Biomedical subjects

L G Durand

Publications and source records attributed to L G Durand.

At least 37 records · Page 2Linked to original sources

PubMed1998

Development of a cardiac acoustic mapping system.

The authors describe a cardiac acoustic mapping system designed to acquire, analyse, and display the amplitude distribution of a phonocardiogram (PCG) recorded from 22 sites on the thorax. A new PCG envelope detection approach, implemented by analogue circuits, enables simultaneous sampling of PCG envelopes from the 22 sites at a rate of 250 Hz/channel. A calibration procedure removes channel-to-channel gain variations, and a coherent averaging of each PCG envelope over several cardiac cycles improves the signal-to-noise ratio. Time congruent samples from the 22 averaged PCG envelopes are then interpolated in 2D to generate the isoamplitude maps. Preliminary results show that the acoustic maps can help locate the source of heart sounds and murmurs, and characterise their radiation and propagation patterns. Cardiac acoustic mapping opens up new avenues for the study of the propagation of heart sounds and murmurs through the heart-thorax acoustic system. This technique could contribute to improvements in the diagnosis of valvular dysfunctions.

Calibration↗

PubMed1998

Kinetics of the "black hole" phenomenon in ultrasound backscattering measurements with red blood cell aggregation.

The observation of a hypoechoic zone around the center of large tubes (the "black hole" phenomenon) in ultrasound backscattering measurements with red blood cell (RBC) aggregation was reported for the first time in 1989. Since then, a very limited number of studies tried to explain its complex mechanisms. In this study, blood models characterized by different RBC aggregation levels were prepared by diluting horse blood plasma with a saline solution in different proportions. A laser reflectometry technique was used to characterize the RBC aggregation kinetics and cohesion forces between RBCs for each blood sample. The blood was circulated in a 12.7 mm diameter vertical tube. For each experimental flow condition tested, 25 or 15 power Doppler ultrasound measurements were performed across the tube with a 10-MHz system and insonation angles varying between 40 degrees to 70 degrees. For flow rates varying between 100 and 1250 mL/min, the "black hole" was observed in most measurements performed with different aggregating RBC models. The "black hole" was more pronounced for RBCs with a high kinetics of aggregation and measurements with increasing Doppler angles. Previous studies suggested that this phenomenon is due to tube entrance effects, and the reduction of RBC aggregation at very low shear rates around the center of the tube. In the present study, the "black hole" was observed for shear rates up to 25 s(-1). It is suggested that the structural organization and orientation of RBC rouleaux may participate in the mechanism leading to the "black hole" phenomenon. A schematic representation of the rheological behavior of horse RBCs in a large tube under steady flow is presented.

Animals↗

PubMed1998

Effects of a sudden flow reduction on red blood cell rouleau formation and orientation using RF backscattered power.

In most studies that were aimed at evaluating the kinetics of red blood cell (RBC) aggregation, human blood was initially circulated at a high shear rate to disrupt the aggregates, and measurements were performed following a complete flow stoppage, during the process of rouleau formation. However, it is known that a very low shear rate can enhance the formation of aggregates, as demonstrated by the modal relationship of the shear-rate dependence of RBC aggregation. The objective of the present study was, thus, to evaluate the influence of sudden flow reductions compared to a complete flow stoppage on the kinetics of rouleau formation, using ultrasound backscattering. Horse blood models, characterized by different aggregation levels, were obtained by diluting the plasma with a saline solution in different proportions. Blood was circulated in a 12.7-mm vertical tube at a flow rate of 1250 mL min-1 (prereduction flow rate) to disrupt the aggregates. The ultrasound radiofrequency (RF) signal was recorded from the center of the tube following different levels of sudden flow reduction or complete stoppage (postreduction flow rate). All measurements were performed over 2 min, using a 10-MHz transducer. No power increase was observed after complete flow stoppage. For postreduction flow rates varying between 20 and 160 mL min-1, the backscattered power increased proportionally with the kinetics of RBC aggregation. The echo buildup was also faster and stronger when the postreduction flow rate was increased. An unexpected pattern of variation of the backscattered power was found for horse RBCs characterized by high kinetics of rouleau formation. The power increased rapidly to a plateau, followed by another rapid increase and another plateau. Rouleau formation, random disorientation and reorientation were postulated to explain the phasic power increases observed.

Analysis of Variance↗

PubMed1998

In vitro evaluation of multiple arterial stenoses using three-dimensional power Doppler angiography.

