Cardiovascular Engineering (dordrecht, Netherlands)最新文献

The objective of this study is to develop a model of the cardiovascular system capable of simulating the normal operation of the systemic and pulmonary circulation, starts from aorta, and follows by upper and lower extremities vessels, finally ends with pulmonary veins. The model consists of a closed loop lumped elements with 43 compartments representing the cardiovascular system. The model parameters have been extracted from the literature. Using MATLAB software, the mathematical model has been simulated for the cardiovascular system. Each compartment includes a Resistor-Inductor-Capacitor (RLC) segment. The normal cardiovascular operation is characterised by the pressure-volume curves in different parts of the system. Model verification is performed by comparing the simulation results with the clinical observation reported in the literature. The described model is a useful tool in studying the physiology of cardiovascular system, and the related diseases. Also, it could be a great tool to investigate the effects of the pathologies of the cardiovascular system.

The conventional impedance cardiogram is a record of pulsatile changes in the electrical impedance of the chest with each heartbeat. The signal seems intuitively related to cardiac stroke volume. However doubts persist about the validity of stroke volume measurements based on electrical impedance. This paper presents a new electrical axis for impedance cardiography that is perpendicular to the conventional head-to-foot axis in an anterior-posterior direction. Dual chest and back electrodes are concentric, permitting tetrapolar technique. A relatively simple analytical model is developed, and this model is validated in a three-dimensional finite element model of current flow through the human chest. Three-dimensional simulations show predictable relationships between the fractional increase in anterior-posterior chest impedance and the ventricular ejection fraction (cardiac stroke volume/ventricular end-diastolic volume). Ejection fraction can be computed accurately with a roughly 30-fold increase in signal level compared to the conventional impedance cardiogram. Breathing causes only modest changes in the signal. When the axis of current flow is optimized, one can interpret the impedance changes during the cardiac cycle with greater confidence as noninvasive, beat-by-beat indicators of ventricular ejection fraction in a wide variety of clinical settings.

Venous obstruction is a major complication of transvenous pacemaker placement. Despite the increasing use of pacemakers and implantable cardiac defibrillators, a lack of understanding remains with regard to risk factors for the development of device-associated venous obstruction. We hypothesize that computational fluid dynamics simulations can reveal prothrombogenic locations and define thrombosis risk based on patient-specific anatomies. Using anatomic data derived from computed tomography, computer models of the superior vena cava, subclavian, innominate, and internal jugular veins were constructed for three adult patients with transvenous pacemakers. These models were used to perform patient-specific simulations examining blood flow velocity, wall shear stress, and blood pressure, both with and without the presence of the pacing leads. To better quantify stasis, mean exposure time fields were computed from the venous blood flow data. In comparing simulations with leads to those without, evident increases in stasis at locations between the leads and along the surface of the vessels closest to the leads were found. These locations correspond to regions at known risk for thrombosis. This work presents a novel application of computational methods to study blood flow changes induced by pacemaker leads and possible complications such as venous occlusion and thrombosis. This methodology may add to our understanding of the development of lead-induced thrombosis and occlusion in the clinical arena, and enable the development of new strategies to avoid such complications.

The rate of biosynthesis and turnover of the plasma protein fibrinogen is a marker of metabolic signaling in aging and disease. The rate in the young normal human subject of 0.260 mg/ml/24 h increases to 0.378 in older normal subjects and to 0.466 in age matched coronary thrombosis patients measured by endogenous labeling of fibrinogen with L: -glutamic acid-C14. The increased rate of fibrinogen turnover has been traced to generation of fibrin by labeling the polymers with glycine C14 ethyl esters in the presence of activated fibrin stabilizing factor. Circulating fibrin increased 520% above normal in ischemic thrombotic cerebrovascular disease. Long chain saturated free fatty acids (FFA) exercise not only primary control over incorporation of Cl4 labeled amino acids into the fibrinogen structure but also activate the cascade sequence of reactions which convert fibrinogen into occlusive fibrin polymers. FFA are normally bound and transported by plasma albumin to mitochondrial sites of energy metabolism. Albumin synthesis declines with aging. This decline is associated with increased plasma levels of FFA resulting in an increase in the plasma FFA/albumin ratio. Correction of this ratio in vitro by restoration of a normal FFA/albumin ratio restores a normal level of fibrinogen synthesis by human hepatocytes.

