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Sample records for cardiac output comparison

  1. Comparison of cardiac output measurement techniques

    DEFF Research Database (Denmark)

    Espersen, K; Jensen, E W; Rosenborg, D

    1995-01-01

    Simultaneously measured cardiac output obtained by thermodilution (TD), transcutaneous suprasternal ultrasonic Doppler (DOP), CO2-rebreathing (CR) and the direct Fick method (FI) were compared in eleven healthy subjects in a supine position (SU), a sitting position (SI), and during sitting exercise...

  2. Cardiac output measurement

    Directory of Open Access Journals (Sweden)

    Andreja Möller Petrun

    2014-02-01

    Full Text Available In recent years, developments in the measuring of cardiac output and other haemodynamic variables are focused on the so-called minimally invasive methods. The aim of these methods is to simplify the management of high-risk and haemodynamically unstable patients. Due to the need of invasive approach and the possibility of serious complications the use of pulmonary artery catheter has decreased. This article describes the methods for measuring cardiac output, which are based on volume measurement (Fick method, indicator dilution method, pulse wave analysis, Doppler effect, and electrical bioimpedance.

  3. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography.

    LENUS (Irish Health Repository)

    Weisz, Dany E

    2012-01-01

    Non-invasive cardiac output monitoring is a potentially useful clinical tool in the neonatal setting. Our aim was to evaluate a new method of non-invasive continuous cardiac output (CO) measurement (NICOM™) based on the principle of bioreactance in neonates.

  4. Comparison of dye dilution method to radionuclide techniques for cardiac output determination in dogs

    International Nuclear Information System (INIS)

    Eng, S.S.; Robayo, J.R.; Porter, W.; Smith, R.E.

    1980-01-01

    A study was undertaken to identify the most accurate /sup 99m/Tc-labeled radiopharmaceutical and to determine the accuracy of a noninvasive radionuclide technique or cardiac output determinations. Phase I employed sodium pertechnetate, stannous pyrophosphate with sodium pertechnetate, /sup 99m/Tc red blood cells, and /sup 99m/Tc human serum albumin as radionuclide tracers. Cardiac output was determined by the dye dilution method and then by the invasive radionuclide technique. A pairied t test and regression analysis indicated that /sup 99m/Tc human serum albumin was the most accurate radiopharmaceutical for cardiac output determinations, and the results compared favorably to those obtained by the dye dilution method. In Phase II, /sup 99m/Tc human serum albumin was used as the radionuclide tracer for cardiac output determinations with the noninvasive technique. The results compared favorably to those obtained by the dye dilution method

  5. Impedance cardiography: a comparison of cardiac output vs waveform analysis for assessing left ventricular systolic dysfunction.

    Science.gov (United States)

    DeMarzo, Arthur P; Kelly, Russell F; Calvin, James E

    2007-01-01

    Early detection of asymptomatic left ventricular systolic dysfunction (LVSD) is beneficial in managing heart failure. Recent studies have cast doubt on the usefulness of cardiac output as an indicator of LVSD. In impedance cardiography (ICG), the dZ/dt waveform has a systolic wave called the E wave. This study looked at measurements of the amplitude and area of the E wave compared with ICG-derived cardiac output, stroke volume, cardiac index, and stroke index as methods of assessing LVSD. ICG data were obtained from patients (n=26) admitted to a coronary care unit. Clinical LVSD severity was stratified into 4 groups (none, mild, moderate, and severe) based on echocardiography data and standard clinical assessment by a cardiologist blinded to ICG data. Statistical analysis showed that the E wave amplitude and area were better indicators of the level of LVSD than cardiac output, stroke volume, cardiac index, or stroke index. ICG waveform analysis has potential as a simple point-of-care test for detecting LVSD in asymptomatic patients at high risk for developing heart failure and for monitoring LVSD in patients being treated for heart failure.

  6. Cardiac output during exercise

    DEFF Research Database (Denmark)

    Siebenmann, C; Rasmussen, P.; Sørensen, H.

    2015-01-01

    Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from...... the right atrium (Q(Fick-M)), Innocor (inert gas rebreathing; Q(Inn)), Physioflow (impedance cardiography; Q(Phys)), and Nexfin (pulse contour analysis; Q(Pulse)) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2  = 12%). While all four methods reported...... a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for Q(Fick-M), Q(Inn), QP hys and Q(Pulse), respectively; P = 0...

  7. Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution

    Directory of Open Access Journals (Sweden)

    Ole Broch

    2016-01-01

    Full Text Available Objective. Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO. The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB. Methods. Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD and by nine pulse contour algorithms (COX1–9. Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. Results. There was only a poor correlation between COTPTD and COX1–9 during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Conclusions. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov.

  8. Comparing Methods for Cardiac Output

    DEFF Research Database (Denmark)

    Graeser, Karin; Zemtsovski, Mikhail; Kofoed, Klaus F

    2018-01-01

    of the left ventricular outflow tract. METHODS: The primary aim was a systematic comparison of CO with Doppler-derived 3D TEE and CO by thermodilution in a broad population of patients undergoing cardiac surgery. A subanalysis was performed comparing cross-sectional area by TEE with cardiac computed...... tomography (CT) angiography. Sixty-two patients, scheduled for elective heart surgery, were included; 1 was subsequently excluded for logistic reasons. Inclusion criteria were coronary artery bypass surgery (N = 42) and aortic valve replacement (N = 19). Exclusion criteria were chronic atrial fibrillation......, left ventricular ejection fraction below 0.40 and intracardiac shunts. Nineteen randomly selected patients had a cardiac CT the day before surgery. All images were stored for blinded post hoc analyses, and Bland-Altman plots were used to assess agreement between measurement methods, defined as the bias...

  9. Cardiac output by Doppler echocardiography in the premature baboon: Comparison with radiolabeled microspheres

    International Nuclear Information System (INIS)

    Kinsella, J.P.; Morrow, W.R.; Gerstmann, D.R.; Taylor, A.F.; deLemos, R.A.

    1991-01-01

    Pulsed-Doppler echocardiography (PDE) is a useful noninvasive method for determining left ventricular output (LVO). However, despite increasingly widespread use in neonatal intensive care units, validation studies in prematures with cardiopulmonary disease are lacking. The purpose of this study was to compare radiolabeled microsphere (RLM) and PDE measurements of LVO, using the critically ill premature baboon as a model of the human neonate. Twenty-two paired RLM and PDE measurements of LVO were obtained in 14 animals between 3 and 24 h of age. Average PDE LVO was 152 ml/min/kg (range, 40-258 ml/min/kg) compared to 158 ml/min/kg (range, 67-278 ml/min/kg) measured by RLM. Linear regression analysis of the paired measurements showed good correlation with a slope near unity (gamma = 0.94x + 4.20, r = 0.91, SEE = 25.7 ml). The authors conclude that PDE determinations of LVO compare well with those measured by RLM in the premature baboon. PDE appears to provide a valid estimate of LVO and should be useful in human prematures with cardiopulmonary distress

  10. Assessment of interchangeability rate between 2 methods of measurements: An example with a cardiac output comparison study.

    Science.gov (United States)

    Lorne, Emmanuel; Diouf, Momar; de Wilde, Robert B P; Fischer, Marc-Olivier

    2018-02-01

    The Bland-Altman (BA) and percentage error (PE) methods have been previously described to assess the agreement between 2 methods of medical or laboratory measurements. This type of approach raises several problems: the BA methodology constitutes a subjective approach to interchangeability, whereas the PE approach does not take into account the distribution of values over a range. We describe a new methodology that defines an interchangeability rate between 2 methods of measurement and cutoff values that determine the range of interchangeable values. We used a simulated data and a previously published data set to demonstrate the concept of the method. The interchangeability rate of 5 different cardiac output (CO) pulse contour techniques (Wesseling method, LiDCO, PiCCO, Hemac method, and Modelflow) was calculated, in comparison with the reference pulmonary artery thermodilution CO using our new method. In our example, Modelflow with a good interchangeability rate of 93% and a cutoff value of 4.8 L min, was found to be interchangeable with the thermodilution method for >95% of measurements. Modelflow had a higher interchangeability rate compared to Hemac (93% vs 86%; P = .022) or other monitors (Wesseling cZ = 76%, LiDCO = 73%, and PiCCO = 62%; P < .0001). Simulated data and reanalysis of a data set comparing 5 CO monitors against thermodilution CO showed that, depending on the repeatability of the reference method, the interchangeability rate combined with a cutoff value could be used to define the range of values over which interchangeability remains acceptable.

  11. Electrical Cardiometry to Monitor Cardiac Output in Preterm Infants with Patent Ductus Arteriosus: A Comparison with Echocardiography.

    Science.gov (United States)

    Hsu, Kai-Hsiang; Wu, Tai-Wei; Wu, I-Hsyuan; Lai, Mei-Yin; Hsu, Shih-Yun; Huang, Hsiao-Wen; Mok, Tze-Yee; Lien, Reyin

    2017-01-01

    Electrical cardiometry (EC) is an impedance-based monitoring that provides noninvasive cardiac output (CO) assessment. Through comparison to transthoracic echocardiography (Echo), the accuracy of EC has been verified. However, left-to-right patent ductus arteriosus (PDA) shunting is a concern because PDA shunts aortic flow to the pulmonary artery and may interfere with EC in measuring CO. To determine the agreement between EC and Echo in preterm infants with a hemodynamically significant PDA (hsPDA). We reviewed our hemodynamic database in which simultaneous CO measurements by Echo and EC (Aesculon®) were recorded. Preterm infants with left-to-right shunting hsPDA were enrolled. A total of 105 paired measurements in 36 preterm infants were compared. Infants' median (range) age and weight at measurement were 27+2 weeks (24+0-33+1) and 1,015 g (518-1,880), with mean (95% CI) ductal diameter 2.11 mm (1.99-2.22) or 2.15 mm/kg (2.00-2.30). Mean COEC and COEcho were 252 ± 32 and 258 ± 45 mL/kg/min, respectively, which demonstrated a moderate correlation and without a significant between-measurement difference. Bland-Altman analysis showed a bias, limits of agreement, and error percentage of -5.3 mL/kg/min, -78.3 to 67.7 mL/kg/min, and 28.6%, respectively. There was a trend of increased bias and error percentage of infants with high CO ≥280 mL/kg/min and supported with high-frequency ventilator. EC and Echo have a wide but clinically acceptable agreement in measuring CO in preterm infants with hsPDA. However, for infants with high CO or ventilated by high-frequency ventilation, interpretation of COEC should be approached with caution. © 2017 S. Karger AG, Basel.

  12. The accuracy of PiCCO® in measuring cardiac output in patients under therapeutic hypothermia: Comparison with transthoracic echocardiography.

    Science.gov (United States)

    Souto Moura, T; Aguiar Rosa, S; Germano, N; Cavaco, R; Sequeira, T; Alves, M; Papoila, A L; Bento, L

    2018-03-01

    Invasive cardiac monitoring using thermodilution methods such as PiCCO® is widely used in critically ill patients and provides a wide range of hemodynamic variables, including cardiac output (CO). However, in post-cardiac arrest patients subjected to therapeutic hypothermia, the low body temperature possibly could interfere with the technique. Transthoracic Doppler echocardiography (ECHO) has long proved its accuracy in estimating CO, and is not influenced by temperature changes. To assess the accuracy of PiCCO® in measuring CO in patients under therapeutic hypothermia, compared with ECHO. Thirty paired COECHO/COPiCCO measurements were analyzed in 15 patients subjected to hypothermia after cardiac arrest. Eighteen paired measurements were obtained at under 36°C and 12 at ≥36°C. A value of 0.5l/min was considered the maximum accepted difference between the COECHO and COPiCCO values. Under conditions of normothermia (≥36°C), the mean difference between COECHO and COPiCCO was 0.030 l/min, with limits of agreement (-0.22, 0.28) - all of the measurements differing by less than 0.5 l/min. In situations of hypothermia (<36°C), the mean difference in CO measurements was -0.426 l/min, with limits of agreement (-1.60, 0.75), and only 44% (8/18) of the paired measurements fell within the interval (-0.5, 0.5). The calculated temperature cut-off point maximizing specificity was 35.95°C: above this temperature, specificity was 100%, with a false-positive rate of 0%. The results clearly show clinically relevant discordance between COECHO and COPiCCO at temperatures of <36°C, demonstrating the inaccuracy of PiCCO® for cardiac output measurements in hypothermic patients. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  13. A comparison of dobutamine and levosimendan on hepatic blood flow in patients with a low cardiac output state after cardiac surgery: a randomised controlled study.

    Science.gov (United States)

    Alvarez, J; Baluja, A; Selas, S; Otero, P; Rial, M; Veiras, S; Caruezo, V; Taboada, M; Rodriguez, I; Castroagudin, J; Tome, S; Rodriguez, A; Rodriguez, J

    2013-11-01

    Liver dysfunction due to a low cardiac output state after cardiac surgery is associated with a poor prognosis, but whether one inotrope is superior to another in improving hepatic perfusion remains uncertain. This study compared the systemic and hepatic haemodynamic effects of levosimendan to dobutamine in patients with a low cardiac output state (cardiac index flow (ml/min): 614.0±124.7, 585.9±144.8; pulsatility index: 2.02±0,28, 2.98±0.27 versus the levosimendan group: cardiac index: 3.02± 0.27, 2.98± 0.30; portal vein flow: 723.0± 143.5, 702.9±117.8; pulsatility index: 1.71±0.26, 1.73±0.27). The improvement in portal vein blood flow at 48 hours was significantly better after levosimendan than dobutamine (41% vs. 11% increment from baseline, Pflow through both the hepatic artery and portal venous system, whereas dobutamine can only improve the portal venous blood flow without vasodilating the hepatic artery.

  14. Cardiac output measurement instruments controlled by microprocessors

    International Nuclear Information System (INIS)

    Spector, M.; Barritault, L.; Boeri, C.; Fauchet, M.; Gambini, D.; Vernejoul, P. de

    The nuclear medicine and biophysics laboratory of the Necker-Enfants malades University Hospital Centre has built a microprocessor controlled Cardiac flowmetre. The principle of the cardiac output measurement from a radiocardiogram is well established. After injection of a radioactive indicator upstream from the heart cavities the dilution curve is obtained by the use of a gamma-ray precordial detector. This curve normally displays two peaks due to passage of the indicator into the right and left sides of the heart respectively. The output is then obtained from the stewart Hamilton principle once recirculation is eliminated. The graphic method used for the calculation however is long and tedious. The decreasing fraction of the dilution curve is projected in logarithmic space in order to eliminate recirculation by determining the mean straight line from which the decreasing exponential is obtained. The principle of the use of microprocessors is explained (electronics, logics) [fr

  15. Peripheral vasodilatation determines cardiac output in exercising humans

    DEFF Research Database (Denmark)

    Bada, A A; Svendsen, J H; Secher, N H

    2012-01-01

    In dogs, manipulation of heart rate has no effect on the exercise-induced increase in cardiac output. Whether these findings apply to humans remain uncertain, because of the large differences in cardiovascular anatomy and regulation. To investigate the role of heart rate and peripheral...... arterial ATP infusion at rest. Exercise and ATP infusion increased cardiac output, leg blood flow and vascular conductance (P heart rate by up to 54 beats min(−1), cardiac output did not change in any of the three...... demonstrate that the elevated cardiac output during steady-state exercise is regulated by the increase in skeletal muscle blood flow and venous return to the heart, whereas the increase in heart rate appears to be secondary to the regulation of cardiac output....

  16. Comparing Methods for Cardiac Output: Intraoperatively Doppler-Derived Cardiac Output Measured With 3-Dimensional Echocardiography Is Not Interchangeable With Cardiac Output by Pulmonary Catheter Thermodilution.

    Science.gov (United States)

    Graeser, Karin; Zemtsovski, Mikhail; Kofoed, Klaus F; Winther-Jensen, Matilde; Nilsson, Jens C; Kjaergaard, Jesper; Møller-Sørensen, Hasse

    2018-01-09

    Estimation of cardiac output (CO) is essential in the treatment of circulatory unstable patients. CO measured by pulmonary artery catheter thermodilution is considered the gold standard but carries a small risk of severe complications. Stroke volume and CO can be measured by transesophageal echocardiography (TEE), which is widely used during cardiac surgery. We hypothesized that Doppler-derived CO by 3-dimensional (3D) TEE would agree well with CO measured with pulmonary artery catheter thermodilution as a reference method based on accurate measurements of the cross-sectional area of the left ventricular outflow tract. The primary aim was a systematic comparison of CO with Doppler-derived 3D TEE and CO by thermodilution in a broad population of patients undergoing cardiac surgery. A subanalysis was performed comparing cross-sectional area by TEE with cardiac computed tomography (CT) angiography. Sixty-two patients, scheduled for elective heart surgery, were included; 1 was subsequently excluded for logistic reasons. Inclusion criteria were coronary artery bypass surgery (N = 42) and aortic valve replacement (N = 19). Exclusion criteria were chronic atrial fibrillation, left ventricular ejection fraction below 0.40 and intracardiac shunts. Nineteen randomly selected patients had a cardiac CT the day before surgery. All images were stored for blinded post hoc analyses, and Bland-Altman plots were used to assess agreement between measurement methods, defined as the bias (mean difference between methods), limits of agreement (equal to bias ± 2 standard deviations of the bias), and percentage error (limits of agreement divided by the mean of the 2 methods). Precision was determined for the individual methods (equal to 2 standard deviations of the bias between replicate measurements) to determine the acceptable limits of agreement. We found a good precision for Doppler-derived CO measured by 3D TEE, but although the bias for Doppler-derived CO by 3D compared to

  17. Measurement of cardiac output in man with MR imaging

    International Nuclear Information System (INIS)

    Lipton, M.J.; Weikl, A.; Mueller, E.; Reinhardt, E.R.

    1987-01-01

    Multiecho electrocardiogram-triggered imaging sequences were obtained in 15 patients to measure aortic blood flow velocity in a 6-cm thick section. The aortic area was calculated from MR images; cardiac output was calculated as the product of velocity and area and was expressed in liters per minute. MR imaging results were compared with measurements obtained by cardiac catheterization and thermodilution. A good correlation of 0.9 was found, with a slope approaching unity

  18. A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients.

    Science.gov (United States)

    Wagner, Julia Y; Körner, Annmarie; Schulte-Uentrop, Leonie; Kubik, Mathias; Reichenspurner, Hermann; Kluge, Stefan; Reuter, Daniel A; Saugel, Bernd

    2018-04-01

    The CNAP technology (CNSystems Medizintechnik AG, Graz, Austria) allows continuous noninvasive arterial pressure waveform recording based on the volume clamp method and estimation of cardiac output (CO) by pulse contour analysis. We compared CNAP-derived CO measurements (CNCO) with intermittent invasive CO measurements (pulmonary artery catheter; PAC-CO) in postoperative cardiothoracic surgery patients. In 51 intensive care unit patients after cardiothoracic surgery, we measured PAC-CO (criterion standard) and CNCO at three different time points. We conducted two separate comparative analyses: (1) CNCO auto-calibrated to biometric patient data (CNCO bio ) versus PAC-CO and (2) CNCO calibrated to the first simultaneously measured PAC-CO value (CNCO cal ) versus PAC-CO. The agreement between the two methods was statistically assessed by Bland-Altman analysis and the percentage error. In a subgroup of patients, a passive leg raising maneuver was performed for clinical indications and we present the changes in PAC-CO and CNCO in four-quadrant plots (exclusion zone 0.5 L/min) in order to evaluate the trending ability of CNCO. The mean difference between CNCO bio and PAC-CO was +0.5 L/min (standard deviation ± 1.3 L/min; 95% limits of agreement -1.9 to +3.0 L/min). The percentage error was 49%. The concordance rate was 100%. For CNCOcal, the mean difference was -0.3 L/min (±0.5 L/min; -1.2 to +0.7 L/min) with a percentage error of 19%. In this clinical study in cardiothoracic surgery patients, CNCO cal showed good agreement when compared with PAC-CO. For CNCO bio , we observed a higher percentage error and good trending ability (concordance rate 100%).

  19. Relationship between cardiac output and effective renal plasma flow in patients with cardiac disease

    Energy Technology Data Exchange (ETDEWEB)

    McGriffin, D; Tauxe, W N; Lewis, C; Karp, R; Mantle, J

    1984-12-01

    The relationship between effective renal plasma flow (ERPF) and cardiac output was examined in 46 patients (22 with congestive heart failure and 24 following cardiac surgical procedures) by simultaneously measuring the global ERPF by the single-injection method and cardiac output by the thermodilution method. Of the patients in the heart-failure group, 21 also had pulmonary artery end diastolic pressure (PAEDP) recorded at the same time. ERPF and cardiac output were found to be related by the regression equations: cardiac output = 2.08 + 0.0065 ERPF (r, 080), with a SE of estimate of 0.81 l/min. ERPF and PAEDP were related by the regression equation: PAEDP = 42.02 - 0.0675 ERPF (r, 0.86), with a SE of estimate of 5.5 mm Hg. ERPF may be a useful noninvasive method of estimating cardiac output if it is known that no intrinsic kidney disease is present, and if the error of 0.81 l/min (1 SE of estimate) is within the range of clinical usefulness. The error is principally attributable to the determination of cardiac output by the thermodilution method.

  20. Measurement of Cardiac Output by Constant Injection of Radioactive Xenon

    Energy Technology Data Exchange (ETDEWEB)

    Kishon, Y.; Avasthey, P.; Barnett, A.; Shillingford, J. P. [MRC Cardiovascular Research Unit and Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London (United Kingdom)

    1971-02-15

    The method of determining cardiac output by the injection of {sup 133}Xe solution has been initially tested in a suitable hydrodynamic model, simulating the cardiovascular system. The indicator was infused in a constant rate into a ''pre-ventricular'' site through a fine polyethylene tubing, and samples were taken from a ''post-ventricular'' site through similar tubing. Specific activity was determined with the use of a universal well-type scintillation counter and output values were derived from the dilutional factor of the specific activity and the rate of the infusion. Good correlation with direct output measurements were demonstrated over a wide range of outputs, stroke volumes and end-diastolic volumes. The method remained valid when either the ''pre-ventricular'' or the ''post-ventricular'' valve was made incompetent. The method was then evaluated in anaesthetized dogs and cardiac output determinations were compared with those obtained by the Fick and dye-dilution techniques. The indicator was injected into the right atrium, and samples were obtained from the pulmonary artery through similar tubings. The method was found to be reliable over a wide range of cardiac outputs (drugs- and bleeding-induced) and in the presence of severe tricuspid incompetence (performed by a valvotome). Finally, the technique was used in six patients, both at rest and after exercise, and the cardiac output values were compared with those obtained by the Fick and the photoelectric-earpiece dye-dilution techniques. It is concluded that, provided the appropriate speed of injection (about 1.5 - 3.5 {mu}Ci/sec) and the time of sampling is carefully observed, good correlation between the method under investigation and other conventional methods could be shown. This method is more convenient for repeated determinations, simpler to perform and final values are obtained almost immediately. (author)

  1. Constant infusion transpulmonary thermodilution for the assessment of cardiac output in exercising humans

    DEFF Research Database (Denmark)

    Calbet, J A L; Mortensen, Stefan; Munch, G D W

    2016-01-01

    To determine the accuracy and precision of constant infusion transpulmonary thermodilution cardiac output (CITT-Q) assessment during exercise in humans, using indocyanine green (ICG) dilution and bolus transpulmonary thermodilution (BTD) as reference methods, cardiac output (Q) was determined......: 6.1-11.1%). In conclusion, cardiac output can be precisely and accurately determined with constant infusion transpulmonary thermodilution in exercising humans....

  2. EVALUATION OF CONTINUOUS THERMODILUTION METHOD FOR CARDIAC OUTPUT MEASUREMENT

    Directory of Open Access Journals (Sweden)

    Roman Parežnik

    2001-12-01

    Full Text Available Background. Continuous monitoring of haemodynamic variables is often necessary for detection of rapid changes in critically ill patients. In our patients recently introduced continuous thermodilution technique (CTD for cardiac output measurement was compared to bolus thermodilution technique (BTD which is a »golden standard« method for cardiac output (CO measurement in intensive care medicine.Methods. Ten critically ill patients were included in a retrospective observational study. Using CTD method cardiac output was measured continuously. BTD measurements using the same equipment were performed intermittently. The data obtained by BTD were compared to those obtained by CTD just before the BTD (CTD-before and 2–3 minutes after the BTD (CTD-after. The CO values were divided into three groups: all CO values, CO > 4.5 L/min, CO < 4.5 L/min. The bias (mean difference between values obtained by two methods, standard deviation, 95% confidence limits and relative error were calculated and the linear regression analysis was performed. t-test for pared data was used to compare the biases for CTD-before and CTD-after for an individual group. The p value of less than 0.05 was considered statistically significant.Results. A total of 60 data triplets were obtained. CTD-before ranged from 1.9 L/min to 12.6 L/min, CTD-after from 2.0 to 13.2 L/min and BTD from 1.9 to 12.0 L/min. For all CO values the bias for CTD-before was 0.13 ± 0.52 L/min (95% confidence limits 1.17–0.91 L/min, relative error was 3.52 ± 15.20%, linear regression equation was CTD-before = 0.96 × BTD + 0.01 and Pearson’s correlation coefficient was 0.95. The values for CTD-after were 0.08 ± 0.46 L/min (1.0–0.84 L/min, 2.22 ± 9.05%, CTD-after = 0.98 × BTD + 0.01 and 0.98 respectively. For all CO values there was no statistically significant difference between biases for CTD-before and CTD-after (p = 0,51. There was no statistically significant difference between biases for CTD

  3. Systematic review of cardiac output measurements by echocardiography vs. thermodilution

    DEFF Research Database (Denmark)

    Wetterslev, Mik; Møller-Sørensen, Hasse; Johansen, Rasmus Rothmann

    2016-01-01

    PURPOSE: Echocardiography is frequently used in the hemodynamic evaluation of critically ill patients, but inaccurate measurements may lead to wrong clinical decisions. The aim of our systematic review was to investigate the interchangeability of echocardiography with thermodilution technique...... of the studies assessed left-sided heart structures and the majority had small bias, wide limits of agreement, and high percentage error between echocardiography and thermodilution. In only two of the 24 studies the precision of each technique (echocardiography and thermodilution) was assessed before comparing...... them. In the single study evaluating trending ability using valid methodology, agreement was observed between echocardiography and thermodilution in detecting the directional changes in cardiac output, but the magnitude of changes varied considerably. CONCLUSIONS: The majority of studies comparing...

  4. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Hann Christopher E

    2010-11-01

    Full Text Available Abstract The application of positive end expiratory pressure (PEEP in mechanically ventilated (MV patients with acute respiratory distress syndrome (ARDS decreases cardiac output (CO. Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management.

  5. Cardiac output and regional blood flow following trauma

    International Nuclear Information System (INIS)

    Malik, A.B.; Loegering, D.J.; Saba, T.M.; Kaplan, J.E.

    1978-01-01

    The changes in cardiac output (2), regional blood blow (2r) and regional vascular resistance, and arterial pressure were studied in rats subjected to moderate (LD0) or severe (LD50) traumatic shock. 2 and 2r were determined using microspheres at 15, 60 and 180 min posttrauma. Arterial pressure decreased in both groups at 15 min and recovered by 3 h after sublethal (LD0) trauma, while arterial pressure did not return to control levels after LD50 trauma. 2 decreased in both groups at 15 min and returned to control only in the LD0 trauma group by 3 h. Cerebral, coronary, and hepatic arterial flows and resistances were maintained in both groups. Renal, intestinal, and splenic flows decreased and resistances were maintained in both groups. Renal, intestinal, and splenic flows decreased and resistances increased in both groups by 15 min and returned to control levels by 3 h only in the LD0 trauma group. Total hepatic and hepatic portal flows decreased at 60 min and returned to control levels at 3 h after LD0 trauma, while there was significant depression in these parameters 3 h after LD50 trauma. Therefore, sublethal and severe trauma resulted in early redistribution of flow favoring the coronary, cerebral, and hepatic arterial beds. However, renal, intestinal, splenic, and portal flows remained depressed only in severely traumatized rats, suggesting that continued hypofusion is a factor in the multiple organ failure and death following severe traumatic injury

  6. Simultaneous cardiac output and regional myocardial perfusion determination with PET and nitrogen 13 ammonia

    DEFF Research Database (Denmark)

    Hove, Jens D; Kofoed, Klaus F; Wu, Hsiao M

    2003-01-01

    The purpose of this study was to evaluate the possibility of measuring cardiac output during positron emission tomography (PET) examination of myocardial perfusion with nitrogen 13 ammonia.......The purpose of this study was to evaluate the possibility of measuring cardiac output during positron emission tomography (PET) examination of myocardial perfusion with nitrogen 13 ammonia....

  7. Kredsløbsmonitorering med lithium dilution cardiac output-systemet

    DEFF Research Database (Denmark)

    Christiansen, Christian; Hostrup, Anette; Tønnesen, Else

    2008-01-01

    The lithium dilution cardiac output (LiDCO) system measures cardiac output beat-to-beat with high precision. The system is based on an arterial pulse power analysis which is calibrated every eight hours with a small non-pharmacological dose of lithium. The system is minimally invasive; it requires...

  8. Mechanisms Regulating the Cardiac Output Response to Cyanide Infusion, a Model of Hypoxia

    Science.gov (United States)

    Liang, Chang-seng; Huckabee, William E.

    1973-01-01

    When tissue metabolic changes like those of hypoxia were induced by intra-aortic infusion of cyanide in dogs, cardiac output began to increase after 3 to 5 min, reached a peak (220% of the control value) at 15 min, and returned to control in 40 min. This pattern of cardiac output rise was not altered by vagotomy with or without atropine pretreatment. However, this cardiac output response could be differentiated into three phases by pretreating the animals with agents that block specific activities of the sympatho-adrenal system. First, ganglionic blockade produced by mecamylamine or sympathetic nerve blockade by bretylium abolished the middle phase of the cardiac output seen in the untreated animal, but early and late phases still could be discerned. Second, beta-adrenergic receptor blockade produced by propranolol shortened the total duration of the cardiac output rise by abolishing the late phase. Third, when given together, propranolol and mecamylamine (or bretylium) prevented most of the cardiac output rise that follows the early phase. When cyanide was given to splenectomized dogs, the duration of the cardiac output response was not shortened, but the response became biphasic, resembling that seen after chemical sympathectomy. A similar biphasic response of the cardiac output also resulted from splenic denervation; sham operation or nephrectomy had no effect on the monophasic pattern of the normal response. Splenic venous blood obtained from cyanide-treated dogs, when infused intraportally, caused an increase in cardiac output in recipient dogs; similar infusion of arterial blood had no effects. These results suggest that the cardiac output response to cyanide infusion consists of three components: an early phase, related neither to the autonomic nervous system nor to circulating catecholamines; a middle phase, caused by a nonadrenergic humoral substance released from the spleen by sympathetic stimulation; and a late phase, dependent upon adrenergic receptors

  9. [Measurement of cardiac output by thermodilution with a diode as a temperature sensor].

    Science.gov (United States)

    Díaz Fernández, A; Benítez, D; Sánchez Tello, G; Márquez, L A

    1979-01-01

    An area integrator for the thermodilution curve in cardiac output measurement is described. A new temperature sensor is used, a diode with some advantages over the thermistor normally used. The main advantages are: easy calibration and replacement, and broad range of linearity. The cardiac output values obtained in dog with the integrator follow a linear relationship with those of the flowmeter. In simultaneous measurements the correlation is R = 0.96. Using a diode as temperature sensor a modification of the Steward Hamilton equation (used for thermistor) is necessary. With this new equation a monogram is performed to calculate the cardiac output from the area given by the numerical integrator.

  10. Impact of pacing modality and biventricular pacing on cardiac output and coronary conduit flow in the post-cardiotomy patient.

    LENUS (Irish Health Repository)

    Healy, David G

    2012-02-03

    We have previously demonstrated the role of univentricular pacing modalities in influencing coronary conduit flow in the immediate post-operative period in the cardiac surgery patient. We wanted to determine the mechanism of this improved coronary conduit and, in addition, to explore the possible benefits with biventricular pacing. Sixteen patients undergoing first time elective coronary artery bypass grafting who required pacing following surgery were recruited. Comparison of cardiac output and coronary conduit flow was performed between VVI and DDD pacing with a single right ventricular lead and biventricular pacing lead placement. Cardiac output was measured using arterial pulse waveform analysis while conduit flow was measured using ultrasonic transit time methodology. Cardiac output was greatest with DDD pacing using right ventricular lead placement only [DDD-univentricular 5.42 l (0.7), DDD-biventricular 5.33 l (0.8), VVI-univentricular 4.71 l (0.8), VVI-biventricular 4.68 l (0.6)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.023) and VVI-biventricular pacing (P=0.001) but there was no significant advantage to DDD-biventricular pacing (P=0.45). In relation to coronary conduit flow, DDD pacing again had the highest flow [DDD-univentricular 55 ml\\/min (24), DDD-biventricular 52 ml\\/min (25), VVI-univentricular 47 ml\\/min (23), VVI-biventricular 50 ml\\/min (26)]. DDD-univentricular pacing was significantly better than VVI-univentricular (P=0.006) pacing but not significantly different to VVI-biventricular pacing (P=0.109) or DDD-biventricular pacing (P=0.171). Pacing with a DDD modality offers the optimal coronary conduit flow by maximising cardiac output. Biventricular lead placement offered no significant benefit to coronary conduit flow or cardiac output.

  11. Lack of agreement and trending ability of the endotracheal cardiac output monitor compared with thermodilution

    DEFF Research Database (Denmark)

    Møller-Sørensen, H; Hansen, K L; Ostergaard, M

    2012-01-01

    BACKGROUND: Minimally invasive monitoring systems of central haemodynamics are gaining increasing popularity. The present study investigated the precision of the endotracheal cardiac output monitor (ECOM) system and its agreement with pulmonary artery catheter thermodilution (PAC TD) for measuring...

  12. High-output cardiac failure secondary to multiple vascular malformations in the liver: case report

    International Nuclear Information System (INIS)

    Spaner, S.; Demeter, S.; Lien, D.; Shapiro, J.; McCarthy, M.; Raymond, G.

    2001-01-01

    High-output cardiac failure is associated with several systemic illnesses, including hyperthyroidism, thiamine deficiency, severe anemia, multiple myeloma, Paget's disease of bone and Osler-Weber-Rendu syndrome. We present an unusual case of a woman with high-output cardiac failure as a result of multiple arteriovenous fistulas in the liver, most likely representing an unusual variant of Osler-Weber-Rendu syndrome (i.e., no other telangiectasias or a family history of vascular malformations was demonstrated). (author)

  13. Comparison of cardiac output optimization with an automated closed-loop goal-directed fluid therapy versus non standardized manual fluid administration during elective abdominal surgery: first prospective randomized controlled trial.

    Science.gov (United States)

    Lilot, Marc; Bellon, Amandine; Gueugnon, Marine; Laplace, Marie-Christine; Baffeleuf, Bruno; Hacquard, Pauline; Barthomeuf, Felicie; Parent, Camille; Tran, Thomas; Soubirou, Jean-Luc; Robinson, Philip; Bouvet, Lionel; Vassal, Olivia; Lehot, Jean-Jacques; Piriou, Vincent

    2018-01-27

    An intraoperative automated closed-loop system for goal-directed fluid therapy has been successfully tested in silico, in vivo and in a clinical case-control matching. This trial compared intraoperative cardiac output (CO) in patients managed with this closed-loop system versus usual practice in an academic medical center. The closed-loop system was connected to a CO monitoring system and delivered automated colloid fluid boluses. Moderate to high-risk abdominal surgical patients were randomized either to the closed-loop or the manual group. Intraoperative final CO was the primary endpoint. Secondary endpoints were intraoperative overall mean cardiac index (CI), increase from initial to final CI, intraoperative fluid volume and postoperative outcomes. From January 2014 to November 2015, 46 patients were randomized. There was a lower initial CI (2.06 vs. 2.51 l min -1 m -2 , p = 0.042) in the closed-loop compared to the control group. No difference in final CO and in overall mean intraoperative CI was observed between groups. A significant relative increase from initial to final CI values was observed in the closed-loop but not the control group (+ 28.6%, p = 0.006 vs. + 1.2%, p = 0.843). No difference was found for intraoperative fluid management and postoperative outcomes between groups. There was no significant impact on the primary study endpoint, but this was found in a context of unexpected lower initial CI in the closed-loop group.Trial registry number ID-RCB/EudraCT: 2013-A00770-45. ClinicalTrials.gov Identifier NCT01950845, date of registration: 17 September 2013.

  14. Determination of myocardial energetic output for cardiac rhythm pacing

    Czech Academy of Sciences Publication Activity Database

    Heřman, D.; Převorovská, Světlana; Maršík, František

    2007-01-01

    Roč. 7, č. 4 (2007), s. 156-161 ISSN 1567-8822 R&D Projects: GA ČR GA106/03/1073 Institutional research plan: CEZ:AV0Z20760514 Keywords : heart arrhythmia * cardiac pacing modes * numerical simulation Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  15. Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery

    NARCIS (Netherlands)

    Verweij, E. J.; Hogenbirk, Karin; Roest, Arno A. W.; van Brempt, Ronald; Hazekamp, Mark G.; de Jonge, Evert

    2012-01-01

    Low cardiac output syndrome is common after paediatric cardiac surgery. Previous studies suggested that hydrocortisone administration may improve haemodynamic stability in case of resistant low cardiac output syndrome in critically ill children. This study was set up to test the hypothesis that the

  16. Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration

    Directory of Open Access Journals (Sweden)

    Amann Matthias

    2007-11-01

    demonstrate an acceptable accuracy in comparison to the clinical standard of cardiac output determination.

  17. Evaluation of a new arterial pressure-based cardiac output device requiring no external calibration

    Science.gov (United States)

    Prasser, Christopher; Bele, Sylvia; Keyl, Cornelius; Schweiger, Stefan; Trabold, Benedikt; Amann, Matthias; Welnhofer, Julia; Wiesenack, Christoph

    2007-01-01

    , the used algorithm (V 1.03) failed to demonstrate an acceptable accuracy in comparison to the clinical standard of cardiac output determination. PMID:17996086

  18. The decrease of cardiac chamber volumes and output during positive-pressure ventilation

    DEFF Research Database (Denmark)

    Kristensen, Kasper Kyhl; Ahtarovski, Kiril Aleksov; Iversen, Kasper

    2013-01-01

    the effect of PPV on the central circulation by studying cardiac chamber volumes with cardiac magnetic resonance imaging (CMR). We hypothesized that PPV lowers cardiac output (CO) mainly via the Frank-Starling relationship. In 18 healthy volunteers, cardiac chamber volumes and flow in aorta and the pulmonary...... artery were measured by CMR during PPV levels of 0, 10, and 20 cmH2O applied via a respirator and a face mask. All cardiac chamber volumes decreased in proportion to the level of PPV. Following 20-cmH2O PPV, the total diastolic and systolic cardiac volumes (±SE) decreased from 605 (±29) ml to 446 (±29......) ml (P volume decreased by 27 (±4) ml/beat; heart rate increased by 7 (±2) beats/min; and CO decreased by 1.0 (±0.4) l/min (P

  19. The relationship between cardiac output and dynamic cerebral autoregulation in humans.

    Science.gov (United States)

    Deegan, B M; Devine, E R; Geraghty, M C; Jones, E; Ólaighin, G; Serrador, J M

    2010-11-01

    Cerebral autoregulation adjusts cerebrovascular resistance in the face of changing perfusion pressures to maintain relatively constant flow. Results from several studies suggest that cardiac output may also play a role. We tested the hypothesis that cerebral blood flow would autoregulate independent of changes in cardiac output. Transient systemic hypotension was induced by thigh-cuff deflation in 19 healthy volunteers (7 women) in both supine and seated positions. Mean arterial pressure (Finapres), cerebral blood flow (transcranial Doppler) in the anterior (ACA) and middle cerebral artery (MCA), beat-by-beat cardiac output (echocardiography), and end-tidal Pco(2) were measured. Autoregulation was assessed using the autoregulatory index (ARI) defined by Tiecks et al. (Tiecks FP, Lam AM, Aaslid R, Newell DW. Stroke 26: 1014-1019, 1995). Cerebral autoregulation was better in the supine position in both the ACA [supine ARI: 5.0 ± 0.21 (mean ± SE), seated ARI: 3.9 ± 0.4, P = 0.01] and MCA (supine ARI: 5.0 ± 0.2, seated ARI: 3.8 ± 0.3, P = 0.004). In contrast, cardiac output responses were not different between positions and did not correlate with cerebral blood flow ARIs. In addition, women had better autoregulation in the ACA (P = 0.046), but not the MCA, despite having the same cardiac output response. These data demonstrate cardiac output does not appear to affect the dynamic cerebral autoregulatory response to sudden hypotension in healthy controls, regardless of posture. These results also highlight the importance of considering sex when studying cerebral autoregulation.

  20. Cardiac Output and Performance during a Marathon Race in Middle-Aged Recreational Runners

    OpenAIRE

    Billat, Véronique L.; Petot, Hélène; Landrain, Morgan; Meilland, Renaud; Koralsztein, Jean Pierre; Mille-Hamard, Laurence

    2012-01-01

    Purpose. Despite the increasing popularity of marathon running, there are no data on the responses of stroke volume (SV) and cardiac output (CO) to exercise in this context. We sought to establish whether marathon performance is associated with the ability to sustain high fractional use of maximal SV and CO (i.e, cardiac endurance) and/or CO, per meter (i.e., cardiac cost). Methods. We measured the SV, heart rate (HR), CO, and running speed of 14 recreational runners in an incremental, maxima...

  1. Clinical Validation of Non-Invasive Cardiac Output Monitoring in Healthy Pregnant Women.

    Science.gov (United States)

    McLaughlin, Kelsey; Wright, Stephen P; Kingdom, John C P; Parker, John D

    2017-11-01

    Non-invasive hemodynamic monitoring has the potential to be a valuable clinical tool for the screening and management of hypertensive disorders of pregnancy. The objective of this study was to validate the clinical utility of the non-invasive cardiac output monitoring (NICOM) system in pregnant women. Twenty healthy pregnant women with a singleton pregnancy at 22 to 26 weeks' gestation were enrolled in this study. Measures of heart rate, stroke volume, and cardiac output were obtained through NICOM and compared with Doppler echocardiography. NICOM significantly overestimated measures of both stroke volume and cardiac output compared with Doppler echocardiography (95 ± 4 vs. 73 ± 4 mL, P gold standard for the measurement of cardiac output in the setting of pregnancy. However, once normal values have been established, NICOM has the potential to be a useful clinical tool for monitoring maternal hemodynamics in pregnant women. Further investigation regarding the validity of NICOM is required in larger populations of healthy and hypertensive pregnant women to determine whether this device is appropriate for maternal hemodynamic assessment during pregnancy. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  2. Rowing increases stroke volume and cardiac output to a greater extent than cycling

    Czech Academy of Sciences Publication Activity Database

    Horn, P.; Ošťádal, P.; Ošťádal, Bohuslav

    2015-01-01

    Roč. 64, č. 2 (2015), s. 203-207 ISSN 0862-8408 Institutional support: RVO:67985823 Keywords : cardiac output * cycling * heart rate * stroke volume Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 1.643, year: 2015

  3. Relationship between stroke volume, cardiac output and filling of the heart during tilt

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M.; Sorensen, H.; Dalsgaard, M.

    2009-01-01

    . With the supine resting position as a reference, we assessed stroke volume (SV), cardiac output (CO) and filling of the heart during graded tilt to evaluate whether SV and CO are maintained during an assumed maximal physiological filling of the heart elicited by 90 degrees HDT in healthy resting humans. METHODS...

  4. Middle cerebral artery blood velocity depends on cardiac output during exercise with a large muscle mass

    NARCIS (Netherlands)

    Ide, K.; Pott, F.; van Lieshout, J. J.; Secher, N. H.

    1998-01-01

    We tested the hypothesis that pharmacological reduction of the increase in cardiac output during dynamic exercise with a large muscle mass would influence the cerebral blood velocity/perfusion. We studied the relationship between changes in cerebral blood velocity (transcranial Doppler), rectus

  5. Changes in cardiac output and incidence of volume overload in cirrhotics receiving 20% albumin infusion.

    Science.gov (United States)

    Shasthry, Saggere M; Kumar, Manoj; Khumuckham, Jelen S; Sarin, Shiv Kumar

    2017-08-01

    Patients with cirrhosis are prone to develop volume over load, have increased capillary permeability and latent or overt cardiomyopathy. Whether albumin infusion causes volume overload in cirrhotics has not been adequately studied. Ninety nine consecutive cirrhotic patients receiving 1gm per kg albumin infusion were evaluated for development of volume overload. Clinical, echocardiographic and haemodynamic changes were closely monitored during and after albumin infusion. Thirty (30.30%) patients developed volume overload. Patients with higher BMI (P=.003), lower CTP (P=.01) and MELD (P=.034) were more often associated with the development of volume overload. Though baseline diastolic dysfunction was present in 82.8% of the patients, it did not influence the development of volume overload or changes in the cardiac output. The cardiac output increased significantly after albumin infusion (4.9±1.554 L/min to 5.86±1.85 L/min, Palbumin infusion develop volume overload, specially, those with higher BMI and lower severity of liver disease. Cardiac output increases after albumin infusion, and, baseline diastolic dysfunction has little effect on the development of volume overload or changes in cardiac output. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Non-invasive measurements of cardiac output in atrial fibrillation: Inert gas rebreathing and impedance cardiography

    DEFF Research Database (Denmark)

    Osbak, Philip S; Henriksen, Jens Henrik Sahl; Kofoed, Klaus F

    2011-01-01

    Abstract Background. Atrial fibrillation (AF) is associated with significant morbidity and mortality. To test the effect of interventions, knowledge of cardiac output (CO) is important. However, the irregular heart rate might cause some methods for determination of CO to have inherent weaknesses....

  7. Effect of Hemorrhage on Cardiac Output, PVP, Alodosterone and Diuresis during Immersion in Men

    Science.gov (United States)

    Simanonok, K.; Greenleaf, John E.; Bernauer, E. M.; Wade, C. E.; Keil, L. C.

    1990-01-01

    The purpose of this study was to test the hypothesis that a reduction in blood volume would attenuate or eliminate immersion-induced increases in cardiac output (Q (sup dot) sub co)) and urine excretion, and to investigate accompanying vasoactive and fluid-electrolyte hormonal responses.

  8. A-V Delay Versus Cardiac Output Measured with Thorax Bioimpedance Monitor

    Czech Academy of Sciences Publication Activity Database

    Vondra, Vlastimil; Halámek, Josef; Viščor, Ivo; Jurák, Pavel; Novák, M.; Lipoldová, J.

    2008-01-01

    Roč. 6, č. 1 (2008), s. 73 ISSN 1556-7451. [World Congress on Heart Disease /14./. 26.07.2008-29.07.2008, Toronto] Institutional research plan: CEZ:AV0Z20650511 Keywords : atrio-ventricular delay * resynchronization therapy * impedance cardiography * cardiac output Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery

  9. Non-invasive cardiac output trending during exercise recovery on a bathroom-scale-based ballistocardiograph

    International Nuclear Information System (INIS)

    Inan, O T; Etemadi, M; Giovangrandi, L; Kovacs, G T A; Paloma, A

    2009-01-01

    Cardiac ejection of blood into the aorta generates a reaction force on the body that can be measured externally via the ballistocardiogram (BCG). In this study, a commercial bathroom scale was modified to measure the BCGs of nine healthy subjects recovering from treadmill exercise. During the recovery, Doppler echocardiogram signals were obtained simultaneously from the left ventricular outflow tract of the heart. The percentage changes in root-mean-square (RMS) power of the BCG were strongly correlated with the percentage changes in cardiac output measured by Doppler echocardiography (R 2 = 0.85, n = 275 data points). The correlation coefficients for individually analyzed data ranged from 0.79 to 0.96. Using Bland–Altman methods for assessing agreement, the mean bias was found to be −0.5% (±24%) in estimating the percentage changes in cardiac output. In contrast to other non-invasive methods for trending cardiac output, the unobtrusive procedure presented here uses inexpensive equipment and could be performed without the aid of a medical professional

  10. Non-invasive cardiac output trending during exercise recovery on a bathroom-scale-based ballistocardiograph.

    Science.gov (United States)

    Inan, O T; Etemadi, M; Paloma, A; Giovangrandi, L; Kovacs, G T A

    2009-03-01

    Cardiac ejection of blood into the aorta generates a reaction force on the body that can be measured externally via the ballistocardiogram (BCG). In this study, a commercial bathroom scale was modified to measure the BCGs of nine healthy subjects recovering from treadmill exercise. During the recovery, Doppler echocardiogram signals were obtained simultaneously from the left ventricular outflow tract of the heart. The percentage changes in root-mean-square (RMS) power of the BCG were strongly correlated with the percentage changes in cardiac output measured by Doppler echocardiography (R(2) = 0.85, n = 275 data points). The correlation coefficients for individually analyzed data ranged from 0.79 to 0.96. Using Bland-Altman methods for assessing agreement, the mean bias was found to be -0.5% (+/-24%) in estimating the percentage changes in cardiac output. In contrast to other non-invasive methods for trending cardiac output, the unobtrusive procedure presented here uses inexpensive equipment and could be performed without the aid of a medical professional.

  11. Estimating changes in cardiac output using an implanted hemodynamic monitor in heart failure patients

    DEFF Research Database (Denmark)

    Ståhlberg, Marcus; Damgaard, Morten; Ersgård, David

    2010-01-01

    OBJECTIVES: The aim of this study was to evaluate an algorithm that estimates changes in cardiac output (CO) from right ventricular (RV) pressure waveforms derived from an implantable hemodynamic monitor (IHM) in heart failure patients. DESIGN: Twelve heart failure patients (NYHA II-III, EF 32......%) with an implantable hemodynamic monitor (Chronicle) were included in this study. Changes in cardiac output were provoked by body position change at rest (left lateral supine, horizontal supine, sitting, and standing) and a steady state bicycle exercise at 20 watts. Estimated CO derived from the IHM (CO...... was -0.39 L/min (11%). Limits of agreement were +/-1.56 L/min and relative error was 21%. CONCLUSIONS: A simple algorithm based on RV pressure wave form characteristics derived from an IHM can be used to estimate changes in CO in heart failure patients. These findings encourage further research aiming...

  12. Is pulmonary gas exchange during exercise in hypoxia impaired with the increase of cardiac output?

    DEFF Research Database (Denmark)

    Calbet, J.A.; Robach, P.; Lundby, C.

    2008-01-01

    During exercise in humans, the alveolar-arterial O(2) tension difference ((A-a)DO(2)) increases with exercise intensity and is an important factor determining the absolute level of oxygen binding to hemoglobin and therefore the level of systemic oxygen transport. During exercise in hypoxia, the (A......-a)DO(2) is accentuated. Using the multiple inert gas elimination technique it has been shown that during exercise in acute hypoxia the contribution of ventilation-perfusion inequality to (A-a)DO(2) is rather small and in the absence of pulmonary edema intrapulmonary shunts can be ruled out. This implies...... that the main mechanism limiting pulmonary gas exchange is diffusion limitation. It is presumed that an elevation of cardiac output during exercise in acute hypoxia should increase the (A-a)DO(2). However, no studies have examined how variations in cardiac output independently affect pulmonary diffusion...

  13. Low cardiac output as physiological phenomenon in hibernating, free-ranging Scandinavian brown bears (Ursus arctos) - an observational study.

    Science.gov (United States)

    Jørgensen, Peter Godsk; Arnemo, Jon; Swenson, Jon E; Jensen, Jan S; Galatius, Søren; Frøbert, Ole

    2014-09-16

    Despite 5-7 months of physical inactivity during hibernation, brown bears (Ursus arctos) are able to cope with physiological conditions that would be detrimental to humans. During hibernation, the tissue metabolic demands fall to 25% of the active state. Our objective was to assess cardiac function associated with metabolic depression in the hibernating vs. active states in free-ranging Scandinavian brown bears. We performed echocardiography on seven free-ranging brown bears in Dalarna, Sweden, anesthetized with medetomidine-zolazepam-tiletamine-ketamine during winter hibernation in February 2013 and with medetomidine-zolazepam-tiletamine during active state in June 2013. We measured cardiac output noninvasively using estimates of hemodynamics obtained by pulsed wave Doppler echocardiography and 2D imaging. Comparisons were made using paired T-tests. During hibernation, all hemodynamic indices were significantly decreased (hibernating vs. active state): mean heart rate was 26.0 (standard deviation (SD): 5.6) beats per min vs. 75.0 (SD: 17.1) per min (P=0.002), mean stroke volume 32.3 (SD: 5.2) ml vs. 47.1 (SD: 7.9) ml (P=0.008), mean cardiac output 0.86 (SD: 0.31) l/min vs. 3.54 (SD: 1.04) l/min (P=0.003), and mean cardiac index 0.63 (SD: 0.21) l/min/kg vs. 2.45 (SD: 0.52) l/min/ m2 (Pbears during hibernation, despite the absence of atrial arrhythmias and valvular disease. Free-ranging brown bears demonstrate hemodynamics comparable to humans during active state, whereas during hibernation, we documented extremely low-flow hemodynamics. Understanding these physiological changes in bears may help to gain insight into the mechanisms of cardiogenic shock and heart failure in humans.

