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At least 1,279 records · Page 71Linked to original sources
PubMed1995

Thrombolysis after stroke hope for the future.

Over the past two decades, several prospective, randomized clinical trials have shown that thrombolytic therapy of acute myocardial infarction (AMI) decreases morbidity and mortality. The generally positive results have been tempered by a small, but clinically significant risk of potentially lethal intracerebral haemorrhage. Given that the pathogenesis of thrombotic stroke is similar to AMI, interest has recently turned to the use of the same drugs to "cure" stroke. The purpose of this paper is to develop a comprehensive position regarding neuroscience nursing roles concerning this new therapy. The importance of proactive public educational programmes and rapid and accurate patient identification derive directly from the pathogenesis of thrombotic stroke, and the pharmacology of the thrombolytic agents. Guidelines for drug preparation and administration and patient monitoring during treatment are developed from tested cardiovascular models.

Cerebrovascular Disorders↗
PubMed1995

The effects of noise and errors in heart size on numerical techniques for the inverse problem of electrocardiography.

In this study we examine the effects of both noise and geometrical errors on four numerical methods proposed for solving the inverse problem of electrocardiography. The heart-body system is modeled using an inhomogeneous eccentric sphere model. The cardiac source is modeled as a double layer spherical cap with either an anterior or posterior location. Epicardial potentials determined using the numerical techniques were compared with the analytically determin potentials in the presence of both noise and errors in assumed geometry.

Biomedical Engineering↗
PubMed1995

Examination of impedance cardiography properties--FEM model studies.

A FEM has been used to examine influence of tissues' conductivities and electrodes' array configurations on the results obtained by Impedance Cardiography. A Geselowitz's relationship has been applied to estimate partial contributions from each region of thorax. The obtained results have indicated the strong dependence of ICG signal on factors mentioned above. It seems that additional measurements and more advanced ICG waveform processing must be done to minimise errors in estimating parameters of mechanical work of heart by means of ICG.

Cardiography, Impedance↗
PubMed1995

Optimal truncation of defibrillation pulses.

The statement that the optimal pulse for defibrillation has not yet been discovered implies that an ideal pulse exists, but that it is different in shape, duration, and energy as compared to pulses of today. The optimum pulse is that which can defibrillate with lowest energy. Reduction of energy can be reached twofold: by looking for a pulse duration with lowest energy threshold, and by finding the optimal truncation with lowest refibrillating effect. Assuming that there is also a rheobase in defibrillation below which no defibrillating but probably a refibrillating effect exists, the exponential pulse should be truncated if it intersects with the rheobase. Combining the fundamental law of electrostimulation with this boundary condition allows for the mathematical solution of the above problem of optimal energy. Defibrillation can be optimized with respect to pulse duration or tilt and to energy efficiency. The most important parameter in determining other optimized parameters such as output capacitor is the chronaxie. The calculations reveal that the "concept of constant energy" does not accurately describe defibrillation, that today's implantable cardioverter defibrillator devices possess refibrillating tilts, that pulse durations should be programmed to values between 4 and 10 msec, and that smaller output capacitors around 30 microF would minimize the energy requirements. Whether optimized monophasic pulses are inferior or equal to biphasic pulses needs further experimental studies.

Animals↗
PubMed1995

Fast stress and rest acquisitions for technetium-99m-sestamibi separate-day SPECT.

UNLABELLED: Abbreviated acquisition protocols were designed for stress and rest to decrease stress and rest SPECT image acquisition times but maintain the high count density of 99mTc-sestamibi separate-day cardiac images. METHODS: Scan findings were compared visually and quantitatively with standard SPECT for 12 rest and 32 stress patient studies. RESULTS: Of 29 stress defects detected by standard SPECT, 27 were present with the fast technique; of 8 resting SPECT defects, all were detected with fast SPECT. Two stress and no resting false-positive defects occurred with fast SPECT. Linear correlations (r) between standard and fast quantitative defect extent and severity were 0.76 and 0.86, respectively for stress SPECT, and 0.88 and 0.96 for rest SPECT. Stress fast defects were slightly less severe (p = 0.02) than those observed using standard acquisition. CONCLUSION: We conclude that these fast protocols for separate-day 99mTc-MIBI SPECT accurately detect and characterize perfusion defects and provide a means to improve patient tolerance and increase laboratory throughput.