The multiscale time irreversibility (MTI) involves the lack of consistency in the properties of a time series if one reverses the reading direction along the time. To analyze the RR time series at rest and during aerobic exercise through the MTI, both in healthy people and cardiac patients. The heartbeat signal was recorded beat to beat for 15 min at rest and 15 min while pedalling on a static bicycle in 10 healthy and active men (age 26.5 +/- 3.3 years; height 179.3 +/- 6.6 cm; weight 80.4 +/- 11.8 kg) and 10 cardiac patients (age 61.1 +/- 4.7 years, height 165.3 +/- 5.3 cm; weight 86.9 +/- 11.1 kg). The MTI was calculated through the asymmetry index (AI), defined as the sum of the values of asymmetry obtained for each scale from 1 to 10. The AI decreases significantly in healthy subjects from 0.51 +/- 0.28 at rest to 0.28 +/- 0.24 during exercise (P = 0.01) but not in cardiac patients (-0.2204 +/- 0.5097 at rest and 0.0848 +/- 0.1200 during exercise; P = 0.07). MTI distinguish adequately the four experimental situations because it can be considered as an index of the internal property of the signal in contrast to linear methods which are highly sensitive to external influences over the heart rhythm, particularly sympathetic and parasympathetic stimuli.

The aim of this study is to detect Acute Hypotensive Episodes (AHE) and Mean Arterial Pressure Dropping Regimes (MAPDRs) using ECG signal and Arterial Blood Pressure waveforms. To meet this end, the QRS complexes and end-systolic end-diastolic pulses are first extracted using two innovative Modified Hilbert Transform-Based algorithms namely as ECGMHT and BPMHT. A new smoothing algorithm is next developed based on piecewise polynomial fitting to smooth the fast fluctuations observed in RR-tachogram, systolic blood pressure (SBP) and diastolic blood pressure (DBP) trends. Afterwards, in order to consider the mutual influence of parameters on the evaluation of shock probability, a Sugeno Adaptive Network-based Fuzzy Inference System-ANFIS is trained using Hasdai et al. (J Am Coll Cardiol, 35: 136–143, 2000) parameters as input, with appropriate membership functions for each parameter. Using this network, it will be possible to incorporate the possible mutual influences between risk parameters such as heart rate, SBP, DBP, ST-segment episodes, age, gender, weight and some miscellaneous factors to the calculation of shock occurrence probability. In the next step, the proposed algorithm is applied to 15 subjects of the MIMIC II Database and AHE and MAPDRs (MAP ≤ 60 mmHg with a period of 30 min or more) are identified. As a result of this study, for a sequence of MAPDRs as long as 20 min or more, there will exist a consequent high peak with the duration of 3–4 min in the corresponding probability of cardiogenic shock diagram.

This report describes a multi-disciplinary program to develop a pediatric blood pump, motivated by the critical need to treat infants and young children with congenital and acquired heart diseases. The unique challenges of this patient population require a device with exceptional biocompatibility, miniaturized for implantation up to 6 months. This program implemented a collaborative, prescriptive design process, whereby mathematical models of the governing physics were coupled with numerical optimization to achieve a favorable compromise among several competing design objectives. Computational simulations of fluid dynamics, electromagnetics, and rotordynamics were performed in two stages: first using reduced-order formulations to permit rapid optimization of the key design parameters; followed by rigorous CFD and FEA simulations for calibration, validation, and detailed optimization. Over 20 design configurations were initially considered, leading to three pump topologies, judged on the basis of a multi-component analysis including criteria for anatomic fit, performance, biocompatibility, reliability, and manufacturability. This led to fabrication of a mixed-flow magnetically levitated pump, the PF3, having a displaced volume of 16.6 cc, approximating the size of a AA battery and producing a flow capacity of 0.3-1.5 L/min. Initial in vivo evaluation demonstrated excellent hemocompatibility after 72 days of implantation in an ovine. In summary, combination of prescriptive and heuristic design principles have proven effective in developing a miniature magnetically levitated blood pump with excellent performance and biocompatibility, suitable for integration into chronic circulatory support system for infants and young children; aiming for a clinical trial within 3 years.