  14. Cardiac output and performance during a marathon race in middle-aged recreational runners.

    Science.gov (United States)

    Billat, Véronique L; Petot, Hélène; Landrain, Morgan; Meilland, Renaud; Koralsztein, Jean Pierre; Mille-Hamard, Laurence

    2012-01-01

    Despite the increasing popularity of marathon running, there are no data on the responses of stroke volume (SV) and cardiac output (CO) to exercise in this context. We sought to establish whether marathon performance is associated with the ability to sustain high fractional use of maximal SV and CO (i.e, cardiac endurance) and/or CO, per meter (i.e., cardiac cost). We measured the SV, heart rate (HR), CO, and running speed of 14 recreational runners in an incremental, maximal laboratory test and then during a real marathon race (mean performance: 3 hr 30 min ± 45 min). Our data revealed that HR, SV and CO were all in a high but submaximal steady state during the marathon (87.0 ± 1.6%, 77.2 ± 2.6%, and 68.7 ± 2.8% of maximal values, respectively). Marathon performance was inversely correlated with an upward drift in the CO/speed ratio (mL of CO × m(-1)) (r = -0.65, P marathon performance is inversely correlated with cardiac cost and positively correlated with cardiac endurance. The CO response could be a benchmark for race performance in recreational marathon runners.

  15. Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery.

    Science.gov (United States)

    Verweij, E J; Hogenbirk, Karin; Roest, Arno A W; van Brempt, Ronald; Hazekamp, Mark G; de Jonge, Evert

    2012-10-01

    Low cardiac output syndrome is common after paediatric cardiac surgery. Previous studies suggested that hydrocortisone administration may improve haemodynamic stability in case of resistant low cardiac output syndrome in critically ill children. This study was set up to test the hypothesis that the effects of hydrocortisone on haemodynamics in children with low cardiac output syndrome depend on the presence of (relative) adrenal insufficiency. A retrospective study was done on paediatric patients who received hydrocortisone when diagnosed with resistant low cardiac output syndrome after paediatric cardiac surgery in the period from 1 November 2005 to 31 December 2008. We studied the difference in effects of treatment with hydrocortisone administration between patients with adrenal insufficiency defined as an exploratory cut-off value of total cortisol of cortisol of ≥ 100 nmol/l. A total of 62 of patients were enrolled, meeting the inclusion criteria for low cardiac output syndrome. Thirty-two patients were assigned to Group 1 (cortisol concentration and those with normal baseline cortisol levels. A cortisol value using an exploratory cut-off value of 100 nmol/l for adrenal insufficiency should not be used as a criterion to treat these patients with hydrocortisone.

  16. Mathematical basis for the measurement of absolute and fractional cardiac output with diffusible tracers by compartmental analysis methods

    International Nuclear Information System (INIS)

    Charkes, N.D.

    1984-01-01

    Using compartmental analysis methods, a mathematical basis is given for the measurement of absolute and fractional cardiac output with diffusible tracers. Cardiac output is shown to be the product of the blood volume and the sum of the rate constants of tracer egress from blood, modified by a factor reflecting transcapillary diffusibility, the transfer fraction. The return of tracer to the blood and distant (intracellular) events are shown to play no role in the solution. Fractional cardiac output is the ratio of the rate constant of tracer egress from blood to an organ, divided by the sum of the egress constants from blood. Predominantly extracellular ions such as sodium or bromide are best suited for this technique, although theoretically any diffusible tracer whose compartmental model can be solved may be used. It is shown that fractional cardiac output is independent of the transfer fraction, and therefore can be measured accurately by tracers which are not freely diffusible

  17. Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output.

    Science.gov (United States)

    Remmers, D E; Wang, P; Cioffi, W G; Bland, K I; Chaudry, I H

    1998-01-01

    To determine whether prolonged (chronic) resuscitation has any beneficial effects on cardiac output and hepatocellular function after trauma-hemorrhage and acute fluid replacement. Acute fluid resuscitation after trauma-hemorrhage restores but does not maintain the depressed hepatocellular function and cardiac output. Male Sprague-Dawley rats underwent a 5-cm laparotomy (i.e., trauma was induced) and were bled to and maintained at a mean arterial pressure of 40 mmHg until 40% of maximal bleed-out volume was returned in the form of Ringer's lactate (RL). The animals were acutely resuscitated with RL using 4 times the volume of maximum bleed-out over 60 minutes, followed by chronic resuscitation of 0, 5, or 10 mL/kg/hr RL for 20 hours. Hepatocellular function was determined by an in vivo indocyanine green clearance technique. Hepatic microvascular blood flow was assessed by laser Doppler flowmetry. Plasma levels of interleukin-6 (IL-6) were determined by bioassay. Chronic resuscitation with 5 mL/kg/hr RL, but not with 0 or 10 mL/kg/hr RL, restored cardiac output, hepatocellular function, and hepatic microvascular blood flow at 20 hours after hemorrhage. The regimen above also reduced plasma IL-6 levels. Because chronic resuscitation with 5 mL/kg/hr RL after trauma-hemorrhage and acute fluid replacement restored hepatocellular function and hepatic microvascular blood flow and decreased plasma levels of IL-6, we propose that chronic fluid resuscitation in addition to acute fluid replacement should be routinely used in experimental studies of trauma-hemorrhage.

  18. Hereditary Hemorrhagic Telangiectasia Presenting as High Output Cardiac Failure during Pregnancy

    Directory of Open Access Journals (Sweden)

    Tareq Goussous

    2009-01-01

    Full Text Available High-output cardiac failure secondary to hepatic involvement is a rare complication of hereditary hemorrhagic telangiectasia (HHT. Here we report a 43-year-old woman who presented at 29 weeks gestation of her second pregnancy with complications of right-sided heart failure and preterm labor. After delivery via cesarean section, the patient was found to have intrahepatic arteriovenous malformations through non-invasive imaging. Subsequently, a family history of vascular malformations and epistaxis was elucidated and a diagnosis of HHT was made. This case is presented, along with a review of the literature and discussion of hepatic involvement in HHT with particular focus on the pregnant patient.

  19. Effects of levosimendan for low cardiac output syndrome in critically ill patients

    DEFF Research Database (Denmark)

    Koster, Geert; Wetterslev, Jørn; Gluud, Christian

    2015-01-01

    PURPOSE: To assess the benefits and harms of levosimendan for low cardiac output syndrome in critically ill patients. METHODS: We conducted a systematic review with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials comparing levosimendan with any type of control. Two...... in the systematic review and 49 trials (6,688 patients) in the meta-analysis. One trial had low risk of bias and nine trials (2,490 patients) were considered lower risk of bias. Trials compared levosimendan with placebo, control interventions, and other inotropes. Pooling all trials including heterogenous...

  20. Cardiac Output and Performance during a Marathon Race in Middle-Aged Recreational Runners

    Directory of Open Access Journals (Sweden)

    Véronique L. Billat

    2012-01-01

    Full Text Available Purpose. Despite the increasing popularity of marathon running, there are no data on the responses of stroke volume (SV and cardiac output (CO to exercise in this context. We sought to establish whether marathon performance is associated with the ability to sustain high fractional use of maximal SV and CO (i.e, cardiac endurance and/or CO, per meter (i.e., cardiac cost. Methods. We measured the SV, heart rate (HR, CO, and running speed of 14 recreational runners in an incremental, maximal laboratory test and then during a real marathon race (mean performance: 3 hr 30 min ± 45 min. Results. Our data revealed that HR, SV and CO were all in a high but submaximal steady state during the marathon (87.0 ± 1.6%, 77.2 ± 2.6%, and 68.7 ± 2.8% of maximal values, respectively. Marathon performance was inversely correlated with an upward drift in the CO/speed ratio (mL of CO×m−1 (r=−0.65, P<0.01 and positively correlated with the runner’s ability to complete the race at a high percentage of the speed at maximal SV (r=0.83, P<0.0002. Conclusion. Our results showed that marathon performance is inversely correlated with cardiac cost and positively correlated with cardiac endurance. The CO response could be a benchmark for race performance in recreational marathon runners.

  1. Use of transesophageal Doppler ultrasonography in ventilated pediatric patients: derivation of cardiac output.

    Science.gov (United States)

    Tibby, S M; Hatherill, M; Murdoch, I A

    2000-06-01

    To ascertain if cardiac output (CO) could be derived from blood flow velocity measured in the descending aorta of ventilated children by transesophageal Doppler ultrasonography (TED) without the need for direct aortic cross sectional area measurement, and to evaluate the ability of TED to follow changes in CO when compared with femoral artery thermodilution. Prospective, comparison study. A 16-bed pediatric intensive care unit of a university hospital. A total of 100 ventilated infants and children aged 4 days to 18 yrs (median age, 27 months). Diagnoses included postcardiac surgery (n = 58), sepsis/multiple organ failure (n = 32), respiratory disease (n = 5), and other (n = 5). A total of 55 patients were receiving inotropes or vasodilators. When patients were hemodynamically stable, a TED probe was placed into the distal esophagus to obtain optimal signal, and minute distance (MD) was recorded. Five consecutive MD measurements were made concurrently with five femoral artery thermodilution measurements, and the concurrent measurements were averaged. CO was then manipulated by fluid administration or inotrope adjustment, and the readings were repeated. Femoral artery thermodilution CO ranged from 0.32 to 9.19 L/min, (median, 2.46 L/min), and encompassed a wide range of high and low flow states. Theoretical consideration revealed the optimal TED estimate for CO to be (MD x patient height2 x 10(-7)). Linear regression analysis yielded a power function model such that: estimated CO = 1.158 x (MD x height2 x 10(-7))(0.785), r2 = 0.879, standard error of the estimate = 0.266. Inclusion of a correction factor for potential changes in aortic cross-sectional area with hypo- and hypertension did not appreciably improve the predictive value of the model. MD was able to follow percentage changes in CO, giving a mean bias of 0.87% (95% confidence interval -0.85% to 2.59%), and limits of agreement of +/- 16.82%. The median coefficient of variation for MD was 3.3%. TED provides

  2. The Unpredictable Effect of Changing Cardiac Output on Hypoxemia after Acute Pulmonary Thromboembolism

    Directory of Open Access Journals (Sweden)

    John Y. C. Tsang

    2008-01-01

    Full Text Available Previous studies reported that the degree of hypoxemia following acute pulmonary thromboembolism (APTE was highly variable and that its mechanism was mainly due to the creation of many high and low ventilation/perfusion (V/Q units, as a result of the heterogeneous regional blood flow (Q caused by embolic obstruction. We studied the effect of changing cardiac output (Q t on gas exchange after APTE in 5 embolized piglets (23 ± 3 Kg, using Dobutamine intermittently at approximately 20 μg/kg/min for 120 minutes. The distribution of ventilation (V and perfusion (Q at various times was mapped using fluorescent microspheres in 941 ± 60 lung regions. After APTE, increase in Q t by Dobutamine improved venous oxygen tension (PvO 2 but arterial PaO 2 did not change consistently. On the other hand, cluster analysis showed that the V/Q ratio of most lung regions was lowered due to increases in Q at the same time. We concluded that the effect of changing cardiac output on gas exchange following APTE was affected by the simultaneous and varying balance between the changing V/Q mismatch and the concomitantly changing PvO 2 , which might explain the unpredictability of PaO 2 in the clinical setting.

  3. Phlebotomy eliminates the maximal cardiac output response to six weeks of exercise training

    DEFF Research Database (Denmark)

    Bonne, Thomas Christian; Doucende, Gregory; Flück, Daniela

    2014-01-01

    With this study we tested the hypothesis that six weeks of endurance training increases maximal cardiac output (Qmax) relatively more by elevating blood volume (BV) than by inducing structural and functional changes within the heart. Nine healthy but untrained volunteers (VO2max 47 ± 5 ml.min(-1......).kg(-1)) underwent supervised training (60 min; 4 times weekly at 65% VO2max for six weeks) and Qmax was determined by inert gas re-breathing during cycle ergometer exercise before and after the training period. After the training period, blood volume (determined in duplicates by CO re......-breathing) was re-established to pre-training values by phlebotomy and Qmax was quantified again. Resting echography revealed no structural heart adaptations as a consequence of the training intervention. Following the training period, plasma volume (PV), red blood cell volume (RBCV) and BV increased (p...

  4. Reference values for total blood volume and cardiac output in humans

    Energy Technology Data Exchange (ETDEWEB)

    Williams, L.R. [Indiana Univ., South Bend, IN (United States). Division of Liberal Arts and Sciences

    1994-09-01

    Much research has been devoted to measurement of total blood volume (TBV) and cardiac output (CO) in humans but not enough effort has been devoted to collection and reduction of results for the purpose of deriving typical or {open_quotes}reference{close_quotes} values. Identification of normal values for TBV and CO is needed not only for clinical evaluations but also for the development of biokinetic models for ultra-short-lived radionuclides used in nuclear medicine (Leggett and Williams 1989). The purpose of this report is to offer reference values for TBV and CO, along with estimates of the associated uncertainties that arise from intra- and inter-subject variation, errors in measurement techniques, and other sources. Reference values are derived for basal supine CO and TBV in reference adult humans, and differences associated with age, sex, body size, body position, exercise, and other circumstances are discussed.

  5. Left ventricular atrioventricular plane displacement is preserved with lifelong endurance training and is the main determinant of maximal cardiac output

    DEFF Research Database (Denmark)

    Steding-Ehrenborg, Katarina; Boushel, Robert C; Calbet, José A

    2015-01-01

    subjects (29 ± 4 years) underwent cardiac MR. All subjects underwent maximal exercise testing and for elderly subjects maximal cardiac output during cycling was determined using dye dilution technique. RESULTS: Longitudinal and radial contribution to stroke volume did not differ between groups......BACKGROUND: Age-related decline in cardiac function can be prevented or postponed by lifelong endurance training. However, effects of normal ageing as well as of lifelong endurance exercise on longitudinal and radial contribution to stroke volume are unknown. The aim of this study was to determine...... groups for RVAVPD (P = 0.2). LVAVPD was an independent predictor of maximal cardiac output (R(2 = ) 0.61, P groups. However, how longitudinal pumping...

  6. Immediate changes in estimated cardiac output and vascular resistance after 60Co exposure in monkeys: implication for performance decrement

    International Nuclear Information System (INIS)

    Bruner, A.

    1977-01-01

    Aortic blood flow velocity, blood pressure, and heart rate were recorded in 12 unanesthetized, nonperforming monkeys during exposure to 1000 rad 60 Co at 129--164 rad/min. The first postradiation changes were seen within 3--4 min of the exposure's start and included tachycardia, a transient hypotension secondary to a loss in peripheral resistance, and a brief increase followed by a decrease to subnormal levels in cardiac output. The lowest cardiac output occurred between 10 and 20 min postexposure while blood pressure and peripheral resistance were recovering. It was proposed that the concurrent combination of low cardiac output, low blood pressure, and supranormal peripheral resistance might sufficiently attenuate cerebral perfusion temporarily to account for the transient behavioral decrements often seen during this time. Histamine release was postulated as responsible for this vascular shock syndrome

  7. Non-invasive measurement of cardiac output during anaesthesia. An evaluation of the soluble gas uptake method

    Energy Technology Data Exchange (ETDEWEB)

    Heneghan, C.P.; Branthwaite, M.A.

    1981-04-01

    A technique for measuring cardiac output which depends on the uptake of an inert soluble gas from the lungs has been evaluated during anesthesia. A respiratory mass spectrometer has been used to follow the concentrations of argon and freon-22 during passive rebreathing in anaesthetized patients before cardiopulmonary bypass. Values for cardiac output obtained with this technique are reproducible, but lower than those recorded using the direct Fick technique before and after the rebreathing manoeuvre. A reduction in cardiac output caused by vigorous rebreathing is the most likely explanation for the discrepancy and, although serial measurements of oxygen consumption may permit application of a correction factor, a method of measurement which causes significant haemodynamic disturbance cannot be recommended for widespread use.

  8. Transit time dispersion in pulmonary and systemic circulation: effects of cardiac output and solute diffusivity.

    Science.gov (United States)

    Weiss, Michael; Krejcie, Tom C; Avram, Michael J

    2006-08-01

    We present an in vivo method for analyzing the distribution kinetics of physiological markers into their respective distribution volumes utilizing information provided by the relative dispersion of transit times. Arterial concentration-time curves of markers of the vascular space [indocyanine green (ICG)], extracellular fluid (inulin), and total body water (antipyrine) measured in awake dogs under control conditions and during phenylephrine or isoproterenol infusion were analyzed by a recirculatory model to estimate the relative dispersions of transit times across the systemic and pulmonary circulation. The transit time dispersion in the systemic circulation was used to calculate the whole body distribution clearance, and an interpretation is given in terms of a lumped organ model of blood-tissue exchange. As predicted by theory, this relative dispersion increased linearly with cardiac output, with a slope that was inversely related to solute diffusivity. The relative dispersion of the flow-limited indicator antipyrine exceeded that of ICG (as a measure of intravascular mixing) only slightly and was consistent with a diffusional equilibration time in the extravascular space of approximately 10 min, except during phenylephrine infusion, which led to an anomalously high relative dispersion. A change in cardiac output did not alter the heterogeneity of capillary transit times of ICG. The results support the view that the relative dispersions of transit times in the systemic and pulmonary circulation estimated from solute disposition data in vivo are useful measures of whole body distribution kinetics of indicators and endogenous substances. This is the first model that explains the effect of flow and capillary permeability on whole body distribution of solutes without assuming well-mixed compartments.

  9. Nasal continuous positive airway pressure (n-CPAP) does not change cardiac output in preterm infants.

    Science.gov (United States)

    Moritz, Barbara; Fritz, Michael; Mann, Christian; Simma, Burkhard

    2008-02-01

    Our objective was to study how invasive mechanical ventilation impairs cardiac output (CO) in children and adults. Although the application of continuous positive airway pressure (CPAP) is widely practiced in neonatal intensive care, its hemodynamic consequences have not yet been investigated. A prospective study to assess the hemodynamic effects was conducted in 21 preterm infants CPAP (n-CPAP). Gestational age was 28.0 +/- 1.9 weeks (mean +/- standard deviation); birthweight, 1000 +/- 238 g; age at study entry, 200 +/- 155 hours; total maintenance fluid, 154 +/- 42 mL/kg/day; and n-CPAP level, 4.4 +/- 0.9 cm H(2)O. None of the infants received inotropic support, and n-CPAP did not cause any significant difference in the parameters measured: stroke volume, 3.1 +/- 1.0 mL (with n-CPAP) versus 3.1 +/- 1.0 mL (without n-CPAP); cardiac output, 487 +/- 156 mL/minute versus 500 +/- 176 mL/minute; left ventricular diastolic diameter, 1.22 +/- 0.15 cm versus 1.24 +/- 0.14 cm; fractional shortening, 0.30 +/- 0.05% versus 0.29 +/- 0.04%; and aortic velocity-time integral, 8.64 +/- 1.80 cm versus 8.70 +/- 1.65 cm. The n-CPAP level did not influence CO; n-CPAP (up to 7 cm H (2)O) has no echocardiographically detectable hemodynamic effect in preterm infants. Our data imply there is no need to withhold n-CPAP support to prevent circulatory compromise in these infants.

  10. Noninvasive pulse contour analysis for determination of cardiac output in patients with chronic heart failure.

    Science.gov (United States)

    Roth, Sebastian; Fox, Henrik; Fuchs, Uwe; Schulz, Uwe; Costard-Jäckle, Angelika; Gummert, Jan F; Horstkotte, Dieter; Oldenburg, Olaf; Bitter, Thomas

    2018-05-01

    Determination of cardiac output (CO) is essential in diagnosis and management of heart failure (HF). The gold standard to obtain CO is invasive assessment via thermodilution (TD). Noninvasive pulse contour analysis (NPCA) is supposed as a new method of CO determination. However, a validation of this method in HF is pending and performed in the present study. Patients with chronic-stable HF and reduced left ventricular ejection fraction (LVEF ≤ 45%; HF-REF) underwent right heart catheterization including TD. NPCA using the CNAP Monitor (V5.2.14, CNSystems Medizintechnik AG) was performed simultaneously. Three standardized TD measurements were compared with simultaneous auto-calibrated NPCA CO measurements. In total, 84 consecutive HF-REF patients were enrolled prospectively in this study. In 4 patients (5%), TD was not successful and for 22 patients (26%, 18 with left ventricular assist device), no NPCA signal could be obtained. For the remaining 58 patients, Bland-Altman analysis revealed a mean bias of + 1.92 L/min (limits of agreement ± 2.28 L/min, percentage error 47.4%) for CO. With decreasing cardiac index, as determined by the gold standard of TD, there was an increasing gap between CO values obtained by TD and NPCA (r = - 0.75, p TD-CI classified 52 (90%) patients to have a reduced CI (REF patients, auto-calibrated NPCA systematically overestimates CO with decrease in cardiac function. Therefore, to date, NPCA cannot be recommended in this cohort.

  11. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    Energy Technology Data Exchange (ETDEWEB)

    Nillesen, M M; Lopata, R G P; Gerrits, I H; Thijssen, J M; De Korte, C L [Clinical Physics Laboratory-833, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); De Boode, W P [Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Huisman, H J [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kapusta, L [Pediatric Cardiology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)], E-mail: m.m.nillesen@cukz.umcn.nl

    2009-04-07

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  12. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    International Nuclear Information System (INIS)

    Nillesen, M M; Lopata, R G P; Gerrits, I H; Thijssen, J M; De Korte, C L; De Boode, W P; Huisman, H J; Kapusta, L

    2009-01-01

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  13. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    Science.gov (United States)

    Nillesen, M. M.; Lopata, R. G. P.; de Boode, W. P.; Gerrits, I. H.; Huisman, H. J.; Thijssen, J. M.; Kapusta, L.; de Korte, C. L.

    2009-04-01

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  14. Depressed left and right ventricular cardiac output in fetuses of diabetic mothers

    Directory of Open Access Journals (Sweden)

    Jennifer Winter MD

    2018-01-01

    Full Text Available Introduction: We compared right and left ventricular cardiac output (RVCO and LVCO in fetuses of diabetic mothers (FDM with a large normal cohort. Methods: We prospectively enrolled 264 normal fetuses and 30 FDM. Fetal CO parameters such as semilunar valve velocity time integrals (AVVTI, PVVTI, ventricular outflow diameters (LVOTD, RVOTD and stroke volumes (AVSV, PVSV were measured, and LVCO and RVCO were calculated. These were normalized using non-linear regression to estimated fetal weight (EFW to provide means and standard deviations. Among FDMs, mean Z scores and 95% confidence limits (CL were calculated and compared to zero. Results: LVCO, RVCO and parameters they were calculated from, increased predictably and non-linearly with increasing EFW. In FDM, LVCO was depressed (mean Z −1.679, 95% CL −2.404, −0.955, P < 0.001, and AVVTI, LVOTD and AVSV were significantly lower than normal. Similarly, RVCO (mean Z = −1.119, CL −1.839, −0.400, P = 0.003, RVOTD (mean −2.085, CL −3.077, −1.093, P < 0.001 and PVSV (mean −1.184, CL −1.921, −0.446, P = 0.003 were lower than normal, however, PVVTI was not different (mean Z 0.078, CL −0.552, +0.707, P = 0.803. Conclusion: Normal biventricular stroke volumes and outputs follow a non-linear regression with EFW. FDM have significantly lower right and left heart stroke volumes and outputs for weight than do normal fetuses.

  15. Pulmonary diffusing capacity, capillary blood volume, and cardiac output during sustained microgravity

    Science.gov (United States)

    Prisk, G. K.; Guy, Harold J. B.; Elliott, Ann R.; Deutschman, Robert A., III; West, John B.

    1993-01-01

    We measured pulmonary diffusing capacity (DL), diffusing capacity per unit lung volume, pulmonary capillary blood volume (Vc), membrane diffusing capacity (Dm), pulmonary capillary blood flow or cardiac output (Qc), and cardiac stroke volume (SV) in four subjects exposed to nine days of microgravity. DL in microgravity was elevated compared with preflight standing values and was higher than preflight supine because of the elevation of both Vc and Dm. The elevation in Vc was comparable to that measured supine in 1 G, but the increase in Dm was in sharp contrast to the supine value. We postulate that, in 0 G, pulmonary capillary blood is evenly distributed throughout the lung, providing for uniform capillary filling, leading to an increase in the surface area available for diffusion. By contrast, in the supine 1-G state, the capillaries are less evenly filled, and although a similar increase in blood volume is observed, the corresponding increase in surface area does not occur. DL and its subdivisions showed no adaptive changes from the first measurement 24 h after the start of 0 G to eight days later. Similarly, there were no trends in the postflight data, suggesting that the principal mechanism of these changes was gravitational. The increase in Dm suggests that subclinical pulmonary edema did not result from exposure to 0 G. Qc was modestly increased inflight and decreased postflight compared with preflight standing. Compared with preflight standing, SV was increased 46 percent inflight and decreased 14 percent in the 1st week postflight. There were temporal changes in Qc and SV during 0 G, with the highest values recorded at the first measurement, 24 h into the flight. The lowest values of Qc and SV occurred on the day of return.

  16. Pilot Study: Estimation of Stroke Volume and Cardiac Output from Pulse Wave Velocity.

    Directory of Open Access Journals (Sweden)

    Yurie Obata

    Full Text Available Transesophageal echocardiography (TEE is increasingly replacing thermodilution pulmonary artery catheters to assess hemodynamics in patients at high risk for cardiovascular morbidity. However, one of the drawbacks of TEE compared to pulmonary artery catheters is the inability to measure real time stroke volume (SV and cardiac output (CO continuously. The aim of the present proof of concept study was to validate a novel method of SV estimation, based on pulse wave velocity (PWV in patients undergoing cardiac surgery.This is a retrospective observational study. We measured pulse transit time by superimposing the radial arterial waveform onto the continuous wave Doppler waveform of the left ventricular outflow tract, and calculated SV (SVPWV using the transformed Bramwell-Hill equation. The SV measured by TEE (SVTEE was used as a reference.A total of 190 paired SV were measured from 28 patients. A strong correlation was observed between SVPWV and SVTEE with the coefficient of determination (R2 of 0.71. A mean difference between the two (bias was 3.70 ml with the limits of agreement ranging from -20.33 to 27.73 ml and a percentage error of 27.4% based on a Bland-Altman analysis. The concordance rate of two methods was 85.0% based on a four-quadrant plot. The angular concordance rate was 85.9% with radial limits of agreement (the radial sector that contained 95% of the data points of ± 41.5 degrees based on a polar plot.PWV based SV estimation yields reasonable agreement with SV measured by TEE. Further studies are required to assess its utility in different clinical situations.

  17. Fluid challenge: tracking changes in cardiac output with blood pressure monitoring (invasive or non-invasive).

    Science.gov (United States)

    Lakhal, Karim; Ehrmann, Stephan; Perrotin, Dominique; Wolff, Michel; Boulain, Thierry

    2013-11-01

    To assess whether invasive and non-invasive blood pressure (BP) monitoring allows the identification of patients who have responded to a fluid challenge, i.e., who have increased their cardiac output (CO). Patients with signs of circulatory failure were prospectively included. Before and after a fluid challenge, CO and the mean of four intra-arterial and oscillometric brachial cuff BP measurements were collected. Fluid responsiveness was defined by an increase in CO ≥10 or ≥15% in case of regular rhythm or arrhythmia, respectively. In 130 patients, the correlation between a fluid-induced increase in pulse pressure (Δ500mlPP) and fluid-induced increase in CO was weak and was similar for invasive and non-invasive measurements of BP: r² = 0.31 and r² = 0.29, respectively (both p area under the receiver-operating curve (AUC) of 0.82 (0.74-0.88), similar (p = 0.80) to that of non-invasive Δ500mlPP [AUC of 0.81 (0.73-0.87)]. Outside large gray zones of inconclusive values (5-23% for invasive Δ500mlPP and 4-35% for non-invasive Δ500mlPP, involving 35 and 48% of patients, respectively), the detection of responsiveness or unresponsiveness to fluid was reliable. Cardiac arrhythmia did not impair the performance of invasive or non-invasive Δ500mlPP. Other BP-derived indices did not outperform Δ500mlPP. As evidenced by large gray zones, BP-derived indices poorly reflected fluid responsiveness. However, in our deeply sedated population, a high increase in invasive pulse pressure (>23%) or even in non-invasive pulse pressure (>35%) reliably detected a response to fluid. In the absence of a marked increase in pulse pressure (<4-5%), a response to fluid was unlikely.

  18. Management of perioperative low cardiac output state without extracorporeal life support: What is feasible?

    International Nuclear Information System (INIS)

    Kumar, Girish; Iyer, Parvathi U

    2010-01-01

    A transient and reversible reduction in cardiac output–low cardiac output state (LCOS) often occurs following surgery for congenital heart disease. Inappropriately managed LCOS is a risk factor for increased morbidity and death. LCOS may occasionally be progressive and refractory needing a period of “myocardial rest” with extracorporeal life support (ECLS). ECLS is currently considered a routine tool available for rapid deployment in most industrialized countries. Accumulated experience and refinements in technology have led to improving survivals – discharge survivals of 35%–50%, with almost 100% survival in select groups on elective left ventricular assist device. Thus, there is an increasing trend to initiate ECLS “early or electively in the operating room” in high-risk patients. India has a huge potential need for ECLS given the large number of infants presenting late with preexisting ventricular dysfunction or in circulatory collapse. ECLS is an expensive and resource consuming treatment modality and is not a viable therapeutic option in our country. The purpose of this paper is to reiterate an anticipatory, proactive approach to LCOS: (1) methods for early detection of evolving LCOS and (2) timely initiation of individualized therapy. This paper also explores what is feasible with the refinement of “simple, conventional, inexpensive strategies” for the management of LCOS. Therapy for LCOS should be multimodal based on the type of circulation and physiology. Our approach to LCOS includes: (1) intraoperative strategies, (2) aggressive afterload reduction, (3) lusitropy, (4) exclusion of structural defects, (5) harnessing cardiopulmonary interactions, and (6) addressing metabolic and endocrine abnormalities. We have achieved a discharge survival rate of greater than 97% with these simple methods

  19. Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease.

    Science.gov (United States)

    Burkhardt, Barbara E U; Rücker, Gerta; Stiller, Brigitte

    2015-03-25

    Children with congenital heart disease often undergo heart surgery at a young age. They are at risk for postoperative low cardiac output syndrome (LCOS) or death. Milrinone may be used to provide inotropic and vasodilatory support during the immediate postoperative period. This review examines the effectiveness of prophylactic postoperative use of milrinone to prevent LCOS or death in children having undergone surgery for congenital heart disease. Electronic and manual literature searches were performed to identify randomised controlled trials. We searched CENTRAL, MEDLINE, EMBASE and Web of Science in February 2014 and conducted a top-up search in September 2014 as well as clinical trial registries and reference lists of published studies. We did not apply any language restrictions. Only randomised controlled trials were selected for analysis. We considered studies with newborn infants, infants, toddlers, and children up to 12 years of age. Two review authors independently extracted data according to a pre-defined protocol. We obtained additional information from all study authors. Three of the five included studies compared milrinone versus levosimendan, one study compared milrinone with placebo, and one compared milrinone verus dobutamine, with 101, 242, and 50 participants, respectively. Three trials were at low risk of bias while two were at higher risk of bias. The number and definitions of outcomes were non-uniform as well. In one study comparing two doses of milrinone and placebo, there was some evidence in an overall comparison of milrinone versus placebo that milrinone lowered risk for LCOS (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.28 to 0.96; 227 participants). The results from two small studies do not provide enough information to determine whether milrinone increases the risk of LCOS when compared to levosimendan (RR 1.22, 95% CI 0.32 to 4.65; 59 participants). Mortality rates in the studies were low, and there was insufficient evidence to

  20. Evaluation of concordance among three cardiac output measurement techniques in adult patients during cardiovascular surgery postoperative care.

    Science.gov (United States)

    Muñoz, L; Velandia, A; Reyes, L E; Arevalo-Rodríguez, I; Mejía, C; Asprilla, D; Uribe, D V; Arevalo, J J

    2017-12-01

    The standard method for cardiac output measuring is thermodilution although it is an invasive technique. Transesophageal Echocardiography (TEE) offers a dynamic and functional alternative to thermodilution. Analyze concordance between two TEE methods and thermodilution for cardiac output assessment. Observational concordance study in cardiovascular surgery patients that required pulmonary artery catheter. TEE cardiac output measurement at both mitral annulus (MA) and left ventricle outflow tract (LVOT) were performed. Results were compared with thermodilution. Correlation was evaluated by Lin's concordance correlation coefficient and Bland-Altman analysis. Statistical analysis was undertaken in STATA 13.0. Twenty-five patients were enrolled. Fifty two percent of patients were male, median age and ejection fraction was 63 years and 35% respectively. Median thermodilution, LVOT and MA -measured cardiac output was 3.25 L/min, 3.46 L/min and 8.4 L/min respectively. Different values between thermodilution and MA measurements were found (Lin concordance=0.071; Confidence Interval 95%=-0.009 to 0.151; Spearman's correlation=0.22) as values between thermodilution and LVOT (Lin concordance=0.232; Confidence Interval 95%=-0.12 a 0.537; Spearman's correlation 0.28). Bland-Altman analysis showed greater difference between MA measurements and thermodilution (DM=-0.408; Bland-Altman Limits=-0.809 to -0.007), than the other echocardiographic findings (DM=0.007; Bland-Altman Limits=-0.441 to 0.428). Results from cardiac output measurement by doppler and 2D-TEE on both MA and LVOT do not correlate with those obtained by thermodilution. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  1. Cerebral oxygen saturation and cardiac output during anaesthesia in sitting position for neurosurgical procedures: a prospective observational study.

    Science.gov (United States)

    Schramm, P; Tzanova, I; Hagen, F; Berres, M; Closhen, D; Pestel, G; Engelhard, K

    2016-10-01

    Neurosurgical operations in the dorsal cranium often require the patient to be positioned in a sitting position. This can be associated with decreased cardiac output and cerebral hypoperfusion, and possibly, inadequate cerebral oxygenation. In the present study, cerebral oxygen saturation was measured during neurosurgery in the sitting position and correlated with cardiac output. Perioperative cerebral oxygen saturation was measured continuously with two different monitors, INVOS ® and FORE-SIGHT ® . Cardiac output was measured at eight predefined time points using transoesophageal echocardiography. Forty patients were enrolled, but only 35 (20 female) were eventually operated on in the sitting position. At the first time point, the regional cerebral oxygen saturation measured with INVOS ® was 70 (sd 9)%; thereafter, it increased by 0.0187% min -1 (P<0.01). The cerebral tissue oxygen saturation measured with FORE-SIGHT ® started at 68 (sd 13)% and increased by 0.0142% min -1 (P<0.01). The mean arterial blood pressure did not change. Cardiac output was between 6.3 (sd 1.3) and 7.2 (1.8) litre min -1 at the predefined time points. Cardiac output, but not mean arterial blood pressure, showed a positive and significant correlation with cerebral oxygen saturation. During neurosurgery in the sitting position, the cerebral oxygen saturation slowly increases and, therefore, this position seems to be safe with regard to cerebral oxygen saturation. Cerebral oxygen saturation is stable because of constant CO and MAP, while the influence of CO on cerebral oxygen saturation seems to be more relevant. NCT01275898. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Effects of cardiac output on the onset of rocuronium-induced neuromuscular block in elderly patients.

    Science.gov (United States)

    Shiraishi, Naoki; Aono, Mayu; Kameyama, Yasuhito; Yamamoto, Mai; Kitajima, Osamu; Suzuki, Takahiro

    2018-05-21

    The aim of this study was to elucidate the relationship between the onset of rocuronium-induced neuromuscular block and arterial pressure-based cardiac output (CO) in elderly patients. Forty elderly patients aged 65-83 years were enrolled in this study. After induction of anesthesia, contractions of the adductor pollicis muscle to ulnar nerve train-of-four stimulation were acceleromyographically evaluated and 1 mg/kg rocuronium was administered following CO measurement. The correlation between onset of rocuronium action and CO was analyzed. The mean [SD] CO reduced after induction of anesthesia from 5.1 [1.8] L/min to 3.8 [1.1] L/min. The onset time of rocuronium-induced neuromuscular block was 110.3 [23.9] s (range 60-165). There was a statistically significant inverse correlation between the onset time of rocuronium and CO [onset time (s) = - 13.2·CO + 159.7, R 2  = 0.376]. In the elderly, CO influences the onset of action of rocuronium.

  3. Association of HeartMate II left ventricular assist device flow estimate with thermodilution cardiac output.

    Science.gov (United States)

    Hasin, Tal; Huebner, Marianne; Li, Zhuo; Brown, Daniel; Stulak, John M; Boilson, Barry A; Joyce, Lyle; Pereira, Naveen L; Kushwaha, Sudhir S; Park, Soon J

    2014-01-01

    Cardiac output (CO) assessment is important in treating patients with heart failure. Durable left ventricular assist devices (LVADs) provide essentially all CO. In currently used LVADs, estimated device flow is generated by a computerized algorithm. However, LVAD flow estimate may be inaccurate in tracking true CO. We correlated LVAD (HeartMate II) flow with thermodilution CO during postoperative care (day 2-10 after implant) in 81 patients (5,616 paired measurements). Left ventricular assist device flow and CO correlated with a low correlation coefficient (r = 0.42). Left ventricular assist device readings were lower than CO measurements by approximately 0.36 L/min, trending for larger difference with higher values. Left ventricular assist device flow measurements showed less temporal variability compared with CO. Grouping for simultaneous measured blood pressure (BP device flow generally trends with measured CO, but large variability exists, hence flow measures should not be assumed to equal with CO. Clinicians should take into account variables such as high CO, BP, and opening of the aortic valve when interpreting LVAD flow readout. Direct flow sensors incorporated in the LVAD system may allow for better estimation.

  4. Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant

    OpenAIRE

    Matos, Lígia Neres; Guimarães, Tereza Cristina Felippe; Brandão, Marcos Antônio Gomes; Santoro, Deyse Conceição

    2012-01-01

    The purposes of the study were to identify the prevalence of defining characteristics (DC) of decreased cardiac output (DCO) in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009....

  5. Children with Burn Injury Have Impaired Cardiac Output during Submaximal Exercise.

    Science.gov (United States)

    Rivas, Eric; Herndon, David N; Beck, Kenneth C; Suman, Oscar E

    2017-10-01

    Burn trauma damages resting cardiac function; however, it is currently unknown if the cardiovascular response to exercise is likewise impaired. We tested the hypothesis that, in children, burn injury lowers cardiac output (Q˙) and stroke volume (SV) during submaximal exercise. Five children with 49% ± 4% total body surface area (BSA) burned (two female, 11.7 ± 1 yr, 40.4 ± 18 kg, 141.1 ± 9 cm) and eight similar nonburned controls (five female, 12.5 ± 2 yr, 58.0 ± 17 kg, 147.3 ± 12 cm) with comparable exercise capacity (peak oxygen consumption [peak V˙O2]: 31.9 ± 11 vs 36.8 ± 8 mL O2·kg·min, P = 0.39) participated. The exercise protocol entailed a preexercise (pre-EX) rest period followed by 3-min exercise stages at 20 W and 50 W. V˙O2, HR, Q˙ (via nonrebreathing), SV (Q˙/HR), and arteriovenous O2 difference ([a-v]O2diff, Q˙/ V˙O2) were the primary outcome variables. Using a 2-way factorial ANOVA (group [G] × exercise [EX]), we found that Q˙ was approximately 27% lower in the burned than the nonburned group at 20 W of exercise (burned 5.7 ± 1.0 vs nonburned: 7.9 ± 1.8 L·min) and 50 W of exercise (burned 6.9 ± 1.6 vs nonburned 9.2 ± 3.2 L·min) (G-EX interaction, P = 0.012). SV did not change from rest to exercise in burned children but increased by approximately 24% in the nonburned group (main effect for EX, P = 0.046). Neither [a-v] O2diff nor V˙O2 differed between groups at rest or exercise, but HR response to exercise was reduced in the burn group (G-EX interaction, P = 0.004). When normalized to BSA, SV (index) was similar between groups; however, Q˙ (index) remained attenuated in the burned group (G-EX interaction, P exercise. Further investigation of hemodynamic function during exercise will provide insights important for cardiovascular rehabilitation in burned children.

  6. High-Intensity Interval Training Increases Cardiac Output and V˙O2max.

    Science.gov (United States)

    Astorino, Todd A; Edmunds, Ross M; Clark, Amy; King, Leesa; Gallant, Rachael A; Namm, Samantha; Fischer, Anthony; Wood, Kimi M

    2017-02-01

    Increases in maximal oxygen uptake (V˙O2max) frequently occur with high-intensity interval training (HIIT), yet the specific adaptation explaining this result remains elusive. This study examined changes in V˙O2max and cardiac output (CO) in response to periodized HIIT. Thirty-nine active men and women (mean age and V˙O2max = 22.9 ± 5.4 yr and 39.6 ± 5.6 mL·kg·min) performed HIIT and 32 men and women (age and V˙O2max = 25.7 ± 4.5 yr and 40.7 ± 5.2 mL·kg·min) were nonexercising controls (CON). The first 10 sessions of HIIT required eight to ten 60 s bouts of cycling at 90%-110% percent peak power output interspersed with 75 s recovery, followed by randomization to one of three regimes (sprint interval training (SIT), high-volume interval training (HIITHI), or periodized interval training (PER) for the subsequent 10 sessions. Before, midway, and at the end of training, progressive cycling to exhaustion was completed during which V˙O2max and maximal CO were estimated. Compared with CON, significant (P HIIT + SIT (39.8 ± 7.3 mL·kg·min to 43.6 ± 6.1 mL·kg·min), HIIT + HIITHI (41.1 ± 4.9 mL·kg·min to 44.6 ± 7.0 mL·kg·min), and HIIT + PER (39.5 ± 5.6 mL·kg·min to 44.1 ± 5.4 mL·kg·min) occurred which were mediated by significant increases in maximal CO (20.0 ± 3.1 L·min to 21.7 ± 3.2 L·min, P = 0.04). Maximal stroke volume was increased with HIIT (P = 0.04), although there was no change in maximal HR (P = 0.88) or arteriovenous O2 difference (P = 0.36). These CO data are accurate and represent the mean changes from pre- to post-HIIT across all three training groups. Increases in V˙O2max exhibited in response to different HIIT regimes are due to improvements in oxygen delivery.

  7. Predictors of Post Pericardiotomy Low Cardiac Output Syndrome in Patients With Pericardial Effusion

    Directory of Open Access Journals (Sweden)

    Sabzi Feridoun

    2015-03-01

    Full Text Available Introduction: Pathological involvement of pericardium by any disease that resulting in effusion may require decompression and pericardiectomy. The current article describes rare patients with effusion who after pericadiectomy and transient hemodynamic improvement rapidly developed progressive heart failure and subsequent multi organ failure.Methods: During periods of five years, 423 patients in our hospital underwent pericardiotomy for decompression of effusion. The clinical characteristics of those patient with postoperative low cardiac output (B group (14 cases recorded and compared with other patients without this postoperative complication (A group by test and X2. Significant variables in invariables (P≤0.1 entered in logistic regression analysis and odd ratio of these significant variables obtained. Results: Idiopathic pericardial effusion, malignancy, renal failure, connective tissue disease, viral pericarditis was found in 125 patients (27%, 105 patients (25.4%, 65 patients (15.6%, 50 (17.1% and 10 (2.4% of patients subsequently. The factors that predict post-operative death in logistic regression analysis were malignancy, radiotherapy, constrictive pericarditis inotropic drug using IABP using, pre-operative EF and pericardial calcification.Conclusion: Certain preoperative variables such as malignancy, radiotherapy, low EF, calcified pericardium and connective tissue disease are associated with POLCOS and post-operative risk of death. This paradoxical response to pericardial decompression may be more frequent than currently appreciated. Its cause may relate to the sudden removal of the chronic external ventricular support from the effusion or thicken pericardium resulting in ventricular dilatation and failure or intra operative myocardial injury due to pericardiectomy of calcified pericardium, radiation and cardiomyopathy.

  8. Omega-3 fatty acid supplementation enhances stroke volume and cardiac output during dynamic exercise.

    Science.gov (United States)

    Walser, Buddy; Stebbins, Charles L

    2008-10-01

    Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have beneficial effects on cardiovascular function. We tested the hypotheses that dietary supplementation with DHA (2 g/day) + EPA (3 g/day) enhances increases in stroke volume (SV) and cardiac output (CO) and decreases in systemic vascular resistance (SVR) during dynamic exercise. Healthy subjects received DHA + EPA (eight men, four women) or safflower oil (six men, three women) for 6 weeks. Both groups performed 20 min of bicycle exercise (10 min each at a low and moderate work intensity) before and after DHA + EPA or safflower oil treatment. Mean arterial pressure (MAP), heart rate (HR), SV, CO, and SVR were assessed before exercise and during both workloads. HR was unaffected by DHA + EPA and MAP was reduced, but only at rest (88 +/- 5 vs. 83 +/- 4 mm Hg). DHA + EPA augmented increases in SV (14.1 +/- 6.3 vs. 32.3 +/- 8.7 ml) and CO (8.5 +/- 1.0 vs. 10.3 +/- 1.2 L/min) and tended to attenuate decreases in SVR (-7.0 +/- 0.6 vs. -10.1 +/- 1.6 mm Hg L(-1) min(-1)) during the moderate workload. Safflower oil treatment had no effects on MAP, HR, SV, CO or SVR at rest or during exercise. DHA + EPA-induced increases in SV and CO imply that dietary supplementation with these fatty acids can increase oxygen delivery during exercise, which may have beneficial clinical implications for individuals with cardiovascular disease and reduced exercise tolerance.

  9. Scientific Output of Croatian Universities: Comparison with Neighbouring Countries

    Directory of Open Access Journals (Sweden)

    Boris Podobnik

    2008-06-01

    Full Text Available We compared the Croatian research output with the neighboring countries and the Croatian universities with the largest Slovenian, Hungarian, and Serbian universities. As far as papers listed by Social Science Citation Index are concerned, since 2000 the University of Zagreb exhibits best results in social sciences compared to the competing universities, that is not the case in “hard” sciences. For the last 12 years, only the University of Ljubljana has shown better results in total research output than the University of Zagreb. The difference in research output between the University of Zagreb and the rest of the Croatian universities has been constantly decreasing. As a case study we compare research output at Faculty of Civil Engeenering on different Croatian universities. By analyzing European countries, we show a functional dependence between the gross domestic product (GDP and the research output. From this fit we conclude that the Croatian science exhibits research output as expected for the given level of GDP.

  10. The effect of halothane on the distribution of cardiac output and organ blood flows in the hemorrhagic, hypotensive dog

    International Nuclear Information System (INIS)

    Ahlgren, I.; Aronsen, K.F.; Bjoerkman, I.

    1978-01-01

    Halothane was given to dogs which had been bled to an arterial mean blood pressure of 60 mmHg, and the circulatory effects were studied with the aid of the radioactive microsphere technique. The cardiac output and coronary blood flow were well maintained, whereas the arterial mean blood pressure was slightly, and the stroke volume markedly increased, indicating an improved heart function. The blood flows to the brain, lungs, liver and kidneys were well preserved throughout the anesthesia. The effect of retransfusing the withdrawn blood was also studied, and it resulted in an increased cardiac output, arterial mean blood pressure and increased blood flows to the heart, lungs, spleen, bowel and liver. (author)

  11. Effect of heat stress on cardiac output and systemic vascular conductance during simulated hemorrhage to presyncope in young men

    DEFF Research Database (Denmark)

    Ganio, Matthew S; Overgaard, Morten; Seifert, Thomas

    2012-01-01

    During moderate actual or simulated hemorrhage, as cardiac output decreases, reductions in systemic vascular conductance (SVC) maintain mean arterial pressure (MAP). Heat stress, however, compromises the control of MAP during simulated hemorrhage, and it remains unknown whether this response is due...... to a persistently high SVC and/or a low cardiac output. This study tested the hypothesis that an inadequate decrease in SVC is the primary contributing mechanism by which heat stress compromises blood pressure control during simulated hemorrhage. Simulated hemorrhage was imposed via lower body negative pressure...... normothermic is no longer adequate during a heat-stressed-simulated hemorrhage. The absence of a decrease in SVC at a time of profound reductions in MAP suggests that inadequate control of vascular conductance is a primary mechanism compromising blood pressure control during these conditions....

  12. Study on cardiac output in children with orthostatic disturbances measured by the external dilution method with a radioisotope

    Energy Technology Data Exchange (ETDEWEB)

    Hattori, K [Nippon Medical School, Tokyo

    1975-04-01

    As one of the studies on circulation dynamics which possibly contributed to orthostatic disturbance, application to children of the external measurement of cardiac output with /sup 131/I labeled human serum albumin was examined. The effect of orthostatic load was then studied by this method on the children with orthostatic disturbances and the patients improving from other diseases, and the following results were obtained: (1) As in the external method with radioisotope, the head of the scintillation detector was easily oriented, and the diversion of orientation was examined by circulation dilution curve, and the cardiac output was easily and safely measured without causing severe pain to the subjects. This method was performed on 40 children in the recumbent position and 27 in orthostatic load, and it was confirmed that the method was fully applicable to the pediatric field. (2) In half of the 20 patients with orthostatic disturbances and 20 control subjects, the cardiac index in the recumbent position was between 3 l/min/m/sup 2/ and 5 l/min/m/sup 2/. Mean cardiac index was 4.45 l/min/m/sup 2/ in male children, while 4.72 l/min/m/sup 2/ in female children. This mean value was the same or a little higher than the reported adult value.

  13. Effect of hemorrhage on cardiac output, vasopressin, aldosterone, and diuresis during immersion in men

    Science.gov (United States)

    Greenleaf, J. E.; Simanonok, K.; Bernauer, E. M.; Wade, C. E.; Keil, L. C.

    1992-01-01

    The purpose of this research was to test the hypotesis that a reduction in blood volume would attenuate or eliminate immersion-induced increases in cardiac output (Q(sub co)) and urine excretion, and to investigate accompanying vasoactive and fluid-electrolyte hormonal responses. Eight men (19-23 yr) were supine during a 2-hr control period in air, and then sat for 5-hr test periods in air at 20 C (dry control, DC); water at 34.5 C (wet control, WC); and water (34.5 C) after hemorrhage (WH) of 14.8 plus or minus 0.3 percent of their blood volume. Blood volume was -11.6 plus or minus 0.6 percent at immersion (time 0). Mean (bar-X hrs 1-5) Q(sub co) was unchanged in WC (5.3 plus or minus 0.01 l/min) and in WH (4.5 plus or minus 0.1 l/min), but decreased (P less than 0.05) in DC to 3.6 plus or minus 0.1 l/min. Mean urine excretion rates were 1.0 plus or minus 0.2 ml/min for DC and 1.1 plus or minus 0.2 ml/min for WH; both were lower (P less than 0.05) than that for WC of 2.0 plus or minus 0.4 ml/min. Plasma (Na+) and (Osm) were unchanged in all experiments. Mean plasma vasopressin (PVP) (bar-X hrs 1-5) was 1.1 plus or minus 0.1 pg/ml in WC, and higher (P less than 0.05) in DC (2.1 plus or minus 0.2 pg/ml)and WH (2.1 plus or minus 0.1 pg/ml); it was unchanged during air and water test periods. Thus, hemorrhage attenuated the immersion-induced increase in Q(sub co), eliminated the WC diuresis, maintained plasma renin activity and PVP at DC levels and did not change immersion-induced aldosterone suppression; the osmotic diuresis during control immersion is apparently not due to either aldosterone suppression or vasopressin suppression.

  14. Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

    Science.gov (United States)

    Caruba, Thibaut; Grosjean, Sandrine; Amour, Julien; Ouattara, Alexandre; Villacorta, Judith; Miguet, Bertrand; Guinet, Patrick; Lévy, François; Squara, Pierre; Aït Hamou, Nora; Carillon, Aude; Boyer, Julie; Boughenou, Marie-Fazia; Rosier, Sebastien; Robin, Emmanuel; Radutoiu, Mihail; Durand, Michel; Guidon, Catherine; Desebbe, Olivier; Charles-Nelson, Anaïs; Menasché, Philippe; Rozec, Bertrand; Girard, Claude; Fellahi, Jean-Luc; Pirracchio, Romain; Chatellier, Gilles

    2017-01-01

    Importance Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function. Objective To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome. Design, Setting, and Participants Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015). Interventions Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction. Main Outcomes and Measures Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo. Results Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, −7% [95% CI, −17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse

  15. Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass: The LICORN Randomized Clinical Trial.

    Science.gov (United States)

    Cholley, Bernard; Caruba, Thibaut; Grosjean, Sandrine; Amour, Julien; Ouattara, Alexandre; Villacorta, Judith; Miguet, Bertrand; Guinet, Patrick; Lévy, François; Squara, Pierre; Aït Hamou, Nora; Carillion, Aude; Boyer, Julie; Boughenou, Marie-Fazia; Rosier, Sebastien; Robin, Emmanuel; Radutoiu, Mihail; Durand, Michel; Guidon, Catherine; Desebbe, Olivier; Charles-Nelson, Anaïs; Menasché, Philippe; Rozec, Bertrand; Girard, Claude; Fellahi, Jean-Luc; Pirracchio, Romain; Chatellier, Gilles

    2017-08-08

    Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function. To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome. Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015). Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction. Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo. Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, -7% [95% CI, -17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse events did not significantly differ between levosimendan and placebo. Among patients with low ejection fraction

  16. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites

    DEFF Research Database (Denmark)

    Krag, A; Bendtsen, F; Møller, S

    2010-01-01

    (130 (SD 46) vs 78 (SD 29) mumol/l, psyndrome type 1 within 3 months was higher in the group with low CI than in the high CI group (43% vs 5%, p = 0.04). Patients with the lowest CI (N = 8) had significantly poorer survival at 3, 9, and 12 months......OBJECTIVES: Recent studies suggest that cardiac dysfunction precedes development of the hepatorenal syndrome. In this follow-up study, we aimed to investigate the relation between cardiac and renal function in patients with cirrhosis and ascites and the impact of cardiac systolic function...

