Myocardial tissue motion influence on laser Doppler perfusion monitoring using tissue Doppler imaging

Tissue motion of the beating heart generates large movement artifacts in the laser Doppler perfusion monitoring (LDPM) signal. The aim of the study was to use tissue Doppler imaging (TDI) to localise intervals during the cardiac cycle where the influence of movement artifacts on the LDPM signal is minimum. TDI velocities and LDPM signals were investigated on three calves, for normal heartbeat and during occlusion of the left anterior descending coronary artery. Intervals of low tissue velocity (TDI_int<1 cm s⁻¹) during the cardiac cycle were identified. During occlusion, these intervals were compared with low LDPM signal intervals (LDPM_int<50% compared with baseline). Low-velocity intervals were found in late systole (normal and occlusion) and late diastole (normal). Systolic intervals were longer and less sensitive to heart rate variation compared with diastolic ones. The overlap between LDPM_int and TDI_int in relation to TDI_int length was 84±27% (n=14). The LDPM signal was significantly (p<0.001, n=14) lower during occlusion if calculated during minimum tissue motion inside TDI_int), compared with averaging over the entire cardiac cycle without taking tissue motion into consideration. In conclusion, movement artifacts are reduced if the LDPM signal is correlated to the ECG and investigated during minimum wall motion. The optimum interval depends on the application; late systole and late diastole can be used.     

Myocardial perfusion monitoring during coronary artery bypass using an electrocardiogram-triggered laser Doppler technique

Electrocardiogram (ECG)—triggered laser Doppler perfusion monitoring (LDPM) was used to assess myocardial perfusion, with minimum myocardial tissue motion influence, during coronary artery bypass grafting (CABG). Thirteen subjects were investigated at six phases: pre- and post-CABG; post aorta cross-clamping; pre and post left internal mammary artery (LIMA) graft declamping; and post aorta declamping. The perfusion signal was calculated in late systole and late diastole, with expected minimum tissue motion, and compared with arrested heart measurements. Patient conditions or artifacts caused by surgical activity made it impossible to perform and analyse data in all six phases for some patients. No significant (n=5) difference between perfusion signals pre- and post-CABG was found. Diastolic perfusion signal levels were significantly (p<0.02) lower compared with systolic levels. After aorta cross-clamping, the signal level was almost zero. A distinct perfusion signal increase after LIMA and aorta declamping, compared with pre-LIMA declamping, was found in ten cases out of 13. A significantly (p<0.04) lower perfusion signal in the arrested heart compared with in the beating heart was registered. Influence from mechanical ventilation was observed in 14 measurements out of 17. In conclusion, ECG-triggered LDPM can be used to assess myocardial perfusion during CABG. Perfusion signals were lower in the arrested heart compared with in the beating heart and in late diastole compared with late systole. No significant difference between pre- and post-CABG was found.     

Signal processing technique for non-invasive real-time estimation of cardiac output by inductance cardiography (thoracocardiography)

Inductance cardiography (thoracocardiography) non-invasively monitors changes in stroke volume by recording ventricular volume curves with an inductive plethysmographic transducer encircling the chest at the level of the heart. Clinical application of this method has been hampered, as data analysis has not been feasible in real time. Therefore a novel, real-time signal processing technique for inductance cardiography has been developed. Its essential concept consists in performance of multiple tasks by several, logically linked signal processing modules that have access to common databases. Based on these principles, a software application was designed that performs acquisition, display, filtering and ECG-triggered ensemble averaging of inductance signals and separates cardiogenic waveforms from noise related to respiration and other sources. The resulting ventricular volume curves are automatically analysed. Performance of the technique for monitoring cardiac output in real time was compared with thermodilution in four patients in an intensive care unit. The bias (mean difference) among 76 paired thoracocardiographic and thermodilution derived changes in cardiac output was 0%; limits of agreement (±2 SD of the bias) were ±25%. It is concluded that the proposed signal processing technique for inductance cardiography holds promise for non-invasive, real-time estimation of changes in cardiac output.     

Sympathetic skin vasoconstriction--further evaluation using laser Doppler techniques.