PURPOSE: The study was done to improve quantification of multiple arterial stenoses and to investigate a new imaging technique for lower limb arteries. Three-dimensional power Doppler angiography was used to quantify in vitro arterial stenoses. METHODS: We built two types of artery phantoms containing multiple stenoses. One used stenotic porcine arteries, and the other was designed to control the proximal and distal stenoses while we assessed central stenosis of a wall-less agar lumen. Three-dimensional power Doppler angiograms of the flow lumens were generated at different flow rates under steady and pulsatile flow conditions with a PowerPC 8500 computer-based three-dimensional ultrasound imaging system. This experimental system works off-line, performs three-dimensional acquisition, reconstruction, and display of ultrasound images. Images of flow lumens were compared with the measured B-mode images or the true geometry. RESULTS: This technique produces good three-dimensional angiographic images of the flow lumen, and multiple stenoses do not affect the diagnosis of arterial stenoses. With this technique, the average errors for estimating 80% and 50% area reduction stenoses were -10% and 4%, respectively. CONCLUSIONS: Three-dimensional power Doppler angiography has the potential to quantitatively grade multisegmental stenoses in lower limbs and generate a map for vasculature surgery planning.

Animals↗

PubMed1998

Analysis-synthesis of the phonocardiogram based on the matching pursuit method.

The matching pursuit method of Mallat and Zhang is applied to the analysis and synthesis of phonocardiograms (PCG's). The method is based on a classical Gabor wavelet or time-frequency atom which is the product of a sinusoid and a Gaussian window function. It decomposes a signal into a series of time-frequency atoms by an iterative process based on selecting the largest inner product of the signal (and the subsequent residues) with atoms from a redundant dictionary. The Gaussian window controls the envelope duration and time position of each atom; and the sinusoid represents the frequency. The method was applied to two sets of PCG's: one with very low-noise level and the other with 10% noise energy. Each data base includes 11 PCG's representing the normal and the pathological conditions of the heart. The normalized root-mean-square error (NRMSE) was computed between the original and the reconstructed signals. The results show that the matching pursuit method is very suitable to the transient and complex properties of the PCG's, as it yielded excellent NRMSE's around 2.2% for the two sets of 11 PCG's tested.

Heart Murmurs↗

PubMed1998

Time-frequency scaling transformation of the phonocardiogram based of the matching pursuit method.

A time-frequency scaling transformation based on the matching pursuit (MP) method is developed for the phonocardiogram (PCG). The MP method decomposes a signal into a series of time-frequency atoms by using an iterative process. The modification of the time scale of the PCG can be performed without perceptible change in its spectral characteristics. It is also possible to modify the frequency scale without changing the temporal properties. The technique has been tested on 11 PCG's containing heart sounds and different murmurs. A scaling/inverse-scaling procedure was used for quantitative evaluation of the scaling performance. Both the spectrogram and a MP-based Wigner distribution were used for visual comparison in the time-frequency domain. The results showed that the technique is suitable and effective for the time-frequency scale transformation of both the transient property of the heart sounds and the more complex random property of the murmurs. It is also shown that the effectiveness of the method is strongly related to the optimization of the parameters used for the decomposition of the signals.

Fourier Analysis↗

PubMed1998

Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valve.

BACKGROUND AND AIMS OF THE STUDY: Previous studies have shown that the effective orifice area of an aortic prosthetic valve may be too small in relation to the patient's body surface area, resulting in abnormally high gradients. The consequences of this condition, termed prosthesis-patient mismatch, have not been fully studied. The study objective was to determine if the condition has a detrimental effect on symptomatic and hemodynamic status, morbidity and mortality of patients undergoing aortic valve replacement. METHODS: A cohort of 392 patients was prospectively followed for up to seven years after implantation of a Medtronic Intact bioprosthesis. Doppler echocardiography was performed annually in 72 patients. Based on previous studies, presence of mismatch was defined as an indexed valve area < or = 0.85 cm2/m2. RESULTS: Mismatch was associated with less postoperative improvement of NYHA functional class (p < 0.009) independently of other predictors, such as age and preoperative functional class, but had no significant impact on patient survival (mismatch: 75 +/- 4%, no mismatch: 79 +/- 3%; p = 0.59) and valve-related morbidity up to seven years. Cardiac index was similar in patients with and without mismatch up to three years after operation but decreased significantly thereafter only in patients with mismatch (-0.54 +/- 0.32 versus -0.17 +/- 0.49 l/min/m2; p = 0.04). Likewise, the mean transprosthetic gradient, which was higher at one year after operation in patients with mismatch (22 +/- 8 versus 15 +/- 7 mmHg), increased significantly (+6 +/- 6 versus +1 +/- 1 mmHg; p = 0.008) only in this group during follow up. CONCLUSIONS: Patients with mismatch have less symptomatic improvement and worse hemodynamics that continue to deteriorate with time. However, medium-term prognosis (up to seven years) is relatively good. Further studies are necessary to determine the longer-term effects of mismatch on morbidity and mortality.