  17. The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy.

    Science.gov (United States)

    Thanigaimani, K; Mohamed, F; Cecil, T; Moran, B J; Bell, J

    2013-12-01

    The optimal strategy for intravenous (IV) fluid management during administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is unclear. In this prospective study we describe the use of a LiDCOrapid™ (LiDCO, Cambridge, UK) cardiac output monitor to guide IV fluid management during cytoreductive surgery (CRS) with HIPEC. The aim of this study was to determine whether cardiac output monitoring will allow close maintenance of physiological parameters during the HIPEC phase. Twenty-five patients who underwent CRS combined with HIPEC were included in the study. Intra-operative IV fluid boluses were titrated using parameters measured by the LiDCOrapid™ monitor. Stroke volume variation was maintained below 10% with fluid boluses and mean arterial pressure was maintained within 20% of the baseline figure with vasopressors. There was no significant change in heart rate and cardiac output. The systemic vascular resistance dropped from an average of 966 dyn.s/cm-5 to 797 dyn s/cm(5) at 60 min during the HIPEC phase (P = 0.62) despite an increase in the dose of phenylepherine. The average total volume of fluid given was 748 ml in the first 30 min and 630 ml in the second 30 min with an average urine output of 307 and 445 ml, respectively. The change in lactate levels was not statistically or clinically significant. LiDCOrapid™ is an effective noninvasive tool for guiding fluid management in this population. It allows the anaesthesiologist to maintain tight control of essential physiological parameters during a phase of the procedure in which there is a risk of renal injury. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  18. International P/L Insurance Output, Input, and Productivity Comparisons

    OpenAIRE

    Mary A. Weiss

    1991-01-01

    This research provides (bilateral) divisia and multilateral divisia indexes of output, input, and productivity for the property-liability (P-L) insurance industry for the following countries: United States, West Germany, Switzerland, France, and Japan. The time period studied is 1975 to 1987. The results indicate that considerable diversity exists among different countries, with Japan showing the weakest productivity growth. The United States and West Germany are associated overall with high ...

  19. Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Ståhlberg, Marcus; Damgaard, Morten; Norsk, Peter

    2009-01-01

    AIMS: The aim of this study was to study the haemodynamic effect of atrioventricular delay (AVD) modifications within a narrow range in different body positions and during exercise in patients receiving cardiac resynchronization therapy (CRT). METHODS: The previously optimized AVD was shortened...... and prolonged by 40 ms in 27 CRT patients and 9 controls without heart failure. Cardiac output (CO) was measured by inert gas rebreathing (Innocor) as the average over different body positions (left-lateral, supine, sitting, standing, and exercise). In eight CRT patients with an implantable haemodynamic monitor......, the estimated pulmonary artery diastolic pressure (ePAD) was analysed. RESULTS: The magnitude of CO response to AVD changes was greater in CRT patients than in controls (0.25 vs. 0.20 L/min, Psize (r=0...

  20. Pulmonary Artery Catheter (PAC Accuracy and Efficacy Compared with Flow Probe and Transcutaneous Doppler (USCOM: An Ovine Cardiac Output Validation

    Directory of Open Access Journals (Sweden)

    Robert A. Phillips

    2012-01-01

    Full Text Available Background. The pulmonary artery catheter (PAC is an accepted clinical method of measuring cardiac output (CO despite no prior validation. The ultrasonic cardiac output monitor (USCOM is a noninvasive alternative to PAC using Doppler ultrasound (CW. We compared PAC and USCOM CO measurements against a gold standard, the aortic flow probe (FP, in sheep at varying outputs. Methods. Ten conscious sheep, with implanted FPs, had measurements of CO by FP, USCOM, and PAC, at rest and during intervention with inotropes and vasopressors. Results. CO measurements by FP, PAC, and USCOM were 4.0±1.2 L/min, 4.8±1.5 L/min, and 4.0±1.4 L/min, respectively, (=280, range 1.9 L/min to 11.7 L/min. Percentage bias and precision between FP and PAC, and FP and USCOM was −17 and 47%, and 1 and 36%, respectively. PAC under-measured Dobutamine-induced CO changes by 20% (relative 66% compared with FP, while USCOM measures varied from FP by 3% (relative 10%. PAC reliably detected −30% but not +40% CO changes, as measured by receiver operating characteristic area under the curve (AUC, while USCOM reliably detected ±5% changes in CO (AUC>0.70. Conclusions. PAC demonstrated poor accuracy and sensitivity as a measure of CO. USCOM provided equivalent measurements to FP across a sixfold range of outputs, reliably detecting ±5% changes.

  1. The correlation between the first heart sound and cardiac output as measured by using digital esophageal stethoscope under anaesthesia.

    Science.gov (United States)

    Duck Shin, Young; Hoon Yim, Kyoung; Hi Park, Sang; Wook Jeon, Yong; Ho Bae, Jin; Soo Lee, Tae; Hwan Kim, Myoung; Jin Choi, Young

    2014-03-01

    The use of an esophageal stethoscope is a basic heart sounds monitoring procedure performed in patients under general anesthesia. As the size of the first heart sound can express the left ventricle function, its correlation with cardiac output should be investigated. The aim of this study was to investigate the effects of cardiac output (CO) on the first heart sound (S1) amplitude. Methods : Six male beagles were chosen. The S1 was obtained with the newly developed esophageal stethoscope system. CO was measured using NICOM, a non-invasive CO measuring device. Ephedrine and beta blockers were administered to the subjects to compare changes in figures, and the change from using an inhalation anesthetic was also compared. The S1 amplitude displayed positive correlation with the change rate of CO (r = 0.935, p < 0.001). The heart rate measured using the esophageal stethoscope and ECG showed considerably close figures through the Bland-Altman plot and showed a high positive correlation (r = 0.988, p < 0,001). In beagles, the amplitude of S1 had a significant correlation with changes in CO in a variety of situations.

  2. Reduced peripheral arterial blood flow with preserved cardiac output during submaximal bicycle exercise in elderly heart failure

    Directory of Open Access Journals (Sweden)

    Leng Xiaoyan

    2009-11-01

    Full Text Available Abstract Background Older heart failure (HF patients exhibit exercise intolerance during activities of daily living. We hypothesized that reduced lower extremity blood flow (LBF due to reduced forward cardiac output would contribute to submaximal exercise intolerance in older HF patients. Methods and Results Twelve HF patients both with preserved and reduced left ventricular ejection fraction (LVEF (aged 68 ± 10 years without large (aorta or medium sized (iliac or femoral artery vessel atherosclerosis, and 13 age and gender matched healthy volunteers underwent a sophisticated battery of assessments including a peak exercise oxygen consumption (peak VO2, b physical function, c cardiovascular magnetic resonance (CMR submaximal exercise measures of aortic and femoral arterial blood flow, and d determination of thigh muscle area. Peak VO2 was reduced in HF subjects (14 ± 3 ml/kg/min compared to healthy elderly subjects (20 ± 6 ml/kg/min (p = 0.01. Four-meter walk speed was 1.35 ± 0.24 m/sec in healthy elderly verses 0.98 ± 0.15 m/sec in HF subjects (p p ≤ 0.03. Conclusion During CMR submaximal bike exercise in the elderly with heart failure, mechanisms other than low cardiac output are responsible for reduced lower extremity blood flow.

  3. Validation of an ultrasound dilution technology for cardiac output measurement and shunt detection in infants and children.

    Science.gov (United States)

    Lindberg, Lars; Johansson, Sune; Perez-de-Sa, Valeria

    2014-02-01

    To validate cardiac output measurements by ultrasound dilution technology (COstatus monitor) against those obtained by a transit-time ultrasound technology with a perivascular flow probe and to investigate ultrasound dilution ability to estimate pulmonary to systemic blood flow ratio in children. Prospective observational clinical trial. Pediatric cardiac operating theater in a university hospital. In 21 children (6.1 ± 2.6 kg, mean ± SD) undergoing heart surgery, cardiac output was simultaneously recorded by ultrasound dilution (extracorporeal arteriovenous loop connected to existing arterial and central venous catheters) and a transit-time ultrasound probe applied to the ascending aorta, and when possible, the main pulmonary artery. The pulmonary to systemic blood flow ratio estimated from ultrasound dilution curve analysis was compared with that estimated from transit-time ultrasound technology. Bland-Altman analysis of the whole cohort (90 pairs, before and after surgery) showed a bias between transit-time ultrasound (1.01 ± 0.47 L/min) and ultrasound dilution technology (1.03 ± 0.51 L/min) of -0.02 L/min, limits of agreement -0.3 to 0.3 L/min, and percentage error of 31%. In children with no residual shunts, the bias was -0.04 L/min, limits of agreement -0.28 to 0.2 L/min, and percentage error 19%. The pooled co efficient of variation was for the whole cohort 3.5% (transit-time ultrasound) and 6.3% (ultrasound dilution), and in children without shunt, it was 2.9% (transit-time ultrasound) and 4% (ultrasound dilution), respectively. Ultrasound dilution identified the presence of shunts (pulmonary to systemic blood flow ≠ 1) with a sensitivity of 100% and a specificity of 92%. Mean pulmonary to systemic blood flow ratio by transit-time ultrasound was 2.6 ± 1.0 and by ultrasound dilution 2.2 ± 0.7 (not significant). The COstatus monitor is a reliable technique to measure cardiac output in children with high sensitivity and specificity for detecting the

  4. Cardiac output by pulse contour analysis does not match the increase measured by rebreathing during human spaceflight.

    Science.gov (United States)

    Hughson, Richard L; Peterson, Sean D; Yee, Nicholas J; Greaves, Danielle K

    2017-11-01

    Pulse contour analysis of the noninvasive finger arterial pressure waveform provides a convenient means to estimate cardiac output (Q̇). The method has been compared with standard methods under a range of conditions but never before during spaceflight. We compared pulse contour analysis with the Modelflow algorithm to estimates of Q̇ obtained by rebreathing during preflight baseline testing and during the final month of long-duration spaceflight in nine healthy male astronauts. By Modelflow analysis, stroke volume was greater in supine baseline than seated baseline or inflight. Heart rate was reduced in supine baseline so that there were no differences in Q̇ by Modelflow estimate between the supine (7.02 ± 1.31 l/min, means ± SD), seated (6.60 ± 1.95 l/min), or inflight (5.91 ± 1.15 l/min) conditions. In contrast, rebreathing estimates of Q̇ increased from seated baseline (4.76 ± 0.67 l/min) to inflight (7.00 ± 1.39 l/min, significant interaction effect of method and spaceflight, P < 0.001). Pulse contour analysis utilizes a three-element Windkessel model that incorporates parameters dependent on aortic pressure-area relationships that are assumed to represent the entire circulation. We propose that a large increase in vascular compliance in the splanchnic circulation invalidates the model under conditions of spaceflight. Future spaceflight research measuring cardiac function needs to consider this important limitation for assessing absolute values of Q̇ and stroke volume. NEW & NOTEWORTHY Noninvasive assessment of cardiac function during human spaceflight is an important tool to monitor astronaut health. This study demonstrated that pulse contour analysis of finger arterial blood pressure to estimate cardiac output failed to track the 46% increase measured by a rebreathing method. These results strongly suggest that alternative methods not dependent on pulse contour analysis are required to track cardiac function in spaceflight

  5. Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure.

    Science.gov (United States)

    Schmid, Jean-Paul; Noveanu, Markus; Morger, Cyrill; Gaillet, Raymond; Capoferri, Mauro; Anderegg, Matthias; Saner, Hugo

    2007-06-01

    Whole-body water immersion leads to a significant shift of blood from the periphery to the intrathoracic circulation, followed by an increase in central venous pressure and heart volume. In patients with severely reduced left ventricular function, this hydrostatically induced volume shift might overstrain the cardiovascular adaptive mechanisms and lead to cardiac decompensation. To assess the haemodynamic response to water immersion, gymnastics and swimming in patients with chronic heart failure (CHF). 10 patients with compensated CHF (62.9 (6.3) years, ejection fraction 31.5% (4.1%), peak oxygen consumption (Vo(2)) 19.4 (2.8) ml/kg/min), 10 patients with coronary artery disease (CAD) but preserved left ventricular function (57.2 (5.6) years, ejection fraction 63.9% (5.5%), peak Vo(2) 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak Vo(2) 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32 degrees C) water immersion and exercise was measured using a non-invasive foreign gas rebreathing method during stepwise water immersion, water gymnastics and swimming. Water immersion up to the chest increased cardiac index by 19% in controls, by 21% in patients with CAD and by 16% in patients with CHF. Although some patients with CHF showed a decrease of stroke volume during immersion, all subjects were able to increase cardiac index (by 87% in healthy subjects, by 77% in patients with CAD and by 53% in patients with CHF). Vo(2) during swimming was 9.7 (3.3) ml/kg/min in patients with CHF, 12.4 (3.5) ml/kg/min in patients with CAD and 13.9 (4) ml/kg/min in controls. Patients with severely reduced left ventricular function but stable clinical conditions and a minimal peak Vo(2) of at least 15 ml/kg/min during a symptom-limited exercise stress test tolerate water immersion and swimming in thermoneutral water well. Although cardiac index and Vo(2) are lower than in patients with CAD with preserved left ventricular function and controls

  6. Comparison of the Net Work Output between Stirling and Ericsson Cycles

    Directory of Open Access Journals (Sweden)

    Rui F. Costa

    2018-03-01

    Full Text Available In this paper, we compare Stirling and Ericsson cycles to determine which engine produces greater net work output for various situations. Both cycles are for external heat engines that utilize regenerators, where the difference is the nature of the regeneration process, which is constant volume for Stirling and constant pressure for Ericsson. This difference alters the performance characteristics of the two engines drastically, and our comparison reveals which one produces greater net work output based on the thermodynamic parameters. The net work output equations are derived and analysed for three different scenarios: (i equal mass and temperature limits; (ii equal mass and pressure or volume; and (iii equal temperature and pressure or volume limits. The comparison is performed by calculating when both cycles produce equal net work output and then analysing which one produces greater net work output based on how the parameters are varied. In general, the results demonstrate that Stirling engines produce more net work output at higher pressures and lower volumes, and Ericsson engines produce more net work output at lower pressures and higher volumes. For certain scenarios, threshold values are calculated to illustrate precisely when one cycle produces more net work output than the other. This paper can be used to inform the design of the engines and to determine when a Stirling or Ericsson engine should be selected for a particular application.

  7. Comparison of Laboratory Experimental Data to XBeach Numerical Model Output

    Science.gov (United States)

    Demirci, Ebru; Baykal, Cuneyt; Guler, Isikhan; Sogut, Erdinc

    2016-04-01

    generating data sets for testing and validation of sediment transport relationships for sand transport in the presence of waves and currents. In these series, there is no structure in the basin. The second and third series of experiments were designed to generate data sets for development of tombolos in the lee of detached 4m-long rubble mound breakwater that is 4 m from the initial shoreline. The fourth series of experiments are conducted to investigate tombolo development in the lee of a 4m-long T-head groin with the head section in the same location of the second and the third tests. The fifth series of experiments are used to investigate tombolo development in the lee of a 3-m-long rubble-mound breakwater positioned 1.5 m offshore of the initial shoreline. In this study, the data collected from the above mentioned five experiments are used to compare the results of the experimental data with XBeach numerical model results, both for the "no-structure" and "with-structure" cases regarding to sediment transport relationships in the presence of only waves and currents as well as the shoreline changes together with the detached breakwater and the T-groin. The main purpose is to investigate the similarities and differences between the laboratory experimental data behavior with XBeach numerical model outputs for these five cases. References: Baykal, C., Sogut, E., Ergin, A., Guler, I., Ozyurt, G.T., Guler, G., and Dogan, G.G. (2015). Modelling Long Term Morphological Changes with XBeach: Case Study of Kızılırmak River Mouth, Turkey, European Geosciences Union, General Assembly 2015, Vienna, Austria, 12-17 April 2015. Gravens, M.B. and Wang, P. (2007). "Data report: Laboratory testing of longshore sand transport by waves and currents; morphology change behind headland structures." Technical Report, ERDC/CHL TR-07-8, Coastal and Hydraulics Laboratory, US Army Engineer Research and Development Center, Vicksburg, MS. Roelvink, D., Reniers, A., van Dongeren, A., van Thiel de

  8. Visualization problems in conductor thermal aging resp. comparison of matlab and gnuplot graphical outputs

    International Nuclear Information System (INIS)

    Beza, J.; Heckenbergerova, J.

    2012-01-01

    The main aim of this paper is comparison of Matlab and Gnuplot software suitability for visualization of results in electro energetic and electro engineering domain. Whole contribution is targeted on specific graphical outputs in problematic of thermal aging of overhead power transmission lines. First, all graphical outputs determined for comparison are visualized in Matlab and furthermore strengths and disadvantages of this implementation are described. Same graphics are then created by free software Gnuplot and finally comparison of both visualization software is made. Last part of the contribution contains main rules and tips about Gnuplot visualization and can be used as User Handbook. The major target of this contribution is to show advantages and shortcomings of Matlab graphical outputs together with introduction of Gnuplot software and suitable alternative for visualization of electrotechnical results. (Authors)

  9. Plasma volume expansion does not increase maximal cardiac output or VO2 max in lowlanders acclimatized to altitude

    DEFF Research Database (Denmark)

    Calbet, José A L; Rådegran, Göran; Boushel, Robert Christopher

    2004-01-01

    liter of 6% dextran 70 (BV = 6.32 +/- 0.34 liters). PV expansion had no effect on Qmax, maximal O2 consumption (VO2), and exercise capacity. Despite maximal systemic O2 transport being reduced 19% due to hemodilution after PV expansion, whole body VO2 was maintained by greater systemic O2 extraction (P...... VO2 during exercise regardless of PV. Pulmonary ventilation, gas exchange, and acid-base balance were essentially unaffected by PV expansion. Sea......With altitude acclimatization, blood hemoglobin concentration increases while plasma volume (PV) and maximal cardiac output (Qmax) decrease. This investigation aimed to determine whether reduction of Qmax at altitude is due to low circulating blood volume (BV). Eight Danish lowlanders (3 females, 5...

  10. Do interindividual differences in cardiac output during submaximal exercise explain differences in exercising muscle oxygenation and ratings of perceived exertion?

    Science.gov (United States)

    Bentley, Robert F; Jones, Joshua H; Hirai, Daniel M; Zelt, Joel T; Giles, Matthew D; Raleigh, James P; Quadrilatero, Joe; Gurd, Brendon J; Neder, J Alberto; Tschakovsky, Michael E

    2018-01-01

    Considerable interindividual differences in the Q˙-V˙O2 relationship during exercise have been documented but implications for submaximal exercise tolerance have not been considered. We tested the hypothesis that these interindividual differences were associated with differences in exercising muscle deoxygenation and ratings of perceived exertion (RPE) across a range of submaximal exercise intensities. A total of 31 (21 ± 3 years) healthy recreationally active males performed an incremental exercise test to exhaustion 24 h following a resting muscle biopsy. Cardiac output (Q˙ L/min; inert gas rebreathe), oxygen uptake (V˙O2 L/min; breath-by-breath pulmonary gas exchange), quadriceps saturation (near infrared spectroscopy) and exercise tolerance (6-20; Borg Scale RPE) were measured. The Q˙-V˙O2 relationship from 40 to 160 W was used to partition individuals post hoc into higher (n = 10; 6.3 ± 0.4) versus lower (n = 10; 3.7 ± 0.4, P exercise (all P > 0.4). Lower cardiac responders had greater leg (P = 0.027) and whole body (P = 0.03) RPE only at 185 W, but this represented a higher %peak V˙O2 in lower cardiac responders (87 ± 15% vs. 66 ± 12%, P = 0.005). Substantially lower Q˙-V˙O2 in the lower responder group did not result in altered RPE or exercising muscle deoxygenation. This suggests substantial recruitment of blood flow redistribution in the lower responder group as part of protecting matching of exercising muscle oxygen delivery to demand. © 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

  11. Preferential cephalic redistribution of left ventricular cardiac output during therapeutic hypothermia for perinatal hypoxic-ischemic encephalopathy.

    Science.gov (United States)

    Hochwald, Ori; Jabr, Mohammad; Osiovich, Horacio; Miller, Steven P; McNamara, Patrick J; Lavoie, Pascal M

    2014-05-01

    To determine the relationship between left ventricular cardiac output (LVCO), superior vena cava (SVC) flow, and brain injury during whole-body therapeutic hypothermia. Sixteen newborns with moderate or severe hypoxic-ischemic encephalopathy were studied using echocardiography during and immediately after therapeutic hypothermia. Measures were also compared with 12 healthy newborns of similar postnatal age. Newborns undergoing therapeutic hypothermia also had cerebral magnetic resonance imaging as part of routine clinical care on postnatal day 3-4. LVCO was markedly reduced (mean ± SD 126 ± 38 mL/kg/min) during therapeutic hypothermia, whereas SVC flow was maintained within expected normal values (88 ± 27 mL/kg/min) such that SVC flow represented 70% of the LVCO. The reduction in LVCO during therapeutic hypothermia was mainly accounted by a reduction in heart rate (99 ± 13 vs 123 ± 17 beats/min; P newborns without brain injury (P = .013). Newborns with perinatal hypoxic-ischemic encephalopathy showed a preferential systemic-to-cerebral redistribution of cardiac blood flow during whole-body therapeutic hypothermia, which may reflect a lack of cerebral vascular adaptation in newborns with more severe brain injury. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Influence of heart motion on cardiac output estimation by means of electrical impedance tomography: a case study

    International Nuclear Information System (INIS)

    Proença, Martin; Braun, Fabian; Rapin, Michael; Solà, Josep; Lemay, Mathieu; Adler, Andy; Grychtol, Bartłomiej; Bohm, Stephan H; Thiran, Jean-Philippe

    2015-01-01

    Electrical impedance tomography (EIT) is a non-invasive imaging technique that can measure cardiac-related intra-thoracic impedance changes. EIT-based cardiac output estimation relies on the assumption that the amplitude of the impedance change in the ventricular region is representative of stroke volume (SV). However, other factors such as heart motion can significantly affect this ventricular impedance change. In the present case study, a magnetic resonance imaging-based dynamic bio-impedance model fitting the morphology of a single male subject was built. Simulations were performed to evaluate the contribution of heart motion and its influence on EIT-based SV estimation. Myocardial deformation was found to be the main contributor to the ventricular impedance change (56%). However, motion-induced impedance changes showed a strong correlation (r = 0.978) with left ventricular volume. We explained this by the quasi-incompressibility of blood and myocardium. As a result, EIT achieved excellent accuracy in estimating a wide range of simulated SV values (error distribution of 0.57 ± 2.19 ml (1.02 ± 2.62%) and correlation of r = 0.996 after a two-point calibration was applied to convert impedance values to millilitres). As the model was based on one single subject, the strong correlation found between motion-induced changes and ventricular volume remains to be verified in larger datasets. (paper)

  13. Measurement of cardiac output in children by pressure-recording analytical method.

    Science.gov (United States)

    Urbano, Javier; López, Jorge; González, Rafael; Solana, María José; Fernández, Sarah N; Bellón, José M; López-Herce, Jesús

    2015-02-01

    We evaluated two pressure-recording analytical method (PRAM) software versions (v.1 and v.2) to measure cardiac index (CI) in hemodynamically stable critically ill children and investigate factors that influence PRAM values. The working hypothesis was that PRAM CI measurements would stay within normal limits in hemodynamically stable patients. Ninety-five CI PRAM measurements were analyzed in 47 patients aged 1-168 months. Mean CI was 4.1 ± 1.4 L/min/m(2) (range 2.0-7.0). CI was outside limits defined as normal (3-5 L/min/m(2)) in 53.7% of measurements (47.8% with software v.1 and 69.2% with software v.2, p = 0.062). Moreover, 14.7% of measurements were below 2.5 L/min/m(2), and 13.6% were above 6 L/min/m(2). CI was significantly lower in patients with a clearly visible dicrotic notch than in those without (3.7 vs. 4.6 L/min/m(2), p = 0.004) and in children with a radial arterial catheter (3.5 L/min/m(2)) than in those with a brachial (4.4 L/min/m(2), p = 0.021) or femoral catheter (4.7 L/min/m(2), p = 0.005). By contrast, CI was significantly higher in children under 12 months (4.2 vs. 3.6 L/min/m(2), p = 0.034) and weighing under 10 kg (4.2 vs. 3.6 L/min/m(2), p = 0.026). No significant differences were observed between cardiac surgery patients and the rest of children. A high percentage of CI measurements registered by PRAM were outside normal limits in hemodynamically stable, critically ill children. CI measured by PRAM may be influenced by the age, weight, location of catheter, and presence of a dicrotic notch.

  14. Oral Consumption of Vitamin K2 for 8 Weeks Associated With Increased Maximal Cardiac Output During Exercise.

    Science.gov (United States)

    McFarlin, Brian K; Henning, Andrea L; Venable, Adam S

    2017-07-01

    Background • Vitamin K1 and K2 are not typically common in a Western diet because they are found in a variety of fermented foods. Vitamin K2 in particular has been demonstrated to restore mitochondrial function and has a key role in production of mitochondrial adenosine triphosphate. Thus, it is reasonable to speculate that dietary supplementation with vitamin K2 could increase the function of muscle with high mitochondrial content (ie, skeletal and cardiac muscle). Objective • The purpose of this study was to determine if 8 wk of dietary supplementation with Vitamin K2 could alter cardiovascular responses to a graded cycle ergometer test. Design • The study was a randomized controlled trial. Setting • The study took place in the Applied Physiology Laboratory of the Department of Biological Sciences at the University of North Texas (Denton, TX, USA). Participants • Participants were aerobically trained males and female athletes (N = 26). Intervention • Participants were randomly assigned either to a control group that received a rice flour placebo or to an intervention group that received vitamin K2. For weeks 1 to 4, participants received 300 mg/d; for weeks 5 to 8, they received 150 mg/d. Subjects assigned to the control group received similar doses to mirror the intervention group. Subjects consumed the supplements during an 8-wk period while they maintained their typical exercise habits. Outcome Measures • At baseline and postintervention, participants completed a standard, graded exercise test on an electronically braked cycle ergometer. Before the test, participants were fitted with a mouth piece, and their oxygen consumption, carbon dioxide production, respiratory rate, and respiratory exchange ratio were measured. In addition, participants were fitted with skin-mounted electrodes that measured noninvasive cardiac output, stroke volume, and heart rate. To assess the cumulative exercise change, an area-under-the-curve (AUC) value was calculated

  15. Increased cardiac output and maximal oxygen uptake in response to ten sessions of high intensity interval training.

    Science.gov (United States)

    Astorino, Todd A; Edmunds, Ross M; Clark, Amy; King, Leesa; Gallant, Rachael M; Namm, Samantha; Fischer, Anthony; Wood, Kimi A

    2018-01-01

    Increases in maximal oxygen uptake (VO2max) are widely reported in response to completion of high intensity interval training (HIIT), yet the mechanism explaining this result is poorly understood. This study examined changes in VO2max and cardiac output (CO) in response to 10 sessions of low-volume HIIT. Participants included 30 active men and women (mean age and VO2max=22.9±5.4 years and 39.6±5.6 mL/kg/min) who performed HIIT and 30 men and women (age and VO2max=25.7±4.5 years and 40.7±5.2 mL/kg/min) who served as non-exercising controls (CON). High intensity interval training consisted of 6-10 s bouts of cycling per session at 90-110 percent peak power output (PPO) interspersed with 75 s recovery. Before and after training, progressive cycling to exhaustion was completed during which CO, stroke volume (SV), and heart rate (HR) were estimated using thoracic impedance. To confirm VO2max attainment, a verification test was completed after progressive cycling at a work rate equal to 110%PPO. Data demonstrated significant improvements in VO2max (2.71±0.63 L/min to 2.86±0.63 L/min, Psessions of HIIT is due to improvements in oxygen delivery.

  16. GGDC Productivity Level Database : International Comparisons of Output, Inputs and Productivity at the Industry Level

    NARCIS (Netherlands)

    Inklaar, Robert; Timmer, Marcel P.

    2008-01-01

    In this paper we introduce the GGDC Productivity Level database. This database provides comparisons of output, inputs and productivity at a detailed industry level for a set of thirty OECD countries. It complements the EU KLEMS growth and productivity accounts by providing comparative levels and

  17. Débito cardíaco e fração de ejeção fetal por meio do spatio-temporal image correlation (STIC: comparação entre fetos masculinos e femininos Fetal cardiac output and ejection fraction by spatio-temporal image correlation (STIC: comparison between male and female fetuses

    Directory of Open Access Journals (Sweden)

    Christiane Simioni

    2012-06-01

    Full Text Available OBJETIVO: Comparar do débito cardíaco (DC e a fração de ejeção (FE do coração de fetos masculinos e femininos obtidos por meio da ultrassonografia tridimensional, utilizando o spatio-temporal image correlation (STIC. MÉTODOS: Realizou-se um estudo de corte transversal com 216 fetos normais, entre 20 a 34 semanas de gestação, sendo 108 masculinos e 108 femininos. Os volumes ventriculares no final da sístole e diástole foram obtidos por meio do STIC, sendo as avaliações volumétricas realizadas pelo virtual organ computer-aided analysis (VOCAL com rotação de 30º. Para o cálculo do DC utilizou-se a fórmula: DC= volume sistólico/frequência cardíaca fetal, enquanto que para a FE utilizou-se a fórmula: FE= volume sistólico/volume diastólico final. O DC (combinado, feminino e masculino e a FE (masculina e feminina foram comparadas utilizando-se o teste t não pareado e ANCOVA. Foram criados gráficos de dispersão com os percentis 5, 50 e 95. RESULTADOS: A média do DC combinado, DC direito, DC esquerdo, FE direita e FE esquerda, para feminino e masculino, foram 240,07 mL/min; 122,67 mL/min; 123,40 mL/min; 72,84%; 67,22%; 270,56 mL/min; 139,22 mL/min; 131,34 mL/min; 70,73% e 64,76%, respectivamente; sem diferença estatística (P> 0,05. CONCLUSÕES: O DC e a FE fetal obtidos por meio da ultrassonografia tridimensional (STIC não apresentaram diferença significativa em relação ao gênero.OBJECTIVE: To compare the cardiac output (CO and ejection fraction (EF of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC. METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL rotated 30º. To calculate the DC used the formula

  18. Techniques of cardiac output measurement during liver transplantation: arterial pulse wave versus thermodilution

    DEFF Research Database (Denmark)

    Nissen, P.; Lieshout, J.J. van; Novovic, S.

    2009-01-01

    reperfusion)-without the detection of any significant difference between the 2 estimates of CO. TDCO ranged from 2.3 to 17.2 L/minute, and the bias (the mean difference between MCO and TDCO) prior to calibration was -0.4 +/- 1.6 L/minute (mean +/- standard deviation; 1309 paired measurements; 95% limits...... of agreement: -3.4 to 2.6 L/minute). After calibration of the first determined MCO by the simultaneously determined TDCO, the bias was 0.1 +/- 1.5 L/minute, with 57% (n = 744) of the comparisons being less than 1 L/minute and 35% (n = 453) being less than 0.5 L/minute; this was independent of the level of CO...

  19. On the statistical comparison of climate model output and climate data

    International Nuclear Information System (INIS)

    Solow, A.R.

    1991-01-01

    Some broad issues arising in the statistical comparison of the output of climate models with the corresponding climate data are reviewed. Particular attention is paid to the question of detecting climate change. The purpose of this paper is to review some statistical approaches to the comparison of the output of climate models with climate data. There are many statistical issues arising in such a comparison. The author will focus on some of the broader issues, although some specific methodological questions will arise along the way. One important potential application of the approaches discussed in this paper is the detection of climate change. Although much of the discussion will be fairly general, he will try to point out the appropriate connections to the detection question. 9 refs

  20. On the statistical comparison of climate model output and climate data

    International Nuclear Information System (INIS)

    Solow, A.R.

    1990-01-01

    Some broad issues arising in the statistical comparison of the output of climate models with the corresponding climate data are reviewed. Particular attention is paid to the question of detecting climate change. The purpose of this paper is to review some statistical approaches to the comparison of the output of climate models with climate data. There are many statistical issues arising in such a comparison. The author will focus on some of the broader issues, although some specific methodological questions will arise along the way. One important potential application of the approaches discussed in this paper is the detection of climate change. Although much of the discussion will be fairly general, he will try to point out the appropriate connections to the detection question

  1. The Higher the Insulin Resistance the Lower the Cardiac Output in Men with Type 1 Diabetes During the Maximal Exercise Test.

    Science.gov (United States)

    Niedzwiecki, Pawel; Naskret, Dariusz; Pilacinski, Stanislaw; Pempera, Maciej; Uruska, Aleksandra; Adamska, Anna; Zozulinska-Ziolkiewicz, Dorota

    2017-06-01

    The aim of this study was to assess the hemodynamic parameters analyzed in bioimpedance cardiography during maximal exercise in patients with type 1 diabetes differing in insulin resistance. The study group consisted of 40 men with type 1 diabetes. Tissue sensitivity to insulin was assessed on the basis of the glucose disposal rate (GDR) analyzed during hyperinsulinemic-euglycemic clamp. Patients were divided into groups with GDR insulin sensitivity) and GDR ≥4.5 mg/kg/min (G2 group-higher insulin sensitivity). During the exercise test, the heart rate, systolic volume, cardiac output, cardiac index were measured by the impedance meter (PhysioFlow). Compared with the G2 group, the G1 group had a lower cardiac output (CO): during exercise 8.6 (IQR 7.7-10.0) versus 12.8 (IQR 10.8-13.7) L/min; P insulin resistance is associated with cardiac hemodynamic parameters assessed during and after exercise. The higher the insulin resistance the lower the cardiac output during maximal exercise in men with type 1 diabetes.

  2. Optimizing Cardiac Out-Put to Increase Cerebral Penumbral Perfusion in Large Middle Cerebral Artery Ischemic Lesion—OPTIMAL Study

    Directory of Open Access Journals (Sweden)

    Hannah Fuhrer

    2017-08-01

    Full Text Available IntroductionIn unsuccessful vessel recanalization, clinical outcome of acute stroke patients depends on early improvement of penumbral perfusion. So far, mean arterial blood pressure (MAP is the target hemodynamic parameter. However, the correlations of MAP to cardiac output (CO and cerebral perfusion are volume state dependent. In severe subarachnoid hemorrhage, optimizing CO leads to a reduction of delayed ischemic neurological deficits and improvement of clinical outcome. This study aims to investigate the effect of standard versus advanced cardiac monitoring with optimization of CO on the clinical outcome in patients with large ischemic stroke.Methods and analysisThe OPTIMAL study is a prospective, multicenter, open, into two arms (1:1 randomized, controlled trial. Sample size estimate: sample sizes of 150 for each treatment group (300 in total ensure an 80% power to detect a difference of 16% of a dichotomized level of functional clinical outcome at 3 months at a significance level of 0.05. Study outcomes: the primary endpoint is the functional outcome at 3 months. The secondary endpoints include functional outcome at 6 months follow-up, and complications related to hemodynamic monitoring and therapies.DiscussionThe results of this trial will provide data on the safety and efficacy of advanced hemodynamic monitoring on clinical outcome.Ethics and disseminationThe trial was approved by the leading ethics committee of Freiburg University, Germany (438/14, 2015 and the local ethics committees of the participating centers. The study is performed in accordance with the Declaration of Helsinki and the guidelines of Good Clinical Practice. It is registered in the German Clinical Trial register (DRKS; DRKS00007805. Dissemination will include submission to peer-reviewed professional journals and presentation at congresses. Hemodynamic monitoring may be altered in a specific stroke patient cohort if the study shows that advanced monitoring is

  3. Beat-by-beat analysis of cardiac output and blood pressure responses to short-term barostimulation in different body positions

    Science.gov (United States)

    Hildebrandt, Wulf; Schütze, Harald; Stegemann, J.

    Rapid quantification of the human baro-reflex control of heart rate has been achieved on a beat-by-beat basis using a neck-chamber with quick ECG-triggered pressure changes. Referring to recent findings on heart rate and stroke volume, the present study uses this technique to compare cardiac output as well as blood pressure changes in supine and upright position to investigate feedback effects and to confirm postural reflex modifications not revealed by RR-interval changes. A suction profile starting at +40 mmHg and running 7 steps of pressure decrease down to -65 mmHg was examined in 0° and 90° tilting position while beat-by-beat recordings were done of heart rate, stroke volume (impedance-cardiography) and blood pressure (Finapres tm) (n=16). The percentual heart rate decrease failed to be significantly different between positions. A suction-induced stroke volume increase led to a cardiac output almost maintained when supine and significantly increased when upright. A decrease in all blood pressure values was found during suction, except for systolic values in upright position which increased. Conclusively, (a) it is confirmed that different inotropy accounts for the seen gravitational effect on the cardiac output not represented by heart rate; (b) identical suction levels in different positions lead to different stimuli at the carotid receptor. This interference has to be considered in microgravity studies by beat-by-beat measurement of cardiac output and blood pressure.

  4. The non-invasive and continuous estimation of cardiac output using a photoplethysmogram and electrocardiogram during incremental exercise

    International Nuclear Information System (INIS)

    Wang, L; Poon, C C Y; Zhang, Y T

    2010-01-01

    Cardiac output (CO) monitoring is not only essential for critically ill patients in the hospital, but also for patients at home and those undergoing cardiopulmonary exercise testing. However, CO is difficult to monitor during daily activities and exercise. In this paper, we aim at developing a novel CO estimation method that can be used under these challenging conditions. The tube model was utilized to derive a CO index, namely the pulse time reflection ratio (PTRR) from an electrocardiogram and photoplethysmogram. After calibration, the PTRR can be used to estimate beat-to-beat CO. The proposed method was verified against CO measured by impedance cardiography on 19 healthy subjects in an incremental intensity exercise test. Results showed that there were strong correlations (r) between the PTRR and reference CO in 18 subjects (mean r: 0.88, n = 245 trials). Two calibration approaches reported in the literature were applied to the proposed method and the corresponding bias ± precisions of estimation errors were 0 ± 1.89 L min −1 and −0.22 ± 2.12 L min −1 , respectively. The percent errors were 21.94% and 24.90%, smaller than the clinical acceptance limit (30%). To conclude, after calibration, this method can be used to monitor CO on healthy subjects during incremental intensity exercise

  5. Diesel Exhaust Inhalation Increases Cardiac Output, Bradyarrhythmias, and Parasympathetic Tone in Aged Heart Failure-Prone Rats

    Science.gov (United States)

    Acute air pollutant inhalation is linked to adverse cardiac events and death, and hospitalizations for heart failure. Diesel exhaust (DE) is a major air pollutant suspected to exacerbate preexisting cardiac conditions, in part, through autonomic and electrophysiologic disturbance...

  6. Transcriptional profile of isoproterenol-induced cardiomyopathy and comparison to exercise-induced cardiac hypertrophy and human cardiac failure

    Directory of Open Access Journals (Sweden)

    McIver Lauren J

    2009-12-01

    Full Text Available Abstract Background Isoproterenol-induced cardiac hypertrophy in mice has been used in a number of studies to model human cardiac disease. In this study, we compared the transcriptional response of the heart in this model to other animal models of heart failure, as well as to the transcriptional response of human hearts suffering heart failure. Results We performed microarray analyses on RNA from mice with isoproterenol-induced cardiac hypertrophy and mice with exercise-induced physiological hypertrophy and identified 865 and 2,534 genes that were significantly altered in pathological and physiological cardiac hypertrophy models, respectively. We compared our results to 18 different microarray data sets (318 individual arrays representing various other animal models and four human cardiac diseases and identified a canonical set of 64 genes that are generally altered in failing hearts. We also produced a pairwise similarity matrix to illustrate relatedness of animal models with human heart disease and identified ischemia as the human condition that most resembles isoproterenol treatment. Conclusion The overall patterns of gene expression are consistent with observed structural and molecular differences between normal and maladaptive cardiac hypertrophy and support a role for the immune system (or immune cell infiltration in the pathology of stress-induced hypertrophy. Cross-study comparisons such as the results presented here provide targets for further research of cardiac disease that might generally apply to maladaptive cardiac stresses and are also a means of identifying which animal models best recapitulate human disease at the transcriptional level.

  7. [Effects of application of pulse contour cardiac output monitoring technology in early treatment of patients with large area burns].

    Science.gov (United States)

    Wang, D Y; Xie, W G; Xi, M M; Li, Z; Wang, B

    2018-01-20

    Objective: To analyze the changes and relationship of early hemodynamic indexes of patients with large area burns monitored by pulse contour cardiac output (PiCCO) monitoring technology, so as to assess the guiding value of this technology in the treatment of patients with large area burns during shock period. Methods: Eighteen patients with large area burns, confirming to the study criteria, were admitted to our unit from May 2016 to May 2017. Pulse contour cardiac output index (PCCI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and extravascular lung water index (EVLWI) of patients were monitored by PiCCO instrument from admission to post injury day (PID) 7, and they were calibrated and recorded once every four hours. The fluid infusion coefficients of patients at the first and second 24 hours post injury were calculated. The blood lactic acid values of patients from PID 1 to 7 were also recorded. The correlations among PCCI, SVRI, and GEDVI as well as the correlation between SVRI and blood lactic acid of these 18 patients were analyzed. Prognosis of patients were recorded. Data were processed with one-way analysis of variance, single sample t test and Bonferroni correction, Pearson correlation analysis, and Spearman rank correlation analysis. Results: (1) There was statistically significant difference in PCCI value of patients from post injury hour (PIH) 4 to 168 ( F =7.428, P 0.05). (2) There was statistically significant difference in SVRI value of patients from PIH 4 to 168 ( F =7.863, P 0.05). (3) There was no statistically significant difference in the GEDVI values of patients from PIH 4 to 168 ( F =0.704, P >0.05). The GEDVI values of patients at PIH 8, 12, 16, 20, and 24 were significantly lower than normal value ( t =-3.112, -3.554, -2.969, -2.450, -2.476, P 0.05). (4) There was statistically significant difference in EVLWI value of patients from PIH 4 to 168 ( F =1.859, P 0.05). (5) The fluid infusion

  8. Does obesity affect the non-invasive measurement of cardiac output performed by electrical cardiometry in children and adolescents?

    Science.gov (United States)

    Altamirano-Diaz, Luis; Welisch, Eva; Rauch, Ralf; Miller, Michael; Park, Teresa Sohee; Norozi, Kambiz

    2018-02-01

    Electrical cardiometry (EC) is a non-invasive and inexpensive method for hemodynamic assessment and monitoring. However, its feasibility for widespread clinical use, especially for the obese population, has yet to be determined. In this study, we evaluated the agreement and reliability of EC compared to transthoracic Doppler echocardiography (TTE) in normal, overweight, and obese children and adolescents. We measured stroke volume (SV) and cardiac output (CO) of 131 participants using EC and TTE simultaneously. We further divided these participants according to BMI percentiles for subanalyses: 95% obese (n = 83). Due to small sample size of the overweight group, we combined overweight and obese groups (OW+OB) with no significant change in results (SV and CO) before and after combining groups. There were strong correlations between EC and TTE measurements of SV (r = 0.869 and r = 0.846; p < 0.0001) and CO (r = 0.831 and r = 0.815; p < 0.0001) in normal and OW+OB groups, respectively. Bias and percentage error for CO measurements were 0.240 and 29.7%, and 0.042 and 29.5% in the normal and OW+OB groups, respectively. Indexed values for SV were lower in the OW+OB group than in the normal weight group when measured by EC (p < 0.0001) but no differences were seen when measured by TTE (p = 0.096). In all weight groups, there were strong correlations and good agreement between EC and TTE. However, EC may underestimate hemodynamic measurements in obese participants due to fat tissue.

  9. Decreased 2,3-diphosphoglycerate concentration in low cardiac output patients and its influence on the determination of in vivo p50.

    Science.gov (United States)

    Piccioni, Marilde A; Cestari, Idágene A; Strunz, Célia M C; Auler, José O

    2003-08-01

    We investigated whether 2,3-diphosphoglycerate (2,3-DPG) is altered in patients with low cardiac output and the influence of its concentration on the calculation of in vivo P(50). Biochemical and blood gas analysis were performed along with the measurement of cardiac output and body temperature in 13 patients submitted to cardiopulmonary bypass surgeries without the use of donor blood. In vivo P(50) was calculated using the measured (P(50m)) and the estimated 2,3-DPG (P(50e)). 2,3-DPG concentration was lower in these patients when compared to the values obtained in normal volunteers (6.9 +/- 2.2 vs. 11.9 +/- 2.4 microm/gHb). P(50m) was lower than P(50e) (21.6 +/- 1.1 vs. 30.1 +/- 1.2 mm Hg) at all time points. Our data show that in patients with low cardiac output, 2,3-DPG concentration is reduced. Therefore, in these patients, the use of standard values for this variable may introduce an error in the calculation of in vivo P(50).

  10. Routine measurements of left and right ventricular output by gated blood pool emission tomography in comparison with thermodilution measurements: a preliminary study

    International Nuclear Information System (INIS)

    Mariano-Goulart, D.; Boudousq, V.; Comte, F.; Eberle, M.C.; Zanca, M.; Kotzki, P.O.; Rossi, M.; Piot, C.; Raczka, F.; Davy, J.M.

    2001-01-01

    The aim of this preliminary study was to evaluate the accuracy of left and right ventricular output computed from a semi-automatic processing of tomographic radionuclide ventriculography data (TRVG) in comparison with the conventional thermodilution method. Twenty patients with various heart diseases were prospectively included in the study. Thermodilution and TRVG acquisitions were carried out on the same day for all patients. Analysis of gated blood pool slices was performed using a watershed-based segmentation algorithm. Right and left ventricular output measured by TRVG correlated well with the measurements obtained with thermodilution (r=0.94 and 0.91 with SEE=0.38 and 0.46 l/min, respectively, P<0.001). The limits of agreement for TRVG and thermodilution measurements were -0.78-1.20 l/min for the left ventricle and -0.34-1.16 l/min for the right ventricle. No significant difference was found between the results of TRVG and thermodilution with respect to left ventricular output (P=0.09). A small but significant difference was found between right ventricular output measured by TRVG and both left ventricular output measured by TRVG (mean difference=0.17 l/min, P=0.04) and thermodilution-derived cardiac output (mean difference=0.41 l/min, P=0.0001). It is concluded that the watershed-based semi-automatic segmentation of TRVG slices provides non-invasive measurements of right and left ventricular output and stroke volumes at equilibrium, in routine clinical settings. Further studies are necessary to check whether the accuracy of these measurements is good enough to permit correct assessment of intracardiac shunts. (orig.)

  11. Change in end-tidal carbon dioxide outperforms other surrogates for change in cardiac output during fluid challenge.

    Science.gov (United States)

    Lakhal, K; Nay, M A; Kamel, T; Lortat-Jacob, B; Ehrmann, S; Rozec, B; Boulain, T

    2017-03-01

    During fluid challenge, volume expansion (VE)-induced increase in cardiac output (Δ VE CO) is seldom measured. In patients with shock undergoing strictly controlled mechanical ventilation and receiving VE, we assessed minimally invasive surrogates for Δ VE CO (by transthoracic echocardiography): fluid-induced increases in end-tidal carbon dioxide (Δ VE E'CO2 ); pulse (Δ VE PP), systolic (Δ VE SBP), and mean systemic blood pressure (Δ VE MBP); and femoral artery Doppler flow (Δ VE FemFlow). In the absence of arrhythmia, fluid-induced decrease in heart rate (Δ VE HR) and in pulse pressure respiratory variation (Δ VE PPV) were also evaluated. Areas under the receiver operating characteristic curves (AUC ROC s) reflect the ability to identify a response to VE (Δ VE CO ≥15%). In 86 patients, Δ VE E'CO2 had an AUC ROC =0.82 [interquartile range 0.73-0.90], significantly higher than the AUC ROC for Δ VE PP, Δ VE SBP, Δ VE MBP, and Δ VE FemFlow (AUC ROC =0.61-0.65, all P  1 mm Hg (>0.13 kPa) had good positive (5.0 [2.6-9.8]) and fair negative (0.29 [0.2-0.5]) likelihood ratios. The 16 patients with arrhythmia had similar relationships between Δ VE E'CO2 and Δ VE CO to patients with regular rhythm ( r 2 =0.23 in both subgroups). In 60 patients with no arrhythmia, Δ VE E'CO2 (AUC ROC =0.84 [0.72-0.92]) outperformed Δ VE HR (AUC ROC =0.52 [0.39-0.66], P AUC ROC =0.73 [0.60-0.84], P =0.21). In the 45 patients with no arrhythmia and receiving ventilation with tidal volume AUC ROC =0.86 [0.72-0.95] vs 0.66 [0.49-0.80], P =0.02. Δ VE E'CO2 outperformed Δ VE PP, Δ VE SBP, Δ VE MBP, Δ VE FemFlow, and Δ VE HR and, during protective ventilation, arrhythmia, or both, it also outperformed Δ VE PPV. A value of Δ VE E'CO2 >1 mm Hg (>0.13 kPa) indicated a likely response to VE. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  12. Indexation of cardiac output to biometric parameters in critically ill patients: A systematic analysis of a transpulmonary thermodilution-derived database.

    Science.gov (United States)

    Saugel, Bernd; Mair, Sebastian; Götz, Simon Q; Tschirdewahn, Julia; Frank, Johanna; Höllthaler, Josef; Schmid, Roland M; Huber, Wolfgang

    2015-10-01

    Cardiac output (CO) (liters per minute) is usually normalized (ie, indexed) to the patient's body surface area (BSA) resulting in the hemodynamic variable cardiac index (CI) (liters per minute per square meter). We aimed (1) to evaluate the impact of different body weight-based CO indexations on the resulting CI values and (2) to identify biometric parameters independently associated with CO in critically ill patients. The study is an analysis of a database containing transpulmonary thermodilution-derived hemodynamic variables of 234 medical intensive care unit patients. Cardiac index indexed to actual BSA was statistically significantly lower compared with CI indexed to predicted BSA in the totality of patients and in the subgroups of patients with body mass index greater than or equal to 25 kg/m(2) but less than 30 kg/m(2) and body mass index greater than or equal to 30 kg/m(2) (with a statistically significant difference in the proportion of low and high CI measurements). Multivariate analysis of the first CO measurement of each patient demonstrated that CO was independently associated with age (P biometric factors independently associated with CO. Age was identified as the most important factor with each year of age decreasing CO by 66 mL/min (95% confidence interval, 47-86 mL/min). The indexation of CO to BSA is highly dependent on the body weight estimation formula used to calculate BSA. Cardiac output is independently associated with the biometric factors age, height, and BWact. These factors might be considered for indexation of CO. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Low cardiac output as physiological phenomenon in hibernating, free-ranging Scandinavian brown bears (Ursus arctos) - an observational study

    DEFF Research Database (Denmark)

    Jørgensen, Peter Godsk; Arnemo, Jon; Swenson, Jon E

    2014-01-01

    cardiac function associated with metabolic depression in the hibernating vs. active states in free-ranging Scandinavian brown bears. METHODS: We performed echocardiography on seven free-ranging brown bears in Dalarna, Sweden, anesthetized with medetomidine-zolazepam-tiletamine-ketamine during winter.......31) l/min vs. 3.54 (SD: 1.04) l/min (P=0.003), and mean cardiac index 0.63 (SD: 0.21) l/min/kg vs. 2.45 (SD: 0.52) l/min/ m2 (Pdisease...

  14. A Monte Carlo Study on Multiple Output Stochastic Frontiers: Comparison of Two Approaches

    DEFF Research Database (Denmark)

    Henningsen, Geraldine; Henningsen, Arne; Jensen, Uwe

    , dividing all other output quantities by the selected output quantity, and using these ratios as regressors (OD). Another approach is the stochastic ray production frontier (SR) which transforms the output quantities into their Euclidean distance as the dependent variable and their polar coordinates......In the estimation of multiple output technologies in a primal approach, the main question is how to handle the multiple outputs. Often an output distance function is used, where the classical approach is to exploit its homogeneity property by selecting one output quantity as the dependent variable...... of both specifications for the case of a Translog output distance function with respect to different common statistical problems as well as problems arising as a consequence of zero values in the output quantities. Although, our results partly show clear reactions to statistical misspecifications...