Coronary Disease↗
PubMed1995

[Evaluation of partial volume effect in quantitative measurement of regional cerebral blood flow in single photon emission computed tomography--effects of limited spatial resolution and first-pass extraction fraction].

Two numerical brain phantoms were generated in order to investigate errors which might be included in the quantitative measurement of regional CBF with use of single photon emission computed tomography (SPECT). The first phantom simulated the normal brain, and effects of the limited spatial resolution of the SPECT scanner were evaluated for 4 tracer kinetic models of the conventional microsphere model, the intra-carotid bolus injection technique of 133Xe, 133Xe Kanno-Lassen method, and the IMP-autoradiography (IMP-ARG) method. The second phantom simulated the diseased brain with middle-carotid artery (MCA) occlusion, and effects of the limited first-pass extraction fraction were investigated for the microsphere model with various permeability-surface area products. The limited spatial resolution caused systematic underestimation of the radioactivity concentration in the gray matter regions, and systematic overestimation in the low CBF regions. These errors in the original radioactivity distribution were found to cause further systematic errors in the calculated regional CBF images. It was also found that these errors were highly dependent on the tracer kinetic model employed, e.g., regional CBF values were overestimated in the clearance and the Kanno-Lassen methods compared with the conventional microsphere method, whereas values were underestimated in the IMP-ARG method. It was also shown in this study that the limited first-pass extraction fraction caused significant underestimation in the calculated rCBF values. In addition, regional contrast can be reduced when using a tracer with small PS product.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain↗
PubMed1995

[Evaluation of partial volume effect in quantitative measurement of regional cerebral blood flow using positron emission tomography].

Effects of limited spatial resolution of the positron emission tomography (PET) scanner on the quantitative measurement of regional cerebral blood flow (rCBF) was investigated for various tracer kinetic models with use of 15O labeled water and PET. Using a numerical brain phantom consisting of a gray matter, white matter and cerebrospinal fluid components, dynamical tracer distribution images were calculated for the H215O bolus injection and for the C15O2 gas inhalation protocols. The tracer distribution images were convoluted with a 2 dimensional gaussian function with full-width at half maximum (FWHM) of 4, 7, 12 mm to simulate a limited spatial resolution of the PET scanner, and rCBF images were calculated according to some kinetic models. Smoothing the tracer distribution images caused a heterogeneous structure (tissue mixture) in a given volume element. rCBF values calculated by models with use of 15O-water and PET were found to provide rCBF values that were systematically underestimated compared with those obtained by the microsphere model for a mixed tissue region. Moreover, the magnitude of the underestimation was shown to be highly dependent on the tracer kinetic models employed, those errors for mixed tissue of gray and white matter were 20% on steady state, 9% on autoradiography and on weighted integration method, and 2% on non-linear least squares fitting, compared with microsphere model. More errors observed by steady state method and autoradiography method happened for tissue mixture consisting gray matter, white matter and cerebrospinal fluid components. It is important to take into account for difference of the partial volume effect for each models in calculated rCBF.

Brain↗
PubMed1995

[A study of the simultaneous acquisition of dual energy SPECT with 99mTc and 123I: evaluation of optimal window setting with myocardial phantom].

To examine crosstalks (CRs) between 99mTc-methoxyisobutyl isonitrile (MIBI) and beta-methyl-p-(123I)iodophenyl-pentadecanoic acid (BMIPP), myocardial phantom studies of simultaneous acquisition were performed with three window widths and four energies where the window located. CRS in 99mTc window were less than 10.5% regardless of the window settings. CRs in 123I window were ranging from 17.0% to 8.6% depending on the window setting. There were significant correlations between the isotope concentration and counts of 99mTc and 123I, respectively (r = 0.98, p < 0.0001). We concluded that the optimal window setting of 99mTc-MIBI and 123I-BMIPP (10% width, 140 keV center 99mTc window and 10% width, 164 keV center 123I window) yields good quality images in dual isotope SPECT.

