Combining Statistical Shape Model and Principal Component Analysis to Estimate Left Ventricular Volume and Ejection Fraction.

Left ventricular ejection fraction (LVEF) assessment is instrumental for cardiac health diagnosis, patient management, and patient eligibility for participation in clinical studies. Due to its non-invasiveness and low operational cost, ultrasound (US) imaging is the most commonly used imaging modality to image the heart and assess LVEF. Even though 3D US imaging technology is becoming more available, cardiologists dominantly use 2D US imaging to visualize the LV blood pool and interpret its area changes between end-systole and end-diastole.

Toward Quantification and Visualization of Active Stress Waves for Myocardial Biomechanical Function Assessment.

Estimating and visualizing myocardial active stress wave patterns is crucial to understanding the mechanical activity of the heart and provides a potential non-invasive method to assess myocardial function. These patterns can be reconstructed by analyzing 2D and/or 3D tissue displacement data acquired using medical imaging. Here we describe an application that utilizes a 3D finite element formulation to reconstruct active stress from displacement data.

A Statistical Shape Model Approach for Computing Left Ventricle Volume and Ejection Fraction Using Multi-plane Ultrasound Images.

Assessing the left ventricular ejection fraction (LVEF) accurately requires 3D volumetric data of the LV. Cardiologists either have no access to 3D ultrasound (US) systems or prefer to visually estimate LVEF based on 2D US images. To facilitate the consistent estimation of the end-diastolic and end-systolic blood pool volume and LVEF based on 3D data without extensive complicated manual input, we propose a statistical shape model (SSM) based on 13 key anchor points-the LV apex (1), mitral valve hinges (6), and the midpoints of the endocardial contours (6)-identified from the LV endocardial contour of the tri-plane 2D US images.

LEFT VENTRICULAR EJECTION FRACTION: COMPARISON BETWEEN TRUE VOLUME-BASED MEASUREMENTS AND AREA-BASED ESTIMATES.

Left ventricular ejection fraction (LVEF) is a critical measure of cardiac health commonly acquired in clinical practice, which serves as the basis for cardiovascular therapeutic treatment. Ultrasound (US) imaging of the heart is the most common, least expensive, reliable and non-invasive modality to assess LVEF. Cardiologists, in practice, persistently use 2D US images to provide visual estimates of LVEF, which are based on 2D information embedded in the US images by examining the area changes in LV blood pool between diastole and systole.

Left Ventricular Ejection Fraction Assessment: Unraveling the Bias between Area- and Volume-based Estimates.

Calculating left ventricular ejection fraction (LVEF) accurately is crucial for the clinical diagnosis of cardiac disease, patient management, or other therapeutic treatment decisions. The measure of a patient's LVEF often affects their candidacy for cardiovascular intervention. Ultrasound (US) is one of the imaging modalities used to non-invasively assess LVEF, and it is the most common and least expensive.

In-Home Cardiovascular Monitoring System for Heart Failure: Comparative Study.

Background: There is a pressing need to reduce the hospitalization rate of heart failure patients to limit rising health care costs and improve outcomes. Tracking physiologic changes to detect early deterioration in the home has the potential to reduce hospitalization rates through early intervention. However, classical approaches to in-home monitoring have had limited success, with patient adherence cited as a major barrier.

Nontraditional Electrocardiogram and Algorithms for Inconspicuous In-Home Monitoring: Comparative Study.

Background: Wearable and connected in-home medical devices are typically utilized in uncontrolled environments and often measure physiologic signals at suboptimal locations. Motion artifacts and reduced signal-to-noise ratio, compared with clinical grade equipment, results in a highly variable signal quality that can change significantly from moment to moment. The use of signal quality classification algorithms and robust feature delineation algorithms designed to achieve high accuracy on poor quality physiologic signals can prove beneficial in addressing concerns associated with measurement accuracy, confidence, and clinical validity.