Aged↗

PubMed1997

Time and frequency domain analysis of acoustic signals from a human muscle.

We wished to determine whether evoked force output from a human muscle could be inferred from the amplitude and the frequency of evoked muscular sounds. Sounds from adductor pollicis were recorded with a microphone and compared to evoked force changes produced by varying the intensity of nerve stimulation or of voluntary effort as well as by fatigue and twitch potentiation. In all instances, high correlations were obtained between evoked acoustic signals amplitude and evoked twitch force changes. Instantaneous time-frequency distributions of evoked acoustic signals also showed a high degree of cross correlation with evoked instantaneous twitch force, but no relationship was found for the group between the maximal frequency of sound and force changes. We conclude that evoked force changes from human muscles cannot be reliably inferred from frequency domain analysis of evoked sound signals and that, for this purpose, analysis of sound signals in time domain can be employed, an analysis potentially useful for muscles whose force output cannot be directly measured.

Adult↗

PubMed1997

Time-frequency analysis of the muscle sound of the human diaphragm.

The time-frequency characteristics of muscular sounds (phonomyogram) produced by the contraction of the human diaphragm under various contractile states is evaluated with the cone-kernel distribution. The results show that the instantaneous frequency of the phonomyogram of the diaphragm has a high cross-correlation (an average of 0.91 +/- 0.06) with the transdiaphragmatic pressure, with a delay varying between 25 and 35 ms. The instantaneous frequency response of the phonomyogram of the diaphragm shows a behaviour similar to that of the frog muscle; it rapidly rises and then fades out. However, the maximum of the instantaneous frequency of the phonomyogram of the diaphragm is not proportional to the maximum of the transdiaphragmatic pressure. This analysis also demonstrates the usefulness of the cone-kernel distribution for studying frequency-modulated signals like the muscular sound signals.

Diaphragm↗

PubMed1997

Time-frequency analysis of the first heart sound: Part 3: Application to dogs with varying cardiac contractility and to patients with mitral mechanical prosthetic heart valves.

The cone-kernel distribution (CKD) is first applied to the analysis of the intracardiac and the thoracic first heart sound (S1) of dogs in various cardiac contractile states, and secondly to the S1 of patients with mitral mechanical prosthetic heart valves. The CKD of native S1 in dogs shows that the dominant components of S1 are generally concentrated in a band at around 50 Hz with a horizontal flat or a semi-lunar shape, independently of the myocardial contractile state. There is no significant systematic rising frequency component. The instantaneous frequency of S1 shows a good cross-correlation with the time derivative of the left ventricular pressure (dP/dt), but the maximum frequency is not proportional to the maximum of dP/dt. The CKD of S1 in patients with mitral mechanical prosthetic heart valves showed a pulse-like component with a high-frequency bandwidth, which is distinct from the low constant-frequency components of S1 produced by native heart valves.

Animals↗

PubMed1997

Time-frequency analysis of heart murmurs. Part I: Parametric modelling and numerical simulations.

The object of this study is to compare the performance of two new bilinear time-frequency representation techniques with the spectrogram to characterise the behaviour of heart murmurs produced by bioprosthetic heart valves implanted in the mitral or aortic position. The murmurs are those of mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, a diastolic musical murmur and a systolic musical murmur. In the first part of the study, the general characteristics of the amplitude and the spectral content of these murmurs are determined by visual observation of the spectrogram of phonocardiograms obtained from several patients with known valvular pathology complemented with a literature review. A parametric model is then generated for each murmur signal. Stenotic and regurgitant murmurs are modelled as the sequential output of a bank of low-pass filters excited by a white noise input signal. The basic parameters of each filter are selected to simulate, as a function of time, the basic characteristics of random heart murmurs. Musical murmurs are modelled as a frequency-modulated deterministic sinusoid of constant amplitude. Numerical simulations of these random and musical heart murmurs are then generated and will be used in Part II to determine the best of three time-frequency representation techniques for analysing heart murmur signals.

Aortic Valve↗

PubMed1997

Time-frequency analysis of heart murmurs. Part II: Optimisation of time-frequency representations and performance evaluation.