  15. Comparison of an Endotracheal Cardiac Output Monitor to a Pulmonary Artery Catheter

    Science.gov (United States)

    2017-12-04

    8217-’ ’ ,, Background In combat, initial resuscitation and life saving measures are in itiated by securing a patent airway and administering fluid therapy. Wh...ile methods of fluid resuscitation remain controversial , maintenance of a patent airway and hemodynamic stabi lity as indicated by invasive...monito ri ng can influence the overall outcome of an injured individual. A patent airway may be maintained via an endotracheal tube . The use of

  16. Cardiac output determined by echocardiography in patients with cirrhosis: comparison with the indicator dilution technique

    DEFF Research Database (Denmark)

    Andersen, Ulrik B; Møller, Søren; Bendtsen, Flemming

    2003-01-01

    technique (CO(I)). METHODS: Twelve patients with cirrhosis were studied. CO(d) was measured as the spatial mean velocity of the left ventricular outflow tract, multiplied by the cross-sectional area and the heart rate. CO(I) was determined by the standard indicator dilution technique after injection of 125I...... albumin and 99mTc albumin into the right atrium and subsequent sampling from the femoral artery. RESULTS: The mean CO(d) and CO(I) were similar (7.20 vs 7.15 l/min, NS). A highly significant correlation was present between CO(d) and CO(I) (r = 0.86, P

  17. Transesophageal Doppler reliably tracks changes in cardiac output in comparison with intermittent pulmonary artery thermodilution in cardiac surgery patients

    DEFF Research Database (Denmark)

    Møller-Sørensen, Hasse; Cordtz, Joakim; Østergaard, Morten

    2017-01-01

    completed the study. Each patient were placed in the following successive positions: (1) supine, (2) head-down tilt, (3) head-up tilt, (4) supine, (5) supine with phenylephrine administration, (6) pace heart rate 80 beats per minute (bpm), (7) pace heart rate 110 bpm. The agreement of compared data...

  18. Cardiac MR imaging: Comparison with echocardiography and dynamic CT

    International Nuclear Information System (INIS)

    Colletti, P.M.; Norris, S.; Raval, J.; Boswell, W.; Lee, K.; Ralls, P.; Haywood, J.; Halls, J.

    1986-01-01

    The authors compared gated cardiac MR imaging with two-dimensional and Doppler echocardiography and dynamic CT. Gated cardiac MR imaging (VISTA unit, 0.5 T) was performed in 55 patients with a variety of conditions. Accuracy of diagnosis was compared. CT showed arterial, valvular, and pericardial calcifications not seen on MR imaging. Many lesions were seen as well on CT as on MR imaging. Two-dimensional echocardiography was superior in demonstrating wall motion and valvular disease. MR imaging was superior in demonstrating myocardial structures

  19. Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.

    Science.gov (United States)

    Hummel, Johanna; Rücker, Gerta; Stiller, Brigitte

    2017-08-02

    Low cardiac output syndrome remains a serious complication, and accounts for substantial morbidity and mortality in the postoperative course of paediatric patients undergoing surgery for congenital heart disease. Standard prophylactic and therapeutic strategies for low cardiac output syndrome are based mainly on catecholamines, which are effective drugs, but have considerable side effects. Levosimendan, a calcium sensitiser, enhances the myocardial function by generating more energy-efficient myocardial contractility than achieved via adrenergic stimulation with catecholamines. Thus potentially, levosimendan is a beneficial alternative to standard medication for the prevention of low cardiac output syndrome in paediatric patients after open heart surgery. To review the efficacy and safety of the postoperative prophylactic use of levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. We identified trials via systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as well as clinical trial registries, in June 2016. Reference lists from primary studies and review articles were checked for additional references. We only included randomised controlled trials (RCT) in our analysis that compared prophylactic levosimendan with standard medication or placebo, in infants and children up to 18 years of age, who were undergoing surgery for congenital heart disease. Two review authors independently extracted data and assessed risk of bias according to a pre-defined protocol. We obtained additional information from all but one of the study authors of the included studies. We used the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of evidence from the studies that contributed data to the meta-analyses for the prespecified outcomes. We created a 'Summary of findings' table to

  20. COMPARISON OF CARDIAC BIOMARKERS AND ECHOCARDIOGRAPHY IN DIAGNOSING MYOCARDITIS

    Directory of Open Access Journals (Sweden)

    Nimi Bharathan

    2017-03-01

    Full Text Available BACKGROUND Conventional methods used to diagnose or rule out myocarditis is not useful in detecting cardiac myocyte injury in clinically suspected cases. Endomyocardial biopsy and histopathological examination is not feasible in most government hospitals in India. Sensitive parameters have yet to be found out. The study was conducted to find out whether diagnosis of myocarditis in clinically suspected cases can be done by measurement of serum levels of cardiac troponinI (cTnI and MB isoform of creatine kinase (CK-MB. MATERIALS AND METHODS 19 patients with clinically suspected myocarditis were screened for CK-MB activity and cTnI. Echocardiography, ECG and IgM for leptospirosis were also checked in these patients. RESULTS cTnI was elevated in 10 out of 19 patients with clinically suspected myocarditis. CK-MB was elevated in 7 patients. CONCLUSION Elevation of cTnI level in blood can be taken as an indicator of cardiac muscle cell injury in suspected cases of myocarditis.

  1. Uncomplicated human type 2 diabetes is associated with meal-induced blood pressure lowering and cardiac output increase.

    Science.gov (United States)

    Smits, Mark M; Muskiet, Marcel H A; Tushuizen, Maarten E; Kwa, Kelly A A; Karemaker, John M; van Raalte, Daniël H; Diamant, Michaela

    2014-12-01

    Since many type 2 diabetes patients experience postprandial hypotension, the aim of this study was to unravel meal-related changes in systemic hemodynamics and autonomic nervous system (ANS)-balance. Forty-two age-matched males (15 type 2 diabetes; 12 metabolic syndrome; 15 controls) without overt autonomic neuropathy received a standardized high-fat mixed meal after an overnight fast. Hemodynamic variables were measured by finger plethysmography. Fourier analysis was used to calculate the low-/high-frequency (LF/HF)-ratio, a marker of autonomic nervous system-balance, and baroreceptor reflex sensitivity (BRS). Following the meal, diastolic blood pressure (DBP) decreased in type 2 diabetes patients only, paralleled by a significant decrement in systemic vascular resistance (SVR) and an increase in cardiac index. All groups showed an increase in postprandial heart rate. Controls, but not metabolic syndrome or type 2 diabetes patients, showed a meal-related increase in LF/HF-ratio. When combining all study subjects, homeostatic model assessment-insulin resistance (HOMA-IR) was inversely correlated with changes in DBP, SVR, LF/HF-ratio and BRS. Based on these data, we hypothesize that in patients with uncomplicated type 2 diabetes, insulin resistance hampers adequate meal-induced sympathetic activation, leading to a decrease in SVR and resulting in a postprandial drop in DBP. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Comparison of x-ray output of inverter-type x-ray equipment

    International Nuclear Information System (INIS)

    Asano, Hiroshi; Miyake, Hiroyuki; Yamamoto, Keiichi

    2000-01-01

    The x-ray output of 54 inverter-type x-ray apparatuses used at 18 institutions was investigated. The reproducibility and linearity of x-ray output and variations among the x-ray equipment were evaluated using the same fluorescence meter. In addition, the x-ray apparatuses were re-measured using the same non-invasive instrument to check for variations in tube voltage, tube current, and irradiation time. The non-invasive instrument was calibrated by simultaneously obtaining measurements with an invasive instrument, employing the tube voltage and current used for the invasive instrument, and the difference was calculated. Reproducibility of x-ray output was satisfactory for all x-ray apparatuses. The coefficient of variation was 0.04 or less for irradiation times of 5 ms or longer. In 84.3% of all x-ray equipment, variation in the linearity of x-ray output was 15% or less for an irradiation time of 5 ms. However, for all the apparatuses, the figure was 50% when irradiation time was the shortest (1 to 3 ms). Variation in x-ray output increased as irradiation time decreased. Variation in x-ray output ranged between 1.8 and 2.5 compared with the maximum and minimum values, excluding those obtained at the shortest irradiation time. The relative standard deviation ranged from ±15.5% to ±21.0%. The largest variation in x-ray output was confirmed in regions irradiated for the shortest time, with smaller variations observed for longer irradiation times. The major factor responsible for variation in x-ray output in regions irradiated for 10 ms or longer, which is a relatively long irradiation time, was variation in tube current. Variation in tube current was slightly greater than 30% at maximum, with an average value of 7% compared with the preset tube current. Variations in x-ray output in regions irradiated for the shortest time were due to photographic effects related to the rise and fall times of the tube voltage waveform. Accordingly, in order to obtain constant x

  3. Formation of oiliness and sebum output--comparison of a lipid-absorbant and occlusive-tape method with photometry.

    Science.gov (United States)

    Serup, J

    1991-07-01

    Sebum output and the development of oiliness formation were studied in 24 acne-prone volunteers. Sebutape and photometric measurement by the Sebumeter were compared. Tapes were taken 1, 2 and 3 h after degreasing. Tapes were scored, and light transmission was measured by a special densitometric device. Sebumeter recordings were performed after 3 h. Densitometric evaluation of tapes was accurate with a high correlation to scoring. Sebutape and Sebumeter assessments correlated. However, in some individuals the tape method overestimated the sebum output. Right-left comparison indicated that the tape method was less reproducible, particularly after longer sampling periods. It is suggested that Sebutape, due to water occlusion and temperature insulation during the sampling period, interferes with sebum droplet formation and spreading. However, such systematic interference may be advantageous since sweating and heat are important clinical prerequisites in the formation of oiliness. Thus, it is suggested that the Sebutape is a specialized method for the determination of 'oiliness', the very last phase of sebum output, in which sebum droplets spread over the skin surface. The tape is not automatically comparable to other methods for determining sebum output from the follicular reservoir.

  4. Comparison of Solar and Wind Power Output and Correlation with Real-Time Pricing

    Science.gov (United States)

    Hoepfl, Kathryn E.; Compaan, Alvin D.; Solocha, Andrew

    2011-03-01

    This study presents a method that can be used to determine the least volatile power output of a wind and solar hybrid energy system in which wind and solar systems have the same peak power. Hourly data for wind and PV systems in Northwest Ohio are used to show that a combination of both types of sustainable energy sources produces a more stable power output and would be more valuable to the grid than either individually. This method could be used to determine the ideal ratio in any part of the country and should help convince electric utility companies to bring more renewable generation online. This study also looks at real-time market pricing and how each system (solar, wind, and hybrid) correlates with 2009 hourly pricing from the Midwest Interconnect. KEH acknowledges support from the NSF-REU grant PHY-1004649 to the Univ. of Toledo and Garland Energy Systems/Ohio Department of Development.

  5. The Comparison of Point Data Models for the Output of WRF Hydro Model in the IDV

    Science.gov (United States)

    Ho, Y.; Weber, J.

    2017-12-01

    WRF Hydro netCDF output files contain streamflow, flow depth, longitude, latitude, altitude and stream order values for each forecast point. However, the data are not CF compliant. The total number of forecast points for the US CONUS is approximately 2.7 million and it is a big challenge for any visualization and analysis tool. The IDV point cloud display shows point data as a set of points colored by parameter. This display is very efficient compared to a standard point type display for rendering a large number of points. The one problem we have is that the data I/O can be a bottleneck issue when dealing with a large collection of point input files. In this presentation, we will experiment with different point data models and their APIs to access the same WRF Hydro model output. The results will help us construct a CF compliant netCDF point data format for the community.

  6. Direct recording of cardiac output- and venous return-curves in the dog heart-lung preparation for a graphical analysis of the effects of cardioactive drugs.

    Science.gov (United States)

    Ishikawa, N; Taki, K; Hojo, Y; Hagino, Y; Shigei, T

    1978-09-01

    The dog heart-lung preparations were prepared. The "equilibrium point", which could be defined as the point at which the cardiac output (CO)-curve and the venous return (VR)-curve crossed, when the CO and VR were plotted against the right atrial pressure, was recorded directly by utilizing an X-Y recorder. The CO-curve was obtained, as a locus of the equilibrium point, by raising and lowering the level of blood in the venous reservoir (competence test). The meaning of the procedure was shown to increase or decrease the mean systemic pressure, and to cause the corresponding parallel shift in the VR-curve. The VR-curve was obtained by changing myocardial contractility. When heart failure was induced by pentobarbital or by chloroform, the equilibrium point shifted downwards to the right, depicting the VR-curve. During development of the failure, the slopes of CO-curves decreased gradually. Effects of cinobufagin and norepinephrine were also analyzed. Utilization of the X-Y recorder enabled us to settle the uniform experimental conditions more easily, and to follow the effects of drugs continuously on a diagram equating the CO- and VR-curves (Gyton's scheme).

  7. G16R single nucleotide polymorphism but not haplotypes of the ß2-adrenergic receptor gene alters cardiac output in humans

    DEFF Research Database (Denmark)

    Rokamp, Kim Z; Staalsø, Jonatan M; Gartmann, Martin

    2013-01-01

    Variation in genes encoding the ß2-adrenergic receptor (ADRB2) and angiotensin-converting enzyme (ACE) may influence Q¿ (cardiac output). The 46G>A (G16R) SNP (single nucleotide polymorphism) has been associated with ß2-mediated vasodilation, but the effect of ADRB2 haplotypes on Q¿ has not been...... studied. Five SNPs within ADRB2 (46G>A, 79C>G, 491C>T, 523C>A and 1053G>C by a pairwise tagging principle) and the I/D (insertion/deletion) polymorphism in ACE were genotyped in 143 subjects. Cardiovascular variables were evaluated by the Model flow method at rest and during incremental cycling exercise...... V¿O2 (oxygen uptake) in G16G subjects, but the increase was 0.5 (0.0-0.9) l/min lower in Arg16 carriers (P=0.035). A similar effect size was observed for the Arg16 haplotypes ACCCG and ACCCC. No interaction was found between ADRB2 and ACE polymorphisms. During exercise, the increase in Q¿ was 0...

  8. Phosphodiesterase inhibitor KMUP-3 displays cardioprotection via protein kinase G and increases cardiac output via G-protein-coupled receptor agonist activity and Ca2+ sensitization

    Directory of Open Access Journals (Sweden)

    Chung-Pin Liu

    2016-02-01

    Full Text Available KMUP-3 (7-{2-[4-(4-nitrobenzene piperazinyl]ethyl}-1, 3-dimethylxanthine displays cardioprotection and increases cardiac output, and is suggested to increase cardiac performance and improve myocardial infarction. To determine whether KMUP-3 improves outcomes in hypoperfused myocardium by inducing Ca2+ sensitization to oppose protein kinase (PKG-mediated Ca2+ blockade, we measured left ventricular systolic blood pressure, maximal rates of pressure development, mean arterial pressure and heart rate in rats, and measured contractility and expression of PKs/RhoA/Rho kinase (ROCKII in beating guinea pig left atria. Hemodynamic changes induced by KMUP-3 (0.5–3.0 mg/kg, intravenously were inhibited by Y27632 [(R-(+-trans-4-1-aminoethyl-N-(4-Pyridyl cyclohexane carboxamide] and ketanserin (1 mg/kg, intravenously. In electrically stimulated left guinea pig atria, positive inotropy induced by KMUP-3 (0.1–100μM was inhibited by the endothelial NO synthase (eNOS inhibitors N-nitro-l-arginine methyl ester (L-NAME and 7-nitroindazole, cyclic AMP antagonist SQ22536 [9-(terahydro-2-furanyl-9H-purin-6-amine], soluble guanylyl cyclase (sGC antagonist ODQ (1H-[1,2,4] oxadiazolo[4,3-a] quinoxalin-1-one, RhoA inhibitor C3 exoenzyme, β-blocker propranolol, 5-hydroxytryptamine 2A antagonist ketanserin, ROCK inhibitor Y27632 and KMUP-1 (7-{2-[4-(2-chlorobenzene piperazinyl]ethyl}-1, 3-dimethylxanthine at 10μM. Western blotting assays indicated that KMUP-3 (0.1–10μM increased PKA, RhoA/ROCKII, and PKC translocation and CIP-17 (an endogenous 17-kDa inhibitory protein activation. In spontaneous right atria, KMUP-3 induced negative chronotropy that was blunted by 7-nitroindazole and atropine. In neonatal myocytes, L-NAME inhibited KMUP-3-induced eNOS phosphorylation and RhoA/ROCK activation. In H9c2 cells, Y-27632 (50μM and PKG antagonist KT5823 [2,3,9,10,11,12-hexahydro-10R- methoxy-2,9-dimethyl-1-oxo-9S,12R-epoxy-1H-diindolo(1,2,3-fg:3′,2′,1

  9. Comparison of soft-input-soft-output detection methods for dual-polarized quadrature duobinary system

    Science.gov (United States)

    Chang, Chun; Huang, Benxiong; Xu, Zhengguang; Li, Bin; Zhao, Nan

    2018-02-01

    Three soft-input-soft-output (SISO) detection methods for dual-polarized quadrature duobinary (DP-QDB), including maximum-logarithmic-maximum-a-posteriori-probability-algorithm (Max-log-MAP)-based detection, soft-output-Viterbi-algorithm (SOVA)-based detection, and a proposed SISO detection, which can all be combined with SISO decoding, are presented. The three detection methods are investigated at 128 Gb/s in five-channel wavelength-division-multiplexing uncoded and low-density-parity-check (LDPC) coded DP-QDB systems by simulations. Max-log-MAP-based detection needs the returning-to-initial-states (RTIS) process despite having the best performance. When the LDPC code with a code rate of 0.83 is used, the detecting-and-decoding scheme with the SISO detection does not need RTIS and has better bit error rate (BER) performance than the scheme with SOVA-based detection. The former can reduce the optical signal-to-noise ratio (OSNR) requirement (at BER=10-5) by 2.56 dB relative to the latter. The application of the SISO iterative detection in LDPC-coded DP-QDB systems makes a good trade-off between requirements on transmission efficiency, OSNR requirement, and transmission distance, compared with the other two SISO methods.

  10. A Comparison of Real Output and Productivity for British and American Manufacturing in 1935

    NARCIS (Netherlands)

    Jong, H. de; Woltjer, P.

    2009-01-01

    The manufacturing productivity gap between the U.S. and the U.K. became much larger during the interwar period than existing estimates suggest. This paper presents a new estimate based on real value added and hours worked. First, a detailed benchmark comparison for 1935 is constructed using official

  11. A Comparison of Isokinetic Knee Strength and Power Output Ratios Between Female Basketball and Volleyball Players

    Directory of Open Access Journals (Sweden)

    Kabaciński Jarosław

    2017-09-01

    Full Text Available Purpose. Tests such as the counter movement jump (CMJ and squat jump (SJ allow for determining the ratio of maximal power output generated during SJ to CMJ (S/C. The isokinetic peak torque ratio of the hamstrings contracting eccentrically to the quadriceps contracting concentrically (H/Q is defined as functional H/Q. The purpose of this study was to compare the S/C and functional H/Q between female basketball and volleyball players. Methods. The total of 14 female basketball players (age, 19.8 ± 1.4 years and 12 female volleyball players (age, 22.3 ± 4.2 years participated in the study. A piezoelectric force platform was used for the CMJ and SJ. Moreover, isokinetic tests of the hamstrings and quadriceps muscle torque during eccentric and concentric contraction were performed. Results. The results of the S/C and functional H/Q at 90 deg · s-1/60 deg · s-1 velocities were higher in basketball players (87.3 ± 9.1% and 91.4 ± 9.3%, respectively than in volleyball players (83.1 ± 9.8% and 83.6 ± 16.5%, respectively. No significant differences in S/C or functional H/Q values between the two groups were found (p > 0.05. Conclusions. Decreasing the S/C may result from an improvement in the power output during CMJ and a better utilization of the stretch-shortening cycle effect. Balancing the functional H/Q through increasing the eccentric hamstrings strength can provide dynamic knee joint stabilization.

  12. The effect of endogenously released glucose, insulin, glucagon-like peptide 1, ghrelin on cardiac output, heart rate, stroke volume, and blood pressure.

    Science.gov (United States)

    Hlebowicz, Joanna; Lindstedt, Sandra; Björgell, Ola; Dencker, Magnus

    2011-12-29

    Ingestion of a meal increases the blood flow to the gastrointestinal organs and affects the heart rate (HR), blood pressure and cardiac output (CO), although the mechanisms are not known. The aim of this study was to evaluate the effect of endogenously released glucose, insulin, glucagon-like peptide 1 (GLP-1), ghrelin on CO, HR, stroke volume (SV), and blood pressure. Eleven healthy men and twelve healthy women ((mean ± SEM) aged: 26 ± 0.2 y; body mass index: 21.8 ± 0.1 kg/m(2))) were included in this study. The CO, HR, SV, systolic and diastolic blood pressure, antral area, gastric emptying rate, and glucose, insulin, GLP-1 and ghrelin levels were measured. The CO and SV at 30 min were significantly higher, and the diastolic blood pressure was significantly lower, than the fasting in both men and women (P blood pressure (P = 0.021, r = -0.681), and the change in SV (P = 0.008, r = -0.748) relative to the fasting in men. The insulin 0-30 min AUC was significantly correlated to the CO 0-30 min AUC (P = 0.002, r = 0.814) in men. Significant correlations were also found between the 0-120 min ghrelin and HR AUCs (P = 0.007, r = 0.966) in men. No statistically significant correlations were seen in women. Physiological changes in the levels of glucose, insulin, GLP-1 and ghrelin may influence the activity of the heart and the blood pressure. There may also be gender-related differences in the haemodynamic responses to postprandial changes in hormone levels. The results of this study show that subjects should not eat immediately prior to, or during, the evaluation of cardiovascular interventions as postprandial affects may affect the results, leading to erroneous interpretation of the cardiovascular effects of the primary intervention. NCT01027507.

  13. Modeling DPOAE input/output function compression: comparisons with hearing thresholds.

    Science.gov (United States)

    Bhagat, Shaum P

    2014-09-01

    Basilar membrane input/output (I/O) functions in mammalian animal models are characterized by linear and compressed segments when measured near the location corresponding to the characteristic frequency. A method of studying basilar membrane compression indirectly in humans involves measuring distortion-product otoacoustic emission (DPOAE) I/O functions. Previous research has linked compression estimates from behavioral growth-of-masking functions to hearing thresholds. The aim of this study was to compare compression estimates from DPOAE I/O functions and hearing thresholds at 1 and 2 kHz. A prospective correlational research design was performed. The relationship between DPOAE I/O function compression estimates and hearing thresholds was evaluated with Pearson product-moment correlations. Normal-hearing adults (n = 16) aged 22-42 yr were recruited. DPOAE I/O functions (L₂ = 45-70 dB SPL) and two-interval forced-choice hearing thresholds were measured in normal-hearing adults. A three-segment linear regression model applied to DPOAE I/O functions supplied estimates of compression thresholds, defined as breakpoints between linear and compressed segments and the slopes of the compressed segments. Pearson product-moment correlations between DPOAE compression estimates and hearing thresholds were evaluated. A high correlation between DPOAE compression thresholds and hearing thresholds was observed at 2 kHz, but not at 1 kHz. Compression slopes also correlated highly with hearing thresholds only at 2 kHz. The derivation of cochlear compression estimates from DPOAE I/O functions provides a means to characterize basilar membrane mechanics in humans and elucidates the role of compression in tone detection in the 1-2 kHz frequency range. American Academy of Audiology.

  14. Comparison of squashing and self-consistent input-output models of quantum feedback

    Science.gov (United States)

    Peřinová, V.; Lukš, A.; Křepelka, J.

    2018-03-01

    The paper (Yanagisawa and Hope, 2010) opens with two ways of analysis of a measurement-based quantum feedback. The scheme of the feedback includes, along with the homodyne detector, a modulator and a beamsplitter, which does not enable one to extract the nonclassical field. In the present scheme, the beamsplitter is replaced by the quantum noise evader, which makes it possible to extract the nonclassical field. We re-approach the comparison of two models related to the same scheme. The first one admits that in the feedback loop between the photon annihilation and creation operators, unusual commutation relations hold. As a consequence, in the feedback loop, squashing of the light occurs. In the second one, the description arrives at the feedback loop via unitary transformations. But it is obvious that the unitary transformation which describes the modulator changes even the annihilation operator of the mode which passes by the modulator which is not natural. The first model could be called "squashing model" and the second one could be named "self-consistent model". Although the predictions of the two models differ only a little and both the ways of analysis have their advantages, they have also their drawbacks and further investigation is possible.

  15. The effect of endogenously released glucose, insulin, glucagon-like peptide 1, ghrelin on cardiac output, heart rate, stroke volume, and blood pressure

    Directory of Open Access Journals (Sweden)

    Hlebowicz Joanna

    2011-12-01

    Full Text Available Abstract Background Ingestion of a meal increases the blood flow to the gastrointestinal organs and affects the heart rate (HR, blood pressure and cardiac output (CO, although the mechanisms are not known. The aim of this study was to evaluate the effect of endogenously released glucose, insulin, glucagon-like peptide 1 (GLP-1, ghrelin on CO, HR, stroke volume (SV, and blood pressure. Methods Eleven healthy men and twelve healthy women ((mean ± SEM aged: 26 ± 0.2 y; body mass index: 21.8 ± 0.1 kg/m2 were included in this study. The CO, HR, SV, systolic and diastolic blood pressure, antral area, gastric emptying rate, and glucose, insulin, GLP-1 and ghrelin levels were measured. Results The CO and SV at 30 min were significantly higher, and the diastolic blood pressure was significantly lower, than the fasting in both men and women (P P = 0.015, r = 0.946, and between ghrelin levels and HR (P = 0.013, r = 0.951 at 110 min. Significant correlations were also found between the change in glucose level at 30 min and the change in systolic blood pressure (P = 0.021, r = -0.681, and the change in SV (P = 0.008, r = -0.748 relative to the fasting in men. The insulin 0-30 min AUC was significantly correlated to the CO 0-30 min AUC (P = 0.002, r = 0.814 in men. Significant correlations were also found between the 0-120 min ghrelin and HR AUCs (P = 0.007, r = 0.966 in men. No statistically significant correlations were seen in women. Conclusions Physiological changes in the levels of glucose, insulin, GLP-1 and ghrelin may influence the activity of the heart and the blood pressure. There may also be gender-related differences in the haemodynamic responses to postprandial changes in hormone levels. The results of this study show that subjects should not eat immediately prior to, or during, the evaluation of cardiovascular interventions as postprandial affects may affect the results, leading to erroneous interpretation of the cardiovascular effects of the

  16. A cardiac electrical activity model based on a cellular automata system in comparison with neural network model.

    Science.gov (United States)

    Khan, Muhammad Sadiq Ali; Yousuf, Sidrah

    2016-03-01

    Cardiac Electrical Activity is commonly distributed into three dimensions of Cardiac Tissue (Myocardium) and evolves with duration of time. The indicator of heart diseases can occur randomly at any time of a day. Heart rate, conduction and each electrical activity during cardiac cycle should be monitor non-invasively for the assessment of "Action Potential" (regular) and "Arrhythmia" (irregular) rhythms. Many heart diseases can easily be examined through Automata model like Cellular Automata concepts. This paper deals with the different states of cardiac rhythms using cellular automata with the comparison of neural network also provides fast and highly effective stimulation for the contraction of cardiac muscles on the Atria in the result of genesis of electrical spark or wave. The specific formulated model named as "States of automaton Proposed Model for CEA (Cardiac Electrical Activity)" by using Cellular Automata Methodology is commonly shows the three states of cardiac tissues conduction phenomena (i) Resting (Relax and Excitable state), (ii) ARP (Excited but Absolutely refractory Phase i.e. Excited but not able to excite neighboring cells) (iii) RRP (Excited but Relatively Refractory Phase i.e. Excited and able to excite neighboring cells). The result indicates most efficient modeling with few burden of computation and it is Action Potential during the pumping of blood in cardiac cycle.

  17. Comparação dos efeitos da dobutamina e da milrinona sobre a hemodinâmica e o transporte de oxigênio em pacientes submetidos à cirurgia cardíaca com baixo débito cardíaco após indução anestésica Comparación de los efectos de la dobutamina y de la milrinona sobre la hemodinámica y el transporte de oxígeno en pacientes sometidos a cirugía cardiaca con bajo débito cardiaco después de inducción anestésica Comparison of the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in patients undergoing cardiac surgery with low cardiac output after anesthetic induction

    Directory of Open Access Journals (Sweden)

    Maria José Carvalho Carmona

    2010-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Diversas classes de fármacos inotrópicos, com efeitos hemodinâmicos diferentes, são utilizadas no tratamento do baixo débito cardíaco em pacientes com disfunção sistólica submetidos a procedimento cirúrgico cardíaco. O objetivo deste estudo foi comparar o efeito da dobutamina e da milrinona sobre a hemodinâmica e o transporte de oxigênio nessa população de pacientes. MÉTODO: Após aprovação do Comitê de Ética institucional e obtenção do consentimento escrito pós-informado, 20 pacientes submetidos à cirurgia cardíaca e com índice cardíaco JUSTIFICATIVA Y OBJETIVOS: Diversas clases de fármacos inotrópicos con efectos hemodinámicos diferentes, se usan en el tratamiento del bajo débito cardíaco en pacientes con disfunción sistólica sometidos al procedimiento quirúrgico cardíaco. El objetivo de este estudio, fue comparar el efecto de la dobutamina y de la milrinona sobre la hemodinámica y el transporte de oxígeno en esa población de pacientes. MÉTODO: Después de la aprobación del Comité de Ética institucional y de la obtención del consentimiento informado, 20 pacientes sometidos a la cirugía cardíaca y con índice cardíaco BACKGROUND AND OBJECTIVES: Several classes of inotropic drugs with different hemodynamic effects are used in the treatment of low cardiac output in patients with diastolic dysfunction undergoing cardiac surgery. The objective of the present study was to compare the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in this population of patients. METHODS: After approval by the Ethics Committee of the institution and signing of the informed consent, 20 patients undergoing cardiac surgery with cardiac index < 2 L.min-1.m2 after anesthetic induction and place ment of a pulmonary artery catheter were randomly divided to receive dobutamine 5 µg.kg-1. min-1 (n = 10, or milrinone 0.5 µg.kg-1.min-1 (n = 10. Hemodynamic parameters were

  18. Multiscale Analysis of the Water Content Output the NWP Model COSMO Over Switzerland and Comparison With Radar Data

    Science.gov (United States)

    Wolfensberger, D.; Gires, A.; Berne, A.; Tchiguirinskaia, I.; Schertzer, D. J. M.

    2015-12-01

    physical process at stake during the events.Second Multifractal comparisons of model outputs will also be made with radar data provided by the Meteo Swiss, both indirectly in terms of precipitation intensities and directly using a polarimetric forward radar operator which is able to simulate radar observations from model outputs.

  19. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review.

    Science.gov (United States)

    Cornette, J; Laker, S; Jeffery, B; Lombaard, H; Alberts, A; Rizopoulos, D; Roos-Hesselink, J W; Pattinson, R C

    2017-01-01

    Most severe pregnancy complications are characterized by profound hemodynamic disturbances, thus there is a need for validated hemodynamic monitoring systems for pregnant women. Pulmonary artery catheterization (PAC) using thermodilution is the clinical gold standard for the measurement of cardiac output (CO), however this reference method is rarely performed owing to its invasive nature. Transthoracic echocardiography (TTE) allows non-invasive determination of CO. We aimed to validate TTE against PAC for the determination of CO in severely ill pregnant women. This study consisted of a meta-analysis combining data from a prospective study and a systematic review. The prospective arm was conducted in Pretoria, South Africa, in 2003. Women with severe pregnancy complications requiring invasive monitoring with PAC according to contemporary guidelines were included. TTE was performed within 15 min of PAC and the investigator was blinded to the PAC measurements. Comparative measurements were extracted from similar studies retrieved from a systematic review of the literature and added to a database. Simultaneous CO measurements by TTE and PAC were compared. Agreement between methods was assessed using Bland-Altman statistics and intraclass correlation coefficients (ICC). Thirty-four comparative measurements were included in the meta-analysis. Mean CO values obtained by PAC and TTE were 7.39 L/min and 7.18 L/min, respectively. The bias was 0.21 L/min with lower and upper limits of agreement of -1.18 L/min and 1.60 L/min, percentage error was 19.1%, and ICC between the two methods was 0.94. CO measurements by TTE show excellent agreement with those obtained by PAC in pregnant women. Given its non-invasive nature and availability, TTE could be considered as a reference for the validation of other CO techniques in pregnant women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Las complicaciones del embarazo más graves se caracterizan por trastornos hemodin

  20. Cardiovascular Ultrasound of Neonatal Long Evans Rats Exposed Prenatally to Trichloroacetic Acid: Effects on Heart Rate, Ejection Fraction, and Cardiac Output

    Science.gov (United States)

    This abstract describes the use of a relatively new technology, cardiovascular ultrasound (echocardiography) for evaluating developmental toxicity affecting heart development. The abstract describes the effects of two known cardiac teratogens, trichloroacetic acid and dimethadio...

  1. A Transcriptomic and Epigenomic Comparison of Fetal and Adult Human Cardiac Fibroblasts Reveals Novel Key Transcription Factors in Adult Cardiac Fibroblasts

    Directory of Open Access Journals (Sweden)

    Malin K.B. Jonsson, PhD

    2016-12-01

    Full Text Available Cardiovascular disease remains the number one global cause of death and presents as multiple phenotypes in which the interplay between cardiomyocytes and cardiac fibroblasts (CFs has become increasingly highlighted. Fetal and adult CFs influence neighboring cardiomyocytes in different ways. Thus far, a detailed comparison between the two is lacking. Using a genome-wide approach, we identified and validated 2 crucial players for maintaining the adult primary human CF phenotype. Knockdown of these factors induced significant phenotypical changes, including senescence and reduced collagen gene expression. These may now represent novel therapeutic targets against deleterious functions of CFs in adult cardiovascular disease.

  2. Aortic and Hepatic Contrast Enhancement During Hepatic-Arterial and Portal Venous Phase Computed Tomography Scanning: Multivariate Linear Regression Analysis Using Age, Sex, Total Body Weight, Height, and Cardiac Output.

    Science.gov (United States)

    Masuda, Takanori; Nakaura, Takeshi; Funama, Yoshinori; Higaki, Toru; Kiguchi, Masao; Imada, Naoyuki; Sato, Tomoyasu; Awai, Kazuo

    We evaluated the effect of the age, sex, total body weight (TBW), height (HT) and cardiac output (CO) of patients on aortic and hepatic contrast enhancement during hepatic-arterial phase (HAP) and portal venous phase (PVP) computed tomography (CT) scanning. This prospective study received institutional review board approval; prior informed consent to participate was obtained from all 168 patients. All were examined using our routine protocol; the contrast material was 600 mg/kg iodine. Cardiac output was measured with a portable electrical velocimeter within 5 minutes of starting the CT scan. We calculated contrast enhancement (per gram of iodine: [INCREMENT]HU/gI) of the abdominal aorta during the HAP and of the liver parenchyma during the PVP. We performed univariate and multivariate linear regression analysis between all patient characteristics and the [INCREMENT]HU/gI of aortic- and liver parenchymal enhancement. Univariate linear regression analysis demonstrated statistically significant correlations between the [INCREMENT]HU/gI and the age, sex, TBW, HT, and CO (all P linear regression analysis showed that only the TBW and CO were of independent predictive value (P linear regression analysis only the TBW and CO were significantly correlated with aortic and liver parenchymal enhancement; the age, sex, and HT were not. The CO was the only independent factor affecting aortic and liver parenchymal enhancement at hepatic CT when the protocol was adjusted for the TBW.

  3. Quantification of mitral regurgitation on cardiac computed tomography: comparison with qualitative and quantitative echocardiographic parameters.

    LENUS (Irish Health Repository)

    Arnous, Samer

    2012-02-01

    PURPOSE: To assess whether cardiac computed tomographic angiography (CCTA) can quantify the severity of chronic mitral regurgitation (MR) compared to qualitative and quantitative echocardiographic parameters. MATERIALS AND METHODS: Cardiac computed tomographic angiography was performed in 23 patients (mean +\\/- SD age, 63 +\\/- 16 years; range, 24-86 years) with MR and 20 patients without MR (controls) as determined by transthoracic echocardiography. Multiphasic reconstructions (20 data sets reconstructed at 5% increments of the electrocardiographic gated R-R interval) were used to analyze the mitral valve. Using CCTA planimetry, 2 readers measured the regurgitant mitral orifice area (CCTA ROA) during systole. A qualitative echocardiographic assessment of severity of MR was made by visual assessment of the length of the regurgitant jet. Quantitative echocardiographic measurements included the vena contracta, proximal isovelocity surface area, regurgitant volume, and estimated regurgitant orifice (ERO). Comparisons were performed using the independent t test, and correlations were assessed using the Spearman rank test. RESULTS: All controls and the patients with MR were correctly identified by CCTA. For patients with mild, moderate, or severe MR, mean +\\/- SD EROs were 0.16 +\\/- 0.03, 0.31 +\\/- 0.08, and 0.52 +\\/- 0.03 cm(2) (P < 0.0001) compared with mean +\\/- SD CCTA ROAs 0.09 +\\/- 0.05, 0.30 +\\/- 0.04, and 0.97 +\\/- 0.26 cm(2) (P < 0.0001), respectively. When echocardiographic measurements were graded qualitatively as mild, moderate, or severe, strong correlations were seen with CCTA ROA (R = 0.89; P < 0.001). When echocardiographic measurements were graded quantitatively, the vena contracta and the ERO showed modest correlations with CCTA ROA (0.48 and 0.50; P < 0.05 for both). Neither the proximal isovelocity surface area nor the regurgitant volume demonstrated significant correlations with CCTA ROA. CONCLUSIONS: Single-source 64-slice CCTA provides a

  4. Comparison of bile acid synthesis determined by isotope dilution versus fecal acidic sterol output in human subjects

    International Nuclear Information System (INIS)

    Duane, W.C.; Holloway, D.E.; Hutton, S.W.; Corcoran, P.J.; Haas, N.A.

    1982-01-01

    Fecal acidic sterol output has been found to be much lower than bile acid synthesis determined by isotope dilution. Because of this confusing discrepancy, we compared these 2 measurements done simultaneously on 13 occasions in 5 normal volunteers. In contrast to previous findings, bile acid synthesis by the Lindstedt isotope dilution method averaged 16.3% lower than synthesis simultaneously determined by fecal acidic sterol output (95% confidence limit for the difference - 22.2 to -10.4%). When one-sample determinations of bile acid pools were substituted for Lindstedt pools, bile acid synthesis by isotope dilution averaged 5.6% higher than synthesis by fecal acidic sterol output (95% confidence limits -4.9 to 16.1%). These data indicate that the 2 methods yield values in reasonably close agreement with one another. If anything, fecal acidic sterol outputs are slightly higher than synthesis by isotope dilution

  5. SU-G-201-05: Comparison of Different Methods for Output Verification of Eleckta Nucletron’s Valencia Skin Applicators

    International Nuclear Information System (INIS)

    Barrett, J; Yudelev, M

    2016-01-01

    Purpose: The provided output factors for Elekta Nucletron’s skin applicators are based on Monte Carlo simulations. These outputs have not been independently verified, and there is no recognized method for output verification of the vendor’s applicators. The purpose of this work is to validate the outputs provided by the vendor experimentally. Methods: Using a Flexitron Ir-192 HDR unit, three experimental methods were employed to determine dose with the 30 mm diameter Valencia applicator: first a gradient method using extrapolation ionization chamber (Far West Technology, EIC-1) measurements in solid water phantom at 3 mm SCD was used. The dose was derived based on first principles. Secondly a combination of a parallel plate chamber (Exradin A-10) and the EIC-1 was used to determine air kerma at 3 mm SCD. The air kerma was converted to dose to water in line with TG-61 formalism by using a muen ratio and a scatter factor measured with the skin applicators. Similarly a combination of the A-10 parallel plate chamber and gafchromic film (EBT 3) was also used. The Nk factor for the A-10 chamber was obtained through linear interpolation between ADCL supplied Nk factors for Cs-137 and M250. Results: EIC-1 measurements in solid water defined the outputs factor at 3 mm as 0.1343 cGy/U hr. The combination of A-10/ EIC-1 and A-10/EBT3 lead to output factors of 0.1383 and 0.1568 cGy/U hr, respectively. For comparison the output recommended by the vendor is 0.1659 cGy/U hr. Conclusion: All determined dose rates were lower than the vendor supplied values. The observed discrepancy between extrapolation chamber and film methods can be ascribed to extracameral gradient effects that may not be fully accounted for by the former method.

  6. SU-G-201-05: Comparison of Different Methods for Output Verification of Eleckta Nucletron’s Valencia Skin Applicators

    Energy Technology Data Exchange (ETDEWEB)

    Barrett, J; Yudelev, M [McLaren-Macomb, Clinton Township, MI (United States)

    2016-06-15

    Purpose: The provided output factors for Elekta Nucletron’s skin applicators are based on Monte Carlo simulations. These outputs have not been independently verified, and there is no recognized method for output verification of the vendor’s applicators. The purpose of this work is to validate the outputs provided by the vendor experimentally. Methods: Using a Flexitron Ir-192 HDR unit, three experimental methods were employed to determine dose with the 30 mm diameter Valencia applicator: first a gradient method using extrapolation ionization chamber (Far West Technology, EIC-1) measurements in solid water phantom at 3 mm SCD was used. The dose was derived based on first principles. Secondly a combination of a parallel plate chamber (Exradin A-10) and the EIC-1 was used to determine air kerma at 3 mm SCD. The air kerma was converted to dose to water in line with TG-61 formalism by using a muen ratio and a scatter factor measured with the skin applicators. Similarly a combination of the A-10 parallel plate chamber and gafchromic film (EBT 3) was also used. The Nk factor for the A-10 chamber was obtained through linear interpolation between ADCL supplied Nk factors for Cs-137 and M250. Results: EIC-1 measurements in solid water defined the outputs factor at 3 mm as 0.1343 cGy/U hr. The combination of A-10/ EIC-1 and A-10/EBT3 lead to output factors of 0.1383 and 0.1568 cGy/U hr, respectively. For comparison the output recommended by the vendor is 0.1659 cGy/U hr. Conclusion: All determined dose rates were lower than the vendor supplied values. The observed discrepancy between extrapolation chamber and film methods can be ascribed to extracameral gradient effects that may not be fully accounted for by the former method.

  7. A Comparison of the Reproductive Output Among the Relatives of Samoan Androphilic Fa'afafine and Gynephilic Men.

    Science.gov (United States)

    Semenyna, Scott W; Petterson, Lanna J; VanderLaan, Doug P; Vasey, Paul L

    2017-01-01

    The sexually antagonistic gene hypothesis (SAGH) for male androphilia posits that genes associated with androphilia (i.e., sexual attraction to adult males) will result in lowered reproduction when present in males, but increased reproduction when present in females. Findings derived from some Western European samples furnish support for the SAGH; however, results from studies conducted in other regions of the world have been more equivocal. Our previous research in Samoa indicated that the mothers as well as the maternal and paternal grandmothers of androphilic males (known locally as fa'afafine) exhibit elevated reproductive output when compared to the relatives of gynephilic men (i.e., males that are sexually attracted to adult females). The present replication study tested the SAGH in Samoa using a sample that was 122 % larger than the one previously studied by our group (VanderLaan, Forrester, Petterson, & Vasey, 2012). In line with the predictions of the SAGH, we hypothesized that the grandmothers, aunts, and mothers of fa'afafine would show elevated reproductive output compared to those of Samoan gynephilic men. Data were collected from 191 fa'afafine and 191 gynephilic men on the reproductive output of their paternal and maternal biological relatives (i.e., mothers, grandmothers, aunts, uncles). The mothers and maternal grandmothers of fa'afafine showed elevated reproductive output compared to those of gynephilic men. The paternal grandmother effect was not replicated. Although these results are consistent with the SAGH, a lack of difference in the reproductive output of aunts renders support for the SAGH in Samoa equivocal.

  8. SU-F-T-610: Comparison of Output Factors for Small Radiation Fields Used in SBRT Treatment

    International Nuclear Information System (INIS)

    Gupta, R; Eldib, A; Li, J; Ma, C

    2016-01-01

    Purpose: In order to fundamentally understand our previous dose verification results between measurements and calculations from treatment planning system (TPS) for SBRT plans for different sized targets, the goal of the present work was to compare output factors for small fields measured using EDR2 films with TPS and Monet Carlo (MC) simulations. Methods: 6MV beam was delivered to EDR2 films for each of the following field sizes; 1×1 cm"2, 1.5×1.5 cm"2, 2×2 cm"2, 3×3 cm"2, 4×4 cm"2, 5×5 cm"2 and 10×10 cm"2. The films were developed in a film processer, then scanned with a Vidar VXR-16 scanner and analyzed using RIT113 version 6.1. A standard calibration curve was obtained with the 6MV beam and was used to get absolute dose for measured field sizes. Similar plans for all fields sizes mentioned above were generated using Eclipse with the Analytical Anisotropic Algorithm. Similarly, MC simulations were carried out using the MCSIM, an in-house MC code for different field sizes. Output factors normalized to 10×10 cm"2 reference field were calculated for different field sizes in all the three cases and compared. Results: For field sizes ranging from 1×1 cm"2 to 2×2 cm"2, the differences in output factors between measurements (films), TPS and MC simulations were within 0.22%. For field sizes ranging from 3×3cm"2 to 5×5cm"2, differences in output factors were within 0.10%. Conclusion: No clinically significant difference was obtained in output factors for different field sizes acquired from films, TPS and MC simulations. Our results showed that the output factors are predicted accurately from TPS when compared to the actual measurements and superior dose calculation Monte Carlo method. This study would help us in understanding our previously obtained dose verification results for small fields used in the SBRT treatment.

  9. A comparison of two Fem-based methods for the solution of the nonlinear output regulation problem

    Czech Academy of Sciences Publication Activity Database

    Rehák, Branislav; Čelikovský, Sergej; Ruiz-León, J.; Orozco-Mora, J.

    2009-01-01

    Roč. 45, č. 3 (2009), s. 427-444 ISSN 0023-5954 R&D Projects: GA ČR GP102/07/P413; GA ČR(CZ) GA102/08/0186 Institutional research plan: CEZ:AV0Z10750506 Keywords : nonlinear output regulation * singularly perturbed equation * byroscope Subject RIV: BC - Control Systems Theory Impact factor: 0.445, year: 2009

  10. Cardiac gated ventilation

    International Nuclear Information System (INIS)

    Hanson, C.W. III; Hoffman, E.A.

    1995-01-01

    There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. The authors evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50 msec scan aperture. Multi slice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. The authors observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a non-failing model of the heart

  11. Utility of physical examination and comparison to echocardiography for cardiac diagnosis

    Directory of Open Access Journals (Sweden)

    Ashish Patel

    2017-03-01

    Conclusion: Careful clinical auscultation using a stethoscope remains a valuable tool for cardiac diagnosis. Decision on initial diagnosis and management of valvular and congenital heart diseases should be based on clinical examination and integrating such information with echocardiography as required.

  12. Aircraft noise effects on sleep: a systematic comparison of EEG awakenings and automatically detected cardiac activations

    International Nuclear Information System (INIS)

    Basner, Mathias; Müller, Uwe; Elmenhorst, Eva-Maria; Kluge, Götz; Griefahn, Barbara

    2008-01-01

    Polysomnography is the gold standard for investigating noise effects on sleep, but data collection and analysis are sumptuous and expensive. We recently developed an algorithm for the automatic identification of cardiac activations associated with cortical arousals, which uses heart rate information derived from a single electrocardiogram (ECG) channel. We hypothesized that cardiac activations can be used as estimates for EEG awakenings. Polysomnographic EEG awakenings and automatically detected cardiac activations were systematically compared using laboratory data of 112 subjects (47 male, mean ± SD age 37.9 ± 13 years), 985 nights and 23 855 aircraft noise events (ANEs). The probability of automatically detected cardiac activations increased monotonically with increasing maximum sound pressure levels of ANEs, exceeding the probability of EEG awakenings by up to 18.1%. If spontaneous reactions were taken into account, exposure–response curves were practically identical for EEG awakenings and cardiac activations. Automatically detected cardiac activations may be used as estimates for EEG awakenings. More investigations are needed to further validate the ECG algorithm in the field and to investigate inter-individual differences in its ability to predict EEG awakenings. This inexpensive, objective and non-invasive method facilitates large-scale field studies on the effects of traffic noise on sleep

  13. Comparison of Single-Particle Monte Carlo Simulation with Measured Output Characteristics of an 0.1µm n-MOSFET

    Directory of Open Access Journals (Sweden)

    F. M. Bufler

    2002-01-01

    Full Text Available A comparison between non-selfconsistent single-particle Monte Carlo (MC simulations and measurements of the output characteristics of an 0.1 µm n-MOSFET is presented. First the bulk MC model, which features a new simplified treatment of inelastic acoustic intravalley scattering, is validated by comparison with experimental literature data for mobilities and velocities. The dopant distribution of the MOSFET is obtained from a 2D process simulation, which is calibrated with SIMS and electrical measurements and fine-tuned by a comparison of the measured transfer characteristics in the subthreshold regime with a coupled Schro¨dinger drift-diffusion (DD simulation. Then the quantum effect is replaced by a shift of the work function and the DD, hydrodynamic (HD and MC models are adjusted to reproduce the measured drain current in the linear regime. The results of the three models in the non-linear regime are compared without further adjustment to the measured output characteristics. While good agreement is found for the MC model, the on-current is significantly overestimated by the HD model and underestimated by the DD model.

  14. SiC JFET Cascode Loss Dependency on the MOSFET Output Capacitance and Performance Comparison with Trench IGBTs

    DEFF Research Database (Denmark)

    Pittini, Riccardo; Zhang, Zhe; Andersen, Michael A. E.

    2013-01-01

    output capacitance on the switching performance of the SiC Cascode connection in terms of switching energy loss, dV/dt and dI/dt stresses. The Cascode connection switching performances are compared with the switching performance latest Trench IGBTs. The analysis is based on a set of several laboratory...... measurements and data post-processing in order to properly characterize the devices and quantify whether the SiC JFET Cascode connection can provide good performances with a simple MOSFET gate driver....

  15. Technical Skills Training for Veterinary Students: A Comparison of Simulators and Video for Teaching Standardized Cardiac Dissection.

    Science.gov (United States)

    Allavena, Rachel E; Schaffer-White, Andrea B; Long, Hanna; Alawneh, John I

    The goal of the study was to evaluate alternative student-centered approaches that could replace autopsy sessions and live demonstration and to explore refinements in assessment procedures for standardized cardiac dissection. Simulators and videos were identified as feasible, economical, student-centered teaching methods for technical skills training in medical contexts, and a direct comparison was undertaken. A low-fidelity anatomically correct simulator approximately the size of a horse's heart with embedded dissection pathways was constructed and used with a series of laminated photographs of standardized cardiac dissection. A video of a standardized cardiac dissection of a normal horse's heart was recorded and presented with audio commentary. Students were allowed to nominate a preference for learning method, and students who indicated no preference were randomly allocated to keep group numbers even. Objective performance data from an objective structure assessment criterion and student perception data on confidence and competency from surveys showed both innovations were similarly effective. Evaluator reflections as well as usage logs to track patterns of student use were both recorded. A strong selection preference was identified for kinesthetic learners choosing the simulator and visual learners choosing the video. Students in the video cohort were better at articulating the reasons for dissection procedures and sequence due to the audio commentary, and student satisfaction was higher with the video. The major conclusion of this study was that both methods are effective tools for technical skills training, but consideration should be given to the preferred learning style of adult learners to maximize educational outcomes.

  16. Infectious complications after out-of-hospital cardiac arrest-A comparison between two target temperatures

    DEFF Research Database (Denmark)

    Dankiewicz, Josef; Nielsen, Niklas; Linder, Adam

    2017-01-01

    -to-treat population. Five-hundred patients (53%) developed pneumonia, severe sepsis or septic shock which was associated with mortality in multivariate analysis (Hazard ratio [HR] 1.39; 95%CI 1.13-1.70; p=0.001). There was no statistically significant difference in the incidence of infectious complications between......BACKGROUND: It has been suggested that target temperature management (TTM) increases the probability of infectious complications after cardiac arrest. We aimed to compare the incidence of pneumonia, severe sepsis and septic shock after out-of-hospital cardiac arrest (OHCA) in patients with two...... complications were recorded daily during the ICU-stay. Pneumonia, severe sepsis and septic shock were considered infectious complications. Procalcitonin (PCT) and C-reactive-protein (CRP) levels were measured at 24h, 48h and 72h after cardiac arrest. RESULTS: There were 939 patients in the modified intention...

  17. Comparison of remifentanil and low-dose fentanyl for fast-track cardiac anesthesia

    DEFF Research Database (Denmark)

    Khanykin, Boris; Siddiqi, Rizwan; Jensen, Per F

    2013-01-01

    BACKGROUND: Different anesthetic techniques have been used for fast tracking in cardiac anesthesia. Remifentanil, with its unique pharmacokinetic profile, could be an ideal drug for fast tracking. Possible limitations of remifentanil are rapid onset of postoperative pain after discontinuation...... of the drug infusion, which may increase the risk of an ischemic event. We conducted this randomized study to compare the efficacy of remifentanil versus low doses of fentanyl in fast-track cardiac anesthesia. It has been hypothesized that remifentanil would provide a safe anesthesia with no impact...... anesthesia. The study was designed as a prospective randomized study. The primary outcomes were changes in the cardiac index and creatine kinase MB fraction (CKMB), extubation times, mobilization times, and lengths of stay in the intensive care unit (ICU) and the hospital. Frequency of myocardial infarction...

