Simulation of cardiac pathologies using an electromechanical biventricular model and XMR interventional imaging

Simulating cardiac electromechanical activity is of great interest for a better understanding of pathologies and for therapy planning. Design and validation of such models is difficult due to the lack of clinical data. XMR systems are a new type of interventional facility in which patients can be rapidly transferred between X-ray and MR systems. Our goal is to design and validate an electromechanical model of the myocardium using XMR imaging. The proposed model is computationally fast and uses clinically observable parameters. We present the integration of anatomy, electrophysiology, and motion from patient data. Pathologies are introduced in the model and simulations are compared to measured data. Initial qualitative comparison on the two clinical cases presented is encouraging. Once fully validated, these models will make it possible to simulate different interventional strategies.     

Basilar membrane tonotopicity in the hook region of the cat cochlea.

Middle-ear to basilar membrane (BM) velocity transfer functions are reported for seven locations in the hook region of a single cat cochlea. These transfer functions were recorded at high sound pressure levels in a linearized, or passive cochlea, and resemble those reported previously by Wilson and Evans (1983). They demonstrate longitudinal tonotopicity with a gradient of approximately 3.6 mm/octave. When allowances are made for the nonlinear mechanisms previously demonstrated in active hook region preparations (Cooper and Rhode, 1992), the data are also consistent with the tonotopic map derived from the intracellular dye-filling studies of Liberman (1982).     

Longitudinal study of heart disease in a Jamaican rural population. 2. Factors influencing mortality

The relationship between cardiovascular characteristics and mortality was investigated in an epidemiological study of heart disease in a representative adult rural community in Jamaica. Of 449 men and 469 women followed up for 5 years, 36 men and 28 women died and the data concerning their status as regards arterial pressure, electrocardiographic abnormalities, and histories of effort pain at the intial survey have been analysed. Cardiovascular disease, and heart disease in particular, was the major cause of death in this population. Blood pressure levels exceeding 160/95 mm Hg had been recorded in about one third of the men and half the women who died and a clear trend was found between overall mortality and arterial pressure. Symptoms of effort pain and ECG abnormalities compatible with myocardial ischaemia, both of which were unexpectedly common, appeared to have independent prognostic significance. The prognosis of each was worse when associated with hypertension; hypertension unaccompanied by either effort pain or ECG “ischaemic” abnormality, on the other hand, caused no excess mortality in either sex within the period of follow-up. Although classical myocardial infarction was confirmed to be relatively infrequent, myocardial disorders with many of the features of ischaemic heart disease are an important cause of death in rural Jamaicans.     

Electron microscopic features of physiologically characterized, HRP-labeled fusiform cells in the cat dorsal cochlear nucleus

We report on the anatomy and physiology of three fusiform cells in the dorsal cochlear nucleus (DCN) of the cat. The extra- and intracellular responses of these cells to pure tones showed features typical of the cell type. Peristimulus time histograms (PSTHs) were usually of the pauser or buildup configuration with chopping behavior noted in certain instances. Intracellular records during stimulus presentations revealed sustained depolarizations for the duration of the tone followed by a prolonged after-hyperpolarization (AHP). On rare occasions, a hyperpolarization corresponding to the pause region of the PSTH was noted. Occasionally, a stimulus-induced depolarization would be maintained after stimulus offset. Rebound excitation was also observed after the AHP. Morphologically, all three cells showed the standard fusiform cell features at the light microscopic level. The cell body gave rise to apical and basal dendritic trees. The apical tree branched frequently and displayed numerous spines distally. The basal tree had fewer branches and fewer, more irregular appendages. The axon originated from the cell body and gave rise to one or more collaterals before leaving the nucleus via the dorsal acoustic stria (DAS). At the electron microscopic (EM) level, the axon collaterals may terminate on a variety of cell types in the DCN, including fusiform cells. Their vesicles are round and the terminals closely resemble many unlabeled terminals seen on the cell body and apical and basal dendrites of our labeled fusiform cells. Terminals containing round vesicles, believed to be eighth nerve terminals, were found, with one exception, only on the basal dendrites. The spine-laden, distal apical dendrites received primarily terminals containing round vesicles, presumed to originate from the unmyelinated axons of granule cells. The cell body and unmyelinated initial segment received mostly terminals containing pleomorphic and flat vesicles, which also made up a large percentage of the dendritic input. Some relevant correlations, between the distribution of synaptic terminals and the observed physiology, may be possible.     