The basic parameters of the spectrogram, the Choi-Williams, and the Bessel distributions are adjusted to provide the best time-frequency representations (TFRs) of the simulated murmur signals of mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, and of two musical murmurs. The initial adjustment of the parameters of each TFR technique is performed by computing and minimising the relative averaged absolute error between the frequency contours at -3 dB and -10 dB of each TFR of the simulated murmurs and those of the theoretical distribution of the same signals. The results show that the spectrogram generally provides very good to excellent performance in representing the TFRs of stenotic and regurgitant murmurs. Improvements provided by the Choi-Williams and the Bessel distributions are minor but not systematic for the two signal-to-noise ratios tested (0 and 30 dB) and for the two frequency contours estimated. The Bessel and the Choi-Williams distributions provide the best performance for the musical murmurs. The study shows that although a single technique cannot be optimal for all six murmurs, the spectrogram using a Hamming window of 30 ms is an acceptable compromise to detect the six simulated heart murmurs.

Computer Simulation↗

PubMed1997

Time-frequency analysis of the first heart sound. Part 1: Simulation and analysis.

The authors propose a simulated first heart sound (S1) signal that can be used as a reference signal to evaluate the accuracy of time-frequency representation techniques for studying multicomponent signals. The composition of this simulated S1 is based on the hypothesis that an S1 recorded on the thorax over the apical area of the heart is composed of constant frequency vibrations from the mitral valve and a frequency modulated vibration from the myocardium. Essentially, the simulated S1 consists of a valvular component and a myocardial component. The valvular component is modelled as two exponentially decaying sinusoids of 50 Hz and 150 Hz and the myocardial component is modelled by a frequency modulated wave between 20 Hz and 100 Hz. The study shows that the simulated S1 has temporal and spectral characteristics similar to S1 recorded in humans and dogs. It also shows that the spectrogram cannot resolve the three components of the simulated S1. It is concluded that it is necessary to search for a better time-frequency representation technique for studying the time-frequency distribution of multicomponent signals such as the simulated S1.

Animals↗

PubMed1997

Time-frequency analysis of the first heart sound. Part 2: An appropriate time-frequency representation technique.

A simulated first heart sound (S1) signal is used to determine the best technique for analysing physiological S1 from the following five time-frequency representations (TFR): the spectrogram, time-varying autoregressive modelling, binomial reduced interference distribution, Bessel distribution and cone-kernel distribution (CKD). To provide information on the time and frequency resolutions of each TFR technique, the instantaneous frequency and the -3 dB bandwidth as functions of time were computed for each simulated component of the S1. The performance index for selecting the best technique was based on the relative error and the correlation coefficient of the instantaneous frequency function between the theoretical distribution and the computed TFR. This index served to select the best technique. The sensitivity of each technique to noise and to small variations of the signal parameters was also evaluated. The results of the comparative study show that, although important limitations were found for all five TFRs tested, the CKD appears to be the best technique for the time-frequency analysis of multicomponent signals such as the simulated S1.

Heart↗

PubMed1996

Estimation of pulmonary artery pressure by spectral analysis of the second heart sound.

The objective of the present work was to test and validate a noninvasive method based on spectral analysis of the second heart sound (S2) to estimate the pulmonary artery (PA) systolic pressure in 89 patients with a bioprosthetic heart valve. The technique was compared with continuous-wave Doppler estimation of PA systolic pressure in these patients. The heart sounds recorded at the pulmonary area on the chest wall were digitized by computer. The spectra of S2 and those of the aortic (A2) and the pulmonary (P2) components of S2 were computed with a fast-Fourier transform. Seven features were extracted from these spectra. The statistical analysis performed with the Pearson linear correlation coefficient showed that the best estimation of PA systolic pressure obtained by spectral phonocardiography (r = 0.84, SEE +/- 5.6 mm Hg, p <0.0001) was provided by the following equation: PA systolic pressure = 47 + 0.68 Fp - 4.4 Qp - 17 Fp/Fa - 0.15 Fs, where Fs and Fp are dominant frequencies associated with the maximal amplitude of the power spectra of S2 and P2, respectively, Qp is the quality of resonance of P2, and Fp/Fa is the ratio of the dominant frequencies of P2 and A2, respectively.

Adult↗

PubMed1996

Power Doppler ultrasound evaluation of the shear rate and shear stress dependences of red blood cell aggregation.