  18. Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Atilla Canbulat

    2012-12-01

    Full Text Available Objectives: We compared effects of mechanical andmanual ventilation during transport to the intensive careunit(ICU in cardiac surgeries.Materials and methods: After ethical approval, 66 patients(ASAgrade II and III, 20-80years were assignedrandomly. Ventilation during transport to ICU was performedmanual (Group EV; n=36 or mechanical ventilation(Group MV; n=30. Measurements were recorded:operation room (A, during transport (T and in ICU (YB.Systolic, diastolic pressures (SAP, DAP, pulmonary arterialpressure (PAP, pulmonary capillary wedge pressure(PCWP, central venous pressure (CVP, heart rate (HR,cardiac output (CO, blood gases (pH, PCO2, PO2, BEand peripheral oxygen saturation (SpO2 were recorded.Stroke volume index (SVI, systemic and pulmonary vascularresistance indices (SVRI, PVRI and mean arterialpressures(MAP were calculated.Results: Patients were similar. Duration of transportwas shorter in Group MV (p< 0.01. The alterations inHR, MAP, DAP, CVP, PAP, PCWP, PVRI, SVRI, SVI, CO,SpO2 were similar, the increase in SAP during T periodwas higher in Group MV (p<0.05. Pulmonary arterial pHin Group MV was lower (p< 0.05. Arterial and pulmonaryarterial pO2, pCO2 decreased in Group MV, there was increasein Group EV during ICU (p< 0.001, p< 0.01, p<0.01, p< 0.05. During T period hypotension and tachycardiain Group EV, and hypertension in Group MV wereobserved.Conclusions: Mechanical ventilation had short transporttime, less alterations in hemodynamic and respiration valuesand less complication rates. We concluded that theuse of mechanical ventilation is a safer method for theintrahospital transport of critical patients. J Clin Exp Invest2012; 3(4: 521-528Key words: Cardiac surgery, patient transport, mechanicalventilator, manual ventilator, hemodynamia

  19. Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Landau, David; Adams, Elizabeth J.; Webb, Steve; Ross, Gillian

    2001-01-01

    Background and purpose: Adjuvant breast radiotherapy (RT) is now part of the routine care of patients with early breast cancer. However, analysis of the Early Breast Cancer Trialists' Collaborative suggests that patients with the lowest risk of dying of breast cancer are at significant risk of cardiac mortality due to longer relapse-free survival. Patients with a significant amount of heart in the high-dose volume have been shown to be at risk of fatal cardiac events. This study was designed to assess whether conformal planning or intensity-modulated radiotherapy (IMRT) techniques allow reduced cardiac irradiation whilst maintaining full target coverage. Material and methods: Ten patients with early breast cancer were available for computed tomography (CT) planning. Each had at least 1 cm maximum heart depth within the posterior border of conventional tangents. For each patient, plans were generated and compared using dose volume histograms for planning target volume (PTV) and organs at risk. The plans included conventional tangents with and without shielding. The shielding was designed to either completely spare the heart or to shield as much heart as possible without compromising PTV coverage. IMRT plans were also prepared using two- and four-field tangential and six-field arc-like beam arrangements. Results: PTV homogeneity was better for the tangential IMRT techniques. For all patients, cardiac irradiation was reduced by the addition of partial cardiac shielding to conventional tangents, without compromise of PTV coverage. The two- and four-field IMRT techniques also reduced heart doses. The average percentage volume of heart receiving >60% of the prescription dose was 4.4% (range 1.0-7.1%) for conventional tangents, 1.5% (0.2-3.9%) for partial shielding, 2.3% (0.5-4.6%) for the two-field IMRT technique and 2.2% (0.4-5.6%) for the four-field IMRT technique. For patients with larger maximum heart depths the four-field IMRT plan achieved greater heart sparing

  20. Multiple Species Comparison of Cardiac Troponin T and Dystrophin: Unravelling the DNA behind Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Jennifer England

    2017-07-01

    Full Text Available Animals have frequently been used as models for human disorders and mutations. Following advances in genetic testing and treatment options, and the decreasing cost of these technologies in the clinic, mutations in both companion and commercial animals are now being investigated. A recent review highlighted the genes associated with both human and non-human dilated cardiomyopathy. Cardiac troponin T and dystrophin were observed to be associated with both human and turkey (troponin T and canine (dystrophin dilated cardiomyopathies. This review gives an overview of the work carried out in cardiac troponin T and dystrophin to date in both human and animal dilated cardiomyopathy.

  1. Multiple Species Comparison of Cardiac Troponin T and Dystrophin: Unravelling the DNA behind Dilated Cardiomyopathy.

    Science.gov (United States)

    England, Jennifer; Loughna, Siobhan; Rutland, Catrin Sian

    2017-07-07

    Animals have frequently been used as models for human disorders and mutations. Following advances in genetic testing and treatment options, and the decreasing cost of these technologies in the clinic, mutations in both companion and commercial animals are now being investigated. A recent review highlighted the genes associated with both human and non-human dilated cardiomyopathy. Cardiac troponin T and dystrophin were observed to be associated with both human and turkey (troponin T) and canine (dystrophin) dilated cardiomyopathies. This review gives an overview of the work carried out in cardiac troponin T and dystrophin to date in both human and animal dilated cardiomyopathy.

  2. Direct comparison of in vivo versus postmortem second-order motion-compensated cardiac diffusion tensor imaging.

    Science.gov (United States)

    Stoeck, Christian T; von Deuster, Constantin; Fleischmann, Thea; Lipiski, Miriam; Cesarovic, Nikola; Kozerke, Sebastian

    2018-04-01

    To directly compare in vivo versus postmortem second-order motion-compensated spin-echo diffusion tensor imaging of the porcine heart. Second-order motion-compensated spin-echo cardiac diffusion tensor imaging was performed during systolic contraction in vivo and repeated upon cardiac arrest by bariumchloride without repositioning of the study animal or replaning of imaging slices. In vivo and postmortem reproducibility was assessed by repeat measurements. Comparison of helix, transverse, and sheet (E2A) angulation as well as mean diffusivity and fractional anisotropy was performed. Intraclass correlation coefficients for repeated measurements (postmortem/in vivo) were 0.95/0.96 for helix, 0.70/0.66 for transverse, and 0.79/0.72 for E2A angulation; 0.83/0.72 for mean diffusivity; and 0.78/0.76 for fractional anisotropy. The corresponding 95% levels of agreement across the left ventricle were: helix 14 to 18°/12 to 15°, transverse 9 to 10°/10 to 11°, E2A 15 to 20°/16 to 18°. The 95% levels of agreement across the left ventricle for the comparison of postmortem versus in vivo were 20 to 22° for helix, 13 to 19° for transverse, and 24 to 31° for E2A angulation. Parameters derived from in vivo second-order motion-compensated spin-echo diffusion tensor imaging agreed well with postmortem imaging, indicating sufficient suppression of motion-induced signal distortions of in vivo cardiac diffusion tensor imaging. Magn Reson Med 79:2265-2276, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  3. Comparison of the effects of inhalational anesthesia with desflurane and total intravenous anesthesia on cardiac biomarkers after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Poonam Malhotra Kapoor

    2015-01-01

    Full Text Available Objective (s: The aim of this study was to compare the effects of using inhalational anesthesia with desflurane with that of a total intravenous (iv anesthetic technique using midazolam-fentanyl-propofol on the release of cardiac biomarkers after aortic valve replacement (AVR for aortic stenosis (AS. The specific objectives included (a determination of the levels of ischemia-modified albumin (IMA and cardiac troponin I (cTnI as markers of myocardial injury, (b effect on mortality, morbidity, duration of mechanical ventilation, length of Intensive Care Unit (ICU and hospital stay, incidence of arrhythmias, pacing, cardioversion, urine output, and serum creatinine. Methodology and Design: Prospective randomized clinical study. Setting: Operation room of a cardiac surgery center of a tertiary teaching hospital. Participants: Seventy-six patients in New York Heart Association classification II to III presenting electively for AVR for severe symptomatic AS. Interventions: Patients included in the study were randomized into two groups and subjected to either a desflurane-fentanyl based technique or total IV anesthesia (TIVA. Blood samples were drawn at preordained intervals to determine the levels of IMA, cTnI, and serum creatinine. Measurements and Main Results: The IMA and cTnI levels were not found to be significantly different between both the study groups. Patients in the desflurane group were found to had significantly lower ICU and hospital stays and duration of postoperative mechanical ventilation as compared to those in the TIVA group. There was no difference found in mean heart rate, urine output, serum creatinine, incidence of arrhythmias, need for cardioversion, and 30-day mortality between both groups. The patients in the TIVA group had higher mean arterial pressures on weaning off cardiopulmonary bypass as well as postoperatively in the ICU and recorded lower inotrope usage. Conclusion: The result of our study remains ambiguous regarding

  4. Comparison of Transcutaneous Electrical Nerve Stimulation and Parasternal Block for Postoperative Pain Management after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Nilgun Kavrut Ozturk

    2016-01-01

    Full Text Available Background. Parasternal block and transcutaneous electrical nerve stimulation (TENS have been demonstrated to produce effective analgesia and reduce postoperative opioid requirements in patients undergoing cardiac surgery. Objectives. To compare the effectiveness of TENS and parasternal block on early postoperative pain after cardiac surgery. Methods. One hundred twenty patients undergoing cardiac surgery were enrolled in the present randomized, controlled prospective study. Patients were assigned to three treatment groups: parasternal block, intermittent TENS application, or a control group. Results. Pain scores recorded 4 h, 5 h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block group than in the TENS and control groups. Total morphine consumption was also lower in the parasternal block group than in the TENS and control groups. It was also significantly lower in the TENS group than in the control group. There were no statistical differences among the groups regarding the extubation time, rescue analgesic medication, length of intensive care unit stay, or length of hospital stay. Conclusions. Parasternal block was more effective than TENS in the management of early postoperative pain and the reduction of opioid requirements in patients who underwent cardiac surgery through median sternotomy. This trial is registered with Clinicaltrials.gov number NCT02725229.

  5. Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes

    Science.gov (United States)

    Høyte, Henning; Jensen, Torstein; Gjesdal, Knut

    2005-01-01

    Background To determine whether the use of an electronic, sensor based stethoscope affects the cardiac auscultation skills of undergraduate medical students. Methods Forty eight third year medical students were randomized to use either an electronic stethoscope, or a conventional acoustic stethoscope during clinical auscultation training. After a training period of four months, cardiac auscultation skills were evaluated using four patients with different cardiac murmurs. Two experienced cardiologists determined correct answers. The students completed a questionnaire for each patient. The thirteen questions were weighted according to their relative importance, and a correct answer was credited from one to six points. Results No difference in mean score was found between the two groups (p = 0.65). Grading and characterisation of murmurs and, if present, report of non existing murmurs were also rated. None of these yielded any significant differences between the groups. Conclusion Whether an electronic or a conventional stethoscope was used during training and testing did not affect the students' performance on a cardiac auscultation test. PMID:15882458

  6. Cardiac auscultation training of medical students: a comparison of electronic sensor-based and acoustic stethoscopes

    Directory of Open Access Journals (Sweden)

    Jensen Torstein

    2005-05-01

    Full Text Available Abstract Background To determine whether the use of an electronic, sensor based stethoscope affects the cardiac auscultation skills of undergraduate medical students. Methods Forty eight third year medical students were randomized to use either an electronic stethoscope, or a conventional acoustic stethoscope during clinical auscultation training. After a training period of four months, cardiac auscultation skills were evaluated using four patients with different cardiac murmurs. Two experienced cardiologists determined correct answers. The students completed a questionnaire for each patient. The thirteen questions were weighted according to their relative importance, and a correct answer was credited from one to six points. Results No difference in mean score was found between the two groups (p = 0.65. Grading and characterisation of murmurs and, if present, report of non existing murmurs were also rated. None of these yielded any significant differences between the groups. Conclusion Whether an electronic or a conventional stethoscope was used during training and testing did not affect the students' performance on a cardiac auscultation test.

  7. Dual-source cardiac computed tomography angiography (CCTA) in the follow-up of cardiac transplant: comparison of image quality and radiation dose using three different imaging protocols

    International Nuclear Information System (INIS)

    Beitzke, D.; Berger-Kulemann, V.; Unterhumer, S.; Loewe, C.; Wolf, F.; Schoepf, V.; Spitzer, E.; Feuchtner, G.M.; Gyoengyoesi, M.; Uyanik-Uenal, K.; Zuckermann, A.

    2015-01-01

    To prospectively evaluate image quality (IQ) and radiation dose of dual-source cardiac computed tomography (CCTA) using different imaging protocols. CCTA was performed in 150 patients using the retrospective ECG-gated spiral technique (rECG) the prospective ECG-gated technique (pECG), or the prospective ECG-gated technique with systolic imaging and automated tube voltage selection (pECGsys). IQ was rated using a 16-segment coronary artery model. Techniques were compared for overall IQ, IQ of the large and the small coronary artery segments. Effective dose was used for comparison of radiation dose. Overall IQ and IQ of the large segments showed no differences between the groups. IQ analysis of the small segments showed lowered IQ in pECGsys compared to rECG (p = 0.02), but not to pECG (p = 0.6). Effective dose did not differ significantly between rECG and pECG (p = 0.13), but was significantly lower for pECGsys (p < 0.001 vs. rECG and pECG). Radiation dose of dual-source CCTA in heart transplant recipients is significantly reduced by using prospective systolic scanning and automated tube voltage selection, while overall IQ and IQ of the large coronary segments are maintained. IQ appears to be lower compared to retrospective techniques with regard to small coronary segments. (orig.)

  8. Dual-source cardiac computed tomography angiography (CCTA) in the follow-up of cardiac transplant: comparison of image quality and radiation dose using three different imaging protocols

    Energy Technology Data Exchange (ETDEWEB)

    Beitzke, D.; Berger-Kulemann, V.; Unterhumer, S.; Loewe, C.; Wolf, F. [Medical University Vienna, Department of Biomedical Imaging and Image Guided Therapy, Division of Cardiovascular and Interventional Radiology, Vienna (Austria); Schoepf, V. [Medical University Vienna, Department of Biomedical Imaging and Image Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Vienna (Austria); Spitzer, E. [Bern University Hospital, Department of Cardiology, Bern (Switzerland); Feuchtner, G.M. [Innsbruck Medical University, Department of Radiology II, Innsbruck (Austria); Gyoengyoesi, M. [Medical University Vienna, Department of Cardiology, Vienna (Austria); Uyanik-Uenal, K.; Zuckermann, A. [Medical University Vienna, Department of Cardiac Surgery, Vienna (Austria)

    2015-08-15

    To prospectively evaluate image quality (IQ) and radiation dose of dual-source cardiac computed tomography (CCTA) using different imaging protocols. CCTA was performed in 150 patients using the retrospective ECG-gated spiral technique (rECG) the prospective ECG-gated technique (pECG), or the prospective ECG-gated technique with systolic imaging and automated tube voltage selection (pECGsys). IQ was rated using a 16-segment coronary artery model. Techniques were compared for overall IQ, IQ of the large and the small coronary artery segments. Effective dose was used for comparison of radiation dose. Overall IQ and IQ of the large segments showed no differences between the groups. IQ analysis of the small segments showed lowered IQ in pECGsys compared to rECG (p = 0.02), but not to pECG (p = 0.6). Effective dose did not differ significantly between rECG and pECG (p = 0.13), but was significantly lower for pECGsys (p < 0.001 vs. rECG and pECG). Radiation dose of dual-source CCTA in heart transplant recipients is significantly reduced by using prospective systolic scanning and automated tube voltage selection, while overall IQ and IQ of the large coronary segments are maintained. IQ appears to be lower compared to retrospective techniques with regard to small coronary segments. (orig.)

  9. Comparison of two teaching methods for cardiac arrhythmia interpretation among nursing students.

    Science.gov (United States)

    Varvaroussis, Dimitrios P; Kalafati, Maria; Pliatsika, Paraskevi; Castrén, Maaret; Lott, Carsten; Xanthos, Theodoros

    2014-02-01

    The aim of this study was to compare the six-stage method (SSM) for instructing primary cardiac arrhythmias interpretation to students without basic electrocardiogram (ECG) knowledge with a descriptive teaching method in a single educational intervention. This is a randomized trial. Following a brief instructional session, undergraduate nursing students, assigned to group A (SSM) and group B (descriptive teaching method), undertook a written test in cardiac rhythm recognition, immediately after the educational intervention (initial exam). Participants were also examined with an unannounced retention test (final exam), one month after instruction. Altogether 134 students completed the study. Interpretation accuracy for each cardiac arrhythmia was assessed. Mean score at the initial exam was 8.71±1.285 for group A and 8.74±1.303 for group B. Mean score at the final exam was 8.25±1.46 for group A vs 7.84±1.44 for group B. Overall results showed that the SSM was equally effective with the descriptive teaching method. The study showed that in each group bradyarrhythmias were identified correctly by more students than tachyarrhythmias. No significant difference between the two teaching methods was seen for any specific cardiac arrhythmia. The SSM effectively develops staff competency for interpreting common cardiac arrhythmias in students without ECG knowledge. More research is needed to support this conclusion and the method's effectiveness must be evaluated if being implemented to trainee groups with preexisting basic ECG interpretation knowledge. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. Quantitative Assessment of Left Ventricular Function and Myocardial Mass: A Comparison of Coronary CT Angiography with Cardiac MRI and Echocardiography

    International Nuclear Information System (INIS)

    Kara, Bedia; Nayman, Alaaddin; Guler, Ibrahim; Gul, Enes Elvin; Koplay, Mustafa; Paksoy, Yahya

    2016-01-01

    The purpose of this study was to compare the left ventricular parameters obtained from multi-detector row computed tomography (MDCT) studies with two-dimensional echocardiography (2DE), and magnetic resonance imaging (MRI), which is accepted as the gold standard in the evaluation of left ventricular functions. The study also aimed to evaluate whether or not there is a relationship between the MR-Argus and CMR tools software programs which are used in post-process calculations of data obtained by MRI. Forty patients with an average age of 51.4±14.9 years who had been scanned with cardiac MDCT were evaluated with cardiac MRI and 2DE. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), and myocardial mass values calculated by MDCT, MRI, and 2DE were compared with each other. Two different MR software programs were used to compare left ventricular functions. The CMR tools LV tutorials method is accepted as the gold standard because it can be used in three-dimensional functional evaluation. The Pearson Correlation and Bland-Altman analysis were performed to compare the results from the two MR methods (MR-Argus and CMR tools) and the results from both the MDCT and the 2DE with the CMR tools results. Strong positive correlations for EF values were found between the MDCT and CMR tools (r=0.702 p<0.001), and between the MR-Argus and CMR tools (r=0.746 p<0.001). The correlation between the 2DE and CMR tools (r=0.449 p<0.004), however, was only moderate. Similar results were obtained for the other parameters. The strongest correlation for ESV, EDV, and EF was between the two MR software programs. The correlation coefficient between the MDCT and CMR tools is close to the correlation coefficient between the two software programs. While the correlation between 2DE and CMR tools was satisfactory for ESV, EDV, and CO values, it was at a moderate level for the other parameters. Left ventricular functional analysis

  11. Cardiac effects of granisetron in a prospective crossover randomized dose comparison trial.

    Science.gov (United States)

    Cakir, F B; Yapar, O; Canpolat, C; Akalin, F; Berrak, S G

    2012-10-01

    Cardiac side effects of granisetron have been studied mostly in adult patients that are using cardiotoxic chemotherapeutics. There is limited evidence in pediatric age group and no information in pediatric oncology patients with non-cardiotoxic chemotherapeutics. In this prospective, crossover randomized study, the cardiac side effects of granisetron are compared in pediatric oncology patients who had carboplatin based chemotherapy. They were randomized to receive either 10 or 40 μg kg(-1) dose(-1) of granisetron before each cycle of chemotherapy. We drew blood for creatine phosphokinase (CPK), CPK-muscle band (MB) and Troponin-T before and 24 h after administering granisetron. Electrocardiography (ECG) tracings were taken at 0, 1, 2, 3, 6 and 24 h of granisetron. Twenty-four hours Holter ECG monitorisation was performed after each granisetron infusion. A total of 16 patients (median 8.7 years of age) were treated with weekly consecutive courses of carboplatin. There was bradycardia (p = 0.000) in patients that had granisetron at 40 μg/kg and PR interval was shortened in patients that had granisetron at 10 μg/kg dose (p = 0.021). At both doses of granisetron, QTc interval and dispersion were found to be similar. CPK, CK-MB and Troponin-T values were found to be normal before and 24 h after granisetron infusion. As the first study that has studied cardiac side effects of granisetron in patients that are not using cardiotoxic chemotherapeutics, we conclude that granisetron at 40 μg kg(-1) dose(-1) causes bradycardia only. We have also demonstrated that granisetron does not cause any clinically cardiac side effects either at 10 or 40 μg kg(-1) dose(-1). However, our results should be supported by prospective randomized studies with larger samples of patient groups.

  12. Multiple species comparison of cardiac troponin T and dystrophin: unravelling the DNA behind dilated cardiomyopathy

    OpenAIRE

    England, Jennifer; Loughna, Siobhan; Rutland, Catrin S.

    2017-01-01

    Animals have frequently been used as models for human disorders and mutations. Following advances in genetic testing and treatment options, and the decreasing cost of these technologies in the clinic, mutations in both companion and commercial animals are now being investigated. A recent review highlighted the genes associated with both human and non-human dilated cardiomyopathy. Cardiac troponin T and dystrophin were observed to be associated with both human and turkey (troponin T) and canin...

  13. Comparison of simultaneous and sequential SPECT imaging for discrimination tasks in assessment of cardiac defects.

    Science.gov (United States)

    Trott, C M; Ouyang, J; El Fakhri, G

    2010-11-21

    Simultaneous rest perfusion/fatty-acid metabolism studies have the potential to replace sequential rest/stress perfusion studies for the assessment of cardiac function. Simultaneous acquisition has the benefits of increased signal and lack of need for patient stress, but is complicated by cross-talk between the two radionuclide signals. We consider a simultaneous rest (99m)Tc-sestamibi/(123)I-BMIPP imaging protocol in place of the commonly used sequential rest/stress (99m)Tc-sestamibi protocol. The theoretical precision with which the severity of a cardiac defect and the transmural extent of infarct can be measured is computed for simultaneous and sequential SPECT imaging, and their performance is compared for discriminating (1) degrees of defect severity and (2) sub-endocardial from transmural defects. We consider cardiac infarcts for which reduced perfusion and metabolism are observed. From an information perspective, simultaneous imaging is found to yield comparable or improved performance compared with sequential imaging for discriminating both severity of defect and transmural extent of infarct, for three defects of differing location and size.

  14. Comparison of simultaneous and sequential SPECT imaging for discrimination tasks in assessment of cardiac defects

    International Nuclear Information System (INIS)

    Trott, C M; Ouyang, J; El Fakhri, G

    2010-01-01

    Simultaneous rest perfusion/fatty-acid metabolism studies have the potential to replace sequential rest/stress perfusion studies for the assessment of cardiac function. Simultaneous acquisition has the benefits of increased signal and lack of need for patient stress, but is complicated by cross-talk between the two radionuclide signals. We consider a simultaneous rest 99m Tc-sestamibi/ 123 I-BMIPP imaging protocol in place of the commonly used sequential rest/stress 99m Tc-sestamibi protocol. The theoretical precision with which the severity of a cardiac defect and the transmural extent of infarct can be measured is computed for simultaneous and sequential SPECT imaging, and their performance is compared for discriminating (1) degrees of defect severity and (2) sub-endocardial from transmural defects. We consider cardiac infarcts for which reduced perfusion and metabolism are observed. From an information perspective, simultaneous imaging is found to yield comparable or improved performance compared with sequential imaging for discriminating both severity of defect and transmural extent of infarct, for three defects of differing location and size.

  15. Therapeutic drug monitoring of digoxin in cardiac heart failure outpatients: comparisons of two analytical methods

    Directory of Open Access Journals (Sweden)

    Isabel Cristina Medeiros Barros

    2014-01-01

    Full Text Available Objective: To compare two analytical techniques used in the determination of plasma digoxin (LC-MS/MS and immunoassay and to verify which one better answer the need of the clinical monitoring routine of patients with cardiac heart failure. Method: The clinical findings in 15 cardiac heart failure (CHF outpatients of the Cardiac Heart Service of the Goias Federal University Clinical Hospital were investigated. Blood samples of the patients were collected and analysed by Immunoassay and by Liquid Chromatography coupled to Mass Spectrometry (LC-MS/MS. Results: The results of the statistic test (Student p = 0,05 showed a significant difference between the analytical methods: immunoassay concentrations were higher than the concentrations determined by LCMS/ MS. The explanation may be because immunoassay method measures digoxin plus other metabolites and endogenous substances, while the LC-MS/MS method measures only the digoxin molecule. None of the patients, showed relevant clinical data suggestive of digitalis intoxication, even several drugs with potential interaction were associated with treatment. Conclusion: It was concluded, therefore, that LC-MS/MS me thod is safer, more selective and specific than immunoassay, being an option for therapeutic drug monitoring of digoxin, since the reference values would be obtain for digoxinemia by LC-MS/MS.

  16. Determination of output factor for 6 MV small photon beam: comparison between Monte Carlo simulation technique and microDiamond detector

    International Nuclear Information System (INIS)

    Krongkietlearts, K; Tangboonduangjit, P; Paisangittisakul, N

    2016-01-01

    In order to improve the life's quality for a cancer patient, the radiation techniques are constantly evolving. Especially, the two modern techniques which are intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are quite promising. They comprise of many small beam sizes (beamlets) with various intensities to achieve the intended radiation dose to the tumor and minimal dose to the nearby normal tissue. The study investigates whether the microDiamond detector (PTW manufacturer), a synthetic single crystal diamond detector, is suitable for small field output factor measurement. The results were compared with those measured by the stereotactic field detector (SFD) and the Monte Carlo simulation (EGSnrc/BEAMnrc/DOSXYZ). The calibration of Monte Carlo simulation was done using the percentage depth dose and dose profile measured by the photon field detector (PFD) of the 10×10 cm 2 field size with 100 cm SSD. Comparison of the values obtained from the calculations and measurements are consistent, no more than 1% difference. The output factors obtained from the microDiamond detector have been compared with those of SFD and Monte Carlo simulation, the results demonstrate the percentage difference of less than 2%. (paper)

  17. Estimating core temperature in infants and children after cardiac surgery: a comparison of six methods.

    Science.gov (United States)

    Maxton, Fiona J C; Justin, Linda; Gillies, Donna

    2004-01-01

    Monitoring temperature in critically ill children is an important component of care, yet the accuracy of methods is often questioned. Temperature measured in the pulmonary artery is considered the 'gold standard', but this route is unsuitable for the majority of patients. An accurate, reliable and less invasive method is, however, yet to be established in paediatric intensive care work. To determine which site most closely reflects core temperature in babies and children following cardiac surgery, by comparing pulmonary artery temperature to the temperature measured at rectal, bladder, nasopharyngeal, axillary and tympanic sites. A convenience sample of 19 postoperative cardiac patients was studied. Temperature was recorded as a continuous measurement from pulmonary artery, rectal, nasopharyngeal and bladder sites. Axillary and tympanic temperatures were recorded at 30 minute intervals for 6 1/2 hours postoperatively. The small sample size of 19 infants and children limits the generalizability of the study. Repeated measures analysis of variance demonstrated no significant difference between pulmonary artery and bladder temperatures, and pulmonary artery and nasopharyngeal temperatures. Intraclass correlation showed that agreement was greatest between pulmonary artery temperature and temperature measured by bladder catheter. There was a significant difference between pulmonary artery temperature and temperature measured at rectal, tympanic and pulmonary artery and axillary sites. Repeated measures analysis showed a significant lag between pulmonary artery and rectal temperature of between 0 and 150 minutes after the 6-hour measurement period. In this study, bladder temperature was shown to be the best estimate of pulmonary artery temperature, closely followed by the temperature measured by nasopharyngeal probe. The results support the use of bladder or nasopharyngeal catheters to monitor temperature in critically ill children after cardiac surgery.

  18. Comparison of neostigmine and sugammadex for hemodynamic parameters in cardiac patients undergoing noncardiac surgery.

    Science.gov (United States)

    Kizilay, Deniz; Dal, Didem; Saracoglu, Kemal T; Eti, Zeynep; Gogus, Fevzi Y

    2016-02-01

    The aim of this study is to compare the hemodynamic effects of neostigmine-atropine combination and sugammadex in patients with cardiac problems undergoing noncardiac surgery. Prospective randomized study. In the operating room. Ninety patients with a class 2 or 3 cardiovascular disease according to the New York Heart Association classification and aged between 18 and 75 years undergoing noncardiac surgery were randomized. Group N (n = 45) received 0.03 mg/kg IV neostigmine when T2 appeared as measured with a nerve muscle stimulator. When heart rate was 5 beats/min (±10 beats/min) lower than the heart rate before administration of the medication, 0.5 mg IV atropine sulfate was given. Group S (n = 45) received 3 mg/kg IV sugammadex when T2 appeared as measured with a nerve muscle stimulator. Heart rate, mean systolic and diastolic blood pressures, and electrocardiographic alterations including the QTc (QT Fredericia and QT Bazett) were recorded. There were no significant differences between and within the groups in terms of QTc values. Sugammadex group had a significant decrease on heart rate 1 minute after the medication when compared to the measurement before the medication (P Sugammadex group had lower systolic, diastolic, and mean blood pressures and heart rate when compared to neostigmine group (P sugammadex might be preferred as it provides more hemodynamic stability compared to neostigmine-atropine combination to reverse rocuronium-induced neuromuscular blockage in cardiac patients undergoing noncardiac surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Comparison of cone beam SPECT with conventional SPECT by means of cardiac-thorax phantom

    International Nuclear Information System (INIS)

    McGrath, M.A.; Manglos, S.H.

    1989-01-01

    Because of poor energy characteristics of Tl-201 used for myocardial perfusion imaging, the high sensitivity of cone-beam collimation is highly desirable. Using a cardiac-thorax phantom, the authors have compared single photon emission computed tomographic (SPECT) images obtained with a cone-beam collimator to those from a parallel hole collimator commonly used for thallium studies. A water-filled circular phantom with a cardiac insert was imaged. The myocardial shell was filled with Tl-201 (220 μCi). Two solid inserts within the myocardium simulated perfusion defects. The phantom ignores truncation effects in this preliminary experiment. For the authors' collimator, the resolution was designed to be similar to the authors' all-purpose, parallel-hole collimator at 10 cm. The focal length was 50 cm. The experimental protocol was chosen to be similar to their clinical protocol. A filtered back projection algorithm was used for cone-beam data. The same algorithm was used for the parallel-hole data, but with focal length set to infinity

  20. Self-gating MR imaging of the fetal heart: comparison with real cardiac triggering

    International Nuclear Information System (INIS)

    Yamamura, Jin; Frisch, Michael; Ecker, Hannes; Adam, Gerhard; Wedegaertner, Ulrike; Graessner, Joachim; Hecher, Kurt

    2011-01-01

    To investigate the self-gating technique for MR imaging of the fetal heart in a sheep model. MR images of 6 fetal sheep heart were obtained at 1.5T. For self-gating MRI of the fetal heart a cine SSFP in short axis, two and four chamber view was used. Self-gated images were compared with real cardiac triggered MR images (pulse-wave triggering). MRI of the fetal heart was performed using both techniques simultaneously. Image quality was assessed and the left ventricular volume and function were measured and compared. Compared with pulse-wave triggering, the self-gating technique produced slightly inferior images with artifacts. Especially the atrial septum could not be so clearly depicted. The contraction of the fetal heart was shown in cine sequences in both techniques. The average blood volumes could be measured with both techniques with no significant difference: at end-systole 3.1 ml (SD± 0.2), at end-diastole 4.9 ml (±0.2), with ejection fractions at 38.6%, respectively 39%. Both self-gating and pulse-wave triggered cardiac MRI of the fetal heart allowed the evaluation of anatomical structures and functional information. Images obtained by self-gating technique were slightly inferior than the pulse-wave triggered MRI. (orig.)

  1. Assessment of acute myocarditis by cardiac magnetic resonance imaging: Comparison of qualitative and quantitative analysis methods.

    Science.gov (United States)

    Imbriaco, Massimo; Nappi, Carmela; Puglia, Marta; De Giorgi, Marco; Dell'Aversana, Serena; Cuocolo, Renato; Ponsiglione, Andrea; De Giorgi, Igino; Polito, Maria Vincenza; Klain, Michele; Piscione, Federico; Pace, Leonardo; Cuocolo, Alberto

    2017-10-26

    To compare cardiac magnetic resonance (CMR) qualitative and quantitative analysis methods for the noninvasive assessment of myocardial inflammation in patients with suspected acute myocarditis (AM). A total of 61 patients with suspected AM underwent coronary angiography and CMR. Qualitative analysis was performed applying Lake-Louise Criteria (LLC), followed by quantitative analysis based on the evaluation of edema ratio (ER) and global relative enhancement (RE). Diagnostic performance was assessed for each method by measuring the area under the curves (AUC) of the receiver operating characteristic analyses. The final diagnosis of AM was based on symptoms and signs suggestive of cardiac disease, evidence of myocardial injury as defined by electrocardiogram changes, elevated troponin I, exclusion of coronary artery disease by coronary angiography, and clinical and echocardiographic follow-up at 3 months after admission to the chest pain unit. In all patients, coronary angiography did not show significant coronary artery stenosis. Troponin I levels and creatine kinase were higher in patients with AM compared to those without (both P quantitative (ER 0.89 and global RE 0.80) analyses were also similar. Qualitative and quantitative CMR analysis methods show similar diagnostic accuracy for the diagnosis of AM. These findings suggest that a simplified approach using a shortened CMR protocol including only T2-weighted STIR sequences might be useful to rule out AM in patients with acute coronary syndrome and normal coronary angiography.

  2. Chemoprophylaxis in cardiac and orthopedic surgery: comparison of cephalothin and cephapirin.

    Science.gov (United States)

    Bryant, R E; Hartstein, A I; Starr, A; Beals, R K

    1982-09-01

    In a retrospective sequential study we determined the rate of infection occurring despite cephalothin or cephapirin chemoprophylaxis in orthopedic and cardiac surgery done from 1973 to 1977. The incidence of infection after prosthetic hip placement or open reduction of hip fracture was 3.4% and 1.0% in patients receiving cephalothin or cephapirin, respectively. The infection rate after prosthetic heart valve implantation was 3.5% in those receiving cephalothin and 1.6% in those receiving cephapirin. There was no significant difference in infection rate, duration of fever greater than or equal to 38.0 C, or length of postoperative hospitalization. The efficacy of selected antistaphylococcal antibiotics in preventing colonization of human fibrin clots by staphylococci was studied. Although cephapirin was effective at lower concentration, the activity of cephalothin and cephapirin was comparable. Cephalothin and cephapirin have equivalent chemoprophylactic activity by clinical and microbiological criteria, permitting cost to be used as a basis for choosing between these antibiotics.

  3. DNA damage in lymphocytes induced by cardiac CT and comparison with physical exposure parameters

    Energy Technology Data Exchange (ETDEWEB)

    Fukumoto, Wataru; Tatsugami, Fuminari; Awai, Kazuo [Department of Diagnostic Radiology, Institute of Biomedical Health Sciences, Hiroshima University, Hiroshima (Japan); Ishida, Mari; Sakai, Chiemi [Institute of Biomedical and Health Sciences, Department of Cardiovascular Physiology and Medicine, Hiroshima University, Hiroshima (Japan); Tashiro, Satoshi [Hiroshima University, Department of Cellular Biology, Research Institute for Radiation Biology and Medicine, Hiroshima (Japan); Ishida, Takafumi [Institute of Clinical Research West Medical Center, Hiroshima (Japan); Nakano, Yukiko [Hiroshima University Hospital, Department of Cardiovascular Medicine, Hiroshima (Japan)

    2017-04-15

    To investigate whether physical exposure parameters such as the dose index (CTDI), dose length product (DLP), and size-specific dose estimate (SSDE) are predictive of DNA damage. In vitro, we scanned a phantom containing blood samples from five volunteers at CTDI 50, 100, and 150 mGy. One sample was not scanned. We also scanned samples in three different-size phantoms at CTDI 100 mGy. In vivo, we enrolled 45 patients and obtained blood samples before and after cardiac CT. The γ-H2AX foci were counted. In vitro, in the control and at CTDI 50, 100, and 150 mGy, the number of γ-H2AX was 0.94 ± 0.24 (standard error, SE), 1.28 ± 0.30, 1.91 ± 0.47, and 2.16 ± 0.20. At SSDE 180, 156, and 135 mGy, it was 2.41 ± 0.20, 1.91 ± 0.47, and 1.42 ± 0.20 foci/cell. The γ-H2AX foci were positively correlated with the radiation dose and negatively correlated with the body size. In vivo, the γ-H2AX foci were significantly increased after CT (from 1.21 ± 0.19 to 1.92 ± 0.22 foci/cell) and correlated with CTDI, DLP, and SSDE. DNA damage was induced by cardiac CT. There was a correlation between the physical exposure parameters and γ-H2AX. (orig.)

  4. Cardiac Organ Damage and Arterial Stiffness in Autonomic Failure: Comparison With Essential Hypertension.

    Science.gov (United States)

    Milazzo, Valeria; Maule, Simona; Di Stefano, Cristina; Tosello, Francesco; Totaro, Silvia; Veglio, Franco; Milan, Alberto

    2015-12-01

    Autonomic failure (AF) is characterized by orthostatic hypotension, supine hypertension, and increased blood pressure (BP) variability. AF patients develop cardiac organ damage, similarly to essential hypertension (EH), and have higher arterial stiffness than healthy controls. Determinants of cardiovascular organ damage in AF are not well known: both BP variability and mean BP values may be involved. The aim of the study was to evaluate cardiac organ damage, arterial stiffness, and central hemodynamics in AF, compared with EH subjects with similar 24-hour BP and a group of healthy controls, and to evaluate determinants of target organ damage in patients with AF. Twenty-seven patients with primary AF were studied (mean age, 65.7±11.2 years) using transthoracic echocardiography, carotid-femoral pulse wave velocity, central hemodynamics, and 24-hour ambulatory BP monitoring. They were compared with 27 EH subjects matched for age, sex, and 24-hour mean BP and with 27 healthy controls. AF and EH had similar left ventricular mass (101.6±33.3 versus 97.7±28.1 g/m(2), P=0.59) and carotid-femoral pulse wave velocity (9.3±1.8 versus 9.2±3.0 m/s, P=0.93); both parameters were significantly lower in healthy controls (Phypertensive heart disease and increased arterial stiffness, similar to EH with comparable mean BP values. Twenty-four-hour and nighttime systolic BP were determinants of cardiovascular damage, independent of BP variability. © 2015 American Heart Association, Inc.

  5. Cardiac manifestations of GH deficiency after treatment for acromegaly: a comparison to patients with biochemical remission and controls

    NARCIS (Netherlands)

    van der Klaauw, Agatha A.; Bax, Jeroen J.; Bleeker, Gabe B.; Holman, Eduard R.; Delgado, V.; Smit, Johannes W. A.; Romijn, Johannes A.; Pereira, Alberto M.

    2008-01-01

    Both GH excess and GH deficiency (GHD) lead to specific cardiac pathology. The aim of this study was to evaluate cardiac morphology and function in patients with GHD after treatment for acromegaly. Cross-sectional study. Cardiac parameters were studied by conventional two-dimensional

  6. Diagnostic value of Doppler echocardiography for identifying hemodynamic significant pulmonary valve regurgitation in tetralogy of Fallot: comparison with cardiac MRI.

    Science.gov (United States)

    Beurskens, Niek E G; Gorter, Thomas M; Pieper, Petronella G; Hoendermis, Elke S; Bartelds, Beatrijs; Ebels, Tjark; Berger, Rolf M F; Willems, Tineke P; van Melle, Joost P

    2017-11-01

    Quantification of pulmonary regurgitation (PR) is essential in the management of patients with repaired tetralogy of Fallot (TOF). We sought to evaluate the accuracy of first-line Doppler echocardiography in comparison with cardiac magnetic resonance imaging (MRI) to identify hemodynamic significant PR. Paired cardiac MRI and echocardiographic studies (n = 97) in patients with repaired TOF were retrospectively analyzed. Pressure half time (PHT) and pulmonary regurgitation index (PRi) were measured using continuous wave Doppler. The ratio of the color flow Doppler regurgitation jet width to pulmonary valve (PV) annulus (jet/annulus ratio) and diastolic to systolic time velocity integral (DSTVI; pulsed wave Doppler) were assessed. Accuracy of echocardiographic measurements was tested to identify significant PR as determined by phase-contrast MRI (PR fraction [PRF] ≥ 20%). Mean PRF was 29.4 ± 15.7%. PHT < 100 ms had a sensitivity of 93%, specificity 75%, positive predictive value (PPV) 92% and negative predictive value (NPV) 78% for identifying significant PR (C-statistic 0.82). PRi < 0.77 had sensitivity and specificity of 66% and 54%, respectively (C-statistic 0.63). Jet/annulus ratio ≥1/3 had sensitivity 96%, specificity 75%, PPV 92% and NPV 82% (C-statistic 0.87). DSTVI had sensitivity 84%, specificity 33%, PPV 84% and NPV 40%, (C-statistic 0.56). Combined jet/annulus ratio ≥1/3 and PHT < 100 ms was highly accurate in identifying PRF ≥ 20%, with sensitivity 97% and specificity 100%. PHT and jet/annulus ratio on Doppler echocardiography, especially when combined, are highly accurate in identifying significant PR and therefore seem useful in the follow-up of patients with repaired TOF.

  7. Simulation and comparison of coils for Hyperpolarized 13C MRS cardiac metabolism studies in pigs

    DEFF Research Database (Denmark)

    Giovannetti, G.; Hartwig, V.; Frijia, Francesca

    2015-01-01

    , by permitting metabolic activity mapping, a number of technological problems still limit this technology and need innovative solutions such as the design of suitable radiofrequency (RF) coils, capable to provide a large sensitivity region. This work describes the simulation and the comparison of different 13C...

  8. [Comparison of the effects of phosphodiesterase III inhibitors, milrinone and olprinone, in infant corrective cardiac surgery].

    Science.gov (United States)

    Sakimura, Shotaro; Yoshino, Jun; Izumi, Kaoru; Jimi, Nobuo; Sumiyoshi, Rieko; Mizuno, Keiichiro

    2013-05-01

    Clinical characteristics of phosphodiesterase (PDE) III inhibitors, milrinone and olprinone, is not fully understood in infants. We therefore retrospectively examined the hemodynamics, metabolism, and oxygenation of two different PDE III inhibitors in infants undergoing radical correction of ventricular septal defect with pulmonary hypertension. Twenty-six infants with pulmonary hypertension undergoing ventricular septum defect repair were retrospectively allocated to milrinone group (n= 13)and olprinone group(n=13). Hemodynamic parameters, acid-base balance, oxygenation and postoperative mechanical ventilation period were compared between the two groups at induction of anesthesia, weaning from cardiopulmonary bypass and the end of the surgery. The patients' mean age was 4.4 +/- 2.5 months. Demographic data were almost similar between the two groups. Milrinone and olprinone were administered at the rates of 0.5 and 0.3 microg x kg-1 x min-1 at the end of surgery, respectively. Hemodynamic variables, acid-base balance, Pao2 /FIo2 ratio and mechanical ventilation period were not significantly different between the two groups. No adverse side effects were observed during the study period. The effects of the PDE III inhibitors, milrinone and olprinone, on hemodynamic parameters, acid-base balance and oxygenation were similar in these infants. Both milrinone and olprinone could be used safely in infant cardiac surgery.

  9. Demonstration of infective endocarditis by cardiac CT and transoesophageal echocardiography: comparison with intra-operative findings.

    Science.gov (United States)

    Koo, Hyun Jung; Yang, Dong Hyun; Kang, Joon-Won; Lee, Joo Yeon; Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae-Won; Lim, Tae-Hwan

    2018-02-01

    We aimed to compare imaging findings of infective endocarditis between computed tomography (CT) and transoesophageal echocardiography (TEE) using surgical inspection as a reference standard. Forty-nine patients (aged 54 ± 17 years, 69% men) who underwent pre-operative CT and TEE for infective endocarditis were included. Twelve of these patients had prosthetic valve endocarditis. Imaging findings of infective endocarditis were classified as vegetation, leaflet perforation, abscess/pseudoaneurysm, and paravalvular leakage. Diagnostic performances of CT and TEE were evaluated using surgical inspection as a reference standard. Interobserver agreements for CT findings were obtained using Cohen's κ test. The detection rates of infective endocarditis per patient with CT and TEE were 93.9% (46/49) and 95.9% (47/49), respectively. In per-imaging analysis, the sensitivities of CT and TEE were not significantly different for both native and prosthetic valve infective endocarditis (sensitivity: vegetation, 100% in TEE and 90.9% in CT; leaflet perforation, 87.5% in TEE and 50.0% in CT; abscess/pseudoaneurysm, 40.0% in TEE and 60.0% in CT; paravalvular leakage, 100% in TEE and 50.0% in CT). Interobserver agreements for CT findings were substantial or excellent (0.79-0.88). Cardiac CT can accurately demonstrate infective endocarditis in pre-operative patients with a similar diagnostic accuracy to TEE. The interobserver agreements for the CT findings of infective endocarditis were excellent. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  10. Value of cardiac multislice spiral CT for the assessment of degenerative aortic stenosis: comparison with echocardiography

    International Nuclear Information System (INIS)

    Mahnken, A.H.; Wildberger, J.E.; Das, M.; Muehlenbruch, G.; Guenther, R.W.; Koos, R.; Sinha, A.M.; Stanzel, S.

    2004-01-01

    Objective: To non-invasively assess the severity of aortic valve stenosis (AS) by the determination of aortic valve calcification (AVC) using multislice spiral computed tomography (MSCT). Materials and Methods: Forty-one consecutive patients (17 male, 24 female, mean age 71.0±7.9 years) with a history of AS and an aortic valve area ≤2 cm 2 underwent retrospectively ECG-gated 4-slice MSCT and echocardiography. The AVCs were quantitatively assessed using the score described by Agatston as well as by calculating the calcium mass. The echocardiographically determined aortic valve area (AVA) and the severity of AS according to the ACC/AHA guidelines were compared to the degree of a aortic valve calcifications. Pearson's correlation coefficient, cut-off values, kappa test and F-test with post hoc Boneferroni t-tests were calculated. Results: Calcium scores were significantly higher in patients with severe AS, when compared to mild or moderate AS (p<0.001). In patients suffering from severe AS, the mean Agatston score was 4125.5±1168.9 (calcium mass 904.1±263.3) while in patients with moderate and mild AS the corresponding values were 1596.3±987.0 (319.1±208.3) and 785.9±390.1 (149.1±90.2), respectively. Pearson's correlation coefficients were r-=0.75 for the Agatston score and r=-0.72 for the calcium mass. There was a moderate agreement between severity of AS according to the ACC/AHA guidelines and the degree of AS determined from AVC scores with κ=0.6091 and κ=0.6985, respectively. Conclusion: Severe AS may be differentiated from moderate or mild AS using cardiac MSCT. Extensive calcifications of the aortic valve presenting with an Agatston-Score ≥2824 (calcium mass ≥611) indicate a severe AS and should be taken as an indication for further diagnostic workup. (orig.)

  11. Comparison of postoperative analgesia with methadone versus morphine in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Ana Carolina Carvalho

    2018-03-01

    Full Text Available Background and objectives: Pain is an aggravating factor of postoperative morbidity and mortality. The aim of this study was to compare the effects of methadone versus morphine using the numerical rating scale of pain and postoperative on-demand analgesia in patients undergoing myocardial revascularization. Method: A randomized, double-blind, parallel clinical trial was performed with patients undergoing coronary artery bypass grafting. The subjects were randomly divided into two groups: morphine group and methadone group. At the end of cardiac surgery, 0.1 mg.kg−1 adjusted body weight of methadone or morphine was administered intravenously. Patients were referred to the ICU, where the following was assessed: extubation time, time to first analgesic request, number of analgesic and antiemetic drug doses within 36 h, numerical pain scale at 12, 24, and 36 h postoperatively, and occurrence of adverse effects. Results: Each group comprised 50 patients. Methadone showed 22% higher efficacy than morphine as it yielded a number-needed-to-treat score of 6 and number-needed-to-harm score of 16. The methadone group showed a mean score of 1.9 ± 2.2 according to the numerical pain scale at 24 h after surgery, whereas as the morphine group showed a mean score of 2.9 ± 2.6 (p = 0.029. The methadone group required less morphine (29% than the morphine group (43% (p = 0.002. However, the time to first analgesic request in the postoperative period was 145.9 ± 178.5 min in the methadone group, and 269.4 ± 252.9 in the morphine group (p = 0.005. Conclusions: Methadone was effective for analgesia in patients undergoing coronary artery bypass grafting without extracorporeal circulation. Resumo: Justificativa e objetivos: A dor é fator agravante da morbidade e mortalidade pós-operatória. O objetivo foi comparar o efeito da metadona versus morfina quanto à dor e demanda de analgesia pós-operatória em pacientes submetidos à revasculariza

  12. Comparison of entrance exposure and signal-to-noise ratio between an SBDX prototype and a wide-beam cardiac angiographic system

    International Nuclear Information System (INIS)

    Speidel, Michael A.; Wilfley, Brian P.; Star-Lack, Josh M.; Heanue, Joseph A.; Betts, Timothy D.; Van Lysel, Michael S.

    2006-01-01

    The scanning-beam digital x-ray (SBDX) system uses an inverse geometry, narrow x-ray beam, and a 2-mm thick CdTe detector to improve the dose efficiency of the coronary angiographic procedure. Entrance exposure and large-area iodine signal-to-noise ratio (SNR) were measured with the SBDX prototype and compared to that of a clinical cardiac interventional system with image intensifier (II) and charge coupled device (CCD) camera (Philips H5000, MRC-200 x-ray tube, 72 kWp max). Phantoms were 18.6-35.0 cm acrylic with an iohexol-equivalent disk placed at midthickness (35 mg/cm 2 iodine radiographic density). Imaging was performed at 15 frame/s, with the disk at mechanical isocenter and an 11-cm object-plane field width. The II/CCD system was operated in cine mode with automatic exposure control. With the SBDX prototype at maximum x-ray output (120 kVp, 24.3 kWp), the SBDX SNR was 107%-69% of the II/CCD SNR, depending on phantom thickness, and the SBDX entrance exposure rate was 10.7-9.3 R/min (9.4-8.2 cGy/min air kerma). For phantoms where an equal-kVp imaging comparison was possible (≥23.3 cm), the SBDX SNR ranged from 47% to 69% of the II/CCD SNR while delivering 6% to 9% of the II/CCD entrance exposure rate. From these measurements it was determined that the relative SBDX entrance exposure at equal SNR would be 31%-16%. Results were consistent with a model for relative entrance exposure at equal SNR, which predicted a 3-7 times reduction in entrance exposure due to SBDX's comparatively low scatter fraction (5.5%-8.1% measured, including off-focus radiation), high detector detective quantum efficiency (66%-73%, measured from 70 to 120 kVp), and large entrance field area (1.7x-2.3x, for the same object-plane field width). With improvements to the system geometry, detector, and x-ray source, SBDX technology is projected to achieve conventional cine-quality SNR over a full range of patient thicknesses, with 5-10 times lower skin dose

  13. Evaluation and optimisation of current milrinone prescribing for the treatment and prevention of low cardiac output syndrome in paediatric patients after open heart surgery using a physiology-based pharmacokinetic drug-disease model.

    Science.gov (United States)

    Vogt, Winnie

    2014-01-01

    Milrinone is the drug of choice for the treatment and prevention of low cardiac output syndrome (LCOS) in paediatric patients after open heart surgery across Europe. Discrepancies, however, among prescribing guidance, clinical studies and practice pattern require clarification to ensure safe and effective prescribing. However, the clearance prediction equations derived from classical pharmacokinetic modelling provide limited support as they have recently failed a clinical practice evaluation. Therefore, the objective of this study was to evaluate current milrinone dosing using physiology-based pharmacokinetic (PBPK) modelling and simulation to complement the existing pharmacokinetic knowledge and propose optimised dosing regimens as a basis for improving the standard of care for paediatric patients. A PBPK drug-disease model using a population approach was developed in three steps from healthy young adults to adult patients and paediatric patients with and without LCOS after open heart surgery. Pre- and postoperative organ function values from adult and paediatric patients were collected from literature and integrated into a disease model as factorial changes from the reference values in healthy adults aged 20-40 years. The disease model was combined with the PBPK drug model and evaluated against existing pharmacokinetic data. Model robustness was assessed by parametric sensitivity analysis. In the next step, virtual patient populations were created, each with 1,000 subjects reflecting the average adult and paediatric patient characteristics with regard to age, sex, bodyweight and height. They were integrated into the PBPK drug-disease model to evaluate the effectiveness of current milrinone dosing in achieving the therapeutic target range of 100-300 ng/mL milrinone in plasma. Optimised dosing regimens were subsequently developed. The pharmacokinetics of milrinone in healthy young adults as well as adult and paediatric patients were accurately described with an

  14. Split-bolus single-phase cardiac multidetector computed tomography for reliable detection of left atrial thrombus. Comparison to transesophageal echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Staab, W.; Zwaka, P.A.; Sohns, J.M.; Schwarz, A.; Lotz, J. [University Medical Center Goettingen Univ. (Germany). Inst. for Diagnostic and Interventional Radiology; Sohns, C.; Vollmann, D.; Zabel, M.; Hasenfuss, G. [Goettingen Univ. (Germany). Dept. of Cardiology and Pneumology; Schneider, S. [Goettingen Univ. (Germany). Dept. of Medical Statistics

    2014-11-15

    Evaluation of a new cardiac MDCT protocol using a split-bolus contrast injection protocol and single MDCT scan for reliable diagnosis of LA/LAA thrombi in comparison to TEE, optimizing radiation exposure and use of contrast agent. A total of 182 consecutive patients with drug refractory AF scheduled for PVI (62.6% male, mean age: 64.1 ± 10.2 years) underwent routine diagnostic work including TEE and cardiac MDCT for the evaluation of LA/LAA anatomy and thrombus formation between November 2010 and March 2012. Contrast media injection was split into a pre-bolus of 30 ml and main bolus of 70 ml iodinated contrast agent separated by a short time delay. In this study, split-bolus cardiac MDCT identified 14 of 182 patients with filling defects of the LA/LAA. In all of these 14 patients, abnormalities were found in TEE. All 5 of the 14 patients with thrombus formation in cardiac MDCT were confirmed by TEE. MDCT was 100% accurate for thrombus, with strong but not perfect overall results for SEC equivalent on MDCT.