The regulation of valvular endothelial phenotypes by the hemodynamic environments of the human aortic valve is poorly understood. The nodular lesions of calcific aortic stenosis (CAS) develop predominantly beneath the aortic surface of the valve leaflets in the valvular fibrosa layer. However, the mechanisms of this regional localization remain poorly characterized. In this study, we combine numerical simulation with in vitro experimentation to investigate the hypothesis that the previously documented differences between valve endothelial phenotypes are linked to distinct hemodynamic environments characteristic of these individual anatomical locations. A finite-element model of the aortic valve was created, describing the dynamic motion of the valve cusps and blood in the valve throughout the cardiac cycle. A fluid mesh with high resolution on the fluid boundary was used to allow accurate computation of the wall shear stresses. This model was used to compute two distinct shear stress waveforms, one for the ventricular surface and one for the aortic surface. These waveforms were then applied experimentally to cultured human endothelial cells and the expression of several pathophysiological relevant genes was assessed. Compared to endothelial cells subjected to shear stress waveforms representative of the aortic face, the endothelial cells subjected to the ventricular waveform showed significantly increased expression of the "atheroprotective" transcription factor Kruppel-like factor 2 (KLF2) and the matricellular protein Nephroblastoma overexpressed (NOV), and suppressed expression of chemokine Monocyte-chemotactic protein-1 (MCP-1). Our observations suggest that the difference in shear stress waveforms between the two sides of the aortic valve leaflet may contribute to the documented differential side-specific gene expression, and may be relevant for the development and progression of CAS and the potential role of endothelial mechanotransduction in this disease.

Heart failure is a well-known debilitating disease. From clinical point of view, segmentation of left ventricle (LV) is important in a cardiac magnetic resonance (CMR) image. Accurate parameters are desired for better diagnosis. Proper and fast image segmentation of LV is of paramount importance prior to estimation of these parameters. We prefer random walk approach over other existing techniques due to two of its advantages: (1) robustness to noise and, (2) it does not require any special condition to work. Performance of the method solely depends on the selection of initial seed and parameter β. Problems arise while applying this method to different kind of CMR images bearing different ischemia. It is due due to their implicit geometry definitions unlike general images, where the boundary of LV in the image is not available in an explicit form. This type of images bear multi-labeled LV and the manual seed selection in these images introduces variability in the results. In view of this, the paper presents two modifications in the algorithm: (1) automatic seed selection and, (2) automatic estimation of β from the image. The highlight of our method is its ability to succeed with minimum number of initial seeds.

The geometry of coronary arteries affects regional atherogenic processes. Accurate images can be assessed using multislice computer tomography (MSCT) to estimate bifurcations angles. We propose a three-dimensional (3D) method to measure true bifurcation angles of coronary arteries and to determine possible correlations between plaque presence and angulations. The left main (LM) coronary artery, left anterior descendent (LAD) and left circumflex artery (LCX) were imaged in 40 atherosclerotic and 35 healthy patients, using 64-rows MSCT. This Y-junction was simplified fitting a 3D cylinder to each vessel to estimate true bifurcation angles and diameters. The method was tested in phantoms and interobserver variability was assessed. Geometrical results were compared between groups using an unpaired t-test. The cylinders fitted reasonably well with mean distances to measured points below 0.4 mm. LAD-LCX bifurcation angles were wider in the atherosclerotic group (p < 0.01). LAD (p < 0.01) and LCX (p < 0.05) diameters were also larger. In phantoms mean absolute difference between true and estimated angles (N = 27) was 0.44 +/- 0.54 degrees . Interobserver mean difference (N = 135) was 1.8 +/- 5.8 degrees . Simplifying coronary bifurcation with cylinders results in a reliable technique to assess coronary artery geometry in 3D, avoiding planar projections and decreasing interobserver variability. Geometrical risk factors should be incorporated to properly predict atherosclerosis processes.