle events were outlined. RESULTS: Our results demonstrate that stage- and location-dependent intracardiac blood flow velocity waveforms can be obtained in the chicken embryo. The blood flow profiles assessed at the four locations in the embryonic heart demonstrated an increase in peak velocity with advancing developmental stage. In the primitive ventricle the 'passive' (P) filling peak decreased whereas the 'active' (A) filling peak increased, resulting in a decrease in P to A ratio with advancing developmental stage. M-mode recordings demonstrated that the fractional closure time of the atrioventricular cushions increased from 20% at stage HH 18 to 60% at stage HH 23. CONCLUSION: High-frequency ultrasound biomicroscopy can be used to define flow velocity waveforms in the embryonic chicken heart. This may contribute to an understanding of Doppler signals derived from valveless embryonic human hearts at 5 to 8 weeks of gestation, prior to septation.

Dynamical visualization of coronary vessels and myocardial perfusion information

Abstract: A method for dynamically visualizing coronary information and an apparatus adapted to implement such method is described. In a preferred embodiment of the method, first dynamic cardiac data is acquired during a first cardiac stage and second dynamic cardiac data is acquired during a second cardiac stage. Then, the two data sets are visualized continuously the in a superimposed presentation, wherein the first cardiac data and the second cardiac data corresponding to a same phase within the cardiac cycle are visualized simultaneously. In this way for example information about the vessel geometry may be immediately linked with information about the muscle irrigation or perfusion. Furthermore, this useful information may be displayed in a high-contrasted and low-noise presentation.

Antepartum non-invasive evaluation of opening and closing timings of the cardiac valves in fetal cardiac cycle.

Abstract: In this study, we propose a non-invasive algorithm to recognize the timings of fetal cardiac events on the basis of analysis of fetal ECG (FECG) and Doppler ultrasound signals. Multiresolution wavelet analysis enabled the frequency contents of the Doppler signals to be linked to the opening (o) and closing (c) of the heart’s valves (Aortic (A) and Mitral (M)). M-mode, B-mode and pulsed Doppler ultrasound were used to verify the timings of opening and closure of these valves. In normal fetuses, the time intervals from Q-wave of QRS complex of FECG to opening and closing of aortic valve, i.e., Q-Ao and Q-Ac were found to be 79.3 ± 17.4 and 224.7 ± 13.3 ms, respectively. For the mitral valve, Q-Mc and Q-Mo were found to be 27.7 ± 9.4 and 294.6 ± 21.3 ms, respectively. Correlations among the timings in opening and closing of cardiac valves were found to be higher in abnormal fetuses than that in normal ones.

Mechanism of Paradoxical Ventricular Septal Motion After Coronary Artery Bypass Grafting

Abstract: Paradoxical septal motion is commonly noted on echocardiography after coronary artery bypass grafting (CABG), but its mechanism is unclear. Cardiac magnetic resonance imaging was performed before and 3 months after CABG in 23 patients. On a mid–left ventricular short-axis cine image, the motion of myocardial landmarks during the cardiac cycle was ascertained relative to a stationary anterior reference point. Before CABG, the movement of the ventricular septum in systole was either posterior or neutral (median −2 mm) in 19 patients, whereas after CABG, the septum moved anteriorly in all 23 patients (+4 mm; p

Improved Dynamic Cardiac Phantom Based on 4D NURBS and Tagged MRI

Abstract: We previously developed a realistic phantom for the cardiac motion for use in medical imaging research. The phantom was based upon a gated magnetic resonance imaging (MRI) cardiac study and using 4D non-uniform rational b-splines (NURBS). Using the gated MRI study as the basis for the cardiac model had its limitations. From the MRI images, the change in the size and geometry of the heart structures could be obtained, but without markers to track the movement of points on or within the myocardium, no explicit time correspondence could be established for the structures. Also, only the inner and outer surfaces of the myocardium could be modeled. We enhance this phantom of the beating heart using 4D tagged MRI data. We utilize NURBS surfaces to analyze the full 3D motion of the heart from the tagged data. From this analysis, time-dependent 3D NURBS surfaces were created for the right (RV) and left ventricles (LV). Models for the atria were developed separately since the tagged data only covered the ventricles. A 4D NURBS surface was fit to the 3D surfaces of the heart creating time-continuous 4D NURBS models. Multiple 4D surfaces were created for the left ventricle (LV) spanning its entire volume. The multiple surfaces for the LV were spline-interpolated about an additional dimension, thickness, creating a 4D NURBS solid model for the LV with the ability to represent the motion of any point within the volume of the LV myocardium at any time during the cardiac cycle. Our analysis of the tagged data was found to produce accurate models for the RV and LV at each time frame. In a comparison with segmented structures from the tagged dataset, LV and RV surface predictions were found to vary by a maximum of 1.5 mm's and 3.4 mm's respectively. The errors can be attributed to the tag spacing in the data (7.97 mm's). The new cardiac model was incorporated into the 4D NURBS-based Cardiac-Torso (NCAT) phantom widely used in imaging research. With its enhanced abilities, the model will provide a useful tool in the study of cardiac imaging and the effects of cardiac motion in medical images.