The use of power Doppler ultrasound at 10 MHz is evaluated as a method to study the shear rate and the shear stress dependences of red blood cell aggregation. This evaluation was based on six in vitro experiments conducted in a 1.27-cm diameter tube under steady flow conditions. Porcine whole blood was circulated in the flow model at flow rates ranging between 125 to 1500 ml/min (mean shear rate across the tube ranging between 6 and 74 s-1). For each flow condition, the variation of the Doppler power across the tube and the velocity profile were measured by moving the Doppler sample volume across the tube diameter. For each radial position, the shear rate within the Doppler sample volume was also determined by considering the radial power pattern of the ultrasound beam. To estimate the shear stress within the Doppler sample volume, the apparent viscosity of blood samples withdrawn from the flow model was measured for each experiment. The variation of the Doppler power as a function of the shear rate within the sample volume showed a rapid reduction of the power between 1 and 5 s-1, a transition region between 5 and 10 s-1, and a very slow reduction beyond 10 s-1. Little variation of the Doppler power was measured for shear stress higher than 2 dyn/cm2. The maximum Doppler power for all flow rates was usually found near the center of the tube. Based on the ultrasonic scattering models, which predict that the Doppler power is related to the volume square of the scatterers, the method described in the present study showed a very high sensitivity to the presence of red blood cell aggregation for shear rates below 10 s-1.

Animals↗

PubMed1996

Characterization of blood flow turbulence with pulsed-wave and power Doppler ultrasound imaging.

Blood turbulence downstream of a concentric 86 percent area reduction stenosis was characterized using absolute and relative Doppler spectral broadening measurements, relative Doppler velocity fluctuation, and Doppler backscattered power. Bidimensional mappings of each Doppler index were obtained using a 10 MHz pulsed-wave Doppler system. Calf red cells suspended in a saline solution were used to scatter ultrasound and were circulated in an in vitro steady flow loop model. Results showed that the absolute spectral broadening was not a good index of turbulence because it was strongly affected by the deceleration of the jet and by the shear layer between the jet and the recirculation zones. Relative Doppler spectral broadening (absolute broadening divided by the frequency shift), velocity fluctuation, and Doppler power indices provided consistent mapping of the centerline axial variation of turbulence evaluated by hot-film anemometry. The best agreement between the hot-film and Doppler ultrasound methods was however obtained with the Doppler back-scattered power. The most consistent bidimensional mapping of the flow characteristics downstream of the stenosis was also observed with the Doppler power index. The relative broadening and the velocity fluctuation produced artifacts in the shear layer and in the recirculation zones. Power Doppler imaging is a new emerging technique that may provide reliable in vivo characterization of blood flow turbulence.

Artifacts↗

PubMed1996

The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical status.

BACKGROUND: High pressure gradients occurring through normally functioning prosthetic valves appear to be related to a mismatch between the effective orifice area of the prosthesis and the patient's body surface area. OBJECTIVE: To determine whether prosthesis-patient mismatch affects clinical and hemodynamic status, a group of patients with a bioprosthetic heart valve in the aortic position was prospectively evaluated at 6.2+/-4.4 years after implantation by transthoracic Doppler echocardiography. METHODS: Manufacturer-derived in vitro valve areas were available in 61 patients allowing classification into two subgroups, with or without mismatch, based on a valve area at implantation indexed for body surface area 0.85 cm2/m2 or less, or greater than 0.85 cm2/m2. Clinical and hemodynamic parameters evaluated at follow-up included New York Heart Association (NYHA) class distribution, mean transprosthetic gradient, prosthetic valve area and cardiac index. RESULTS: Prosthesis-patient mismatch was present in 32 of 61 patients (52%). Although NYHA class of the patients was similar in both groups, hemo-dynamic performance of the aortic bioprostheses was worse in patients with mismatch than in patients with no mismatch, as indicated by a higher mean gradient (22+/-9 versus 15+/-8 mm Hg, P=0.002) and a lower cardiac index (3.0+/-0.7 versus 3.4+/-0.7 L/min/m2, P=0.04). The prevalence and severity of intrinsic prosthetic dysfunction were similar in both groups. Despite similar NYHA functional class distribution in both groups, the occurrence of syncope, acute pulmonary edema and angina pectoris was significantly higher in patients with mismatch (50% versus 21%, P=0.017). CONCLUSIONS: Prosthesis-patient mismatch is associated with worse hemodynamic performance and higher prevalence of adverse clinical events. However, mismatch did not promote accelerated hemodynamic or structural deterioration of the bioprosthesis.

Angina Pectoris↗