The aim of this study was to quantify the reflex sympathetic vasoconstriction in skin at different depths. Twenty healthy subjects were studied. Finger skin blood flow was measured using laser Doppler perfusion imaging (LDPI) and laser Doppler perfusion monitoring (LDPM). In LDPM, a probe with fibres separated 0.25 mm (deep) and 0.14 mm (superficial) from the illuminating fibre was used. Local heating (40 degrees C) was achieved with a Peltier element, and reflex vasoconstriction induced by immersion of the contra-lateral hand and forearm for 3 min in water at 15 degrees C. The change in skin blood flow was measured and a vasoconstriction index (VAC: cooling/before cooling) calculated. VAC indices of LDPI, LDPM-0.25 and LDPM-0.14 were 0.60, 0.59 and 0.60, respectively. The two components of the LDPM perfusion value, blood cell velocity and concentration, were studied separately. Their contributions in LDPM-0.25 were roughly the same, whereas the velocity component dominated in LDPM-0.14, although their relative responses in the two channels were similar. We conclude that sympathetic skin vasoconstriction does not significantly differ in two compartments, as probed with fibres separated by 0.25 and 0.14 mm. Blood cell velocity is influenced in a proportional way, as is concentration.     

Polarized laser Doppler perfusion imaging--reduction of movement-induced artifacts

Laser Doppler perfusion imaging (LDPI) enables superficial tissue perfusion assessment, but is sensitive to tissue motion not related to blood cells. The aim was to investigate if a polarization technique could reduce movement-induced artifacts. A linearly polarized laser and a cross-polarized filter, placed in front of the detectors, were used to block specular reflection. Measurements were performed with, and without, the polarization filter, at a single site during horizontal and vertical movement of skin tissue (index finger, twelve subjects, n = 112) and of a flow model (n = 432), with varying surface structures. Measurements were repeated during different flow conditions and at increased skin specular reflection. Statistical analysis was performed using ANOVA models. The perfusion signal was lower (p < 0.001, skin and p < 0.05, flow model) using the polarization filter, due to movement artifact reduction. No significant influence from surface structure was found when using the polarization filter. Movement artifacts were lower (p < 0.05) in the vertical movement direction, however, depending on flow conditions for skin measurements. Increased skin specular reflection gave rise to large movement artifacts without the polarization filter. In conclusion, the polarized LDPI technique reduces movement artifacts and is particularly appropriate when assessing, e.g., ulcers and burns, where specular reflection is high.     

Artificial neural network-based classification of body movements in ambulatory ECG signal

Abstract

Ambulatory ECG monitoring provides electrical activity of the heart when a person is involved in doing normal routine activities. Thus, the recorded ECG signal consists of cardiac signal along with motion artifacts introduced due to a person’s body movements during routine activities. Detection of motion artifacts due to different physical activities might help in further cardiac diagnosis. Ambulatory ECG signal analysis for detection of various motion artifacts using adaptive filtering approach is addressed in this paper. We have used BIOPAC MP 36 system for acquiring ECG signal. The ECG signals of five healthy subjects (aged between 22–30 years) were recorded while the person performed various body movements like up and down movement of the left hand, up and down movement of the right hand, waist twisting movement while standing and change from sitting down on a chair to standing up movement in lead I configuration. An adaptive filter-based approach has been used to extract the motion artifact component from the ambulatory ECG signal. The features of motion artifact signal, extracted using Gabor transform, have been used to train the artificial neural network (ANN) for classifying body movements.     

Comparison of laser speckle and laser Doppler perfusion imaging: Measurement in human skin and rabbit articular tissue

Laser Doppler perfusion imaging (LDI) is currently used in a variety of clinical applications, however, LDI instruments produce images of low resolution and have long scan times. A new optical perfusion imager using a laser speckle measurement technique and its use for in vivo blood flow measurements are described. Measurements of human skin and surgically exposed rabbit tissue made using this instrument were compared with a commercial laser Doppler perfusion imaging instrument. Results from blood flow measurements showed that the laser speckle imager measured an 11–67% decrease in blood flow under arterial occlusion. Under similar conditions, the laser Doppler imager measured blood flow decreases of 21–63%. In comparison with LDI, it was observed that the higher temporal resolution of the laser speckle imager was more sensitive to measuring the hyperaemic response immediately following occlusion. This in vivo study demonstrated some of the several advantages laser speckle imaging has over conventional LDI, making the new instrument more versatile in a clinical environment.     