Functional morphology and patterns of blood flow in the heart of Python regius.

Abstract: Brightness-modulated ultrasonography, continuous-wave Doppler, and pulsed-wave Doppler-echocardiography were used to analyze the functional morphology of the undisturbed heart of ball pythons. In particular, the action of the muscular ridge and the atrio-ventricular valves are key features to understand how patterns of blood flow emerge from structures directing blood into the various chambers of the heart. A step-by-step image analysis of echocardiographs shows that during ventricular diastole, the atrio-ventricular valves block the interventricular canals so that blood from the right atrium first fills the cavum venosum, and blood from the left atrium fills the cavum arteriosum. During diastole, blood from the cavum venosum crosses the muscular ridge into the cavum pulmonale. During middle to late systole the muscular ridge closes, thus prohibiting further blood flow into the cavum pulmonale. At the same time, the atrio-ventricular valves open the interventricular canal and allow blood from the cavum arteriosum to flow into the cavum venosum. In the late phase of ventricular systole, all blood from the cavum pulmonale is pressed into the pulmonary trunk; all blood from the cavum venosum is pressed into both aortas. Quantitative measures of blood flow volume showed that resting snakes bypass the pulmonary circulation and shunt about twice the blood volume into the systemic circulation as into the pulmonary circulation. When digesting, the oxygen demand of snakes increased tremendously. This is associated with shunting more blood into the pulmonary circulation. The results of this study allow the presentation of a detailed functional model of the python heart. They are also the basis for a functional hypothesis of how shunting is achieved. Further, it was shown that shunting is an active regulation process in response to changing demands of the organism (here, oxygen demand). Finally, the results of this study support earlier reports about a dual pressure circulation in Python regius.

Pulmonary intravascular blood volume changes through the cardiac cycle in healthy volunteers studied by cardiovascular magnetic resonance measurements of arterial and venous flow

Abstract: Background This study aims to present a novel method for using cardiovascular magnetic resonance (CMR) to non-invasively quantify the variation in pulmonary blood volume throughout the cardiac cycle in humans.

Optimal phase for coronary interpretations and correlation of ejection fraction using late-diastole and end-diastole imaging in cardiac computed tomography angiography: implications for prospective triggering

Abstract: A typical acquisition protocol for multi-row detector computed tomography (MDCT) angiography is to obtain all phases of the cardiac cycle, allowing calculation of ejection fraction (EF) simultaneously with plaque burden. New MDCT protocols scanner, designed to reduce radiation, use prospectively acquired ECG gated image acquisition to obtain images at certain specific phases of the cardiac cycle with least coronary artery motion. These protocols do not we allow acquisition of functional data which involves measurement of ejection fraction requiring end-systolic and end-diastolic phases. We aimed to quantitatively identify the cardiac cycle phase that produced the optimal images as well as aimed to evaluate, if obtaining only 35% (end-systole) and 75% (as a surrogate for end-diastole) would be similar to obtaining the full cardiac cycle and calculating end diastolic volumes (EDV) and EF from the 35th and 95th percentile images. 1,085 patients with no history of coronary artery disease were included; 10 images separated by 10% of R–R interval were retrospectively constructed. Images with motion in the mid portion of RCA were graded from 1 to 3; with ‘1’ being no motion, ‘2’ if 0 to 1 mm motion and/or non-interpretable study. In a subgroup of 216 patients with EF > 50%, we measured left ventricular (LV) volumes in the 10 phases, and used those obtained during 25, 35, 75 and 95% phase to calculate the EF for each patient. The average heart rate (HR) for our patient group was 56.5 ± 8.4 (range 33–140). The distribution of image quality at all heart rates was 958 (88.3%) in Grade 1, 113 (10.42%) in Grade 2 and 14 (1.29%) in Grade 3 images. The area under the curve for optimum image quality (Grade 1 or 2) in patients with HR > 60 bpm for phase 75% was 0.77 ± 0.04 [95% CI: 0.61–0.87], while for similar heart rates the area under the curve for phases 75 + 65 + 55 + 45% combined was 0.92 ± 0.02. LV volume at 75% phase was strongly correlated with EDV (LV volume at 95% phase) (r = 0.970, P 90% interpretable studies, if HR 60 analysis of images in 4 phases (75, 35, 45 and 55%) is needed. Our data demonstrates that LVEF can be predicted with reasonable accuracy by using data acquired in phases 35 and 75% of the R–R interval. Future prospective acquisition that obtains two phases (35 and 75%) will allow for motion free images of the coronary arteries and EF estimates in over 90% of patients.