  15. Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure.

    Science.gov (United States)

    Patil, Satish Gurunathrao; Patil, Shankargouda S; Aithala, Manjunatha R; Das, Kusal Kanti

    Arterial aging along with increased blood pressure(BP) has become the major cardiovascular(CV) risk in elderly. The aim of the study was to compare the effects of yoga program and walking-exercise on cardiac function in elderly with increased pulse pressure (PP). An open label, parallel-group randomized controlled study design was adopted. Elderly individuals aged ≥60 years with PP≥60mmHg were recruited for the study. Yoga (study) group (n=30) was assigned for yoga training and walking (exercise) group (n=30) for walking with loosening practices for one hour in the morning for 6days in a week for 3 months. The outcome measures were cardiac time intervals derived from pulse wave analysis and ECG: resting heart rate (RHR), diastolic time(DT), ventricular ejection time(LVET), upstroke time(UT), ejection duration index (ED%), pre-ejection period (PEP), rate pressure product (RPP) and percentage of mean arterial pressure (%MAP). The mean within-yoga group change in RHR(bpm) was 4.41 (p=0.031), PD(ms): -50.29 (p=0.042), DT(ms): -49.04 (p=0.017), ED%: 2.107 (p=0.001), ES(mmHg/ms): 14.62 (p=0.118), ET(ms): -0.66 (p=0.903), UT(ms): -2.54 (p=0.676), PEP(ms): -1.25 (p=0.11) and %MAP: 2.08 (p=0.04). The mean within-control group change in HR (bpm) was 0.35 (p=0.887), PD (ms): 11.15(p=0.717), DT (ms): 11.3 (p=0.706), ED%: -0.101 (p=0.936), ES (mmHg/ms): 0.75 (p=0.926), ET(ms): 2.2 (p=0.721), UT(ms):4.7(p=455), PEP (ms): 2.1(p=0.11), %MAP: 0.65 (p=0.451). A significant difference between-group was found in RHR (p=0.036), PD (p=0.02), ED% (p=0.049), LVET (p=0.048), DT (p=0.02) and RPP (p=0.001). Yoga practice for 3 months showed a significant improvement in diastolic function with a minimal change in systolic function. Yoga is more effective than walking in improving cardiac function in elderly with high PP. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  16. Evaluation of commissural malalignment of aortic-pulmonary sinus using cardiac CT for arterial switch operation: comparison with transthoracic echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Bang, Ji Hyun; Park, Jeong-Jun [Asan Medical Center, University of Ulsan College of Medicine, Divisions of Pediatric Cardiac Surgery, Seoul (Korea, Republic of); Goo, Hyun Woo [Asan Medical Center, University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)

    2017-05-15

    There are limited data regarding the influence of commissural malalignment of the aortic-pulmonary sinus on the arterial switch operation. To compare diagnostic accuracy between cardiac CT and echocardiography for evaluating commissural malalignment of aortic-pulmonary sinus in children with complete transposition of the great arteries and to seek potential clinical implication of commissural malalignment on the arterial switch operation. In 37 patients (35 boys; median age: 8 days, range: 3-80 days) with complete transposition of the great arteries who had tricuspid semilunar valves and underwent an arterial switch operation, the degree of the commissural rotation of the aortic-pulmonary sinus was assessed on cardiac CT (n=37) and echocardiography (n=35). With surgical finding as a reference, cardiac CT was compared with echocardiography in identifying commissural malalignment in 35 patients. The influence of the height difference between the semilunar valves measured by cardiac CT on the identification of commissural malalignment with cardiac CT and echocardiography was evaluated. The impact of commissural malalignment on coronary transfer techniques was evaluated. In operative findings, the commissures of the semilunar valves were aligned in 24 patients and malaligned in 13. With surgical findings as a reference, cardiac CT showed higher, but not statistically significant (P>0.05), sensitivity (91.7% vs. 75.0%), specificity (87.0% vs. 78.3%) and accuracy (88.6% vs. 77.1%) for the diagnosis of the malalignment than echocardiography. The measured height difference between the semilunar valves did not affect the identification of the malalignment with cardiac CT and echocardiography. The surgical malalignment group showed a higher requirement of modified coronary transfer techniques than the surgical aligned group (11/13 vs. 11/24, P=0.03). Cardiac CT and echocardiography appear useful for evaluating commissural malalignment of the semilunar valves in patients with

  17. Evaluation of commissural malalignment of aortic-pulmonary sinus using cardiac CT for arterial switch operation: comparison with transthoracic echocardiography

    International Nuclear Information System (INIS)

    Bang, Ji Hyun; Park, Jeong-Jun; Goo, Hyun Woo

    2017-01-01

    There are limited data regarding the influence of commissural malalignment of the aortic-pulmonary sinus on the arterial switch operation. To compare diagnostic accuracy between cardiac CT and echocardiography for evaluating commissural malalignment of aortic-pulmonary sinus in children with complete transposition of the great arteries and to seek potential clinical implication of commissural malalignment on the arterial switch operation. In 37 patients (35 boys; median age: 8 days, range: 3-80 days) with complete transposition of the great arteries who had tricuspid semilunar valves and underwent an arterial switch operation, the degree of the commissural rotation of the aortic-pulmonary sinus was assessed on cardiac CT (n=37) and echocardiography (n=35). With surgical finding as a reference, cardiac CT was compared with echocardiography in identifying commissural malalignment in 35 patients. The influence of the height difference between the semilunar valves measured by cardiac CT on the identification of commissural malalignment with cardiac CT and echocardiography was evaluated. The impact of commissural malalignment on coronary transfer techniques was evaluated. In operative findings, the commissures of the semilunar valves were aligned in 24 patients and malaligned in 13. With surgical findings as a reference, cardiac CT showed higher, but not statistically significant (P>0.05), sensitivity (91.7% vs. 75.0%), specificity (87.0% vs. 78.3%) and accuracy (88.6% vs. 77.1%) for the diagnosis of the malalignment than echocardiography. The measured height difference between the semilunar valves did not affect the identification of the malalignment with cardiac CT and echocardiography. The surgical malalignment group showed a higher requirement of modified coronary transfer techniques than the surgical aligned group (11/13 vs. 11/24, P=0.03). Cardiac CT and echocardiography appear useful for evaluating commissural malalignment of the semilunar valves in patients with

  18. Consenso brasileiro de monitorização e suporte hemodinâmico - parte III: métodos alternativos de monitorização do débito cardíaco e da volemia Brazilian consensus of monitoring and hemodynamic support - part III: alternative methods for cardiac output monitoring and volemia estimation

    Directory of Open Access Journals (Sweden)

    Guilherme Schettino

    2006-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A interpretação do débito cardíaco e da pré-carga como números absolutos não traz grandes informações sobre a hemodinâmica do paciente crítico. Em contrapartida, a monitorização da resposta do débito cardíaco à expansão volêmica ou suporte inotrópico é uma ferramenta muito útil na unidade de terapia intensiva, quando o paciente apresenta algum sinal de má perfusão tecidual. Apesar do CAP ser considerado como " padrão-ouro" na avaliação destes parâmetros, foram desenvolvidas tecnologias alternativas bastante confiáveis para a sua monitorização. MÉTODO: O processo de desenvolvimento de recomendações utilizou o método Delphi modificado para criar e quantificar o consenso entre os participantes. A AMIB determinou um coordenador para o consenso, o qual escolheu seis especialistas para comporem o comitê consultivo. Outros 18 peritos de diferentes regiões do país foram selecionados para completar o painel de 25 especialistas, médicos e enfermeiros. Um levantamento bibliográfico na MEDLINE de artigos na língua inglesa foi realizado no período de 1966 a 2004. RESULTADOS: Foram apresentadas recomendações referentes à análise da variação da pressão arterial durante ventilação mecânica, débito cardíaco contínuo por contorno de pulso arterial, débito cardíaco por diluição do lítio, Doppler transesofágico, bioimpedância transtorácica, ecocardiografia e reinalação parcial de gás carbônico. CONCLUSÕES: As novas e menos invasivas técnicas para medida do débito cardíaco, pré-carga e fluidoresponsividade apresentam adequada precisão e podem ser uma alternativa ao uso do CAP em pacientes graves.BACKGROUND AND OBJECTIVES: Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the

  19. Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant Prevalencia del diagnóstico de enfermería de disminución del gasto cardíaco y valor predictivo de las características definidoras en pacientes en fase de evaluación para trasplante cardíaco Prevalência do diagnóstico de enfermagem de débito cardíaco diminuído e valor preditivo das características definidoras em pacientes em avaliação para transplante cardíaco

    OpenAIRE

    Lígia Neres Matos; Tereza Cristina Felippe Guimarães; Marcos Antônio Gomes Brandão; Deyse Conceição Santoro

    2012-01-01

    The purposes of the study were to identify the prevalence of defining characteristics (DC) of decreased cardiac output (DCO) in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009....

  20. Why do some countries publish more than others? An international comparison of research funding, English proficiency and publication output in highly ranked general medical journals.

    Science.gov (United States)

    Man, Jonathan P; Weinkauf, Justin G; Tsang, Monica; Sin, Don D

    2004-01-01

    National factor(s) influencing publication output in the highest ranked medical journals are largely unknown. We sought to examine the relationship between national research funding and English proficiency on publication output. We identified all original research articles appearing in the five highest ranked general medical journals between 1997 and 2001. Using the country of the corresponding author as the source nation for each article, we determined a standardized publication rate across developed nations. We used multiple regression techniques to determine the influence of national expenditures on research and scores from the Test of English as a Foreign Language (TOEFL), a surrogate for English proficiency, on publication output. There was a significant relationship of national spending on research and TOEFL scores to publication output of developed countries (p = 0.04; p < 0.01, respectively). These two variables explained approximately 71.5% of the variation in publication rate across developed nations around the world (R = 0.85; p < 0.01). Normalized for population size, English-speaking nations and certain northern European countries such as Denmark, The Netherlands, Switzerland, and Sweden had the highest rate of publication in the five highest ranked general medical journals, while Asian countries had generally low rates of publication. Research spending and English proficiency were strongly associated with publication output in the highest ranked general medical journals. While these data cannot be considered definitive due to their observational nature, they do suggest that for English-language medical journals, research funding and English proficiency may be important determinants of publication.

  1. Comparison of dynamic dual spin-echo and fast-gradient-echo techniques in the evaluation of cardiac diseases

    International Nuclear Information System (INIS)

    Pettigrew, R.I.; Eisner, R.L.; Groen, J.P.; Baron, M.G.

    1987-01-01

    To determine the relative roles of a dynamic spin-echo method and a fast acquisition with multiphase excitations (FAME) technique, ten patients with myocardial infarction (MI), five with myocardial masses, and five healthy patients were studied with both methods. The dynamic dual-spin-echo (DSE) technique allows acquisition of each of seven sections at 14 cardiac phases in 20 minutes. Wall motion abnormalities were seen equally well with both techniques, but FAME usually required a shorter study time (10 minutes). DSE, however, was superior for evaluating cardiac masses and provided superior wall blood contrast. Thus, these techniques are complementary, and both are now a routine part of the authors' study of cardiac patients

  2. Comparison of Warfarin Requirements in Post-cardiac Surgery Patients: Valve Replacement Versus Non-valve Replacement.

    Science.gov (United States)

    Olson, Logan M; Nei, Andrea M; Joyce, David L; Ou, Narith N; Dierkhising, Ross A; Nei, Scott D

    2018-01-11

    Anticoagulation with warfarin affects approximately 140,000 post-cardiac surgery patients every year, yet there remains limited published data in this patient population. Dosing remains highly variable due to intrinsic risk factors that plague cardiac surgery candidates and a lack of diverse literature that can be applied to those who have undergone a cardiac surgery alternative to heart valve replacement (HVR). In the present study, our aim was to compare the warfarin requirements between HVR and non-HVR patients. This was a single-center, retrospective study of post-cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester, from January 1st, 2013 to October 31st, 2016. The primary outcome was the maintenance warfarin dose at the earliest of discharge or warfarin day 10 between patients with HVR and non-HVR cardiac surgeries. A total of 683 patients were assessed during the study period: 408 in the HVR group and 275 in the non-HVR group. The mean warfarin maintenance doses in the HVR and non-HVR groups were 2.55 mg [standard deviation (SD) 1.52] and 2.43 mg (SD 1.21), respectively (adjusted p = 0.65). A multivariable analysis was performed to adjust for gender, age, body mass index and drug interactions. This was the largest study to evaluate warfarin dose requirements in post-cardiac surgery patients and is the first to compare warfarin requirements between HVR and non-HVR patients during the immediate post-operative period. Both groups had similar warfarin requirements, which supports expanding the initial warfarin dosing recommendations of the 9th edition Chest guideline to include non-HVR patients as well as HVR patients.

  3. Unit 16 - Output

    OpenAIRE

    Unit 16, CC in GIS; Star, Jeffrey L.

    1990-01-01

    This unit discusses issues related to GIS output, including the different types of output possible and the hardware for producing each. It describes text, graphic and digital data that can be generated by a GIS as well as line printers, dot matrix printers/plotters, pen plotters, optical scanners and cathode ray tubes (CRTs) as technologies for generating the output.

  4. Static stretching vs. dynamic warm-ups: a comparison of their effects on torque and electromyography output of the quadriceps and hamstring muscles.

    Science.gov (United States)

    Williams, N; Coburn, J; Gillum, T

    2015-11-01

    The aim of this paper was to determine if two different warm-up protocols differently affect torque of the quadriceps and hamstrings, and electromyography (EMG) output of the rectus femoris (RF) and vastus lateralis (VL) when completing 30 maximal leg extensions and curls. Twenty-one healthy male (N.=8) and female (N.=13) subjects volunteered to participate in a familiarization session and three testing sessions. The three testing sessions control, dynamic, and static were completed in a counterbalanced order on non-consecutive days. First, subjects warmed-up on a treadmill for five minutes before completing six dynamic movements, six static-stretches, or no stretches. They then rested for five minutes before completing 30 maximal leg extensions and curls at a speed of 60 s-1. A significant decrease in quadriceps torque output over time was determined for the dynamic protocol when compared to the control (Phamstring torque or EMG output of the RF and VL. Short duration static-stretching has the ability to increase peak and average torque of the leg extensors, while some types of anaerobic exercise involving maximal contractions to fatigue may be hindered by performing dynamic movements as part of the warm-up.

  5. Cardiac involvement in female Duchenne and Becker muscular dystrophy carriers in comparison to their first-degree male relatives: a comparative cardiovascular magnetic resonance study.

    Science.gov (United States)

    Florian, Anca; Rösch, Sabine; Bietenbeck, Michael; Engelen, Markus; Stypmann, Jörg; Waltenberger, Johannes; Sechtem, Udo; Yilmaz, Ali

    2016-03-01

    Duchenne (DMD) and Becker (BMD) muscular dystrophies are X-linked recessive disorders associated with both skeletal myopathy and progressive cardiomyopathy in males. Female DMD/BMD carriers (DMDc/BMDc) are mostly free of skeletal muscle symptoms, but they are also prone to cardiomyopathy. The aim of the current study was to characterize the frequency, pattern, and extent of cardiomyopathy in female DMD/BMD carriers (DMDc/BMDc) in comparison to their first-degree male MD relatives. Thirty-six (age 44 ± 14 years) female MD carriers (20 DMDc and 16 BMDc) constituted the 'MD carrier group' and were prospectively enrolled. All MD carriers underwent a complete CMR study comprising cine- and late gadolinium enhancement (LGE) imaging. In 22 of these women ('female MD carrier comparison group', 7 DMD and 15 BMD), at least one first-degree male relative with a previously established diagnosis of MD underwent the same CMR protocol and was assigned to the 'male MD comparison group' (n = 24, 6 DMD and 18 BMD). In the total MD carrier group, 17 (47%) MD carriers had at least one pathological CMR finding [5 (14%) with a reduced left ventricular ejection fraction (LV-EF) and 16 (44%) with the presence of LGE]. All LGE-positive patients (n = 16) showed non-ischaemic LGE with subepicardial involvement of the LV lateral free wall being the most frequent pattern (13/16, 81%). Compared with BMDc, DMDc demonstrated more frequently a pathological CMR result (65 vs. 19%; P = 0.008)--in spite of being significantly younger (40 ± 11 vs. 50 ± 16 years, P = 0.038). In the male MD comparison group, the same LGE pattern as in female carriers was seen, but with a significantly higher prevalence of cardiac abnormalities compared with their female carrier relatives constituting the female MD comparison group (75 vs. 27%; P = 0.003). Cardiac involvement is a frequent finding in female carriers of DMD, but less frequently observed in carriers of BMD. Those DMDc and BMDc with cardiac involvement

  6. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    Science.gov (United States)

    Hogan, T S

    2012-10-01

    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  7. External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    LENUS (Irish Health Repository)

    Hogan, T S

    2012-10-01

    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient\\'s cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless

  8. Head-to-head comparison of cardiac troponin T and troponin I in patients without acute coronary syndrome

    DEFF Research Database (Denmark)

    Árnadóttir, Ásthildur; Falk Klein, Christine; Iversen, Kasper

    2017-01-01

    BACKGROUND: Cardiac-specific troponin T (cTnT) and troponin I (cTnI) are considered diagnostically equal in patients with acute coronary syndrome (ACS). The aim of this systematic review was to compare the prevalence and prognostic strength of elevations of cTnT and cTnI in patients with other...

  9. Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

    Science.gov (United States)

    Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Valentino, Massimo; Nicolini, Francesco; Molardi, Alberto; Gherli, Tiziano; Corradi, Francesco

    2014-12-01

    Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Cardiac surgery intensive care unit. One hundred fifty-one consecutive adult patients undergoing cardiac surgery. All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. The egsys and oesil risk scores for classification of cardiac etiology of syncope: comparison, revaluation, and clinical Implications

    Czech Academy of Sciences Publication Activity Database

    Plášek, J.; Doupal, V.; Fürstová, Jana; Martínek, A.

    2010-01-01

    Roč. 154, č. 2 (2010), s. 169-173 ISSN 1213-8118 Institutional research plan: CEZ:AV0Z10300504 Keywords : Syncope * Cardiac Syncope * EGSYS * OESIL * Emergency Department * Decision - Making * Syncope Management Unit Subject RIV: IN - Informatics, Computer Science Impact factor: 0.716, year: 2010

  11. Shivering and rewarming after cardiac surgery: comparison of ventilator circuits with humidifier and heated wires to heat and moisture exchangers.

    Science.gov (United States)

    McEvoy, M T; Carey, T J

    1995-07-01

    Detrimental physiologic effects of shivering in the cardiac surgery patient have been well documented. Rewarming techniques have been compared, with noted differences in the incidence of shivering. Ventilator circuits have not been examined independently from other rewarming variables. To compare heated wire humidification circuits with heat and moisture exchanger circuits on the incidence of shivering and speed and pattern of rewarming in mechanically ventilated patients. A prospective, descriptive, correlational study was done on 140 adult cardiac surgery patients in a university teaching medical center. All subjects underwent cardiac surgical procedures with hypothermic cardiopulmonary bypass. Subjects were randomized to humidified, heated wire circuits (n = 70) or heat and moisture exchanger circuits (n = 70). Heated water blankets were used on all patients. Mean intensive care unit admission temperature was 35.28 degrees C. No statistical differences were found in preoperative, demographic, or operative course data between treatment and control groups. Shivering was more common in the heat and moisture exchanger group than in the heated wire group. In our analysis, the only variable associated with shivering was the type of ventilator circuit. Patients using heated wire systems rewarmed more rapidly and had significantly higher temperatures than did patients using heat and moisture exchangers. These data suggest that use of heated wire humidified ventilator circuits with heated water blankets in adult cardiac surgery patients significantly reduces the incidence of shivering and results in a more rapid return to normothermia.

  12. 82Rb Cardiac PET in patients with known ischemic heart disease – a direct comparison with 15O-water Cardiac PET

    DEFF Research Database (Denmark)

    Hoff, Camilla Molich; Tolbod, Lars Poulsen; Harms, Hans

    2017-01-01

    for both tracers and the extraction correction by Lortie et al for 82Rb. Comparisons included 1) correlation of absolute MBF for 82Rb versus 15O-water, 2) standard clinical practice for 82Rb using assessment of static, gated and dynamic scans by 2 experienced physicians (consensus), 3) in-house established...... was false positive in seven and false negative in zero, yielding a sensitivity of 100%, specificity 64%, PPV 68 % and NPV 100%. Comparing stress MBF, 82Rb on the patient-level was false positive in one and false negative in five, yielding a sensitivity of 71%, specificity 95%, PPV 92% and NPV 81......%. On the vessel-level there were six false positive and 24 false negative, yielding a sensitivity of 51%, specificity 91%, PPV 81% and NPV 72%. Global CFR (patient-level) identified five false positive and 10 false negative with a sensitivity of 41%, specificity 77%, PPV 58% and NPV 63%. Conclusion Standard...

  13. Hemodynamic effects of aerosol propellants. I. Cardiac depression in the dog.

    Science.gov (United States)

    Simaan, J A; Aviado, D M

    1975-11-01

    The inhalation of fluorocarbons caused a depression of myocardial contractility, aortic hypotension, a decrease in cardiac output and an increase in pulmonary vascular resistance. The minimal concentrations that elicited these changes are as follows: 1% trichlorofluoromethane (FC11); 2.5% dichlorotetrafluoroethane (FC114); and 10% dichlorodifluoromethane (FC12). Inhalation of 20% octafluorocyclobutane (FC318) and difluoroethane (FC152a) did not influence these hemodynamic parameters. As in previous comparisons, the most widely used aerosol propellants are potentially cardiotoxic in the anesthetized dog.

  14. Comparison of cardiac gating and refocusing pulses for correction of cerebrospinal fluid pulsation artifacts in MR images

    International Nuclear Information System (INIS)

    Modic, M.T.; Haacke, E.M.; Lenz, G.W.; Masaryk, T.; Kaufman, B.; Ross, J.S.

    1986-01-01

    This study compared cardiac gating and additional refocusing gradient pulses in combination or alone for correction of cerebrospinal fluid (CSF) pulsation artifacts in both normal volunteers and in patients with suspected spinal pathology. Refocusing pulses or cardiac gating when used alone produced a decrease in ghosting artifacts on sagittal images and reduced the nonuniformity of the CSF signal on axial images. There is improved thin-section T2 imaging of the cord with long TEs and as few as one excitation. The refocusing pulses reduced ghosting artifacts also from respiratory motion and enhanced the CSF signal with shorter TRs leading to increased CSF contrast. When used together, the results were significantly better than either alone. Refocusing schemes can be used with any TR, do not require gating, and are now routinely employed at the authors' institution

  15. Validation of the concept Risk for Decreased Cardiac Output Validación del concepto riesgo de débito cardiaco disminuido Validação do conceito risco de débito cardíaco diminuído

    Directory of Open Access Journals (Sweden)

    Eduarda Ribeiro dos Santos

    2013-02-01

    Full Text Available OBJECTIVES: to validate the concept "risk for decreased cardiac output". METHOD: Six of the eight steps suggested in the technique developed by Walker & Avant were adopted to analyze the concept of the phenomenon under study and the proposal made by Hoskins was used for content validation, taking into account agreement achieved among five experts. RESULTS: the concept "decreased cardiac output" was found in the nursing and medical fields and refers to the heart's pumping capacity while the concept "risk" is found in a large number of disciplines. In regard to the defining attributes, "impaired pumping capacity" was the main attribute of decreased cardiac output and "probability" was the main attribute of risk. The uses and defining attributes of the concepts "decreased cardiac output" and "risk" were analyzed as well as their antecedent and consequent events in order to establish the definition of "risk for decreased cardiac output", which was validated by 100% of the experts. CONCLUSION: The obtained data indicate that the risk for decreased cardiac output phenomenon can be a nursing diagnosis and refining it can contribute to the advancement of nursing classifications in this context.OBJETIVO: Validar el concepto riesgo del débito cardíaco disminuido. MÉTODO: Fue adoptada la técnica de Walker & Avant para analizar la definición del fenómeno enfocado, utilizando seis de las ocho etapas sugeridas y la propuesta de Hoskins para validar el contenido, considerándose la conformidad entre cinco expertos. RESULTADOS: el concepto de debito cardíaco disminuido se encuentra en las áreas enfermería y médica y su atención se centra en la capacidad de bombeo del corazón. Sin embargo, el concepto de riesgo es presente en un gran número de áreas. Las características definitorias de la disminución del gasto cardíaco mostraron como principal atributo deficiencia de la bomba cardiaca y, para el riesgo, el atributo de probabilidad. Analizados

  16. Cardiac rehabilitation

    Science.gov (United States)

    ... rehab; Heart failure - cardiac rehab References Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: ... of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed ...

  17. Outcomes in a Community-Based Intensive Cardiac Rehabilitation Program: Comparison with Hospital-Based and Academic Programs.

    Science.gov (United States)

    Katzenberg, Charles; Silva, Edna; Young, M Jean; Gilles, Greg

    2018-04-13

    The purpose of this study was to test the hypothesis that a community-based intensive cardiac rehabilitation program could produce positive changes in risk factor profile and outcomes in an at-risk population. Participants seeking either primary or secondary coronary artery disease prevention voluntarily enrolled in the 12-week intensive cardiac rehabilitation program. Data were obtained at baseline and 6-12 months after completion of the program. A total of 142 individuals, mean age 69 years, completed the Heart Series between 2012 and 2016. Follow-up data were available in 105 participants (74%). Participants showed statistically significant improvements in mean weight (165 to 162 lbs, P = .0005), body mass index (26 to 25 kg/m 2 , P = .001), systolic blood pressure (126 to 122 mm Hg, P = .01), diastolic blood pressure (73 to 70 mm Hg, P = .0005), total cholesterol (175 to 168 mg/dL, P = .03), low-density lipoprotein cholesterol (LDL-C) (100 to 93 mg/dL, P = .005), LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (1.8 to 1.6, P = .005), and cholesterol/HDL-C ratio (3.2 to 3.0, P = .003). Changes in HDL-C, triglycerides, and fasting blood glucose did not reach statistical significance, but all trended in favorable directions. Adverse cardiovascular disease outcomes were rare (one stent placement, no deaths). A total of 105 participants completed our 12-week community-based intensive cardiac rehabilitation program and showed significant positive changes in several measures of cardiac risk, with only 1 adverse event. These results compare favorably with those of hospital-based and academic institutional programs. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Input-output supervisor

    International Nuclear Information System (INIS)

    Dupuy, R.

    1970-01-01

    The input-output supervisor is the program which monitors the flow of informations between core storage and peripheral equipments of a computer. This work is composed of three parts: 1 - Study of a generalized input-output supervisor. With sample modifications it looks like most of input-output supervisors which are running now on computers. 2 - Application of this theory on a magnetic drum. 3 - Hardware requirement for time-sharing. (author) [fr

  19. Latent cardiac dysfunction as assessed by echocardiography in bed-bound patients following cerebrovascular accidents: comparison with nutritional status.

    Science.gov (United States)

    Masugata, Hisashi; Senda, Shoichi; Goda, Fuminori; Yoshihara, Yumiko; Yoshikawa, Kay; Fujita, Norihiro; Himoto, Takashi; Okuyama, Hiroyuki; Taoka, Teruhisa; Imai, Masanobu; Kohno, Masakazu

    2007-07-01

    The aim of this study was to elucidate the cardiac function in bed-bound patients following cerebrovascular accidents. In accord with the criteria for activities of daily living (ADL) of the Japanese Ministry of Health, Labour and Welfare, 51 age-matched poststroke patients without heart disease were classified into 3 groups: rank A (house-bound) (n = 16, age, 85 +/- 6 years), rank B (chair-bound) (n = 16, age, 84 +/- 8 years), and rank C (bed-bound) (n = 19, age, 85 +/- 9 years). Using echocardiography, the left ventricular (LV) diastolic function was assessed by the ratio of early filling (E) and atrial contraction (A) transmitral flow velocities (E/A) of LV inflow. LV systolic function was assessed by LV ejection fraction (LVEF), and the Tei index was also measured to assess both LV systolic and diastolic function. No difference was observed in the E/A and LVEF among the 3 groups. The Tei index was higher in rank C (0.56 +/- 0.17) than in rank A (0.39 +/- 0.06) and rank B (0.48 +/- 0.17), and a statistically significant difference was observed between rank A and rank C (P cerebrovascular accidents. The Tei index may be a useful index of cardiac dysfunction in bed-bound patients because it is independent of the cardiac loading condition.

  20. Pediatric cardiac postoperative care

    Directory of Open Access Journals (Sweden)

    Auler Jr. José Otávio Costa

    2002-01-01

    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  1. Tracking Success: Outputs Versus Outcomes-A Comparison of Accredited and Non-Accredited Public Health Agencies' Community Health Improvement Plan objectives.

    Science.gov (United States)

    Perrault, Evan K; Inderstrodt-Stephens, Jill; Hintz, Elizabeth A

    2018-06-01

    With funding for public health initiatives declining, creating measurable objectives that are focused on tracking and changing population outcomes (i.e., knowledge, attitudes, or behaviors), instead of those that are focused on health agencies' own outputs (e.g., promoting services, developing communication messages) have seen a renewed focus. This study analyzed 4094 objectives from the Community Health Improvement Plans (CHIPs) of 280 local PHAB-accredited and non-accredited public health agencies across the United States. Results revealed that accredited agencies were no more successful at creating outcomes-focused objectives (35% of those coded) compared to non-accredited agencies (33% of those coded; Z = 1.35, p = .18). The majority of objectives were focused on outputs (accredited: 61.2%; non-accredited: 63.3%; Z = 0.72, p = .47). Outcomes-focused objectives primarily sought to change behaviors (accredited: 85.43%; non-accredited: 80.6%), followed by changes in knowledge (accredited: 9.75%; non-accredited: 10.8%) and attitudes (accredited: 1.6%; non-accredited: 5.1%). Non-accredited agencies had more double-barreled objectives (49.9%) compared to accredited agencies (32%; Z = 11.43, p < .001). The authors recommend that accreditation procedures place a renewed focus on ensuring that public health agencies strive to achieve outcomes. It is also advocated that public health agencies work with interdisciplinary teams of Health Communicators who can help them develop procedures to effectively and efficiently measure outcomes of knowledge and attitudes that are influential drivers of behavioral changes.

  2. Effects of Statin Treatment on Inflammation and Cardiac Function in Heart Failure: An Adjusted Indirect Comparison Meta-Analysis of Randomized Trials.

    Science.gov (United States)

    Bonsu, Kwadwo Osei; Reidpath, Daniel Diamond; Kadirvelu, Amudha

    2015-12-01

    Statins are known to prevent heart failure (HF). However, it is unclear whether statins as class or type (lipophilic or hydrophilic) improve outcomes of established HF. The current meta-analysis was performed to compare the treatment effects of lipophilic and hydrophilic statins on inflammation and cardiac function in HF. Outcomes were indicators of cardiac function [changes in left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP)] and inflammation [changes in highly sensitive C-reactive protein (hsCRP) and interluekin-6 (IL-6)]. We conducted a search of PubMed, EMBASE, and the Cochrane databases until December 31, 2014 for randomized control trials (RCTs) of statin versus placebo in patients with HF. RCTs with their respective extracted information were dichotomized into statin type evaluated and analyzed separately. Outcomes were pooled with random effect approach, producing standardized mean differences (SMD) for each statin type. Using these pooled estimates, we performed adjusted indirect comparisons for each outcome. Data from 6214 patients from 19 trials were analyzed. Lipophilic statin was superior to hydrophilic statin treatment regarding follow-up LVEF (SMD, 4.54; 95% CI, 4.16-4.91; P statin produces greater treatment effects on cardiac function and inflammation compared with hydrophilic statin in patients with HF. Until data from adequately powered head-to-head trial of the statin types are available, our meta-analysis brings clinicians and researchers a step closer to the quest on which statin--lipophilic or hydrophilic--is associated with better outcomes in HF. © 2015 John Wiley & Sons Ltd.

  3. Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization

    International Nuclear Information System (INIS)

    Kaul, S.; Lilly, D.R.; Gascho, J.A.; Watson, D.D.; Gibson, R.S.; Oliner, C.A.; Ryan, J.M.; Beller, G.A.

    1988-01-01

    The goal of this study was to determine the prognostic utility of the exercise thallium-201 stress test in ambulatory patients with chest pain who were also referred for cardiac catheterization. Accordingly, 4 to 8 year (mean +/- 1SD, 4.6 +/- 2.6 years) follow-up data were obtained for all but one of 383 patients who underwent both exercise thallium-201 stress testing and cardiac catheterization from 1978 to 1981. Eighty-three patients had a revascularization procedure performed within 3 months of testing and were excluded from analysis. Of the remaining 299 patients, 210 had no events and 89 had events (41 deaths, nine nonfatal myocardial infarctions, and 39 revascularization procedures greater than or equal to 3 months after testing). When all clinical, exercise, thallium-201, and catheterization variables were analyzed by Cox regression analysis, the number of diseased vessels (when defined as greater than or equal to 50% luminal diameter narrowing) was the single most important predictor of future cardiac events (chi 2 = 38.1) followed by the number of segments demonstrating redistribution on delayed thallium-201 images (chi 2 = 16.3), except in the case of nonfatal myocardial infarction, for which redistribution was the most important predictor of future events. When coronary artery disease was defined as 70% or greater luminal diameter narrowing, the number of diseased vessels significantly (p less than .01) lost its power to predict events (chi 2 = 14.5). Other variables found to independently predict future events included change in heart rate from rest to exercise (chi 2 = 13.0), ST segment depression on exercise (chi 2 = 13.0), occurrence of ventricular arrhythmias on exercise (chi 2 = 5.9), and beta-blocker therapy (chi 2 = 4.3)

  4. Towards clinical molecular diagnosis of inherited cardiac conditions: a comparison of bench-top genome DNA sequencers.

    Directory of Open Access Journals (Sweden)

    Xinzhong Li

    Full Text Available Molecular genetic testing is recommended for diagnosis of inherited cardiac disease, to guide prognosis and treatment, but access is often limited by cost and availability. Recently introduced high-throughput bench-top DNA sequencing platforms have the potential to overcome these limitations.We evaluated two next-generation sequencing (NGS platforms for molecular diagnostics. The protein-coding regions of six genes associated with inherited arrhythmia syndromes were amplified from 15 human samples using parallelised multiplex PCR (Access Array, Fluidigm, and sequenced on the MiSeq (Illumina and Ion Torrent PGM (Life Technologies. Overall, 97.9% of the target was sequenced adequately for variant calling on the MiSeq, and 96.8% on the Ion Torrent PGM. Regions missed tended to be of high GC-content, and most were problematic for both platforms. Variant calling was assessed using 107 variants detected using Sanger sequencing: within adequately sequenced regions, variant calling on both platforms was highly accurate (Sensitivity: MiSeq 100%, PGM 99.1%. Positive predictive value: MiSeq 95.9%, PGM 95.5%. At the time of the study the Ion Torrent PGM had a lower capital cost and individual runs were cheaper and faster. The MiSeq had a higher capacity (requiring fewer runs, with reduced hands-on time and simpler laboratory workflows. Both provide significant cost and time savings over conventional methods, even allowing for adjunct Sanger sequencing to validate findings and sequence exons missed by NGS.MiSeq and Ion Torrent PGM both provide accurate variant detection as part of a PCR-based molecular diagnostic workflow, and provide alternative platforms for molecular diagnosis of inherited cardiac conditions. Though there were performance differences at this throughput, platforms differed primarily in terms of cost, scalability, protocol stability and ease of use. Compared with current molecular genetic diagnostic tests for inherited cardiac arrhythmias

  5. Comparison of two modes of ventilation after fast-track cardiac surgery: Adaptive support ventilation versus synchronized intermittent mandatory ventilation

    International Nuclear Information System (INIS)

    Aghadavoudi, O.

    2012-01-01

    Objective: There is substantial debate regarding the appropriate protocol for ventilatory management in fast-track cardiac anesthesia (FTCA). This study was carried out to assess and compare the risks and benefits of respiratory weaning based on adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation (SIMV) after uncomplicated cardiac surgery. Methodology: In a randomized clinical trial, after receiving approval of the Department Research Committee and informed consent from study subjects, 100 patients undergoing elective coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) were enrolled during a 4-month period at a university-based hospital. After surgery and admission to the intensive care unit (ICU), patients were randomized to ASV and SIMV groups. Arterial blood gas (ABG) and hemodynamic variables, respiratory and ventilator characteristics including lung compliance, rapid shallow breathing index (RSBI), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (P peak), mean airway pressure (p mean), Pao2/FIo2, duration of mechanical ventilation and tracheal intubation, and length of ICU stay were recorded and compared between the two groups. The data were analyzed in 82 patients after considering the exclusion criteria. Results: There were no differences between ASV and SIMV groups in demographics and preoperative characteristics. The duration of tracheal intubation and the length of ICU stay were similar in both groups. There were no statistically and clinically relevant differences between the two groups in ABG, hemodynamic changes, and respiratory and ventilator characteristics during ICU stay. Conclusion: Although ASV may facilitate postoperative respiratory management in FTCA, both ASV and SIMV provide similarly safe and practicable respiratory weaning in the cardiac ICU. The evaluation of potential advantages in patient outcomes and resource utilization of respiratory weaning based on ASV

  6. Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings

    Energy Technology Data Exchange (ETDEWEB)

    Busch, S.; Johnson, T.R.C.; Wintersperger, B.J.; Minaifar, N.; Bhargava, A.; Rist, C.; Reiser, M.F.; Becker, C.; Nikolaou, K. [University of Munich, Department of Clinical Radiology, Munich (Germany)

    2008-03-15

    Cardiac magnetic resonance imaging and echocardiography are currently regarded as standard modalities for the quantification of left ventricular volumes and ejection fraction. With the recent introduction of dual-source computedtomography (DSCT), the increased temporal resolution of 83 ms should also improve the assessment of cardiac function in CT. The aim of this study was to evaluate the accuracy of DSCT in the assessment of left ventricular functional parameters with cardiac magnetic resonance imaging (MRI) as standard of reference. Fifteen patients (two female, 13 male; mean age 50.8 {+-} 19.2 years) underwent CT and MRI examinations on a DSCT (Somatom Definition; Siemens Medical Solutions, Forchheim, Germany) and a 3.0-Tesla MR scanner (Magnetom Trio; Siemens Medical Solutions), respectively. Multiphase axial CT images were analysed with a semiautomatic region growing algorithms (Syngo Circulation; Siemens Medical Solutions) by two independent blinded observers. In MRI, dynamic cine loops of short axis slices were evaluated with semiautomatic contour detection software (ARGUS; Siemens Medical Solutions) independently by two readers. End-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF) and stroke volume (SV) were determined for both modalities, and correlation coefficient, systematic error, limits of agreement and inter-observer variability were assessed. In DSCT, EDV and ESV were 135.8 {+-} 41.9 ml and 54.9 {+-} 29.6 ml, respectively, compared with 132.1 {+-} 40.8 ml EDV and 57.6 {+-} 27.3 ml ESV in MRI. Thus, EDV was overestimated by 3.7 ml (limits of agreement -46.1/+53.6), while ESV was underestimated by 2.6 ml (-36.6/+31.4). Mean EF was 61.6 {+-} 12.4% in DSCT and 57.9 {+-} 9.0% in MRI, resulting in an overestimation of EF by 3.8% with limits of agreement at -14.7 and +22.2%. Rank correlation rho values were 0.81 for EDV (P = 0.0024), 0.79 for ESV (P = 0.0031) and 0.64 for EF (P = 0.0168). The kappa value of inter

  7. Quantitative assessment of left ventricular function with dual-source CT in comparison to cardiac magnetic resonance imaging: initial findings

    International Nuclear Information System (INIS)

    Busch, S.; Johnson, T.R.C.; Wintersperger, B.J.; Minaifar, N.; Bhargava, A.; Rist, C.; Reiser, M.F.; Becker, C.; Nikolaou, K.

    2008-01-01

    Cardiac magnetic resonance imaging and echocardiography are currently regarded as standard modalities for the quantification of left ventricular volumes and ejection fraction. With the recent introduction of dual-source computedtomography (DSCT), the increased temporal resolution of 83 ms should also improve the assessment of cardiac function in CT. The aim of this study was to evaluate the accuracy of DSCT in the assessment of left ventricular functional parameters with cardiac magnetic resonance imaging (MRI) as standard of reference. Fifteen patients (two female, 13 male; mean age 50.8 ± 19.2 years) underwent CT and MRI examinations on a DSCT (Somatom Definition; Siemens Medical Solutions, Forchheim, Germany) and a 3.0-Tesla MR scanner (Magnetom Trio; Siemens Medical Solutions), respectively. Multiphase axial CT images were analysed with a semiautomatic region growing algorithms (Syngo Circulation; Siemens Medical Solutions) by two independent blinded observers. In MRI, dynamic cine loops of short axis slices were evaluated with semiautomatic contour detection software (ARGUS; Siemens Medical Solutions) independently by two readers. End-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF) and stroke volume (SV) were determined for both modalities, and correlation coefficient, systematic error, limits of agreement and inter-observer variability were assessed. In DSCT, EDV and ESV were 135.8 ± 41.9 ml and 54.9 ± 29.6 ml, respectively, compared with 132.1 ± 40.8 ml EDV and 57.6 ± 27.3 ml ESV in MRI. Thus, EDV was overestimated by 3.7 ml (limits of agreement -46.1/+53.6), while ESV was underestimated by 2.6 ml (-36.6/+31.4). Mean EF was 61.6 ± 12.4% in DSCT and 57.9 ± 9.0% in MRI, resulting in an overestimation of EF by 3.8% with limits of agreement at -14.7 and +22.2%. Rank correlation rho values were 0.81 for EDV (P = 0.0024), 0.79 for ESV (P 0.0031) and 0.64 for EF (P = 0.0168). The kappa value of inter-observer variability were

  8. Low dose prospective ECG-gated delayed enhanced dual-source computed tomography in reperfused acute myocardial infarction comparison with cardiac magnetic resonance

    International Nuclear Information System (INIS)

    Wang Rui; Zhang Zhaoqi; Xu Lei; Ma Qin; He Yi; Lu Dongxu; Yu Wei; Fan Zhanming

    2011-01-01

    Purpose: To determine whether prospective electrocardiogram (ECG)-gated delayed contrast-enhanced dual-source computed tomography (DCE-DSCT) can accurately delineate the extension of myocardial infarction (MI) compared with delayed enhanced cardiac MR (DE-MR). Material and methods: Eleven patients were examined using dual-source CT and cardiac MR in 2 weeks after a first reperfused MI. DCE-DSCT scan protocol was performed with prospective ECG-gating sequential scan model 7 min after contrast administration. In a 17-model, infarcted myocardium detected by DE-MR was categorized as transmural and subendocardial extension. Segment of infarcted location and graded transmurality were compared between DCE-MDCT and DE-MR. Results: In all eleven patients, diagnostic quality was obtained for depicting delayed enhanced myocardium. Agreement between DCE-DSCT and MR was good on myocardial segment based comparison (kappa = 0.85, p < 0.001), and on transmural and subendocardial infarction type comparison (kappa = 0.82, p < 0.001, kappa = 0.52, p < 0.001, respectively). CT value was higher on infarcted region than that of normal region (100.02 ± 9.57 HU vs. 72.63 ± 7.32 HU, p < 0.001). Radiation dose of prospectively ECG-gating protocol were 0.99 ± 0.08 mSv (0.82-1.19 mSv). Conclusions: Prospective ECG-gated DCE-DSCT can accurately assess the extension and the patterns of myocardial infarction with low radiation dose.

  9. Low dose prospective ECG-gated delayed enhanced dual-source computed tomography in reperfused acute myocardial infarction comparison with cardiac magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Wang Rui, E-mail: rui_wang1979@yahoo.cn [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Zhang Zhaoqi, E-mail: zhaoqi5000@vip.sohu.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Xu Lei, E-mail: leixu2001@hotmail.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Ma Qin, E-mail: tel1367@gmail.com [Department of Emergency, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); He Yi, E-mail: heyi139@sina.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Lu Dongxu, E-mail: larry.hi@163.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Yu Wei, E-mail: yuwei02@gmail.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Fan Zhanming, E-mail: fanzm120@tom.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China)

    2011-11-15

    Purpose: To determine whether prospective electrocardiogram (ECG)-gated delayed contrast-enhanced dual-source computed tomography (DCE-DSCT) can accurately delineate the extension of myocardial infarction (MI) compared with delayed enhanced cardiac MR (DE-MR). Material and methods: Eleven patients were examined using dual-source CT and cardiac MR in 2 weeks after a first reperfused MI. DCE-DSCT scan protocol was performed with prospective ECG-gating sequential scan model 7 min after contrast administration. In a 17-model, infarcted myocardium detected by DE-MR was categorized as transmural and subendocardial extension. Segment of infarcted location and graded transmurality were compared between DCE-MDCT and DE-MR. Results: In all eleven patients, diagnostic quality was obtained for depicting delayed enhanced myocardium. Agreement between DCE-DSCT and MR was good on myocardial segment based comparison (kappa = 0.85, p < 0.001), and on transmural and subendocardial infarction type comparison (kappa = 0.82, p < 0.001, kappa = 0.52, p < 0.001, respectively). CT value was higher on infarcted region than that of normal region (100.02 {+-} 9.57 HU vs. 72.63 {+-} 7.32 HU, p < 0.001). Radiation dose of prospectively ECG-gating protocol were 0.99 {+-} 0.08 mSv (0.82-1.19 mSv). Conclusions: Prospective ECG-gated DCE-DSCT can accurately assess the extension and the patterns of myocardial infarction with low radiation dose.

  10. Estimating raw material equivalents on a macro-level: comparison of multi-regional input-output analysis and hybrid LCI-IO.

    Science.gov (United States)

    Schoer, Karl; Wood, Richard; Arto, Iñaki; Weinzettel, Jan

    2013-12-17

    The mass of material consumed by a population has become a useful proxy for measuring environmental pressure. The "raw material equivalents" (RME) metric of material consumption addresses the issue of including the full supply chain (including imports) when calculating national or product level material impacts. The RME calculation suffers from data availability, however, as quantitative data on production practices along the full supply chain (in different regions) is required. Hence, the RME is currently being estimated by three main approaches: (1) assuming domestic technology in foreign economies, (2) utilizing region-specific life-cycle inventories (in a hybrid framework), and (3) utilizing multi-regional input-output (MRIO) analysis to explicitly cover all regions of the supply chain. While the first approach has been shown to give inaccurate results, this paper focuses on the benefits and costs of the latter two approaches. We analyze results from two key (MRIO and hybrid) projects modeling raw material equivalents, adjusting the models in a stepwise manner in order to quantify the effects of individual conceptual elements. We attempt to isolate the MRIO gap, which denotes the quantitative impact of calculating the RME of imports by an MRIO approach instead of the hybrid model, focusing on the RME of EU external trade imports. While, the models give quantitatively similar results, differences become more pronounced when tracking more detailed material flows. We assess the advantages and disadvantages of the two approaches and look forward to ways to further harmonize data and approaches.

  11. Comparisons of four categories of waste recycling in China’s paper industry based on physical input–output life-cycle assessment model

    International Nuclear Information System (INIS)

    Liang Sai; Zhang, Tianzhu; Xu Yijian

    2012-01-01

    Highlights: ► Using crop straws and wood wastes for paper production should be promoted. ► Bagasse and textile waste recycling should be properly limited. ► Imports of scrap paper should be encouraged. ► Sensitivity analysis, uncertainties and policy implications are discussed. - Abstract: Waste recycling for paper production is an important component of waste management. This study constructs a physical input–output life-cycle assessment (PIO-LCA) model. The PIO-LCA model is used to investigate environmental impacts of four categories of waste recycling in China’s paper industry: crop straws, bagasse, textile wastes and scrap paper. Crop straw recycling and wood utilization for paper production have small total intensity of environmental impacts. Moreover, environmental impacts reduction of crop straw recycling and wood utilization benefits the most from technology development. Thus, using crop straws and wood (including wood wastes) for paper production should be promoted. Technology development has small effects on environmental impacts reduction of bagasse recycling, textile waste recycling and scrap paper recycling. In addition, bagasse recycling and textile waste recycling have big total intensity of environmental impacts. Thus, the development of bagasse recycling and textile waste recycling should be properly limited. Other pathways for reusing bagasse and textile wastes should be explored and evaluated. Moreover, imports of scrap paper should be encouraged to reduce large indirect impacts of scrap paper recycling on domestic environment.

  12. Comparison of Quantitative Characteristics of Early Post-resuscitation EEG Between Asphyxial and Ventricular Fibrillation Cardiac Arrest in Rats.

    Science.gov (United States)

    Chen, Bihua; Chen, Gang; Dai, Chenxi; Wang, Pei; Zhang, Lei; Huang, Yuanyuan; Li, Yongqin

    2018-04-01

    Quantitative electroencephalogram (EEG) analysis has shown promising results in studying brain injury and functional recovery after cardiac arrest (CA). However, whether the quantitative characteristics of EEG, as potential indicators of neurological prognosis, are influenced by CA causes is unknown. The purpose of this study was designed to compare the quantitative characteristics of early post-resuscitation EEG between asphyxial CA (ACA) and ventricular fibrillation CA (VFCA) in rats. Thirty-two Sprague-Dawley rats of both sexes were randomized into either ACA or VFCA group. Cardiopulmonary resuscitation was initiated after 5-min untreated CA. Characteristics of early post-resuscitation EEG were compared, and the relationships between quantitative EEG features and neurological outcomes were investigated. Compared with VFCA, serum level of S100B, neurological deficit score and brain histopathologic damage score were dramatically higher in the ACA group. Quantitative measures of EEG, including onset time of EEG burst, time to normal trace, burst suppression ratio, and information quantity, were significantly lower for CA caused by asphyxia and correlated with the 96-h neurological outcome and survival. Characteristics of earlier post-resuscitation EEG differed between cardiac and respiratory causes. Quantitative measures of EEG not only predicted neurological outcome and survival, but also have the potential to stratify CA with different causes.

  13. Resting technetium-99m methoxyisobutylisonitrile cardiac imaging in chronic coronary artery disease: comparison with rest-redistribution thallium-201 scintigraphy

    International Nuclear Information System (INIS)

    Cuocolo, A.; Maurea, S.; Pace, L.; Nicolai, E.; Nappi, A.; Imbriaco, M.; Trimarco, B.; Salvatore, M.

    1993-01-01

    We studied 19 patients with angiographically proven coronary artery disease and left ventricular dysfunction (ejection fraction 33%±8%) by resting technetium-99m methoxyisobutylisonitrile ( 99m Tc-MIBI) and rest-redistribution thallium-201 cardiac imaging. Thallium and 99m Tc-MIBI studies were visually analysed. Of 285 segments, 203 (71%) had normal thallium uptake, 48 (17%) showed reversible thallium defects and 34 (12%) showed irreversible thallium defects. Of these 34 irreversible thallium defects, 19 (56%) were moderate and 15 (44%) were severe. Of the corresponding 285 segments, 200 (70%) had normal 99m Tc-MIBI uptake, while 37 (13%) showed moderate and 48 (17%) showed severe reduction of MIBI uptake. Myocardial segmental agreement for regional uptake score between initial thallium and resting 99m Tc-MIBI images was 90% (κ=0.78). Segmental agreement between delayed thallium and resting 99m Tc-MIBI images was 77% (κ=0.44). In particular, in 26 (9%) segments 99m Tc-MIBI uptake was severely reduced while delayed thallium uptake was normal or only moderately reduced. These data suggest that although rest-redistribution thallium and resting 99m Tc-MIBI cardiac imaging provide concordant results in the majority of myocardial segments, some segments with severely reduced resting 99m Tc-MIBI uptake may contain viable but hypoperfused myocardium. Thus, conclusions on myocardial viability based on 99m Tc-MIBI uptake should be made with caution in chronic coronary artery disease. (orig.)