The information content of Doppler ultrasound signals from the fetal heart

Knowledge of the content of Doppler ultrasound signals from the fetal heart is essential if the performance of fetal heart rate (FHR) monitors based upon this technology is to be improved. For this reason instrumentation was constructed to enable the simultaneous collection of Doppler audio signals and the transabdominal fetal ECG (for signal registration), with a total of 22 recordings being made with an average length of around 20 minutes. These data demonstrate the transient nature of the Doppler audio data with wide variations in the signal content observable on a beat-to-beat basis. Short-time Fourier analysis enabled the content of the Doppler signals to be linked to six cardiac events, four valve and two wall motions, with higher frequency components being associated with the latter. This differing frequency content together with information regarding the direction of movement that can be discerned from Doppler signals provided a potential means of discriminating between these six events (which are unlikely to all contribute to the Doppler signal within the same cardiac cycle). Analysis of 100 records showed that wall contractions generate the most prominent signals, with atrial contraction recognisable in all records and ventricular wall contraction in 95% (although its amplitude is only around 30% of that of the atrial signal). Valve motion, with amplitudes between 15 and 25% that of the atrial wall signal, were visible in 75% of records. These results suggest means by which the six events that contribute to the Doppler signal may be distinguished, providing information that should enable an improvement in the current performance of Doppler ultrasound-based FHR monitors.     

In vivo gated 4D imaging of the embryonic heart using optical coherence tomography

We demonstrate the first in vivo gated 4D images of avian embryonic hearts by use of optical coherence tomography (OCT). We present a gated 4D dataset of an in vivo beating quail heart consisting of approximately 864,000 A-scans accumulated over multiple heartbeats. Generation of a gating trigger from a laser Doppler velocimetry (LDV) signal, collected from an outlying vitelline vessel, enabled us to gate image acquisition to the cardiac cycle. To fully characterize the genesis and mechanisms of cardiac defects, a tool capable of assessing structure and function simultaneously at early stages of development is needed, and gated OCT has the capability to become such a tool.     

Neural network for photoplethysmographic respiratory rate monitoring

The reflection mode photoplethysmographic (PPG) signal was studied with the aim of determining respiratory rate. The PPG signal includes respiratory synchronous components, seen as frequency modulation of the heart rate (respiratory sinus arrhythmia), amplitude modulation of the cardiac pulse and respiratory-induced intensity variations (RIIVs) in the PPG baseline. PPG signals were recorded from the foreheads of 15 healthy subjects. From these signals, the systolic wavefrm diastolic waveform, respiratory sinus arrhythmia, pulse amplitude and RIIVs were extracted. Using basic algorithms, the rates of false positive and false negative detection of breaths were calculated separately for each of the five components. Furthermore, a neural network was assessed in a combined pattern recognition approach. The error rates (sum of false positive and false negative breath detections) for the basic algorithms ranged from 9.7% (pulse amplitude) to 14.5% (systolic waveform). The corresponding values for the neural network analysis were 9.5–9.6%. These results suggest the use of a combined PPG system for simultaneous monitoring of respiratory rate and arterial oxygen saturation (pulse oximetry).     

Apparatus for the study of motile sperm using microprocessor analysis of scattered laser light

An apparatus for the analysis of scattered laser light from motile human sperm samplesin vitro is described. The scattered light is converted to electrical signals by a photomultiplier and the signals resulting from Doppler effects due to sperm movement are analysed using a microprocessor. Autocorrelation functions produced by the apparatus are in agreement with theoretical predictions based on an accepted swimming speed distribution. Measurements on samples have been used to yield values of percentage motility and velocity of sperm which are in agreement with results obtained by other methods.     