Aged↗
PubMed1995

[Restoration filtering based on projection power spectrum for single-photon emission computed tomography].

To improve the quality of single-photon emission computed tomographic (SPECT) images, a restoration filter has been developed. This filter was designed according to practical "least squares filter" theory. It is necessary to know the object power spectrum and the noise power spectrum. The power spectrum is estimated from the power spectrum of a projection, when the high-frequency power spectrum of a projection is adequately approximated as a polynomial exponential expression. A study of the restoration with the filter based on a projection power spectrum was conducted, and compared with that of the "Butterworth" filtering method (cut-off frequency of 0.15 cycles/pixel), and "Wiener" filtering (signal-to-noise power spectrum ratio was a constant). Normalized mean-squared errors (NMSE) of the phantom, two line sources located in a 99mTc filled cylinder, were used. NMSE of the "Butterworth" filter, "Wiener" filter, and filtering based on a power spectrum were 0.77, 0.83, and 0.76 respectively. Clinically, brain SPECT images utilizing this new restoration filter improved the contrast. Thus, this filter may be useful in diagnosis of SPECT images.

Brain↗
PubMed1994

[A new methodologic approach for determining right ventricular volumes from transesophageal echocardiography].

In order to develop a concept of right ventricular volume estimation accounting for variance in positioning of the transesophageal transducer, non-linear scale transformations of suitable measurements of areas and perimeters were used in a new modeling-approach. This type of modeling supposes self-similarity of ventricular dimensions, a mathematical concept generalizing the notion of proportionality. In a study using right ventricular casts, we were able to demonstrate the geometry of right ventricles complies with these assumptions. The resulting multivariate power law volume estimators were developed by non-linear data fitting by learning-analyses based upon angiographic reference volumes and two areas derived from non-orthogonal sections using a monoplane transducer in a first series of studies, and two orthogonal areas with corresponding perimeters using a biplane device in a second series. Correction factors for systolic and diastolic volumes were applied. By prospective test-analyses angiographic and TEE-derived volumes were compared to evaluate our volume estimator and good agreement was found. Trend was evaluated by correlation amounts to r = 0.95 (n = 22) in series 1 with monoplane transducer, and r = 0.9 (n = 20) in series 2 with biplane transducer. This approach is of use in monitoring right ventricular function in cases with unsuitable transthoracical windows, e.g., in cardiac surgery postoperatively.

Adult↗
PubMed1994

[New data in cardiology: the electric charge of the heart].

This study emerging from profound consideration of the basis of vectorcardiography reveals a new electric model of the heart, the starting point for a computer programme of which only the principle is described. Noting inadequacies of vectorcardiography linked to necessary but possibly excessive simplifications, the author suggests a solution based only on Einthoven's postulate of a single dipole: at each instant during the cardiac revolution, the positions of point N, the centre of negative charges and origin of the dipole, of point P, the centre of positive charges and extremity of the dipole, and the value of the load borne by this dipole are calculated. The classical orientations of septal, parietal and basal vectors are thus found. It is shown that electric charge follows a bell-shaped curve and that the velocity of the dipole is compatible with that of the depolarisation wave, in contrast to velocities given by vectorcardiography. The trajectory of the dipole, a veritable "dipologram" visualises breaks in continuity which are interpreted. This new method has the advantage of being entirely confirmable: the dipole provided by the programme enables the calculation of potentials. Comparison between measured potentials and calculated potentials ensures the reliability of results provided by this programme. This method is totally in contrast with conventional vectorcardiography: the dipole is entirely mobile regarding both its origin and extremity, its site in the thorax is precisely identified, and its length is calculated, together with its velocity and the charge which it carries.(ABSTRACT TRUNCATED AT 250 WORDS)

Electricity↗
PubMed1994

[Quantitative analysis of 123I-metaiodobenzylguanidine myocardial scintigraphy by myocardial uptake using a phantom].