Neuronal regulation of aortic valve cusps.

Abstract: Heart valves have long been considered exclusively passive structures that open and close in response to changes in transvalvular pressure during the cardiac cycle. Although this is partly true, recent evidence suggests that valves are far more sophisticated structures. Microscopic examination of heart valves reveals a complex network of endothelial cells, interstitial cells, an extracellular matrix and a rich network of intrinsic nerves. The distribution of these nerve networks varies between the four valves, but is remarkably conserved between species. The present review will focus mainly on aortic valve innervation for several reasons: it is most commonly involved in disease processes, it lies in a unique hemodynamic environment and is exposed to extreme mechanical forces. These nerves are likely to play a significant role in the modulation of aortic valve structure and function and its adaptation to different hemodynamic and humoral conditions. The objectives of this review are first to describe the anatomy of aortic valve innervation, then detail the functional significance of innervation to the valve and finally make the case for the clinical relevance of understanding the neural control of aortic valves and its potential pharmacologic implications.

In vivo quantification of blood velocity in mouse carotid and pulmonary arteries by ECG-triggered 3D time-resolved magnetic resonance angiography

Abstract: Blood flow velocity is a functional parameter of fundamental importance in diagnosis and follow-up of various vascular diseases. Vascular pathologies can be efficiently studied in animal models, especially in small rodents. ECG-gated magnetic resonance imaging (MRI) assessment of blood velocity in small animals is a challenge because of limited spatial resolution and high-frequency physiological parameters. Here it is shown that a bright-blood cine-3D-MRI method can be used to measure blood velocity at specific times of the cardiac cycle in mouse pulmonary and carotid arteries. The method used a series of time-of-flight (TOF) acquisitions in a volume of interest at different times after signal cancellation in the same volume. This scheme was repeated at different periods of the cardiac cycle by varying the delay between the ECG R-wave peak and signal cancellation. Velocity values in mouse pulmonary artery varied from 35 cm/s in systole to 0–10 cm/s in diastole. A similar pattern was displayed in carotid arteries (18 and 2.5 cm/s, in systole and diastole, respectively). Results are discussed in terms of efficiency, limitation, and comparison with other methods. Copyright © 2009 John Wiley & Sons, Ltd.

Feasibility of left ventricular shape analysis from transthoracic real-time 3-D echocardiographic images.

Abstract: Despite the potential ability of left ventricular (LV) shape analysis to provide independent information complementary to ventricular size and function, in clinical practice only ejection fraction (EF) is currently assessed while LV shape is not routinely quantified. Moreover, geometric assumptions in the computation of EF from multiple two-dimensional (2-D) cut-planes by disc summation or area-length methods, introduce inaccuracies in the estimates. Also, previous approaches for the quantification of LV shape were based on geometric modeling and, as a result, proved inaccurate. Our aims were (1) to develop and test a three-dimensional (3-D) technique for direct quantification of LV shape from real-time 3-D echocardiographic (RT3DE) images without the need for geometric modeling using a new class of LV shape indices; and (2) to study the relationship between these indices and ventricular size and function in normal and abnormal ventricles. Spherical (S), ellipsoidal (E) and conical (C) shape indices were calculated using custom software for analysis of transthoracic RT3DE images on both global and regional levels and initially tested on computer simulated objects of different shapes. The feasibility of using these indices to differentiate between normal and abnormal ventricles was tested in three groups of patients: normal volunteers (NL, n=9), dilated cardiomyopathy (DCM, n=9) and coronary artery disease with apical regional wall motion abnormalities (RWMA, n=9). Computer simulation demonstrated that these shape indices are size-independent and can correctly classify the simulated objects. In human ventricles, both S and C but not E correlated well with LV volumes and EF. Also, S and C changed throughout the cardiac cycle while E remained almost constant. In addition, both regional and global S and C were able to identify differences between NL and abnormal ventricles: normal ventricles were less spherical and more conical than those of patients with DCM at both end-systole and end-diastole (p<0.05) both globally and regionally. In contrast, in patients with RWMA, similar differences were noted only at end-systole, both on a global level and in the apical region. In this study, we demonstrated the feasibility of quantifying LV shape from transthoracic RT3DE images at both global and regional levels. Potentially, such 3-D shape analysis could be combined with conventional evaluation of LV volume and function to provide a more comprehensive assessment of left ventricular performance.