  14. Output hardcopy devices

    CERN Document Server

    Durbeck, Robert

    1988-01-01

    Output Hardcopy Devices provides a technical summary of computer output hardcopy devices such as plotters, computer output printers, and CRT generated hardcopy. Important related technical areas such as papers, ribbons and inks, color techniques, controllers, and character fonts are also covered. Emphasis is on techniques primarily associated with printing, as well as the plotting capabilities of printing devices that can be effectively used for computer graphics in addition to their various printing functions. Comprised of 19 chapters, this volume begins with an introduction to vector and ras

  15. Comparison of Boer, Kiko, and Spanish meat goat does for stayability and cumulative reproductive output in the humid subtropical southeastern United States

    Directory of Open Access Journals (Sweden)

    Pellerin Ashley N

    2012-08-01

    Full Text Available Abstract Background Longevity is the amount of time breeding females stay active in a herd by avoiding death or culling because of illness or reproductive failure. This is a trait of economic relevance in commercial small ruminant breeding herds as it affects lifetime reproductive output. The purpose of this study was to determine if breed of meat goat influences breeding doe survival rates and cumulative reproductive performance under semi-intensive management. Results Boer (n = 132, Kiko (n = 92 and Spanish (n = 79 does were evaluated for longevity trends and cumulative kid production. The herd was managed on humid subtropical pasture. Does had the chance to complete 2 to 6 production years. Survival curves were analyzed for 2 culling methods. The actual culling practice removed does after two failures to wean a kid. An alternative culling protocol removed doe records after the first failure to wean a kid. Kid production traits analyzed across herd life were the total number of kids weaned and cumulative kid weight weaned to the 2-, 3-, and 5-year stayability endpoints. Most (82% doe exits were illness-related under the actual culling method. Reproductive failure represented 51% of doe exits under the alternative culling protocol. Boer does had greater survival declines (P P P  Conclusion Boer does had low stayability and cumulative kid production rates compared with Kiko and Spanish does. Poor health was the primary driver of does exiting the herd. Kiko and Spanish does did not differ for longevity and lifetime performance indicators.

  16. Evaluation of left ventricular function by cardiac CT

    International Nuclear Information System (INIS)

    Naito, Hiroaki; Kozuka, Takahiro

    1982-01-01

    Left ventricular function was evaluated by CT, which was compared with the data of left ventriculography for various cardiac diseases. The end diastolic volume of the left ventricle can be readily computed from CT, with a satisfactory correlation with that of left ventriculography (r = 0.95). The left ventricular ejection fraction, calculated from the areal ratio of the left ventricular lumen in end-diastolic imaging to that in end-sytolic imaging, also roughly reflects left ventricular contractile function, but shows correlation with left ventriculography by only r = 0.79. Although the cardiac output is not sensitive for functional evaluation, it can be directly calculated by means of dynamic scanning and shows a satisfactory correlation with the ear piece pigment dilution (r = 0.85). Evaluation of left ventricular function by CT shows a high precision in comparison with left ventriculography, but still lacks temporal resolving power. (Chiba, N.)

  17. WRF Model Output

    Data.gov (United States)

    U.S. Environmental Protection Agency — This dataset contains WRF model output. There are three months of data: July 2012, July 2013, and January 2013. For each month, several simulations were made: A...

  18. VMS forms Output Tables

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These output tables contain parsed and format validated data from the various VMS forms that are sent from any given vessel, while at sea, from the VMS devices on...

  19. Governmentally amplified output volatility

    Science.gov (United States)

    Funashima, Yoshito

    2016-11-01

    Predominant government behavior is decomposed by frequency into several periodic components: updating cycles of infrastructure, Kuznets cycles, fiscal policy over business cycles, and election cycles. Little is known, however, about the theoretical impact of such cyclical behavior in public finance on output fluctuations. Based on a standard neoclassical growth model, this study intends to examine the frequency at which public investment cycles are relevant to output fluctuations. We find an inverted U-shaped relationship between output volatility and length of cycle in public investment. This implies that periodic behavior in public investment at a certain frequency range can cause aggravated output resonance. Moreover, we present an empirical analysis to test the theoretical implication, using the U.S. data in the period from 1968 to 2015. The empirical results suggest that such resonance phenomena change from low to high frequency.

  20. CMAQ Model Output

    Data.gov (United States)

    U.S. Environmental Protection Agency — CMAQ and CMAQ-VBS model output. This dataset is not publicly accessible because: Files too large. It can be accessed through the following means: via EPA's NCC tape...

  1. Comparison of granisetron, metoclopramide and gastric decompression for prevention of postoperative nausea and vomiting after fast track cardiac anesthesia

    Directory of Open Access Journals (Sweden)

    Omid Aghadavoudi

    2008-08-01

    Full Text Available

    • BACKGROUND: Different methods have been suggested to prevent postoperative nausea and vomiting (PONV, but the efficacy of these methods has not been fully studied in fast track cardiac anesthesia (FTCA.
    • METHODS: In a randomized double blind clinical trial study, 120 patients aged 18-70 years with ASA II or III, undergoing elective cardiac surgery, were selected. They were divided randomly into four groups. In group M, group G and group P, intravenous (IV metoclopramide (0.1 mg/kg, granisetron (0.01 mg/kg, and normal saline were administered, respectively, about thirty minutes before extubation in the intensive care unit (ICU. In group N, a nasogastric (NG tube was inserted after tracheal intubation in the operating room and removed about thirty minutes before extubation in the ICU. The incidence and severity of nausea and the episodes of vomiting were recorded by a blinded investigator at the time of extubation and performed regularly for a maximum of 24 hours. Assessment of severity of nausea was scored using a visual analogue scale (VAS device. Data were analyzed by using ANOVA, chi-squared and Kruskal- Wallis and repeated measures tests.
    • RESULTS: Overall the 24-h incidence of PONV was significantly lower in the G and M groups than in the P and N groups (10% and 16.7% vs. 33.3% and 40%, respectively; P < 0.02. Postoperative rescue medication was significantly less required in the G and M groups compared to the other two groups (P < 0.01. Less satisfaction, according to PONV status, was observed in the P and N groups (P < 0.01.
    • CONCLUSIONS: According to this study, metoclopramide and granisetron, but not gastric decompression, are effective regimens for preventing PONV after FTCA. Given the economics and a considerable background incidence in patients exhibiting PONV, we suggest metoclopramide as a routine prophylactic antiemetic in FTCA

    • Comparison in the determination of absorbed dose by biological and physical methods to patients in treatment of cardiac intervention

      International Nuclear Information System (INIS)

      Guerrero C, C.; Arceo M, C.

      2014-10-01

      The use of less invasive procedures, lower risk and quick recovery as cardiac intervention have proven to be an efficient alternative to reestablish the correct bloodstream of the patient. In this case the patient is subjected to values of absorbed dose above to which is subjected in a study with X-rays for medical diagnosis, and this can cause radiation injuries to the skin. The target organ, in this case can be exposed to doses of 2 Gy above. Different methods to estimate the dose were use, physical by Radiochromic film, as biological by dicentric analysis. Both methods provided additional information demonstrating thus the risk in the target organ and the patient. The most reliable biological indicator of exposure to ionizing radiation is the study of chromosomal aberrations, specifically dicentric in human lymphocytes. This test allowed establishing the exposure dose depending of the damage. (Author)

    • Cardiac interbeat interval dynamics from childhood to senescence : comparison of conventional and new measures based on fractals and chaos theory

      Science.gov (United States)

      Pikkujamsa, S. M.; Makikallio, T. H.; Sourander, L. B.; Raiha, I. J.; Puukka, P.; Skytta, J.; Peng, C. K.; Goldberger, A. L.; Huikuri, H. V.

      1999-01-01

      BACKGROUND: New methods of R-R interval variability based on fractal scaling and nonlinear dynamics ("chaos theory") may give new insights into heart rate dynamics. The aims of this study were to (1) systematically characterize and quantify the effects of aging from early childhood to advanced age on 24-hour heart rate dynamics in healthy subjects; (2) compare age-related changes in conventional time- and frequency-domain measures with changes in newly derived measures based on fractal scaling and complexity (chaos) theory; and (3) further test the hypothesis that there is loss of complexity and altered fractal scaling of heart rate dynamics with advanced age. METHODS AND RESULTS: The relationship between age and cardiac interbeat (R-R) interval dynamics from childhood to senescence was studied in 114 healthy subjects (age range, 1 to 82 years) by measurement of the slope, beta, of the power-law regression line (log power-log frequency) of R-R interval variability (10(-4) to 10(-2) Hz), approximate entropy (ApEn), short-term (alpha(1)) and intermediate-term (alpha(2)) fractal scaling exponents obtained by detrended fluctuation analysis, and traditional time- and frequency-domain measures from 24-hour ECG recordings. Compared with young adults (60 years, n=29). CONCLUSIONS: Cardiac interbeat interval dynamics change markedly from childhood to old age in healthy subjects. Children show complexity and fractal correlation properties of R-R interval time series comparable to those of young adults, despite lower overall heart rate variability. Healthy aging is associated with R-R interval dynamics showing higher regularity and altered fractal scaling consistent with a loss of complex variability.

    • A multi-centre analysis of radiotherapy beam output measurement

      Directory of Open Access Journals (Sweden)

      Matthew A. Bolt

      2017-10-01

      Conclusions: Machine beam output measurements were largely within ±2% of 1.00 cGy/MU. Clear trends in measured output over time were seen, with some machines having large drifts which would result in additional burden to maintain within acceptable tolerances. This work may act as a baseline for future comparison of beam output measurements.

    • Multi-slice CT (MSCT) in cardiac function imaging: threshold-value-supported 3D volume reconstructions to determine the left ventricular ejection fraction in comparison to MRI

      International Nuclear Information System (INIS)

      Ehrhard, K.; Oberholzer, K.; Gast, K.; Mildenberger, P.; Kreitner, K.F.; Thelen, M.

      2002-01-01

      Purpose: To assess MSCT of the heart to determining left ventricular ejection fraction (EF) based on threshold-value-supported 3D volume reconstructions compared to MRI. Methods: Cardiac MSCT was performed in 7 patients. Images were reconstructed during end-systolic and end-diastolic phases of the cardiac cycle and transformed to 3D volumes to determine end-systolic (ESV) and end-diastolic volume (EDV) by using different lower threshold values: besides fixed lower threshold values, identical for each image sequence, individual lower threshold values dependent on contrast enhancement of the left ventricle were applied. The latter represent the mean value calculated by combining the average CT-density of the myocardium and the contrast-enhanced blood in the left ventricle. The EF derived from ESV and EDV. Results: The best correlation with MR imaging was obtained for ESV and EDV by using the individual lower threshold values for the respective sequence. The correlation coefficient for ESV was 0.95 and for EDV it was 0.93. On average, the ESV was overestimated by 3.72 ml, while the ESD was underestimated by 2.85 ml. The respective standard deviation for the ESV was 14,87 ml, for the EDV it was 26.83 ml. On average, the EF was underestimated by 3.57% with a standard deviation of 9.43% and a correlation coefficient of 0.83 in comparison to MRI. Conclusion: The threshold-value-supported 3D volume reconstruction of the left ventricle represents a good method to determine the left ventricular function parameters. Due to the differences in the contrast enhancement, the use of an individual lower threshold value for every image sequence is of particular importance. (orig.) [de

    • Oil output's changing fortunes

      International Nuclear Information System (INIS)

      Eldridge, D.

      1994-01-01

      The Petroleum Economist, previously the Petroleum Press Service, has been making annual surveys of output levels of petroleum in all the oil-producing countries since its founding in 1934. This article documents trends and changes in the major oil-producing countries output from 1934 until the present. This analysis is linked with the political and historical events accompanying these changes, notably the growth of Middle Eastern oil production, the North Sea finds and most recently, Iraq's invasion of Kuwait in 1990. (UK)

    • Performance comparison of independent component analysis algorithms for fetal cardiac signal reconstruction: a study on synthetic fMCG data

      International Nuclear Information System (INIS)

      Mantini, D; II, K E Hild; Alleva, G; Comani, S

      2006-01-01

      Independent component analysis (ICA) algorithms have been successfully used for signal extraction tasks in the field of biomedical signal processing. We studied the performances of six algorithms (FastICA, CubICA, JADE, Infomax, TDSEP and MRMI-SIG) for fetal magnetocardiography (fMCG). Synthetic datasets were used to check the quality of the separated components against the original traces. Real fMCG recordings were simulated with linear combinations of typical fMCG source signals: maternal and fetal cardiac activity, ambient noise, maternal respiration, sensor spikes and thermal noise. Clusters of different dimensions (19, 36 and 55 sensors) were prepared to represent different MCG systems. Two types of signal-to-interference ratios (SIR) were measured. The first involves averaging over all estimated components and the second is based solely on the fetal trace. The computation time to reach a minimum of 20 dB SIR was measured for all six algorithms. No significant dependency on gestational age or cluster dimension was observed. Infomax performed poorly when a sub-Gaussian source was included; TDSEP and MRMI-SIG were sensitive to additive noise, whereas FastICA, CubICA and JADE showed the best performances. Of all six methods considered, FastICA had the best overall performance in terms of both separation quality and computation times

    • Comparison of the calcium release channel of cardiac and skeletal muscle sarcoplasmic reticulum by target inactivation analysis

      International Nuclear Information System (INIS)

      McGrew, S.G.; Inui, Makoto; Chadwick, C.C.; Boucek, R.J. Jr.; Jung, C.Y.; Fleischer, S.

      1989-01-01

      The calcium release channel of sarcoplasmic reticulum which triggers muscle contraction in excitation-contraction coupling has recently been isolated. The channel has been found to be morphologically identical with the feet structures of the junctional face membrane of terminal cisternae and consists of an oligomer of a unique high molecular weight polypeptide. In this study, the authors compare the target size of the calcium release channel from heart and skeletal muscle using target inactivation analysis. The target molecular weights of the calcium release channel estimated by measuring ryanodine binding after irradiation are similar for heart (139,000) and skeletal muscle (143,000) and are smaller than the monomeric unit (estimated to be about 360,000). The target size, estimated by measuring polypeptide remaining after irradiation, was essentially the same for heart and skeletal muscle, 1,061,000 and 1,070,000, respectively, indicating an oligomeric association of protomers. Thus, the calcium release channel of both cardiac and skeletal muscle reacts uniquely with regard to target inactivation analysis in that (1) the size by ryanodine binding is smaller than the monomeric unit and (2) a single hit leads to destruction of more than one polypeptide, by measuring polypeptide remaining. The target inactivation analysis studies indicate that heart and skeletal muscle receptors are structurally very similar

    • Comparison of Conventional versus Steerable-Catheter Guided Coronary Sinus Lead Positioning in Patients Undergoing Cardiac Resynchronization Device Implantation.

      Directory of Open Access Journals (Sweden)

      Fikret Er

      Full Text Available The aim of this study was to compare conventional versus steerable catheter guided coronary sinus (CS cannulation in patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT.Steerable catheter guided coronary sinus cannulation could reduce fluoroscopy time and contrast medium use during CRT implantation.176 consecutive patients with ischemic and non-ischemic heart failure undergoing CRT implantation from January 2008 to December 2012 at the University Hospital of Cologne were identified. During the study period two concurrent CS cannulation techniques were used: standard CS cannulation technique (standard-group, n = 113 and CS cannulation using a steerable electrophysiology (EP catheter (EPCath-group, n = 63. Propensity-score matched pairs of conventional and EP-catheter guided CS cannulation made up the study population (n = 59 pairs. Primary endpoints were total fluoroscopy time and contrast medium amount used during procedure.The total fluoroscopy time was 30.9 min (interquartile range (IQR, 19.9-44.0 min in the standard-group and 23.4 min (IQR, 14.2-34-2 min in the EPCath-group (p = 0.011. More contrast medium was used in the standard-group (60.0 ml, IQR, 30.0-100 ml compared to 25.0 ml (IQR, 20.0-50.0 ml in the EPCath-group (P<0.001.Use of steerable EP catheter was associated with significant reduction of fluoroscopy time and contrast medium use in patients undergoing CRT implantation.

    • Comparison of Image Processing Techniques for Nonviable Tissue Quantification in Late Gadolinium Enhancement Cardiac Magnetic Resonance Images.

      Science.gov (United States)

      Carminati, M Chiara; Boniotti, Cinzia; Fusini, Laura; Andreini, Daniele; Pontone, Gianluca; Pepi, Mauro; Caiani, Enrico G

      2016-05-01

      The aim of this study was to compare the performance of quantitative methods, either semiautomated or automated, for left ventricular (LV) nonviable tissue analysis from cardiac magnetic resonance late gadolinium enhancement (CMR-LGE) images. The investigated segmentation techniques were: (i) n-standard deviations thresholding; (ii) full width at half maximum thresholding; (iii) Gaussian mixture model classification; and (iv) fuzzy c-means clustering. These algorithms were applied either in each short axis slice (single-slice approach) or globally considering the entire short-axis stack covering the LV (global approach). CMR-LGE images from 20 patients with ischemic cardiomyopathy were retrospectively selected, and results from each technique were assessed against manual tracing. All methods provided comparable performance in terms of accuracy in scar detection, computation of local transmurality, and high correlation in scar mass compared with the manual technique. In general, no significant difference between single-slice and global approach was noted. The reproducibility of manual and investigated techniques was confirmed in all cases with slightly lower results for the nSD approach. Automated techniques resulted in accurate and reproducible evaluation of LV scars from CMR-LGE in ischemic patients with performance similar to the manual technique. Their application could minimize user interaction and computational time, even when compared with semiautomated approaches.

    • Measurement of cardiac ventricular volumes using multidetector row computed tomography: comparison of two- and three-dimensional methods

      International Nuclear Information System (INIS)

      Montaudon, M.; Laffon, E.; Berger, P.; Corneloup, O.; Latrabe, V.; Laurent, F.

      2006-01-01

      This study compared a three-dimensional volumetric threshold-based method to a two-dimensional Simpson's rule based short-axis multiplanar method for measuring right (RV) and left ventricular (LV) volumes, stroke volumes, and ejection fraction using electrocardiography-gated multidetector computed tomography (MDCT) data sets. End-diastolic volume (EDV) and end-systolic volume (ESV) of RV and LV were measured independently and blindly by two observers from contrast-enhanced MDCT images using commercial software in 18 patients. For RV and LV the three-dimensionally calculated EDV and ESV values were smaller than those provided by two-dimensional short axis (10%, 5%, 15% and 26% differences respectively). Agreement between the two methods was found for LV (EDV/ESV: r=0.974/0.910, ICC=0.905/0.890) but not for RV (r=0.882/0.930, ICC=0.663/0.544). Measurement errors were significant only for EDV of LV using the two-dimensional method. Similar reproducibility was found for LV measurements, but the three-dimensional method provided greater reproducibility for RV measurements than the two-dimensional. The threshold value supported three-dimensional method provides reproducible cardiac ventricular volume measurements, comparable to those obtained using the short-axis Simpson based method. (orig.)

    • Quantification of Right and Left Ventricular Function in Cardiac MR Imaging: Comparison of Semiautomatic and Manual Segmentation Algorithms

      Directory of Open Access Journals (Sweden)

      Jose Martin Carreira

      2013-04-01

      Full Text Available The purpose of this study was to evaluate the performance of a semiautomatic segmentation method for the anatomical and functional assessment of both ventricles from cardiac cine magnetic resonance (MR examinations, reducing user interaction to a “mouse-click”. Fifty-two patients with cardiovascular diseases were examined using a 1.5-T MR imaging unit. Several parameters of both ventricles, such as end-diastolic volume (EDV, end-systolic volume (ESV and ejection fraction (EF, were quantified by an experienced operator using the conventional method based on manually-defined contours, as the standard of reference; and a novel semiautomatic segmentation method based on edge detection, iterative thresholding and region growing techniques, for evaluation purposes. No statistically significant differences were found between the two measurement values obtained for each parameter (p > 0.05. Correlation to estimate right ventricular function was good (r > 0.8 and turned out to be excellent (r > 0.9 for the left ventricle (LV. Bland-Altman plots revealed acceptable limits of agreement between the two methods (95%. Our study findings indicate that the proposed technique allows a fast and accurate assessment of both ventricles. However, further improvements are needed to equal results achieved for the right ventricle (RV using the conventional methodology.

    • Cardiac function studies

      International Nuclear Information System (INIS)

      Horn, H.J.

      1986-01-01

      A total of 27 patients were subjected tointramyocardial sequential scintiscanning (first pass) using 99m-Tc human serum albumin. A refined method is described that is suitable to analyse clinically relevant parameters like blood volume, cardiac output, ejection fraction, stroke volume, enddiastolic and endsystolic volumes as well as pulmonal transition time and uses a complete camaracomputer system adapted to the requirements of a routine procedure. Unless there is special hardware available, the method does not yet appear mature enough to be put into general practice. Its importance recently appeared in a new light due to the advent of particularly shortlived isotopes. For the time being, however, ECG-triggered equilibrium studies are to be preferred for cardiac function tests. (TRV) [de

    • The Association Between Urine Output, Creatinine Elevation, and Death.

      Science.gov (United States)

      Engoren, Milo; Maile, Michael D; Heung, Michael; Jewell, Elizabeth S; Vahabzadeh, Christie; Haft, Jonathan W; Kheterpal, Sachin

      2017-04-01

      Acute kidney injury can be defined by a fall in urine output, and urine output criteria may be more sensitive in identifying acute kidney injury than traditional serum creatinine criteria. However, as pointed out in the Kidney Disease Improving Global Outcome guidelines, the association of urine output with subsequent creatinine elevations and death is poorly characterized. The purpose of this study was to determine what degrees of reduced urine output are associated with subsequent creatinine elevation and death. This was a retrospective cohort study of adult patients (age ≥18 years) cared for in a cardiovascular intensive care unit after undergoing cardiac operations in a tertiary care university medical center. All adult patients who underwent cardiac operations and were not receiving dialysis preoperatively were studied. The development of acute kidney injury was defined as an increase in creatinine of more than 0.3 mg/dL or by more than 50% above baseline by postoperative day 3. Acute kidney injury developed in 1,061 of 4,195 patients (25%). Urine output had moderate discrimination in predicting subsequent acute kidney injury (C statistic = .637 ± .054). Lower urine output and longer duration of low urine output were associated with greater odds of developing acute kidney injury and death. We found that there is similar accuracy in using urine output corrected for actual, ideal, or adjusted weight to discriminate future acute kidney injury by creatinine elevation and recommend using actual weight for its simplicity. We also found that low urine output is associated with subsequent acute kidney injury and that the association is greater for lower urine output and for low urine output of longer durations. Low urine output (creatinine elevation, is independently associated with mortality. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

    • Effects of perindopril on cardiac sympathetic nerve activity in patients with congestive heart failure: comparison with enalapril

      Energy Technology Data Exchange (ETDEWEB)

      Kasama, Shu; Toyama, Takuji; Suzuki, Tadashi; Kurabayashi, Masahiko [Gunma University School of Medicine, Department of Cardiovascular Medicine, Maebashi, Gunma (Japan); Kumakura, Hisao; Takayama, Yoshiaki; Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan, Department of Internal Medicine, Gunma (Japan)

      2005-08-01

      The production of aldosterone in the heart is suppressed by the angiotensin-converting enzyme (ACE) inhibitor perindopril in patients with congestive heart failure (CHF). Moreover, perindopril has been reported to have more cardioprotective effects than enalapril. Forty patients with CHF [left ventricular ejection fraction (LVEF) <45%; mean 33{+-}7%] were randomly assigned to perindopril (2 mg/day; n=20) or enalapril (5 mg/day; n=20). All patients were also treated with diuretics. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from {sup 123}I-meta-iodobenzylguanidine (MIBG) images, and plasma brain natriuretic peptide (BNP) concentrations were measured before and 6 months after treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and LVEF were also determined by echocardiography. After treatment, in patients receiving perindopril, TDS decreased from 39{+-}10 to 34{+-}9 (P<0.01), H/M ratios increased from 1.62{+-}0.27 to 1.76{+-}0.29 (P<0.01), WR decreased from 50{+-}14% to 42{+-}14% (P<0.05) and plasma BNP concentrations decreased from 226{+-}155 to 141{+-}90 pg/ml (P<0.0005). In addition, the LVEDV decreased from 180{+-}30 to 161{+-}30 ml (P<0.05) and the LVESV decreased from 122{+-}35 to 105{+-}36 ml (P<0.05). Although the LVEF tended to increase, the change was not statistically significant (from 33{+-}8% to 36{+-}12%; P=NS). On the other hand, there were no significant changes in these parameters in patients receiving enalapril. Plasma BNP concentrations, {sup 123}I-MIBG scintigraphic and echocardiographic parameters improved after 6 months of perindopril treatment. These findings indicate that perindopril treatment can ameliorate the cardiac sympathetic nerve activity and the left ventricular performance in patients with CHF. (orig.)

    • Intraindividual comparison of T1 relaxation times after gadobutrol and Gd-DTPA administration for cardiac late enhancement imaging

      Energy Technology Data Exchange (ETDEWEB)

      Doeblin, Patrick, E-mail: Patrick.doeblin@charite.de [Department of Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Berlin (Germany); Schilling, Rene, E-mail: rene.schilling@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Berlin (Germany); Wagner, Moritz, E-mail: moritz.wagner@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Berlin (Germany); Luhur, Reny, E-mail: renyluhur@yahoo.com [Department of Radiology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Berlin (Germany); Huppertz, Alexander, E-mail: alexander.huppertz@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Berlin (Germany); Imaging Science Institute, Charité, Berlin (Germany); Hamm, Bernd, E-mail: bernd.hamm@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Berlin (Germany); Taupitz, Matthias, E-mail: matthias.taupitz@harite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Berlin (Germany); and others

      2014-04-15

      Purpose: To evaluate T1-relaxation times of chronic myocardial infarction (CMI) using gadobutrol and gadopentetate dimeglumine (Gd-DTPA) over time and to determine the optimal imaging window for late enhancement imaging with both contrast agents. Material and methods: Twelve patients with CMI were prospectively included and examined on a 1.5 T magnetic resonance (MR) system using relaxivity-adjusted doses of gadobutrol (0.15 mmol/kg) and Gd-DTPA (0.2 mmol/kg) in random order. T1-relaxation times of remote myocardium (RM), infarcted myocardium (IM), and left ventricular cavity (LVC) were assessed from short-axis TI scout imaging using the Look–Locker approach and compared intraindividually using a Wilcoxon paired signed-rank test (α < 0.05). Results: Within 3 min of contrast agent administration (CA), IM showed significantly lower T1-relaxation times than RM with both contrast agents, indicating beginning cardiac late enhancement. Differences between gadobutrol and Gd-DTPA in T1-relaxation times of IM and RM were statistically not significant through all time points. However, gadobutrol led to significantly higher T1-relaxation times of LVC than Gd-DTPA from 6 to 9 min (220 ± 15 ms vs. 195 ± 30 ms p < 0.01) onwards, resulting in a significantly greater ΔT1 of IM to LVC at 9–12 min (−20 ± 35 ms vs. 0 ± 35 ms, p < 0.05) and 12–15 min (−25 ± 45 ms vs. −10 ± 60 ms, p < 0.05). Using Gd-DTPA, comparable ΔT1 values were reached only after 25–35 min. Conclusion: This study indicates good delineation of IM to RM with both contrast agents as early as 3 min after administration. However, we found significant differences in T1 relaxation times with greater ΔT1 IM–LVC using 0.15 mmol/kg gadobutrol compared to 0.20 mmol/kg Gd-DTPA after 9–15 min post-CA suggesting earlier differentiability of IM and LVC using gadobutrol.

    • Impact of knowledge-based iterative model reconstruction on myocardial late iodine enhancement in computed tomography and comparison with cardiac magnetic resonance.

      Science.gov (United States)

      Tanabe, Yuki; Kido, Teruhito; Kurata, Akira; Fukuyama, Naoki; Yokoi, Takahiro; Kido, Tomoyuki; Uetani, Teruyoshi; Vembar, Mani; Dhanantwari, Amar; Tokuyasu, Shinichi; Yamashita, Natsumi; Mochizuki, Teruhito

      2017-10-01

      We evaluated the image quality and diagnostic performance of late iodine enhancement computed tomography (LIE-CT) with knowledge-based iterative model reconstruction (IMR) for the detection of myocardial infarction (MI) in comparison with late gadolinium enhancement magnetic resonance imaging (LGE-MRI). The study investigated 35 patients who underwent a comprehensive cardiac CT protocol and LGE-MRI for the assessment of coronary artery disease. The CT protocol consisted of stress dynamic myocardial CT perfusion, coronary CT angiography (CTA) and LIE-CT using 256-slice CT. LIE-CT scans were acquired 5 min after CTA without additional contrast medium and reconstructed with filtered back projection (FBP), a hybrid iterative reconstruction (HIR), and IMR. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were assessed. Sensitivity and specificity of LIE-CT for detecting MI were assessed according to the 16-segment model. Image quality scores, and diagnostic performance were compared among LIE-CT with FBP, HIR and IMR. Among the 35 patients, 139 of 560 segments showed MI in LGE-MRI. On LIE-CT with FBP, HIR, and IMR, the median SNRs were 2.1, 2.9, and 6.1; and the median CNRs were 1.7, 2.2, and 4.7, respectively. Sensitivity and specificity were 56 and 93% for FBP, 62 and 91% for HIR, and 80 and 91% for IMR. LIE-CT with IMR showed the highest image quality and sensitivity (p quality and diagnostic performance of LIE-CT for detecting MI in comparison with FBP and HIR.

    • Assessment of global and regional left ventricular function using 64-slice multislice computed tomography and 2D echocardiography: A comparison with cardiac magnetic resonance

      International Nuclear Information System (INIS)

      Annuar, Bin Rapaee; Liew, Chee Khoon; Chin, Sze Piaw; Ong, Tiong Kiam; Seyfarth, M. Tobias; Chan, Wei Ling; Fong, Yean Yip; Ang, Choon Kiat; Lin, Naing; Liew, Houng Bang; Sim, Kui Hian

      2008-01-01

      Objectives: To compare the assessment of global and regional left ventricular (LV) function using 64-slice multislice computed tomography (MSCT), 2D echocardiography (2DE) and cardiac magnetic resonance (CMR). Methods: Thirty-two consecutive patients (mean age, 56.5 ± 9.7 years) referred for evaluation of coronary artery using 64-slice MSCT also underwent 2DE and CMR within 48 h. The global left ventricular function which include left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVdV) and left ventricular end systolic volume (LVsV) were determine using the three modalities. Regional wall motion (RWM) was assessed visually in all three modalities. The CMR served as the gold standard for the comparison between 64-slice MSCT with CMR and 2DE with CMR. Statistical analysis included Pearson correlation coefficient, Bland-Altman plots and κ-statistics. Results: The 64-slice MSCT agreed well with CMR for assessment of LVEF (r = 0.92; p < 0.0001), LVdV (r = 0.98; p < 0.0001) and LVsV (r = 0.98; p < 0.0001). In comparison with 64-slice MSCT, 2DE showed moderate correlation with CMR for the assessment of LVEF (r = 0.84; p < 0.0001), LVdV (r = 0.83; p < 0.0001) and LVsV (r = 0.80; p < 0.0001). However in RWM analysis, 2DE showed better accuracy than 64-slice MSCT (94.3% versus 82.4%) and closer agreement (κ = 0.89 versus 0.63) with CMR. Conclusion: 64-Slice MSCT correlates strongly with CMR in global LV function however in regional LV function 2DE showed better agreement with CMR than 64-slice MSCT

    • Assessment of global and regional left ventricular function using 64-slice multislice computed tomography and 2D echocardiography: A comparison with cardiac magnetic resonance

      Energy Technology Data Exchange (ETDEWEB)

      Annuar, Bin Rapaee [Faculty of Medicine, University Malaysia Sarawak (Malaysia); Department of Cardiology, Sarawak General Hospital (Malaysia)], E-mail: rannuar@fmhs.unimas.my; Liew, Chee Khoon; Chin, Sze Piaw; Ong, Tiong Kiam [Department of Cardiology, Sarawak General Hospital (Malaysia); Seyfarth, M. Tobias [Sieman Medical Solution (Germany); Chan, Wei Ling; Fong, Yean Yip; Ang, Choon Kiat [Department of Cardiology, Sarawak General Hospital (Malaysia); Lin, Naing [Universiti Sains Malaysia (Malaysia); Liew, Houng Bang; Sim, Kui Hian [Department of Cardiology, Sarawak General Hospital (Malaysia)

      2008-01-15

      Objectives: To compare the assessment of global and regional left ventricular (LV) function using 64-slice multislice computed tomography (MSCT), 2D echocardiography (2DE) and cardiac magnetic resonance (CMR). Methods: Thirty-two consecutive patients (mean age, 56.5 {+-} 9.7 years) referred for evaluation of coronary artery using 64-slice MSCT also underwent 2DE and CMR within 48 h. The global left ventricular function which include left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVdV) and left ventricular end systolic volume (LVsV) were determine using the three modalities. Regional wall motion (RWM) was assessed visually in all three modalities. The CMR served as the gold standard for the comparison between 64-slice MSCT with CMR and 2DE with CMR. Statistical analysis included Pearson correlation coefficient, Bland-Altman plots and {kappa}-statistics. Results: The 64-slice MSCT agreed well with CMR for assessment of LVEF (r = 0.92; p < 0.0001), LVdV (r = 0.98; p < 0.0001) and LVsV (r = 0.98; p < 0.0001). In comparison with 64-slice MSCT, 2DE showed moderate correlation with CMR for the assessment of LVEF (r = 0.84; p < 0.0001), LVdV (r = 0.83; p < 0.0001) and LVsV (r = 0.80; p < 0.0001). However in RWM analysis, 2DE showed better accuracy than 64-slice MSCT (94.3% versus 82.4%) and closer agreement ({kappa} = 0.89 versus 0.63) with CMR. Conclusion: 64-Slice MSCT correlates strongly with CMR in global LV function however in regional LV function 2DE showed better agreement with CMR than 64-slice MSCT.

    • Assessment of global and regional left ventricular function using 64-slice multislice computed tomography and 2D echocardiography: a comparison with cardiac magnetic resonance.

      Science.gov (United States)

      Annuar, Bin Rapaee; Liew, Chee Khoon; Chin, Sze Piaw; Ong, Tiong Kiam; Seyfarth, M Tobias; Chan, Wei Ling; Fong, Yean Yip; Ang, Choon Kiat; Lin, Naing; Liew, Houng Bang; Sim, Kui Hian

      2008-01-01

      To compare the assessment of global and regional left ventricular (LV) function using 64-slice multislice computed tomography (MSCT), 2D echocardiography (2DE) and cardiac magnetic resonance (CMR). Thirty-two consecutive patients (mean age, 56.5+/-9.7 years) referred for evaluation of coronary artery using 64-slice MSCT also underwent 2DE and CMR within 48h. The global left ventricular function which include left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVdV) and left ventricular end systolic volume (LVsV) were determine using the three modalities. Regional wall motion (RWM) was assessed visually in all three modalities. The CMR served as the gold standard for the comparison between 64-slice MSCT with CMR and 2DE with CMR. Statistical analysis included Pearson correlation coefficient, Bland-Altman plots and kappa-statistics. The 64-slice MSCT agreed well with CMR for assessment of LVEF (r=0.92; p<0.0001), LVdV (r=0.98; p<0.0001) and LVsV (r=0.98; p<0.0001). In comparison with 64-slice MSCT, 2DE showed moderate correlation with CMR for the assessment of LVEF (r=0.84; p<0.0001), LVdV (r=0.83; p<0.0001) and LVsV (r=0.80; p<0.0001). However in RWM analysis, 2DE showed better accuracy than 64-slice MSCT (94.3% versus 82.4%) and closer agreement (kappa=0.89 versus 0.63) with CMR. 64-Slice MSCT correlates strongly with CMR in global LV function however in regional LV function 2DE showed better agreement with CMR than 64-slice MSCT.

  1. Cardiac arrest

    Science.gov (United States)

    ... magnesium. These minerals help your heart's electrical system work. Abnormally high or low levels can cause cardiac arrest. Severe physical stress. Anything that causes a severe stress on your ...

  2. Cardiac Ochronosis

    Science.gov (United States)

    Erek, Ersin; Casselman, Filip P.A.; Vanermen, Hugo

    2004-01-01

    We report the case of 67-year-old woman who underwent aortic valve replacement and mitral valve repair due to ochronotic valvular disease (alkaptonuria), which was diagnosed incidentally during cardiac surgery. PMID:15745303

  3. Cardiac catheterization

    Science.gov (United States)

    ... tests. However, it is very safe when done by an experienced team. The risks include: Cardiac tamponade Heart attack Injury to a coronary artery Irregular heartbeat Low blood pressure Reaction to the contrast dye Stroke Possible complications ...

  4. Nuclear cardiac

    International Nuclear Information System (INIS)

    Slutsky, R.; Ashburn, W.L.

    1982-01-01

    The relationship between nuclear medicine and cardiology has continued to produce a surfeit of interesting, illuminating, and important reports involving the analysis of cardiac function, perfusion, and metabolism. To simplify the presentation, this review is broken down into three major subheadings: analysis of myocardial perfusion; imaging of the recent myocardial infarction; and the evaluation of myocardial function. There appears to be an increasingly important relationship between cardiology, particularly cardiac physiology, and nuclear imaging techniques

  5. Cardiac output and vasodilation in the vasovagal response

    DEFF Research Database (Denmark)

    Wieling, Wouter; Jardine, David L.; de Lange, Frederik J

    2016-01-01

    . Plethysmographic measurements were intermittent and not frequent enough to capture rapid changes in blood flow during progressive hypotension. However, later investigations by Weissler, Murray, and Stevens performed between 1950 and 1970 used invasive beat-to-beat BP measurements and more frequent measurements...

  6. Effects of Exercise Training on Haematology and Maximal Cardiac Output

    DEFF Research Database (Denmark)

    Bonne, Thomas Christian

    = 0.051) and time to complete 3000 m tended (P = 0.09) to increase in LHTH but not after sea level training. In study III haematological parameters were determined weekly three times before and four times after classical altitude and sea level training and ABP thresholds for [Hb], %ret, OFF......-score and the abnormal blood profile score (ABPS) were generated using the official ABP software. After altitude training, six swimmers exceeded the 99% ABP thresholds: Two swimmers exceeded the OFF-score thresholds at day 7; One swimmer exceeded the OFF-score threshold at day 28; One swimmer exceeded the threshold...... for %ret at day 14; One swimmer surpassed the ABPS threshold at day 7 and one swimmer exceeded the ABPS threshold 28 days after altitude training. No values exceeded the individual thresholds in the control group. In conclusion, this thesis demonstrated that BV is a main determinant of the exercise induced...

  7. Cardiac MR tagging: optimization of sequence parameters and comparison at 1.5 T and 3.0 T in a volunteer study

    International Nuclear Information System (INIS)

    Kramer, U.; Fenchel, M.; Klumpp, B.; Claussen, C.D.; Miller, S.; Deshpande, V.; Laub, G.; Finn, J.P.

    2006-01-01

    Purpose: The aim of this study was the optimization of a gradient echo (GRE) MR tagging sequence at 3.0 T in comparison to 1.5 T in order to obtain the best image contrast between the myocardium, tag lines and blood signal. Theoretically expected improvements of signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were also calculated. Materials and methods: 14 healthy volunteers (8 male, 6 female; mean age 43.4±10.3 years) were scanned using a 3.0 T as well as a 1.5 T whole-body system. A GRE flash-2 D tagging sequence was evaluated (midventricular short axis view) by varying the flip angle (8-16 ), slice thickness (4-8 mm; fixed flip angle 1.5/3.0 T: 12 /8 , tag size 8 mm) and tag size (4-8 mm, fixed flip angle 1.5/3.0 T: 12 /8 , slice thickness 6 mm). The field of view, acquisition time and temporal resolution (45 ms) were kept constant. Qualitative and quantitative image analysis was performed by calculating the SNR, CNR tag as well as the relative contrast between the myocardium and tag lines (RCMT). Results: Based on individual comparison, the best imaging protocol was found at a slice thickness of 6 mm, tag size of 8 mm, optimized flip angle of 8 (3.0 T) and 12 (1.5 T), respectively. Compared to 1.5 T, a significantly higher overall image score was determined (mean±sd; 3.2±0.2 vs 2.7±0.4) and a strong correlation between the CNR tag and RCMT for flip angle α and the slice thickness was found. A higher field strength resulted in an 80% increase in the CNR tag compared to 1.5 T (mean 10.7/6.1). Furthermore, the SNR was improved by 35% (mean 20.6/15.3) and the RCMT by 35% (mean 0.47/0.35). Conclusion: Myocardial tagging at 3.0 T has shown superior image quality in comparison to 1.5 T due to a higher baseline SNR and an improved CNR as well as RCMT. The suppressed fading of the tags enables the accessibility to the diastolic phase of the cardiac cycle. (orig.)

  8. Prenatal Detection of Cardiac Anomalies in Fetuses with Single Umbilical Artery: Diagnostic Accuracy Comparison of Maternal-Fetal-Medicine and Pediatric Cardiologist

    Directory of Open Access Journals (Sweden)

    Ilir Tasha

    2014-01-01

    Full Text Available Aim. To determine agreement of cardiac anomalies between maternal fetal medicine (MFM physicians and pediatric cardiologists (PC in fetuses with single umbilical artery (SUA. Methods. A retrospective review of all fetuses with SUA between 1999 and 2008. Subjects were studied by MFM and PC, delivered at our institution, and had confirmation of SUA and cardiac anomaly by antenatal and neonatal PC follow-up. Subjects were divided into four groups: isolated SUA, SUA and isolated cardiac anomaly, SUA and multiple anomalies without heart anomalies, and SUA and multiple malformations including cardiac anomaly. Results. 39,942 cases were studied between 1999 and 2008. In 376 of 39,942 cases (0.94%, SUA was diagnosed. Only 182 (48.4% met inclusion criteria. Cardiac anomalies were found in 21% (38/182. Agreement between MFM physicians and PC in all groups combined was 94% (171/182 (95% CI [89.2, 96.8]. MFM physicians overdiagnosed cardiac anomalies in 4.4% (8/182. MFM physicians and PC failed to antenatally diagnose cardiac anomaly in the same two cases. Conclusions. Good agreement was noted between MFM physicians and PC in our institution. Studies performed antenatally by MFM physicians and PC are less likely to uncover the entire spectrum of cardiac abnormalities and thus neonatal follow-up is suggested.

  9. Right-sided cardiac function in healthy volunteers measured by first-pass radionuclide ventriculography and gated blood-pool SPECT: comparison with cine MRI

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Lebech, Anne-Mette; Hesse, Birger

    2005-01-01

    for evaluation of right-sided cardiac function. The aim of our study was to compare the agreement between these methods when measuring right-sided cardiac function. METHODS: Twenty-four healthy volunteers were included. Mean age was 44 years (range: 25-60) and 29% were females. All participants had FP, GBPS...

  10. Relationship between cardiac function and resting cerebral blood flow

    DEFF Research Database (Denmark)

    Henriksen, Otto M; Jensen, Lars T; Krabbe, Katja

    2014-01-01

    ) and 2.4 l min(-1) m(-2), respectively, in females. No effects of cardiac output or cardiac index on CBF or structural signs of brain ageing were observed. However, fractional brain flow defined as the ratio of total brain flow to cardiac output was inversely correlated with cardiac index (r(2) = 0.22, P...... = 0.008) and furthermore lower in males than in females (8.6% versus 12.5%, P = 0.003). Fractional brain flow was also inversely correlated with cerebral white matter lesion grade, although this effect was not significant when adjusted for age. Frequency analysis of heart rate variability showed...

  11. Cardiac CT

    International Nuclear Information System (INIS)

    Dewey, Marc

    2011-01-01

    Computed tomography of the heart has become a highly accurate diagnostic modality that is attracting increasing attention. This extensively illustrated book aims to assist the reader in integrating cardiac CT into daily clinical practice, while also reviewing its current technical status and applications. Clear guidance is provided on the performance and interpretation of imaging using the latest technology, which offers greater coverage, better spatial resolution, and faster imaging. The specific features of scanners from all four main vendors, including those that have only recently become available, are presented. Among the wide range of applications and issues to be discussed are coronary artery bypass grafts, stents, plaques, and anomalies, cardiac valves, congenital and acquired heart disease, and radiation exposure. Upcoming clinical uses of cardiac CT, such as plaque imaging and functional assessment, are also explored. (orig.)

  12. Cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, Marc [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

    2011-07-01

    Computed tomography of the heart has become a highly accurate diagnostic modality that is attracting increasing attention. This extensively illustrated book aims to assist the reader in integrating cardiac CT into daily clinical practice, while also reviewing its current technical status and applications. Clear guidance is provided on the performance and interpretation of imaging using the latest technology, which offers greater coverage, better spatial resolution, and faster imaging. The specific features of scanners from all four main vendors, including those that have only recently become available, are presented. Among the wide range of applications and issues to be discussed are coronary artery bypass grafts, stents, plaques, and anomalies, cardiac valves, congenital and acquired heart disease, and radiation exposure. Upcoming clinical uses of cardiac CT, such as plaque imaging and functional assessment, are also explored. (orig.)

  13. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanović-Krstić Branislava A.

    2002-01-01

    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  14. Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study).

    Science.gov (United States)

    Margossian, Renee; Schwartz, Marcy L; Prakash, Ashwin; Wruck, Lisa; Colan, Steven D; Atz, Andrew M; Bradley, Timothy J; Fogel, Mark A; Hurwitz, Lynne M; Marcus, Edward; Powell, Andrew J; Printz, Beth F; Puchalski, Michael D; Rychik, Jack; Shirali, Girish; Williams, Richard; Yoo, Shi-Joon; Geva, Tal

    2009-08-01

    Assessment of the size and function of a functional single ventricle (FSV) is a key element in the management of patients after the Fontan procedure. Measurement variability of ventricular mass, volume, and ejection fraction (EF) among observers by echocardiography and cardiac magnetic resonance imaging (CMR) and their reproducibility among readers in these patients have not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9 +/- 3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Interobserver agreement for qualitative grading of ventricular function by echocardiography was modest for left ventricular (LV) morphology (kappa = 0.42) and weak for right ventricular (RV) morphology (kappa = 0.12). For quantitative assessment, high intraclass correlation coefficients were found for echocardiographic interobserver agreement (LV 0.87 to 0.92, RV 0.82 to 0.85) of systolic and diastolic volumes, respectively. In contrast, intraclass correlation coefficients for LV and RV mass were moderate (LV 0.78, RV 0.72). The corresponding intraclass correlation coefficients by CMR were high (LV 0.96, RV 0.85). Volumes by echocardiography averaged 70% of CMR values. Interobserver reproducibility for the EF was similar for the 2 modalities. Although the absolute mean difference between modalities for the EF was small (<2%), 95% limits of agreement were wide. In conclusion, agreement between observers of qualitative FSV function by echocardiography is modest. Measurements of FSV volume by 2-dimensional echocardiography underestimate CMR measurements, but their reproducibility is high. Echocardiographic and CMR measurements of FSV EF demonstrate similar interobserver reproducibility, whereas measurements of FSV mass and LV diastolic volume are more reproducible by CMR.

  15. [Cardiac cachexia].

    Science.gov (United States)

    Miján, Alberto; Martín, Elvira; de Mateo, Beatriz

    2006-05-01

    Chronic heart failure (CHF), especially affecting the right heart, frequently leads to malnutrition. If the latter is severe and is combined to other factors, it may lead to cardiac cachexia. This one is associated to increased mortality and lower survival of patients suffering from it. The causes of cardiac cachexia are diverse, generally associated to maintenance of a negative energy balance, with increasing evidence of its multifactorial origin. Neurohumoral, inflammatory, immunological, and metabolic factors, among others, are superimposed in the patient with CHF, leading to involvement and deterioration of several organs and systems, since this condition affects both lean (or active cellular) mass and adipose and bone tissue osteoporosis. Among all, the most pronounced deterioration may be seen at skeletal muscle tissue, at both structural and functional levels, the heart not being spared. As for treatment, it should be based on available scientific evidence. Assessment of nutritional status of any patient with CHF is a must, with the requirement of nutritional intervention in case of malnutrition. In this situation, especially if accompanied by cardiac cachexia, it is required to modify energy intake and oral diet quality, and to consider the indication of specific complementary or alternative artificial nutrition. Besides, the causal relationship of the beneficial role of moderate physical exertion is increasing, as well as modulation of metabolic and inflammatory impairments observed in cardiac cachexia with several drugs, leading to a favorable functional and structural response in CHF patients.

  16. Cardiac Pacemakers

    International Nuclear Information System (INIS)

    Fiandra, O.; Espasandin, W.; Fiandra, H.

    1984-01-01

    A complete survey of physiological biophysical,clinical and engineering aspects of cardiac facing,including the history and an assessment of possible future developments.Among the topics studied are: pacemakers, energy search, heart stimulating with pacemakers ,mathematical aspects of the electric cardio stimulation chronic, pacemaker implants,proceeding,treatment and control

  17. Pulmonary vascular volume ratio measured by cardiac computed tomography in children and young adults with congenital heart disease: comparison with lung perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo; Park, Sang Hyub [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of)

    2017-11-15

    Lung perfusion scintigraphy is regarded as the gold standard for evaluating differential lung perfusion ratio in congenital heart disease. To compare cardiac CT with lung perfusion scintigraphy for estimated pulmonary vascular volume ratio in patients with congenital heart disease. We included 52 children and young adults (median age 4 years, range 2 months to 28 years; 31 males) with congenital heart disease who underwent cardiac CT and lung perfusion scintigraphy without an interim surgical or transcatheter intervention and within 1 year. We calculated the right and left pulmonary vascular volumes using threshold-based CT volumetry. Then we compared right pulmonary vascular volume percentages at cardiac CT with right lung perfusion percentages at lung perfusion scintigraphy by using paired t-test and Bland-Altman analysis. The right pulmonary vascular volume percentages at cardiac CT (66.3 ± 14.0%) were significantly smaller than the right lung perfusion percentages at lung perfusion scintigraphy (69.1 ± 15.0%; P=0.001). Bland-Altman analysis showed a mean difference of -2.8 ± 5.8% and 95% limits of agreement (-14.1%, 8.5%) between these two variables. Cardiac CT, in a single examination, can offer pulmonary vascular volume ratio in addition to pulmonary artery anatomy essential for evaluating peripheral pulmonary artery stenosis in patients with congenital heart disease. However there is a wide range of agreement between cardiac CT and lung perfusion scintigraphy. (orig.)

  18. Pulmonary vascular volume ratio measured by cardiac computed tomography in children and young adults with congenital heart disease: comparison with lung perfusion scintigraphy

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Park, Sang Hyub

    2017-01-01

    Lung perfusion scintigraphy is regarded as the gold standard for evaluating differential lung perfusion ratio in congenital heart disease. To compare cardiac CT with lung perfusion scintigraphy for estimated pulmonary vascular volume ratio in patients with congenital heart disease. We included 52 children and young adults (median age 4 years, range 2 months to 28 years; 31 males) with congenital heart disease who underwent cardiac CT and lung perfusion scintigraphy without an interim surgical or transcatheter intervention and within 1 year. We calculated the right and left pulmonary vascular volumes using threshold-based CT volumetry. Then we compared right pulmonary vascular volume percentages at cardiac CT with right lung perfusion percentages at lung perfusion scintigraphy by using paired t-test and Bland-Altman analysis. The right pulmonary vascular volume percentages at cardiac CT (66.3 ± 14.0%) were significantly smaller than the right lung perfusion percentages at lung perfusion scintigraphy (69.1 ± 15.0%; P=0.001). Bland-Altman analysis showed a mean difference of -2.8 ± 5.8% and 95% limits of agreement (-14.1%, 8.5%) between these two variables. Cardiac CT, in a single examination, can offer pulmonary vascular volume ratio in addition to pulmonary artery anatomy essential for evaluating peripheral pulmonary artery stenosis in patients with congenital heart disease. However there is a wide range of agreement between cardiac CT and lung perfusion scintigraphy. (orig.)

  19. Comparison of a Simple Angiographic Approach With a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery Score-Based Approach for Left Main Coronary Artery Stenting: A Pooled Analysis of Serial PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) Studies.

    Science.gov (United States)

    Lee, Pil Hyung; Lee, Jong-Young; Lee, Cheol Whan; Kim, Seon-Ok; Ahn, Jung-Min; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Park, Seung-Jung

    2018-01-01

    The applicability of Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores to left main coronary artery disease (CAD) has been questioned. A simplified alternative is needed for guiding decision making. We evaluated the prognostic value of a simplified angiographic classification in comparison with a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score-based approach for patients with left main CAD undergoing drug-eluting stent implantation. The proposed approach classified left main CAD as either extensive (n=819), defined as left main bifurcation lesions with an involvement of ostial left circumflex artery or as any left main lesion plus multivessel CAD, or limited (n=453), defined as ostial/midshaft lesions or left main bifurcation lesions without an involvement of ostium of left circumflex artery, alone or plus 1-vessel disease. The databases from 4 prospective Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease studies were pooled, and the primary outcome was a major adverse cardiac event, defined as death, myocardial infarction, or repeat revascularization. During follow-up (median 38 months; interquartile range, 36-61 months), the risk for major adverse cardiac event was significantly higher with extensive than with limited left main CAD (adjusted hazard ratio, 2.13; 95% confidence interval, 1.54-2.94; P Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score tertiles did not effectively stratify these 2 outcome measures. Compared with Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores, the simpler angiographic approach provided better discrimination for future cardiovascular events in patients with left main CAD undergoing drug-eluting stent implantation. © 2018 American Heart Association, Inc.