To evaluate the quantitative analysis of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, total injected dose measured by first pass (FP) method (TFP) was compared with that measured by phantom method using an acrylic phantom in 45 patients with cardiac disease. Heart per mediastinum ratio (H/M) was compared to myocardial uptake calculated with TFP. The total injected dose measured using the phantom in which the syringe was set in depth of 3.5 cm (Tpham) was correlated with TFP (r = 0.73, p = 0.0001). When Tpham was corrected by body weight (c-Tpham), c-Tpham showed better correlation with TFP. MU calculated by TFP (MU-FP) was well correlated with MU by c-Tpham (MU-pham) (r = 0.94, p = 0.001). These results indicate that phantom method is sufficient to substitute for FP method. Though H/M was correlated with MU-FP (p < 0.001), the interpatient variation was relatively large. Then the analysis by H/M is insufficient to substitute for the myocardial uptake. It is though to be enough to use the phantom method on daily routine work, since this method is accurate and easy to quantitate the myocardial uptake of MIBG taking a short time.

3-Iodobenzylguanidine↗
PubMed1994

Effects of epidural analgesia and atropine on heart rate and blood pressure variability: implications for the interpretation of beat-to-beat fluctuations.

Cardiovascular variables such as heart rate, arterial blood pressure, stroke volume and the shape of electrocardiographic complexes all vary beat-by-beat. This variability occurs because of the dynamic response of cardiovascular regulatory systems to perturbations in cardiovascular function. We applied spectral analysis to the effects of sympathetic vasomotor blockade by epidural analgesia and parasympathetic blockade of the heart by atropine on the beat-to-beat variability of heart rate and blood pressure in humans. High-frequency fluctuations in heart rate (+/- 0.2 Hz) are caused by respiratory induced fluctuations of blood pressure, mediated by the vagus nerve. Low-frequency fluctuations (0.06-0.12 Hz) are related to sympathetic baroreflex control of vasomotor activity and heart rate. In our study, even partial parasympathetic blockade of the heart by atropine decreased the power in the high and low frequency heart rate fluctuations. There were no significant changes in blood pressure fluctuations in either frequency range. Sympathetic blockade by epidural analgesia decreased only low-frequency fluctuations of both heart rate and blood pressure. From a cardiovascular model and our experimental results we support the view that high frequency fluctuations in heart rate are due to the vagal response to blood pressure fluctuations caused by respiration and that the fluctuations around 0.1 Hz in both heart rate and blood pressure have their origin in the sympathetic baroreflex control loop of vasomotor activity.

Adolescent↗
PubMed1994

On-line beat-to-beat monitoring of spectral parameters of heart rate variability signal using a pole-tracking algorithm.

Spectral parameters extracted from the heart rate variability (HRV) signal are obtained on a beat-to-beat basis, following a procedure which uses two recursive algorithms. In the first step of the procedure the set of the AR model coefficients is updated each time a new RR value is available. Then from the estimated AR model parameters, the new position of the poles of the model transfer function in the complex z-plane is evaluated and, finally, through a residual calculation, it is possible to calculate the spectral parameters which quantify the control of the autonomic nervous system in assessing the cardiac frequency (i.e., power and frequency of LF and HF components). The whole procedure has first been tested on a simulated time series, in order to evaluate its performance in tracking the dynamic changes during different conditions; next the algorithms were employed in the study of the HRV signal for continuous monitoring of non-stationary conditions.

Algorithms↗
PubMed1993

Comparison of measured and computed epicardial potentials from a patient-specific inverse model.

This study reports the first direct comparison of measured and computed epicardial potentials in which the specific anatomy of a test subject has been used to calculate the inverse electrocardiographic model. It is now feasible to obtain low-noise body surface potential maps and to incorporate accurate anatomic data into inverse procedures for the purpose of computing epicardial potential distributions. The direct verification of computed human epicardial distributions remains an important goal. The experiment reported here obtained direct measurements from six transcutaneous pacing wires that were attached to points on the epicardial surface of the human heart in an intact subject. From the same subject, a magnetic resonance scan was used to produce a specific thoracic model consisting of 5-mm cubes. The forward model uses the finite difference method to compute a forward transfer matrix that relates each of 26 epicardial regions to body surface measurements. The inverse computation was performed by zero-order Tikhonov regularization. Body surface potentials were used in the inverse procedure to compute epicardial potentials, which were then compared with direct epicardial measurements. The computed epicardial potentials were compared to the measured ones by correlation, which gave an amplitude-independent measure of similarity. Amplitude differences and time delays in computed potentials were observed, but the morphologic trend was generally well recovered. The results obtained indicate the sensitivity of the inverse model to a number of factors. The robustness of computed epicardial distributions to errors in assumed lung conductivity is shown. Results from a nonpatient-specific, but realistic, torso model are presented.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗
PubMed1994

A mathematical study of turbulent blood flow through an arterial bifurcation.