Pulsed local-field fluorescence microscopy: a new approach for measuring cellular signals in the beating heart

In cardiac research, single-cell experimental models have been extensively used to study the molecular mechanisms of intracellular Ca(2+) homeostasis. The results of these studies are usually extrapolated to the tissue level assuming that the phenomena studied at the cellular level are either similar in the intact organ, or only slightly modified by variables that exist at the whole-heart level. The validity of these assumptions has rarely been confirmed experimentally. Common obstacles associated with the study of intracellular Ca(2+) signals in beating hearts include motion artifacts and spatio-temporal limitations of the recording system. In this work, action potentials and intracellular Ca(2+) signals were measured in beating hearts from young rats, with spatio-temporal resolutions similar to cellular studies using a novel pulsed local-field fluorescence technique. This method was based on maximizing emitted fluorescence to increase the signal-to-noise ratio (S/N). The fluorescence emission of the indicator molecules was synchronized with brief (<1 ns), high-power (400 W) laser pulses, and the common mode noise of the fluorescence signal was differentially cancelled. To follow rapidly evolving signals, a highly sensitive and fast detection system was used (10 kHz). The spatial resolution was improved using a small (50-200 microm diameter) multimode fiberoptic. Mechanical artifacts were effectively reduced by inserting the fiberoptic into a "floating" glass micropipette sealed to the heart wall with negative pressure. Our results demonstrate that local-field fluorescence microscopy offers an outstanding experimental approach for studying physiological signals at the whole-organ level with the high spatio-temporal resolution common to normal cellular approaches.     

Radio frequency electrode system for optical lesion size estimation in functional neurosurgery

Radiofrequency (RF) lesioning in the human brain is one possible surgical therapy for severe pain as well as movement disorders. One obstacle for a safer lesioning procedure is the lack of size monitoring. The aim of this study was to investigate if changes in laser Doppler or intensity signals could be used as markers for size estimation during experimental RF lesioning. A 2 mm in diameter monopolar RF electrode was equipped with optical fibers and connected to a digital laser Doppler system. The optical RF electrode's performance was equal to a standard RF electrode with the same dimensions. An albumin solution with scatterers was used to evaluate the intensity and laser Doppler signal changes during lesioning at 70, 80, and 90 degrees C. Significant signal changes were found for these three different clot sizes, represented by the temperatures (p<0.05, n=10). The volume, width, and length of the created coagulations were correlated to the intensity signal changes (r=0.88, n=30, p<0.0001) and to the perfusion signal changes (r=0.81, n=30, p<0.0001). Both static and Doppler-shifted light can be used to follow the lesioning procedure as well as being used for lesion size estimation during experimental RF lesioning.     

Assessing spatial resolution versus sensitivity from laser speckle contrast imaging: application to frequency analysis

For blood perfusion monitoring, laser speckle contrast (LSC) imaging is a recent non-contact technique that has the characteristic of delivering noise-like speckled images. To exploit LSC images for quantitative physiological measurements, we developed an approach that implements controlled spatial averaging to reduce the detrimental impact of the noise and improve measurement sensitivity. By this approach, spatial resolution and measurement sensitivity can be traded-off in a flexible way depending on the quantitative prospect of the study. As an application, detectability of the cardiac activity from LSC images of forearm using power spectrum analysis is studied through the construction of spatial activity maps offering a window on the blood flow perfusion and its regional distribution. Comparisons with results obtained with signals of laser Doppler flowmetry probes are performed.     

Functional state of myocardium after transmyocardial revascularization with Nd:YAG laser

Providing a better perfusion of the myocardium, transmyocardial revascularization with an Nd:YAG laser improves cardiac function and general condition of patients with ischemic heart disease. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 124, No. 8, pp. 204–206, August, 1997     

基于动态心脏模型的体表心电图仿真研究

以往的电生理心脏模型大多是静态的,而非动态模型.这样在用准静电场理论求解体表电位时,整个心动周期中等效心电偶极子（源点）与体表（场点）之间的距离假设为恒定不变,从而会引入较大的系统误差.因此,为了更准确仿真心电图,有必要采用动态或跳动的心脏模型.基于原来静态心脏模型,构造了一个动态心脏模型,并对体表12导联心电图进行仿真比较研究.在动态心脏模型中考虑了心肌电兴奋引起的心脏机械力学收缩,通过计算心动周期中心室壁的位移,从而将心脏与体表之间的相对距离变化考虑进体表电位计算过程.仿真结果表明,对于正常心电图,基于动态心脏模型的仿真结果比基于静态心脏模型的仿真结果更符合临床记录心电图,特别是V1-V6胸导联的ST段和T波.对于前壁轻微缺血情况,在动态心脏模型的仿真心电图中能明显看出ST段和T波的变化,而在静态心脏模型的仿真心电图中与正常心电图相比看不出什么变化.本研究的仿真研究证实了动态心脏模型的确能更准确地仿真体表心电图.     