Longitudinal study of heart disease in a Jamaican rural population. 3. Factors influencing changes in serial electrocardiograms

A longitudinal survey of heart disease in adults in a representative rural population in Jamaica provided an opportunity to study factors influencing the progression and incidence of electrocardiographic abnormalities in serial tracings taken at a 5-year interval. An analysis of changes occurring in those with ECG abnormalities compatible with ischaemia at the first survey showed that progression from a less severe to a more severe category was greater in men than in women, in hypertensive than in normotensive subjects, and, among men, in those with the amplitude criteria of left ventricular hypertrophy. The incidence of abnormal Q/QS patterns was greater in men than in women, and that of all abnormalities suggesting ischaemia was greater in hypertensive than in normotensive persons; in men, it was greater in those with high amplitude R waves. The incidence cases showed S—T and T wave abnormalities, the great majority of which were classified as showing features compatible with ischaemia rather than with strain secondary to hypertrophy. These findings, which are discussed in terms of their possible causes, seem to confirm that much of the heart disease in this Jamaican community has features of myocardial ischaemia despite other evidence that extramural coronary vessels tend to be spared from such severe occlusive atheromatous disease as is found in many other populations.     

An integrated platform for image-guided cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is an effective procedure for patients with heart failure but 30% of patients do not respond. This may be due to sub-optimal placement of the left ventricular (LV) lead. It is hypothesized that the use of cardiac anatomy, myocardial scar distribution and dyssynchrony information, derived from cardiac magnetic resonance imaging (MRI), may improve outcome by guiding the physician for optimal LV lead positioning. Whole heart MR data can be processed to yield detailed anatomical models including the coronary veins. Cine MR data can be used to measure the motion of the LV to determine which regions are late-activating. Finally, delayed Gadolinium enhancement imaging can be used to detect regions of scarring. This paper presents a complete platform for the guidance of CRT using pre-procedural MR data combined with live x-ray fluoroscopy. The platform was used for 21 patients undergoing CRT in a standard catheterization laboratory. The patients underwent cardiac MRI prior to their procedure. For each patient, a MRI-derived cardiac model, showing the LV lead targets, was registered to x-ray fluoroscopy using multiple views of a catheter looped in the right atrium. Registration was maintained throughout the procedure by a combination of C-arm/x-ray table tracking and respiratory motion compensation. Validation of the registration between the three-dimensional (3D) roadmap and the 2D x-ray images was performed using balloon occlusion coronary venograms. A 2D registration error of 1.2 ± 0.7?mm was achieved. In addition, a novel navigation technique was developed, called Cardiac Unfold, where an entire cardiac chamber is unfolded from 3D to 2D along with all relevant anatomical and functional information and coupled to real-time device detection. This allowed more intuitive navigation as the entire 3D scene was displayed simultaneously on a 2D plot. The accuracy of the unfold navigation was assessed off-line using 13 patient data sets by computing the registration error of the LV pacing lead electrodes which was found to be 2.2 ± 0.9?mm. Furthermore, the use of Unfold Navigation was demonstrated in real-time for four clinical cases.     

Effect of orange juice,folic acid,and oral contraceptives on serum folate in women taking a folate-restricted diet.

The effect of folate intake from orange juice on serum folate was evaluated in 60 women (age 20-39) during 9 weeks of a folate-restricted diet. Twenty-one were users of oral contraceptives (OCA). Folate intake from the restricted diet was 159 +/? 5 micrograms/day, as assessed by dietary surveys. Serum folate of women taking OCA was lower than in nonusers at the inception of the study (P less than 0.01). During the initial 2 weeks of restricted diet, serum folates decreased significantly (13.8 +/? 1.8 to 8.5 +/? 0.4 ng/ml; P less than 0.002). This decrease was further prevented by supplementation of the diet for 7 weeks with 100 micrograms/day of total folate from reconstituted frozen orange juice or synthetic folic acid (PteGlu). Both folate supplements were effective (P less than 0.05) in increasing serum folate (9.4 +/? 1.0 to 14.5 +/? 1.4 ng/ml, orange juice; 8.4 +/? 0.7 to 20.5 +/? 5.8 ng/ml, folic acid). Serum folates were similar in women taking either orange juice or folic acid. Serum folate of nonsupplemented women decreased from 10.2 +/? 0.8 to 8.3 +/? 0.4 ng/ml (P less than 0.05). No difference between serum folates of OCA users and nonusers was detected during the restricted diet or folate supplementation. These data indicate that folate in reconstituted orange juice was as available as folic acid, and that utilization of both folate forms and folate in a mixed diet was unaffected by oral contraceptives.