Left Ventricular Systolic Function Assessed by Global Longitudinal Strain is Impaired in Atrial Fibrillation Compared to Sinus Rhythm.

Background: Atrial fibrillation (AF) is the most common aberrant cardiac arrhythmia. Many AF patients present with symptoms of dyspnea and fatigue, but have normal left ventricular ejection fraction (LVEF).

Purpose: To determine the reproducibility of measurements of global longitudinal strain (GLS) and strain rate in patients with AF and examine if the arrhythmia is associated with abnormal LV strain and strain rate independent of age, sex, heart rate, LVEF and LV mass.

Identification of Left Ventricle Failure on Pulmonary Artery CTA: Diagnostic Significance of Decreased Aortic & Left Ventricle Enhancement.

Purpose: This study aimed to identify findings on non-ECG-gated CT pulmonary angiography (CTPA) indicating decreased left ventricle (LV) systolic function, later confirmed by echocardiogram.

Methods: After obtaining institutional review board approval, review was performed of emergency department (ED) patients who had CTPA and follow-up echocardiogram within 48 h, over 18 months. Patients with pulmonary embolus, suboptimal CTPA, arrhythmias or pericardial tamponade were excluded.

Prevalence of Non-Left Anterior Descending Septal Perforator Culprit in Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation.

Identifying the coronary branch that supplies the basal septum is the cornerstone for successful alcohol septal ablation (ASA). The basal septum is often supplied by septal perforator artery/arteries (SPA/SPAs) not originating from the left anterior descending (LAD) coronary artery. We aim to investigate the prevalence and significance of non-LAD septal "culprit" in patients undergoing ASA.

Long-term total cardiac support in a Fontan-type circulation with HeartMate II left ventricular assist device.

Interest in utilizing long-term mechanical circulatory support for Fontan-type circulation has been high. Unfortunately, so far such attempts have not been successful. Herein, we are presenting the first case of an individual with biventricular heart failure and Fontan-type circulation on long-term mechanical circulatory support with a continuous-flow left ventricular assist device.

Pulse Wave Velocity Prediction and Compliance Assessment in Elastic Arterial Segments.

Pressure wave velocity (PWV) is commonly used as a clinical marker of vascular elasticity. Recent studies have increased clinical interest in also analyzing the impact of heart rate, blood pressure, and left ventricular ejection time on PWV. In this article we focus on the development of a theoretical one-dimensional model and validation via direct measurement of the impact of ejection time and peak pressure on PWV using an in vitro hemodynamic simulator.

Predictors of mortality in patients hospitalized for congestive heart failure with left ventricular ejection fraction ≥ 40.

Background: There are limited data regarding the predictors of mortality in patients with acute congestive heart failure (CHF) and left ventricular ejection fraction (LVEF) ≥ 40%.

Methods: We evaluated clinical characteristics, mortality and prognostic factors in a sample of consecutive patients hospitalized for CHF with LVEF ≥ 40%. Multivariable Cox regression models were developed to predict mortality using baseline clinical characteristics and echocardiographic variables.

Evaluation and treatment of pump thrombosis and hemolysis.

Ventricular assist devices (VADs) are not fully biocompatible, and are therefore predisposed to device thrombosis and subsequent pump dysfunction. Clinically significant hemolysis in VADs most often occurs as a result of device thrombosis, but can also be caused by other factors. Herein we describe the evaluation and management of VAD thrombosis and hemolysis.

Ventricular assist device thrombosis following recovery of left ventricular function.

Although ventricular assist devices (VADs) are lifesaving therapy for patients with severe heart failure, complications such as pump thrombosis can occur. In this report, we present a case of VAD thrombosis following recovery of left ventricular (LV) function. The patient had been supported with a VAD for 8 months, and at the time of presentation, echocardiography revealed near normal native systolic function, aortic valve opening with significant native heart ejection, reduced systolic flow in the outflow and inflow cannulae, and no forward flow through the VAD during diastole.