Analysis of the O-wave in acute right ventricular apex impedance measurements with a standard pacing lead in animals

Modern pacemakers (implantable devices used for maintaining an appropriate heart rate in patients) can use an intracardiac ventricular impedance signal for physiological cardiac stimulation control. Intracardiac ventricular impedance from nine animal subjects is analysed and presented (seven sheep: 49.0±6.5 kg, sinus rhythm 100.3±16.5 beats min⁻¹, average impedance 629.8±72.6Ω; and two dogs: 30 kg each, sinus rhythm 86.0 beats min⁻¹, 862.1Ω and 134.0 beats min⁻¹, 1114.6Ω, respectively). The averaged curve and standard deviation curve of the impedance in sinus rhythm were analysed in MATLAB to clarify and study consistent impedance shape over one heart cycle. In eight of nine (89%) animal subjects, a consistent impedance slope change (notch) was observed in the early stage of the cardiac filling phase. This result was reproduced in an additional subject with simultaneous echocardiographical measurements of mitral valve blood flow. The notch occured soon after rapid early filling (E-wave in mitral flow) but prior to ventricular filling caused by atrial contraction, indicating that the impedance notch was caused by rapid ventricular filling and that it might be a sensed feature of diagnostic value. The intracardiac impedance notch in the present study had similar features to the non-invasive transthoracic impedance O-wave reported by others, and it is shown here that an O-wave is found in intracardiac impedance signals, strongly suggesting that the non-invasive O-wave is caused by cardiac events.     

Application of FFT analyzed cardiac Doppler signals to fuzzy algorithm

Doppler signals, recorded from the output of tricuspid, mitral, and aorta valves of 60 patients, were transferred to a personal computer via 16-bit sound card. The fast Fourier transform (FFT) method was applied to the recorded signal from each patient. Since FFT method inherently cannot offer a good spectral resolution at highly turbulent blood flows, it sometimes leads to wrong interpretation of cardiac Doppler signals. In order to avoid this problem, firstly six known diseased heart signals such as hypertension, mitral stenosis, mitral failure, tricuspid stenosis, aorta stenosis, aorta insufficiency were introduced to fuzzy algorithm. Then, the unknown heart diseases from 15 patients were applied to the same fuzzy algorithm in order to detect the kinds of diseases. It is observed that the fuzzy algorithm gives true results for detecting the kind of diseases.     

Spectral signature and heterodyne efficiency for different wavelengths in laser Doppler flowmetry

Laser Doppler perfusion monitoring and imaging technologies generate time traces and two-dimensional flow maps of the microcirculation. With the goal of reaching different tissue depths, these technologies are equipped with lassers operating at different wavelengths λ. The fact that the average scattering angle, at a single scattering event, between a photon and a red blood cell increases with λ is compensated for by a 1/λ effect in the scattering vector, rendering the average frequency shift virtually independent of the choice of wavelength. Monte Carlo simulations showed that the corresponding spectral signature of the Doppler signals for λ=632.8nm and 780nm were close to identical. The theoretical predictions were verified by calculating the centre-of-gravity (COG) frequency of the laser Doppler power spectral density for the two wavelengths from forearm and finger skin, representing a low and high perfusion area, respectively (forearm COG=123 against 121Hz, finger COG=220 against 212 Hz). When the wavelength changes from 632.8nm to 780nm, the heterodyne efficiency of the detector and, thereby, the inherent system amplifcation increase. For tissues with identical microvascular flow conditions, the output signal therfore tends to increase in magnitude when shifting to longer wavelengths.