A turbulent model of flow through an arterial bifurcation is proposed in order to investigate flow separation, secondary flow and the variation of pressure and stress along the wall when blood passes through a bifurcation. Blood is assumed to behave like a Newtonian fluid, with viscosity depending on the angle of bifurcation. The geometry of the models used here for aortic bifurcations is set by employing the principle of conservation of mass. The results show that: the peak axial velocity in the entrance region of the daughter vessel occurs on the inner wall of the bifurcation; a strong secondary flow may develop in the branch, which has much less effect on axial flow when the Reynolds number is low; there is a tendency toward separation in the branch with low mean flow, and the flow is increasingly disturbed as the bluntness of the apex increases.

Arteries↗
PubMed1993

Cardiac phantom evaluation of simultaneously acquired dual-isotope rest thallium-201/stress technetium-99m SPECT images.

Simultaneously acquired dual-isotope 201Tl/99mTc SPECT studies were performed using cardiac and thoracic phantoms to evaluate the dual-isotope myocardial perfusion technique. Cardiac phantom images representing infarction, viable myocardium and various levels of ischemia were analyzed. Studies with and without attenuating media were performed, and myocardium-to-defect count ratios and defect sizes from dual-isotope SPECT images were compared to myocardium-to-defect count ratios and defect sizes from single-isotope (201Tl and 99mTc) SPECT images. Dual-isotope studies also were interpreted qualitatively. Studies with background activity simulating clinical conditions were performed and interpreted qualitatively. Myocardium-to-defect count ratios from both 99mTc and 201Tl were similar in single-isotope and dual-isotope SPECT images. Thallium-201 and 99mTc defect sizes were decreased slightly (mean +/- s.d., 1.0 +/- 1.7 cc for 201Tl and 0.7 +/- 1.0 cc for 99mTc) on dual studies when compared to single studies but were not statistically significant. Dual-isotope image simulations of normal, ischemic and infarcted and viable myocardium were correctly identified by experienced clinicians in 95% of the cases (21/22). Simultaneous dual-isotope 201Tl/99mTc SPECT imaging of cardiac phantoms produced images that had similar myocardium-to-defect count ratios to those produced using single-isotope techniques and were correctly evaluated on qualitative analysis. Changes in defect size related to dual-isotope imaging were minimal and not qualitatively important.

Evaluation Studies as Topic↗
PubMedDate not supplied

Localization of atherosclerosis in arterial junctions. Modeling the release rate of low density lipoprotein and its breakdown products accumulated in blood vessel walls.

Arterial bifurcations and surgically created junctions at anastomoses are places where blood flow may be disturbed and slow recirculation may occur. To address the hypothesis that such disturbances in flow may result in atherogenesis, the transfer of atherogenic substances from vessel wall to flowing blood was studied theoretically using a two dimensional T-junction model. Calculations showed that the transfer of atherogenic substances from vessel wall into flowing blood was suppressed in the two regions of disturbed flow, one in the main vessel, the other in the subsidiary vessel. The lowest release rates were at the points of flow separation and were found to be much lower than those in the undisturbed flow regions. Therefore, our mathematical model predicts that locally disturbed blood flows at arterial bifurcations and surgically created junctions are responsible for two distinct phenomena. First, they provide favorable conditions for the accumulation of LDL at the luminal surface, thus increasing the potential for lipid infiltration into the vessel wall, and second, they impair the transfer into blood of atherogenic substances accumulated in the vessel wall. Such mass transfer abnormalities may account for atherogenesis and late failures of arterial grafts at these sites.

Anastomosis, Surgical↗