In vitro hemodynamic model of the arm arteriovenous circulation to study hemodynamics of native arteriovenous fistula and the distal revascularization and interval ligation procedure.

Background: Experimental modeling of arteriovenous hemodialysis fistula (AVF) hemodynamics is challenging. Mathematical modeling struggles to accurately represent the capillary bed and venous circulation. In vivo animal models are expensive and labor intensive.

Propranolol versus corticosteroids in the treatment of infantile hemangioma: a systematic review and meta-analysis.

Background: Infantile hemangiomas are benign vascular neoplasms that can cause numerous functional or cosmetic problems. The authors reviewed the pathogenesis of hemangioma and compared the efficacy and complications related to therapy with propranolol versus corticosteroids.

Methods: A comprehensive review of the literature was conducted from 1965 to March of 2012 using MEDLINE, PubMed, Ovid, Cochrane Review database, and Google Scholar.

Subcutaneous pre-expansion of mastectomy flaps before breast reconstruction with deep inferior epigastric perforator flaps: eliminating the patch-like appearance and improving aesthetic outcomes.

Introduction: Free tissue transfer and tissue expansion are important tools in the reconstructive surgeon's armamentarium, yet are not often used in conjunction. Although tissue transfer has its advantages, the patch-like appearance of the skin paddle on the breast can be unappealing.

Objective: To present our clinical experience of using subcutaneous breast tissue expansion before reconstruction with deep inferior epigastric perforator (DIEP) flaps, and to show how this technique eliminates the patch-like appearance of the skin paddle.

Non-invasive flow measurement of a rotary pump ventricular assist device using quantitative contrast echocardiography.

Background: Many implantable ventricular assist devices (VADs) have no direct measurement of pump output. The aim of this study was to test the hypothesis that quantitative contrast echocardiography can be used to measure VAD output.

Methods: Contrast-enhanced Doppler velocity-time integral (VTI) was measured in the VAD inlet and outlet cannulae.

Predictive capability of left atrial size measured by CT, TEE, and TTE for recurrence of atrial fibrillation following radiofrequency catheter ablation.

Background: Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) has been well established and is in part related to left atrial (LA) size. The purpose of this study was to assess the predictive capability of LA diameter (LAD) and LA volume (LAV) by echocardiography and computed tomography (CT) to determine success in patients undergoing RFCA of AF.

Methods: Eighty-eight patients with paroxysmal or persistent AF who had undergone RFCA and had a prior transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and CT were enrolled in the study.

Identification of a retained intravascular wire by three-dimensional transesophageal echocardiography.

A 78-year-old man with an implantable cardioverter-defibrillator (ICD) for ischemic cardiomyopathy and prior ventricular tachycardia (VT) ablation presented with abdominal pain and was found to have a small bowel obstruction requiring immediate surgery. His postoperative course was complicated by incessant VT leading to multiple ICD shocks. He was referred to our hospital for repeat VT ablation.

Ranolazine shortens repolarization in patients with sustained inward sodium current due to type-3 long-QT syndrome.

Introduction: One form of the hereditary long-QT syndrome, LQT3-Delta KPQ, is associated with sustained inward sodium current during membrane depolarization. Ranolazine reduces late sodium channel current, and we hypothesized that ranolazine would have beneficial effects on electrical and mechanical cardiac function in LQT3 patients with the SCN5A-DeltaKPQ mutation.

Methods: We assessed the effects of 8-hour intravenous ranolazine infusions (45 mg/h for 3 hours followed by 90 mg/h for 5 hours) on ventricular repolarization and myocardial relaxation in 5 LQT3 patients with the SCN5A-Delta KPQ mutation.

Prophylactic mastectomy and reconstruction: clinical outcomes and patient satisfaction.

Background: The purpose of this study was to evaluate both clinical outcomes and satisfaction in patients who have undergone prophylactic mastectomy and breast reconstruction.

Methods: A 5-year retrospective analysis of the senior author's (S.L.