  20. Comparison of {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) in corticosteroid-naive patients with conduction system disease due to cardiac sarcoidosis

    Energy Technology Data Exchange (ETDEWEB)

    Ohira, Hiroshi; Birnie, David H.; Mc Ardle, Brian; Dick, Alexander; Klein, Ran; Renaud, Jennifer; DeKemp, Robert A.; Davies, Ross; Hessian, Renee; Liu, Peter; Nery, Pablo B. [University of Ottawa Heart Institute, Molecular Function and Imaging Program, National Cardiac PET Centre, Ottawa, ON (Canada); University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON (Canada); Pena, Elena; Dennie, Carole [The Ottawa Hospital, Medical Imaging Department, Ottawa, ON (Canada); University of Ottawa, Department of Radiology, Ottawa, ON (Canada); Bernick, Jordan; Wells, George A. [University of Ottawa Heart Institute, Cardiovascular Research Methods Center, Ottawa, ON (Canada); Leung, Eugene [The Ottawa Hospital, Division of Nuclear Medicine, Department of Medicine, Ottawa, Ontario (Canada); Yoshinaga, Keiichiro [Hokkaido University School of Medicine, Department of Molecular Imaging, Hokkaido (Japan); Tsujino, Ichizo; Sato, Takahiro; Nishimura, Masaharu [Hokkaido University School of Medicine, First Department of Medicine, Hokkaido (Japan); Manabe, Osamu; Tamaki, Nagara [Hokkaido University School of Medicine, Department of Nuclear Medicine, Hokkaido (Japan); Oyama-Manabe, Noriko [Hokkaido University Hospital, Diagnostic and Interventional Radiology, Hokkaido (Japan); Ruddy, Terrence D.; Beanlands, Rob S.B. [University of Ottawa Heart Institute, Molecular Function and Imaging Program, National Cardiac PET Centre, Ottawa, ON (Canada); University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON (Canada); The Ottawa Hospital, Medical Imaging Department, Ottawa, ON (Canada); University of Ottawa, Department of Radiology, Ottawa, ON (Canada); The Ottawa Hospital, Division of Nuclear Medicine, Department of Medicine, Ottawa, Ontario (Canada); Chow, Benjamin J.W. [University of Ottawa Heart Institute, Molecular Function and Imaging Program, National Cardiac PET Centre, Ottawa, ON (Canada); University of Ottawa Heart Institute, Arrhythmia Service, Division of Cardiology, Department of Medicine, Ottawa, ON (Canada); The Ottawa Hospital, Medical Imaging Department, Ottawa, ON (Canada); University of Ottawa, Department of Radiology, Ottawa, ON (Canada)

    2016-02-15

    Cardiac sarcoidosis (CS) is a cause of conduction system disease (CSD). {sup 18}F-Fluorodeoxyglucose-positron emission tomography (FDG PET) and cardiac magnetic resonance (CMR) are used for detection of CS. The relative diagnostic value of these has not been well studied. The aim was to compare these imaging modalities in this population. We recruited steroid-naive patients with newly diagnosed CSD due to CS. All CS patients underwent both imaging studies within 12 weeks of each other. Patients were classified into two groups: group A with chronic mild CSD (right bundle branch block and/or axis deviation), and group B with new-onset atrioventricular block (AVB, Mobitz type II or third-degree AVB). Thirty patients were included. Positive findings on both imaging studies were seen in 72 % of patients (13/18) in group A and in 58 % of patients (7/12) in group B. The remainder (28 %) of the patients in group A were positive only on CMR. Of the patients in group B, 8 % were positive only on CMR and 33 % were positive only on FDG PET. Patients in group A were more likely to be positive only on CMR, and patients in group B were more likely to be positive only on FDG PET (p = 0.02). Patients in group B positive only on FDG PET underwent CMR earlier relative to their symptomatology than patients positive only on CMR (median 7.0, IQR 1.5 - 34.3, vs. 72.0, IQR 25.0 - 79.5 days; p = 0.03). The number of positive FDG PET and CMR studies was different in patients with CSD depending on their clinical presentation. This study demonstrated that CMR can adequately detect cardiac involvement associated with chronic mild CSD. In patients presenting with new-onset AVB and a negative CMR study, FDG PET may be useful for detecting cardiac involvement due to CS. (orig.)

  1. Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants. Comparison with transthoracic echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of)

    2018-02-15

    Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT. To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography. The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001). Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. (orig.)

  2. Identification of coronary artery anatomy on dual-source cardiac computed tomography before arterial switch operation in newborns and young infants. Comparison with transthoracic echocardiography

    International Nuclear Information System (INIS)

    Goo, Hyun Woo

    2018-01-01

    Considering inherent limitations of transthoracic echocardiography, the diagnostic accuracy of cardiac CT in identifying coronary artery anatomy before arterial switch operation needs to be investigated with recently improved coronary artery visibility using electrocardiogram (ECG)-synchronized dual-source CT. To compare diagnostic accuracy between cardiac CT using a dual-source scanner and transthoracic echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. The study included 101 infants (median age 4 days, range 0 days to 10 months; M:F=78:23) who underwent ECG-synchronized cardiac dual-source CT and transthoracic echocardiography before arterial switch operation between July 2011 and December 2016. We evaluated and classified coronary artery anatomy on cardiac CT and transthoracic echocardiography. With the surgical findings as the reference standard, we compared the diagnostic accuracy for identifying coronary artery anatomy between cardiac CT and transthoracic echocardiography. The most common coronary artery pattern was the usual pattern (left coronary artery from sinus 1 and right coronary artery from sinus 2; 64.4%, 65/101), followed by a single coronary artery from sinus 2 and a conal branch from sinus 1 (7.9%, 8/101), the inverted pattern (5.9%, 6/101), the right coronary artery and left anterior descending artery from sinus 1 and the left circumflex artery from sinus 2 (5.9%, 6/101), and others. In 96 infants with surgically proven coronary artery anatomy, the diagnostic accuracy of cardiac CT was significantly higher than that of transthoracic echocardiography (91.7%, 88/96 vs. 54.2%, 52/96; P<0.0001). Diagnostic accuracy of cardiac CT is significantly higher than that of echocardiography in identifying coronary artery anatomy before arterial switch operation in newborns and young infants. (orig.)

  3. Comparison of volumetric and functional parameters in simultaneous cardiac PET/MR: feasibility of volumetric assessment with residual activity from prior PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Luecke, C.; Brenneis, B.; Grothoff, M.; Gutberlet, M. [University Leipzig - Heart Center, Department of Diagnostic and Interventional Radiology, Leipzig (Germany); Oppolzer, B.; Werner, P.; Jochimsen, T.; Sattler, B.; Barthel, H.; Sabri, O. [University Hospital Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Foldyna, B. [University Leipzig - Heart Center, Department of Diagnostic and Interventional Radiology, Leipzig (Germany); Massachusetts General Hospital - Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Lurz, P. [University Leipzig - Heart Center, Clinic for Internal Medicine/Cardiology, Leipzig (Germany); Lehmkuhl, L. [Herz- und Gefaess-Klinik GmbH, Radiologische Klinik, Bad Neustadt (Germany)

    2017-12-15

    To compare cardiac left ventricular (LV) parameters in simultaneously acquired hybrid fluorine-18-fluorodeoxyglucose ([18F] FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with residual tracer activity of upstream PET/CT. Twenty-nine patients (23 men, age 58±17 years) underwent cardiac PET/MRI either directly after a non-cardiac PET/CT with homogenous cardiac [18F] FDG uptake (n=20) or for viability assessment (n=9). Gated cardiac [18F] FDG PET and cine MR sequences were acquired simultaneously and evaluated blinded to the cross-imaging results. Image quality (IQ), end-diastolic (LVEDV), end-systolic volume (LVESV), ejection fraction (LVEF) and myocardial mass (LVMM) were measured. Pearson correlation and intraclass correlation coefficient (ICC), regression and a Bland-Altman analysis were assessed. Except LVMM, volumetric and functional LV parameters demonstrated high correlations (LVESV: r=0.97, LVEDV: r=0.95, LVEF: r=0.91, LVMM: r=0.87, each p<0.05), but wide limits of agreement (LOA) for LVEDV (-25.3-82.5ml); LVESV (-33.1-72.7ml); LVEF (-18.9-14.8%) and LVMM (-78.2-43.2g). Intra- and interobserver reliability were very high (ICC≥0.95) for all parameters, except for MR-LVEF (ICC=0.87). PET-IQ (0-3) was high (mean: 2.2±0.9) with significant influence on LVMM calculations only. In simultaneously acquired cardiac PET/MRI data, LVEDV, LVESV and LVEF show good agreement. However, the agreement seems to be limited if cardiac PET/MRI follows PET/CT and only the residual activity is used. (orig.)

  4. Direct comparison of cardiac magnetic resonance feature tracking and 2D/3D echocardiography speckle tracking for evaluation of global left ventricular strain.

    Science.gov (United States)

    Obokata, Masaru; Nagata, Yasufumi; Wu, Victor Chien-Chia; Kado, Yuichiro; Kurabayashi, Masahiko; Otsuji, Yutaka; Takeuchi, Masaaki

    2016-05-01

    Cardiac magnetic resonance (CMR) feature tracking (FT) with steady-state free precession (SSFP) has advantages over traditional myocardial tagging to analyse left ventricular (LV) strain. However, direct comparisons of CMRFT and 2D/3D echocardiography speckle tracking (2/3DEST) for measurement of LV strain are limited. The aim of this study was to investigate the feasibility and reliability of CMRFT and 2D/3DEST for measurement of global LV strain. We enrolled 106 patients who agreed to undergo both CMR and 2D/3DE on the same day. SSFP images at multiple short-axis and three apical views were acquired. 2DE images from three levels of short-axis, three apical views, and 3D full-volume datasets were also acquired. Strain data were expressed as absolute values. Feasibility was highest in CMRFT, followed by 2DEST and 3DEST. Analysis time was shortest in 3DEST, followed by CMRFT and 2DEST. There was good global longitudinal strain (GLS) correlation between CMRFT and 2D/3DEST (r = 0.83 and 0.87, respectively) with the limit of agreement (LOA) ranged from ±3.6 to ±4.9%. Excellent global circumferential strain (GCS) correlation between CMRFT and 2D/3DEST was observed (r = 0.90 and 0.88) with LOA of ±6.8-8.5%. Global radial strain showed fair correlations (r = 0.69 and 0.82, respectively) with LOA ranged from ±12.4 to ±16.3%. CMRFT GCS showed least observer variability with highest intra-class correlation. Although not interchangeable, the high GLS and GCS correlation between CMRFT and 2D/3DEST makes CMRFT a useful modality for quantification of global LV strain in patients, especially those with suboptimal echo image quality. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  5. An evaluation of data-driven motion estimation in comparison to the usage of external-surrogates in cardiac SPECT imaging

    International Nuclear Information System (INIS)

    Mukherjee, Joyeeta Mitra; Johnson, Karen L; Pretorius, P Hendrik; King, Michael A; Hutton, Brian F

    2013-01-01

    Motion estimation methods in single photon emission computed tomography (SPECT) can be classified into methods which depend on just the emission data (data-driven), or those that use some other source of information such as an external surrogate. The surrogate-based methods estimate the motion exhibited externally which may not correlate exactly with the movement of organs inside the body. The accuracy of data-driven strategies on the other hand is affected by the type and timing of motion occurrence during acquisition, the source distribution, and various degrading factors such as attenuation, scatter, and system spatial resolution. The goal of this paper is to investigate the performance of two data-driven motion estimation schemes based on the rigid-body registration of projections of motion-transformed source distributions to the acquired projection data for cardiac SPECT studies. Comparison is also made of six intensity based registration metrics to an external surrogate-based method. In the data-driven schemes, a partially reconstructed heart is used as the initial source distribution. The partially-reconstructed heart has inaccuracies due to limited angle artifacts resulting from using only a part of the SPECT projections acquired while the patient maintained the same pose. The performance of different cost functions in quantifying consistency with the SPECT projection data in the data-driven schemes was compared for clinically realistic patient motion occurring as discrete pose changes, one or two times during acquisition. The six intensity-based metrics studied were mean-squared difference, mutual information, normalized mutual information (NMI), pattern intensity (PI), normalized cross-correlation and entropy of the difference. Quantitative and qualitative analysis of the performance is reported using Monte-Carlo simulations of a realistic heart phantom including degradation factors such as attenuation, scatter and system spatial resolution. Further the

  6. Cardiac ablation

    Directory of Open Access Journals (Sweden)

    Kelly Ratheal

    2016-01-01

    Full Text Available Cardiac ablation is a procedure that uses either radiofrequency or cryothermal energy to destroy cells in the heart to terminate and/or prevent arrhythmias. The indications for cardiac catheter ablation include refractory, symptomatic arrhythmias, with more specific guidelines for atrial fibrillation in particular. The ablation procedure itself involves mapping the arrhythmia and destruction of the aberrant pathway in an effort to permanently prevent the arrhythmia. There are many types of arrhythmias, and they require individualized approaches to ablation based on their innately different electrical pathways. Ablation of arrhythmias, such as Wolff-Parkinson-White syndrome, AV nodal reentrant tachycardia, and atrial-fibrillation, is discussed in this review. Ablation has a high success rate overall and minimal complication rates, leading to improved quality of life in many patients.

  7. Evaluation of the cardiac efficiency by means of functional radiocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Scheibe, J; Stoll, W [Friedrich-Schiller-Universitaet, Jena (German Democratic Republic). Bereich Medizin

    1982-01-01

    A new method of evaluating the cardiac efficiency by means of radiocardiography performed on exertion with /sup 113m/InCl is reported. Analysis of stroke volume, end diastolic volume and of the quotient of cardiac output to end diastolic volume on exertion enables an adequate evaluation of the actual myocardial efficiency.

  8. A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis.

    Science.gov (United States)

    Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

    2017-01-01

    The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755-0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691-0.783) and 0.742 (0.698-0.785), p machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction.

  9. SiC MOSFETs based split output half bridge inverter

    DEFF Research Database (Denmark)

    Li, Helong; Munk-Nielsen, Stig; Beczkowski, Szymon

    2014-01-01

    output. The double pulse test shows the devices' current during commutation process and the reduced switching losses of SiC MOSFETs compared to that of the traditional half bridge. The efficiency comparison is presented with experimental results of half bridge power inverter with split output...... and traditional half bridge inverter, from switching frequency 10 kHz to 100 kHz. The experimental results comparison shows that the half bridge with split output has an efficiency improvement of more than 0.5% at 100 kHz switching frequency....

  10. Technetium-99m labeled 1-(4-fluorobenzyl)-4-(2-mercapto-2-methyl-4-azapentyl)-4- (2-mercapto-2-methylp ropylamino)-piperidine and iodine-123 metaiodobenzylguanidine for studying cardiac adrenergic function: a comparison of the uptake characteristics in vascular smooth muscle cells and neonatal cardiac myocytes, and an investigation in rats

    International Nuclear Information System (INIS)

    Samnick, Samuel; Scheuer, Claudia; Muenks, Sven; El-Gibaly, Amr M.; Menger, Michael D.; Kirsch, Carl-Martin

    2004-01-01

    drugs in lowering cardiac uptake of 99m Tc-FBPBAT. Uptake reduction was more pronounced in myocardium than in other adrenergic-rich organs, including the lung, spleen, kidney, and adrenals, suggesting that the 99m Tc-FBPBAT uptake in myocardium specifically reflects a high degree of α 1 /β 1 -receptor binding to cardiac adrenergic neurons. In comparison, reduction of cardiac and pulmonary uptake of 123 I-MIBG was effective after pretreatment of rats with desipramine and reserpine, confirming distinct neuronal binding sites for 99m Tc-FBPBAT and 123 I-MIBG. 99m Tc-FBPBAT was excreted via urine and to a lower degree via feces. Urine analysis 6 hours p.i. revealed that more than 40% of the total excreted radioactivity was unmetabolized 99m Tc-FBPBAT. In conclusion, the uptake of 99m Tc-FBPBAT in rat myocardium specifically reflects binding to cardiac adrenergic neurons. The 99m Tc-FBPBAT uptake appears to be predominantly mediated via the α 1 /β 1 -adrenoceptor pathway. These data indicate that 99m Tc-FBPBAT, like 123 I-MIBG, may be suitable for mapping cardiac adrenergic innervation by SPET, especially for α 1 /β 1 -adrenoceptors as target in numerous heart diseases

  11. Technetium-99m labeled 1-(4-fluorobenzyl)-4-(2-mercapto-2-methyl-4-azapentyl)-4- (2-mercapto-2-methylp ropylamino)-piperidine and iodine-123 metaiodobenzylguanidine for studying cardiac adrenergic function: a comparison of the uptake characteristics in vascular smooth muscle cells and neonatal cardiac myocytes, and an investigation in rats

    Energy Technology Data Exchange (ETDEWEB)

    Samnick, Samuel E-mail: rassam@uniklinik-saarland.de; Scheuer, Claudia; Muenks, Sven; El-Gibaly, Amr M.; Menger, Michael D.; Kirsch, Carl-Martin

    2004-05-01

    -MIBG, respectively. Prazosin, urapidil, and metoprolol were as effective as treatment with other adrenergic drugs in lowering cardiac uptake of {sup 99m}Tc-FBPBAT. Uptake reduction was more pronounced in myocardium than in other adrenergic-rich organs, including the lung, spleen, kidney, and adrenals, suggesting that the {sup 99m}Tc-FBPBAT uptake in myocardium specifically reflects a high degree of {alpha}{sub 1}/{beta}{sub 1}-receptor binding to cardiac adrenergic neurons. In comparison, reduction of cardiac and pulmonary uptake of {sup 123}I-MIBG was effective after pretreatment of rats with desipramine and reserpine, confirming distinct neuronal binding sites for {sup 99m}Tc-FBPBAT and {sup 123}I-MIBG. {sup 99m}Tc-FBPBAT was excreted via urine and to a lower degree via feces. Urine analysis 6 hours p.i. revealed that more than 40% of the total excreted radioactivity was unmetabolized {sup 99m}Tc-FBPBAT. In conclusion, the uptake of {sup 99m}Tc-FBPBAT in rat myocardium specifically reflects binding to cardiac adrenergic neurons. The {sup 99m}Tc-FBPBAT uptake appears to be predominantly mediated via the {alpha}{sub 1}/{beta}{sub 1}-adrenoceptor pathway. These data indicate that {sup 99m}Tc-FBPBAT, like {sup 123}I-MIBG, may be suitable for mapping cardiac adrenergic innervation by SPET, especially for {alpha}{sub 1}/{beta}{sub 1}-adrenoceptors as target in numerous heart diseases.

  12. Pregnancy as a cardiac stress model

    Science.gov (United States)

    Chung, Eunhee; Leinwand, Leslie A.

    2014-01-01

    Cardiac hypertrophy occurs during pregnancy as a consequence of both volume overload and hormonal changes. Both pregnancy- and exercise-induced cardiac hypertrophy are generally thought to be similar and physiological. Despite the fact that there are shared transcriptional responses in both forms of cardiac adaptation, pregnancy results in a distinct signature of gene expression in the heart. In some cases, however, pregnancy can induce adverse cardiac events in previously healthy women without any known cardiovascular disease. Peripartum cardiomyopathy is the leading cause of non-obstetric mortality during pregnancy. To understand how pregnancy can cause heart disease, it is first important to understand cardiac adaptation during normal pregnancy. This review provides an overview of the cardiac consequences of pregnancy, including haemodynamic, functional, structural, and morphological adaptations, as well as molecular phenotypes. In addition, this review describes the signalling pathways responsible for pregnancy-induced cardiac hypertrophy and angiogenesis. We also compare and contrast cardiac adaptation in response to disease, exercise, and pregnancy. The comparisons of these settings of cardiac hypertrophy provide insight into pregnancy-associated cardiac adaptation. PMID:24448313

  13. Clinical comparison of cardiac blood pool visualization with technetium-99m red blood cells labeled in vivo and with technetium-99m human serum albumin

    International Nuclear Information System (INIS)

    Thrall, J.H.; Freitas, J.E.; Swanson, D.; Rogers, W.L.; Clare, J.M.; Brown, M.L.; Pitt, B.

    1978-01-01

    Technetium-99m red blood cells (Tc-RBC) labeled by an in vivo technique were compared with two preparations of Tc-99m human serum albumin (HSA) for cardiac blood-pool imaging. Relative distribution of the tracers was analyzed on end-diastolic frames of gated blood-pool studies and on whole-body (head to mid-thigh) anterior pinhole images. The Tc-RBC demonstrated greater relative percentage localization in the cardiac blood pool, higher target-to-background ratios in the left ventricle, and less liver concentration. For cardiac blood-pool imaging, Tc-RBC labeled by the in vivo approach appears to be superior to the two Tc-HSA preparations studied

  14. Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization

    International Nuclear Information System (INIS)

    Kaul, S.; Finkelstein, D.M.; Homma, S.; Leavitt, M.; Okada, R.D.; Boucher, C.A.

    1988-01-01

    The purpose of this study was to determine the prognostic utility of quantitative exercise thallium-201 imaging and compare it with that of cardiac catheterization in ambulatory patients. Accordingly, long-term (4 to 9 years) follow-up was obtained in 293 patients who underwent both tests for the evaluation of chest pain: 89 had undergone coronary artery bypass graft surgery within 3 months of testing and were excluded from analysis, 119 experienced no cardiac events and 91 had an event (death in 20, nonfatal myocardial infarction in 21 and coronary artery bypass operations performed greater than 3 months after cardiac catheterization in 50). When all variables were analyzed using Cox regression analysis, the quantitatively assessed lung/heart ratio of thallium-201 activity was the most important predictor of a future cardiac event (chi 2 = 40.21). Other significant predictors were the number of diseased vessels (chi 2 = 17.11), patient gender (chi 2 = 9.43) and change in heart rate from rest to exercise (chi 2 = 4.19). Whereas the number of diseased vessels was an important independent predictor of cardiac events, it did not add significantly to the overall ability of the exercise thallium-201 test to predict events. Furthermore, information obtained from thallium-201 imaging alone was marginally superior to that obtained from cardiac catheterization alone (p = 0.04) and significantly superior to that obtained from exercise testing alone (p = 0.02) in determining the occurrence of events. In addition, unlike the exercise thallium-201 test, which could predict the occurrence of all categories of events, catheterization data were not able to predict the occurrence of nonfatal myocardial infarction. The exclusion of bypass surgery and previous myocardial infarction did not alter the results

  15. Pulmonary vascular volume ratio measured by cardiac computed tomography in children and young adults with congenital heart disease: comparison with lung perfusion scintigraphy.

    Science.gov (United States)

    Goo, Hyun Woo; Park, Sang Hyub

    2017-11-01

    Lung perfusion scintigraphy is regarded as the gold standard for evaluating differential lung perfusion ratio in congenital heart disease. To compare cardiac CT with lung perfusion scintigraphy for estimated pulmonary vascular volume ratio in patients with congenital heart disease. We included 52 children and young adults (median age 4 years, range 2 months to 28 years; 31 males) with congenital heart disease who underwent cardiac CT and lung perfusion scintigraphy without an interim surgical or transcatheter intervention and within 1 year. We calculated the right and left pulmonary vascular volumes using threshold-based CT volumetry. Then we compared right pulmonary vascular volume percentages at cardiac CT with right lung perfusion percentages at lung perfusion scintigraphy by using paired t-test and Bland-Altman analysis. The right pulmonary vascular volume percentages at cardiac CT (66.3 ± 14.0%) were significantly smaller than the right lung perfusion percentages at lung perfusion scintigraphy (69.1 ± 15.0%; P=0.001). Bland-Altman analysis showed a mean difference of -2.8 ± 5.8% and 95% limits of agreement (-14.1%, 8.5%) between these two variables. Cardiac CT, in a single examination, can offer pulmonary vascular volume ratio in addition to pulmonary artery anatomy essential for evaluating peripheral pulmonary artery stenosis in patients with congenital heart disease. However there is a wide range of agreement between cardiac CT and lung perfusion scintigraphy.

  16. Development and validation of a direct-comparison method for cardiac {sup 123}I-metaiodobenzylguanidine washout rates derived from late 3-hour and 4-hour imaging

    Energy Technology Data Exchange (ETDEWEB)

    Okuda, Koichi; Hashimoto, Mitsumasa [Kanazawa Medical University, Department of Physics, Kahoku, Ishikawa (Japan); Nakajima, Kenichi; Matsuo, Shinro; Taki, Junichi; Kinuya, Seigo [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa, Ishikawa (Japan); Sugino, Shuichi [Okayama Kyokuto Hospital, Department of Radiology, Okayama, Okayama (Japan); Kirihara, Yumiko [FUJIFILM RI Pharma Co., Ltd., Chuo-Ku, Tokyo (Japan)

    2016-02-15

    The washout rate (WR) has been used in {sup 123}I-metaiodobenzylguanidine (MIBG) imaging to evaluate cardiac sympathetic innervation. However, WR varies depending on the time between the early and late MIBG scans. Late scans are performed at either 3 or 4 hours after injection of MIBG. The aim of this study was to directly compare the WR at 3 hours (WR{sub 3h}) with the WR at 4 hours (WR{sub 4h}). We hypothesized that the cardiac count would reduce linearly between the 3-hour and 4-hour scans. A linear regression model for cardiac counts at two time-points was generated. We enrolled a total of 96 patients who underwent planar {sup 123}I-MIBG scintigraphy early (15 min) and during the late phase at both 3 and 4 hours. Patients were randomly divided into two groups: a model-creation group (group 1) and a clinical validation group (group 2). Cardiac counts at 15 minutes (count{sub early}), 3 hours (count{sub 3h}) and 4 hours (count{sub 4h}) were measured. Cardiac count{sub 4h} was mathematically estimated using the linear regression model from count{sub early} and count{sub 3h}. In group 1, the actual cardiac count{sub 4h}/count{sub early} was highly significantly correlated with count{sub 3h}/count{sub early} (r = 0.979). In group 2, the average estimated count{sub 4h} was 92.8 ± 31.9, and there was no significant difference between this value and the actual count{sub 4h} (91.9 ± 31.9). Bland-Altman analysis revealed a small bias of -0.9 with 95 % limits of agreement of -6.2 and +4.3. WR{sub 4h} calculated using the estimated cardiac count{sub 4h} was comparable to the actual WR{sub 4h} (24.3 ± 9.6 % vs. 25.1 ± 9.7 %, p = ns). Bland-Altman analysis and the intraclass correlation coefficient showed that there was excellent agreement between the estimated and actual WR{sub 4h}. The linear regression model that we used accurately estimated cardiac count{sub 4h} using count{sub early} and count{sub 3h}. Moreover, WR{sub 4h} that was mathematically calculated using

  17. A comparison of left ventricular mass between two-dimensional echocardiography, using fundamental and tissue harmonic imaging, and cardiac MRI in patients with hypertension

    International Nuclear Information System (INIS)

    Alfakih, Khaled; Bloomer, Tim; Bainbridge, Samantha; Bainbridge, Gavin; Ridgway, John; Williams, Gordon; Sivananthan, Mohan

    2004-01-01

    Purpose: To compare left ventricular mass (LVM) as measured by two-dimensional (2D) echocardiography using two different calculation methods: truncated ellipse (TE) and area length (AL), in both fundamental and tissue harmonic imaging frequencies, to LVM as measured by, the current gold standard, cardiac magnetic resonance imaging (MRI). Turbo gradient echo (TGE) pulse sequence was utilized for MRI. Materials and methods: Thirty-two subjects with history of hypertension were recruited. The images were acquired, contours were traced and the LVM was calculated for all four different echocardiography methods as well as for the cardiac MRI method. The intra-observer variabilities were calculated. The four different echocardiography methods were compared to cardiac MRI using the method described by Bland and Altman. Results: Twenty-five subjects had adequate paired data sets. The mean LVM as measured by cardiac MRI was 162±55 g and for the four different echocardiography methods were: fundamental AL 165±55 g, harmonic AL 168±53 g, fundamental TE 148±50 g, harmonic TE 149±45 g. The intra-observer variability for cardiac MRI method, expressed as bias ± 1 standard deviation of the difference (S.D.D.), was 2.3±9.2 g and for the four different echocardiography methods were: fundamental TE 0.4±26.8 g, fundamental AL 0.6±27.0 g, harmonic TE 6.7±21.8 g, harmonic AL 6.4±22.9 g. The mean LVM for the AL method was closest to the cardiac MRI technique, while TE underestimated LVM. The 95% limits of agreement were consistently wide for all the 2D echocardiography modalities when compared with the cardiac MRI technique. Conclusion: The intra-observer variability in measurements of 2D echocardiographic LVM, together with the wide limits of agreement when compared to the gold standard (cardiac MRI) are sufficiently large to make serial estimates of LVM, of single patients or small groups of subjects, by 2D echocardiography, unreliable

  18. Influence of high magnetic field strengths and parallel acquisition strategies on image quality in cardiac 2D CINE magnetic resonance imaging: comparison of 1.5 T vs. 3.0 T

    International Nuclear Information System (INIS)

    Gutberlet, Matthias; Schwinge, Kerstin; Freyhardt, Patrick; Spors, Birgit; Grothoff, Matthias; Denecke, Timm; Luedemann, Lutz; Felix, Roland; Noeske, Ralph; Niendorf, Thoralf

    2005-01-01

    The aim of this paper is to examine signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image quality of cardiac CINE imaging at 1.5 T and 3.0 T. Twenty volunteers underwent cardiac magnetic resonance imaging (MRI) examinations using a 1.5-T and a 3.0-T scanner. Three different sets of breath-held, electrocardiogram-gated (ECG) CINE imaging techniques were employed, including: (1) unaccelerated SSFP (steady state free precession), (2) accelerated SSFP imaging and (3) gradient-echo-based myocardial tagging. Two-dimensional CINE SSFP at 3.0 T revealed an SNR improvement of 103% and a CNR increase of 19% as compared to the results obtained at 1.5 T. The SNR reduction in accelerated 2D CINE SSFP imaging was larger at 1.5 T (37%) compared to 3.0 T (26%). The mean SNR and CNR increase at 3.0 T obtained for the tagging sequence was 88% and 187%, respectively. At 3.0 T, the duration of the saturation bands persisted throughout the entire cardiac cycle. For comparison, the saturation bands were significantly diminished at 1.5 T during end-diastole. For 2D CINE SSFP imaging, no significant difference in the left ventricular volumetry and in the overall image quality was obtained. For myocardial tagging, image quality was significantly improved at 3.0 T. The SNR reduction in accelerated SSFP imaging was overcompensated by the increase in the baseline SNR at 3.0 T and did not result in any image quality degradation. For cardiac tagging techniques, 3.0 T was highly beneficial, which holds the promise to improve its diagnostic value. (orig.)

  19. Inverter communications using output signal

    Science.gov (United States)

    Chapman, Patrick L.

    2017-02-07

    Technologies for communicating information from an inverter configured for the conversion of direct current (DC) power generated from an alternative source to alternating current (AC) power are disclosed. The technologies include determining information to be transmitted from the inverter over a power line cable connected to the inverter and controlling the operation of an output converter of the inverter as a function of the information to be transmitted to cause the output converter to generate an output waveform having the information modulated thereon.

  20. A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest

    NARCIS (Netherlands)

    van Alem, Anouk P.; Chapman, Fred W.; Lank, Paula; Hart, Augustinus A. M.; Koster, Rudolph W.

    2003-01-01

    Background: Evidence suggests that biphasic waveforms are more effective than monophasic waveforms for defibrillation in out-of-hospital cardiac arrest (OHCA), yet their performance has only been compared in un-blinded studies. Methods and results: We compared the success of biphasic truncated

  1. Large-Animal Biventricular Working Heart Perfusion System with Low Priming Volume-Comparison between in vivo and ex vivo Cardiac Function.

    Science.gov (United States)

    Abicht, Jan-Michael; Mayr, Tanja Axinja Jelena; Jauch, Judith; Guethoff, Sonja; Buchholz, Stefan; Reichart, Bruno; Bauer, Andreas

    2018-01-01

    Existing large-animal, ex vivo, cardiac perfusion models are restricted in their ability to establish an ischemia/reperfusion condition as seen in cardiac surgery or transplantation. Other working heart systems only challenge one ventricle or require a substantially larger priming volume. We describe a novel biventricular cardiac perfusion system with reduced priming volume. Juvenile pig hearts were cardiopleged, explanted, and reperfused ex vivo after 150 minutes of cold ischemia. Autologous whole blood was used as perfusate (minimal priming volume 350 mL). After 15 minutes of Langendorff perfusion (LM), the system was switched into a biventricular working mode (WM) and studied for 3 hours. During reperfusion, complete unloading of both ventricles and constant-pressure coronary perfusion was achieved. During working mode perfusion, the preload and afterload pressure of both ventricles was controlled within the targeted physiologic range. Functional parameters such as left ventricular work index were reduced in ex vivo working mode (in vivo: 787 ± 186 vs. 1 h WM 498 ± 66 mm Hg·mL/g·min; p  hours while functional and blood parameters are easily accessible. Moreover, because of the minimal priming volume, the novel ex vivo cardiac perfusion circuit allows for autologous perfusion, using the limited amount of blood available from the organ donating animal. Georg Thieme Verlag KG Stuttgart · New York.

  2. Human technology after cardiac epigenesis. Artificial heart versus cardiac transplantation.

    Science.gov (United States)

    Losman, J G

    1977-09-24

    Cardiovascular disease is the chief cause of death in technologically advanced countries and accounts for more than 50% of all deaths in the USA. For a patient with end-stage cardiac failure the only treatment presently available is organ replacement, either by transplantation or by the use of a mechanical heart. Transplantation has demonstrated its value: survival of more than 8 years and restoration of a normal quality of life to patients who were in end-stage cardiac decompensation. However, the prospect of routine clinical application of an artificial heart remains distant. The development of a totally implantable artificial heart still presents a series of challenging engineering problems with regard to strict constraints of size, weight, blood-material compatibility, adaptability of output to demand, efficiency and reliability of the power supply, and safety if nuclear fuel is used. The totally artificial heart is presently not an alternative to the cardiac allograft, but could provide short-term support for patients awaiting cardiac transplantation.

  3. Comparative cardiac toxicity of anthracyclines in vitro and in vivo in the mouse.

    Directory of Open Access Journals (Sweden)

    Stefano Toldo

    Full Text Available PURPOSE: The antineoplastic efficacy of anthracyclines is limited by their cardiac toxicity. In this study, we evaluated the toxicity of doxorubicin, non-pegylated liposomal-delivered doxorubicin, and epirubicin in HL-1 adult cardiomyocytes in culture as well as in the mouse in vivo. METHODS: The cardiomyocytes were incubated with the three anthracyclines (1 µM to assess reactive oxygen generation, DNA damage and apoptotic cell death. CF-1 mice (10/group received doxorubicin, epirubicin or non-pegylated liposomal-doxorubicin (10 mg/kg and cardiac function was monitored by Doppler echocardiography to measure left ventricular ejection fraction (LVEF, heart rate (HR and cardiac output (CO both prior to and 10 days after drug treatment. RESULTS: In HL-1 cells, non-pegylated liposomal-doxorubicin generated significantly less reactive oxygen species (ROS, as well as less DNA damage and apoptosis activation when compared with doxorubicin and epirubicin. Cultured breast tumor cells showed similar sensitivity to the three anthracyclines. In the healthy mouse, non-pegylated liposomal doxorubicin showed a minimal and non-significant decrease in LVEF with no change in HR or CO, compared to doxorubicin and epirubicin. CONCLUSION: This study provides evidence for reduced cardiac toxicity of non-pegylated-liposomal doxorubicin characterized by attenuation of ROS generation, DNA damage and apoptosis in comparison to epirubicin and doxorubicin.

  4. Enhanced performance CCD output amplifier

    Science.gov (United States)

    Dunham, Mark E.; Morley, David W.

    1996-01-01

    A low-noise FET amplifier is connected to amplify output charge from a che coupled device (CCD). The FET has its gate connected to the CCD in common source configuration for receiving the output charge signal from the CCD and output an intermediate signal at a drain of the FET. An intermediate amplifier is connected to the drain of the FET for receiving the intermediate signal and outputting a low-noise signal functionally related to the output charge signal from the CCD. The amplifier is preferably connected as a virtual ground to the FET drain. The inherent shunt capacitance of the FET is selected to be at least equal to the sum of the remaining capacitances.

  5. The cardiac sonography workforce in New Zealand

    Science.gov (United States)

    White, Steve; Poppe, Katrina; Whalley, Gillian

    2015-01-01

    Abstract Introduction: The aim of this paper is to investigate the cardiac sonography workforce characteristics and registration requirements in New Zealand (NZ), with a comparison to similar workforces internationally. Methods: The Survey of Clinical Echocardiography in New Zealand 2 (SCANZ2) audit was performed in December 2010. All of NZ's public‐funded District Health Board (DHB) centers providing echocardiography services responded to questions relating to staff, equipment, procedure types and patient statistics. The Medical Radiation Technologists Board (MRTB), Clinical Physiologists Registration Board (CPRB) and Australian Sonographers Association Registry (ASAR) websites were reviewed in March 2012 for registered sonographers with a cardiac scope of practice. The cardiac sonography workforces in Australia, the UK, the USA and Canada were investigated for comparison. Results: There are 84 cardiac sonographers (60.3 full‐time equivalent) working in DHBs: 71% from a cardiac technical background; 40% have post‐graduate qualifications; a further 17% are undertaking post‐graduate qualifications; and 59 cardiac sonographers have registration with professional bodies in NZ and/or Australia. Cardiac sonographers in NZ do not undergo compulsory registration, but other sonographers in NZ have compulsory registration with the MRTB. Sonographers are predominantly not licensed internationally. Discussion: Disparity exists between registration of cardiac and non‐cardiac sonographers in NZ. Many cardiac sonographers have voluntary registration but few are registered with the MRTB. Reasons for this include professional alignment, educational qualifications and representation. International trends show increased pressure from governments and professional bodies to regulate sonographers. Conclusion: This study provides a snapshot of the cardiac sonography workforce in NZ for the first time. PMID:28191178

  6. Three-dimensional display and measurement of cardiac dynamic indexes from MR images

    International Nuclear Information System (INIS)

    Kono, M.; Matsuo, M.; Yamasaki, K.; Banno, T.; Toriwaki, J.; Yokoi, S.; Oshita, H.

    1986-01-01

    The cardiac dynamic index, to which such variables as cardiac output, ejection fraction, and wall motion contribute, is routinely determined using various modalities such as angiography, radionuclide imaging, US, and x-ray CT. Each of these modalities, however, has some disadvantages in regard to evaluating the cardiac dynamic index. The authors have obtained precise multidirectional projection images of the heart by means of computer graphics and reformatted data of cardiac MR images obtained with cardiac gating. The contiguous coronal MR images of the heart are made at an interimage distance of 5 mm. In each section, five or six cardiac images can be obtained, depending on the systolic or diastolic phase. These images are stored in a computer, and a three-dimensional display of the heart with biocular observation and with multiplex holograms is made possible with computer graphics. Three-dimensional measurement of the cardiac index is now being attempted, including cardiac output, ejection fraction, and wall motion

  7. Geometric and Dosimetric Approach to Determine Probability of Late Cardiac Mortality in Left Tangential Breast Irradiation: Comparison Between Wedged Beams and Field-in-Field Technique

    International Nuclear Information System (INIS)

    Pili, Giorgio; Grimaldi, Luca; Fidanza, Christian; Florio, Elena T.; Petruzzelli, Maria F.; D'Errico, Maria P.; De Tommaso, Cristina; Tramacere, Francesco; Musaio, Francesca; Castagna, Roberta; Francavilla, Maria C.; Gianicolo, Emilio A.L.; Portaluri, Maurizio

    2011-01-01

    Purpose: To evaluate the probability of late cardiac mortality resulting from left breast irradiation planned with tangential fields and to compare this probability between the wedged beam and field-in-field (FIF) techniques and to investigate whether some geometric/dosimetric indicators can be determined to estimate the cardiac mortality probability before treatment begins. Methods and Materials: For 30 patients, differential dose-volume histograms were calculated for the wedged beam and FIF plans, and the corresponding cardiac mortality probabilities were determined using the relative seriality model. As a comparative index of the dose distribution uniformity, the planning target volume (PTV) percentages involved in 97-103% of prescribed dose were determined for the two techniques. Three geometric parameters were measured for each patient: the maximal length, indicates how much the heart contours were displaced toward the PTV, the angle subtended at the center of the computed tomography slice by the PTV contour, and the thorax width/thickness ratio. Results: Evaluating the differential dose-volume histograms showed that the gain in uniformity between the two techniques was about 1.5. With the FIF technique, the mean dose sparing for the heart, the left anterior descending coronary artery, and the lung was 15% (2.5 Gy vs. 2.2 Gy), 21% (11.3 Gy vs. 9.0 Gy), and 42% (8.0 Gy vs. 4.6 Gy) respectively, compared with the wedged beam technique. Also, the cardiac mortality probability decreased by 40% (from 0.9% to 0.5%). Three geometric parameters, the maximal length, angle subtended at the center of the computed tomography slice by the PTV contour, and thorax width/thickness ratio, were the determining factors (p = .06 for FIF, and p = .10 for wedged beam) for evaluating the cardiac mortality probability. Conclusion: The FIF technique seemed to yield a lower cardiac mortality probability than the conventional wedged beam technique. However, although our study

  8. Cardiac cine MRI: Comparison of 1.5 T, non-enhanced 3.0 T and blood pool enhanced 3.0 T imaging

    International Nuclear Information System (INIS)

    Gerretsen, S.C.; Versluis, B.; Bekkers, S.C.A.M.; Leiner, T.

    2008-01-01

    Introduction: Cardiac cine imaging using balanced steady state free precession sequences (bSSFP) suffers from artefacts at 3.0 T. We compared bSSFP cardiac cine imaging at 1.5 T with gradient echo imaging at 3.0 T with and without a blood pool contrast agent. Materials and methods: Eleven patients referred for cardiac cine imaging underwent imaging at 1.5 T and 3.0 T. At 3.0 T images were acquired before and after administration of 0.03 mmol/kg gadofosveset. Blood pool signal-to-noise ratio (SNR), temporal variations in SNR, ejection fraction and myocardial mass were compared. Subjective image quality was scored on a four-point scale. Results: Blood pool SNR increased with more than 75% at 3.0 T compared to 1.5 T (p < 0.001); after contrast administration at 3.0 T SNR increased with 139% (p < 0.001). However, variations in blood pool SNR at 3.0 T were nearly three times as high versus those at 1.5 T in the absence of contrast medium (p < 0.001); after contrast administration this was reduced to approximately a factor 1.4 (p = 0.21). Saturation artefacts led to significant overestimation of ejection fraction in the absence of contrast administration (1.5 T: 44.7 ± 3.1 vs. 3.0 T: 50.7 ± 4.2 [p = 0.04] vs. 3.0 T post contrast: 43.4 ± 2.9 [p = 0.55]). Subjective image quality was highest for 1.5 T (2.8 ± 0.3), and lowest for non-enhanced 3.0 T (1.7 ± 0.6; p = 0.006). Conclusions: GRE cardiac cine imaging at 3.0 T after injection of the blood pool agent gadofosveset leads to improved objective and subjective cardiac cine image quality at 3.0 T and to the same conclusions regarding cardiac ejection fraction compared to bSSFP imaging at 1.5 T

  9. GDP Growth, Potential Output, and Output Gaps in Mexico

    OpenAIRE

    Ebrima A Faal

    2005-01-01

    This paper analyzes the sources of Mexico's economic growth since the 1960s and compares various decompositions of historical growth into its trend and cyclical components. The role of the implied output gaps in the inflationary process is then assessed. Looking ahead, the paper presents medium-term paths for GDP based on alternative assumptions for productivity growth rates. The results indicate that the most important factor underlying the slowdown in output growth was a decline in trend to...

  10. Output characteristic of photovoltaic module on different installing conditions. Comparison with calculated value and measured value; Secchi joken no kotonaru taiyo denchi module no shutsuryoku tokusei. Suchi kaiseki to jissokuchi tono hikaku

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, T.; Morita, Y.; Iwawaki, H.; Fujisawa, T.; Tani, T. [Science University of Tokyo, Tokyo (Japan)

    1997-11-25

    The paper studied output characteristics of photovoltaic modules different in installation conditions on the basis of the energy balance state. In the study, an energy balance equation was constructed for insolation intensity, heat losses from PV surface/back, and output, in order to calculate cell temperatures in each installation condition. A comparative study was made between calculated results and measured data obtained on the top of the school building. The results indicated the following: The thickness of thermal boundary layer became approximately 27mm at insolation intensity of 800 W/m{sup 2}, ambient air temperature of 25degC, and wind velocity of 0.5m/s. When widening air gap from 20mm to 40mm, the cell temperature decreased 4degC, and the output increased 1.6%. In the case of installing photovoltaic modules on the roof considering the relation between the air gap in the heat balance state and the thickness of thermal boundary layer, heat from PV back was released outside the air gap if widening the air gap to more than 30-40mm. The type with a heat insulating material on the panel back decreased in output from other types. 5 refs., 7 figs., 4 tabs.

  11. Diagnosis of acute myocardial infarction in patients undergoing open heart surgery: a comparison of serial myocardial imaging with cardiac enzymes, electrocardiography, and vectocardiography

    International Nuclear Information System (INIS)

    Lowenthal, I.S.; Parisi, A.F.; Tow, D.E.; Barsamian, E.M.; Sasahara, A.A.; McCaughan, D.; Clemson, H.C.

    1977-01-01

    In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patients imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery

  12. Cardiac pacemaker

    International Nuclear Information System (INIS)

    Kolenik, S.A.

    1976-01-01

    The construction of a cardiac pacemaker is described which is characterized by particularly small dimensions, small weight and long life duration. The weight is under 100g, the specific weight under 1.7. Mass inertia forces which occur through acceleration and retardation processes, thus remain below the threshold values, above which one would have to reckon with considerable damaging of the surrounding body tissue. The maintaining of small size and slight weight is achieved by using an oscillator on COSMOS basis, where by considerably lower energy consumption, amongst others the lifetimes of the batteries used - a lithium anode with thionyl chloride electrolyte - is extended to over 5 years. The reliability can be increased by the use of 2 or more batteries. The designed dimension are 20x60x60 mm 3 . (ORU/LH) [de

  13. Cardiac ventriculography

    International Nuclear Information System (INIS)

    Hillis, L.D.; Grossman, W.

    1986-01-01

    Cardiac ventriculography has been used extensively to define the anatomy of the ventricles and related structures in patients with congenital, valvular, coronary, and cardiomyopathic heart disease. Specifically, left ventriculography may provide valuable information about global and segmental left ventricular function, mitral valvular incompetence, and the presence, location, and severity of a number of other abnormalities, including ventricular septal defect and hypertrophic cardiomyopathy. As a result, it should be a routine part of catheterization in patients being evaluated for coronary artery disease, aortic or mitral valvular disease, unexplained left ventricular failure, or congenital heart disease. Similarly, right ventriculography may provide information about global and segmental right ventricular function and can be especially helpful in patients with congenital heart disease

  14. Comparison between (99m)Tc-diphosphonate imaging and MRI with late gadolinium enhancement in evaluating cardiac involvement in patients with transthyretin familial amyloid polyneuropathy.

    Science.gov (United States)

    Minutoli, Fabio; Di Bella, Gianluca; Mazzeo, Anna; Donato, Rocco; Russo, Massimo; Scribano, Emanuele; Baldari, Sergio

    2013-03-01

    Cardiac involvement is not rare in systemic amyloidosis and is associated with poor prognosis. Both (99m)Tc-diphosphonate imaging and cardiac MRI with late gadolinium enhancement are considered valuable tools in revealing amyloid deposition in the myocardium; however, to our knowledge, no comparative study between the two techniques exists. We compared findings of these two techniques in patients with transthyretin-familial amyloid polyneuropathy (FAP). Eighteen patients with transthyretin-FAP underwent (99m)Tc-diphosphonate imaging and MRI with late gadolinium enhancement. Images were visually evaluated by independent readers to determine the presence of radiotracer accumulation or late gadolinium enhancement-positive areas at the level of cardiac chambers. Interobserver agreement ranged from moderate to very good for (99m)Tc-diphosphonate imaging findings and was very good for findings of MRI with late gadolinium enhancement. Left ventricle (LV) radiotracer uptake was found in 10 of 18 patients, whereas LV late gadolinium enhancement-positive areas were found in eight of 18 patients (χ(2) = 0.9; p = 0.343). One hundred fifty-nine LV segments showed (99m)Tc-diphosphonate accumulation, and 57 LV segments were late gadolinium enhancement positive (p < 0.0001). Radiotracer uptake was found in the right ventricle (RV) in eight patients and in both atria in five patients, whereas MRI showed that RV was involved in three patients and both atria in six patients; the differences were not statistically significant (RV, p = 0.07; atria, p = 1). Intermodality agreement between (99m)Tc-diphosphonate imaging and MRI ranged from fair to good. Our study shows that, although (99m)Tc-diphosphonate imaging and MRI with late gadolinium enhancement have similar capabilities to identify patients with myocardial amyloid deposition, cardiac amyloid infiltration burden can be significantly underestimated by visual analysis of MRI with late gadolinium enhancement compared with (99m

  15. Dosimetric comparison to the heart and cardiac substructure in a large cohort of esophageal cancer patients treated with proton beam therapy or Intensity-modulated radiation therapy.

    Science.gov (United States)

    Shiraishi, Yutaka; Xu, Cai; Yang, Jinzhong; Komaki, Ritsuko; Lin, Steven H

    2017-10-01

    To compare heart and cardiac substructure radiation exposure using intensity-modulated radiotherapy (IMRT) vs. proton beam therapy (PBT) for patients with mid- to distal esophageal cancer who received chemoradiation therapy. We identified 727 esophageal cancer patients who received IMRT (n=477) or PBT (n=250) from March 2004 to December 2015. All patients were treated to 50.4Gy with IMRT or to 50.4 cobalt Gray equivalents with PBT. IMRT and PBT dose-volume histograms (DVHs) of the whole heart, atria, ventricles, and four coronary arteries were compared. For PBT patients, passive scattering proton therapy (PSPT; n=237) and intensity-modulated proton therapy (IMPT; n=13) DVHs were compared. Compared with IMRT, PBT resulted in significantly lower mean heart dose (MHD) and heart V5, V10, V20, V30, and V40as well as lower radiation exposure to the four chambers and four coronary arteries. Compared with PSPT, IMPT resulted in significantly lower heart V20, V30, and V40 but not MHD or heart V5 or V10. IMPT also resulted in significantly lower radiation doses to the left atrium, right atrium, left main coronary artery, and left circumflex artery, but not the left ventricle, right ventricle, left anterior descending artery, or right coronary artery. Factors associated with lower MHD included PBT (Pheart and cardiac substructures than IMRT. Long-term studies are necessary to determine how this cardiac sparing effect impacts the development of coronary artery disease and other cardiac complications. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Hung, J.; Chaitman, B.R.; Lam, J.; Lesperance, J.; Dupras, G.; Fines, P.; Bourassa, M.G.

    1984-01-01

    Several diagnostic noninvasive tests to detect coronary and multivessel coronary disease are available for women. However, all are imperfect and it is not yet clear whether one particular test provides substantially more information than others. The aim of this study was to evaluate clinical findings, exercise electrocardiography, exercise thallium myocardial scintigraphy and cardiac fluoroscopy in 92 symptomatic women without previous infarction and determine which tests were most useful in determining the presence of coronary disease and its severity. Univariate analysis revealed two clinical, eight exercise electrocardiographic, seven myocardial scintigraphic and seven fluoroscopic variables predictive of coronary or multivessel disease with 70% or greater stenosis. The multivariate discriminant function analysis selected a reversible thallium defect, coronary calcification and character of chest pain syndrome as the variables most predictive of presence or absence of coronary disease. The ranked order of variables most predictive of multivessel disease were cardiac fluoroscopy score, thallium score and extent of ST segment depression in 14 electrocardiographic leads. Each provided statistically significant information to the model. The estimate of predictive accuracy was 89% for coronary disease and 97% for multivessel coronary disease. The results suggest that cardiac fluoroscopy or thallium scintigraphy provide significantly more diagnostic information than exercise electrocardiography in women over a wide range of clinical patient subsets

  17. Beneficial effect of perindopril on cardiac sympathetic nerve activity and brain natriuretic peptide in patients with chronic heart failure. Comparison with enalapril

    International Nuclear Information System (INIS)

    Tsutamoto, Takayoshi; Tanaka, Toshinari; Sakai, Hiroshi

    2008-01-01

    In patients with chronic heart failure (CHF), it remains unclear whether perindopril is more cardioprotective than enalapril. Forty-five stable CHF outpatients undergoing conventional therapy including enalapril therapy were randomized to 2 groups [group I (n=24): continuous enalapril treatment; group II (n=21): enalapril was changed to perindopril]. Cardiac sympathetic nerve activity was evaluated using cardiac 123 I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and 6 months after treatment. There was no difference in baseline characteristics between the 2 groups. In group I, there were no changes in MIBG parameters, left ventricular ejection fraction (LVEF) or plasma level of brain natriuretic peptide (BNP). In contrast, in group II delayed heart/mediastinum count ratio was significantly increased (2.0±0.07 vs 2.15±0.07, p=0.013) and the washout rate was significantly decreased (33.0±1.4 vs 30.5±1.2, p=0.030) after 6 months compared with the baseline value. In addition, LVEF was significantly increased and the plasma BNP level was significantly decreased. These findings suggest that for the treatment of CHF, perindopril is superior to enalapril with respect of cardiac sympathetic nerve activity and BNP. (author)

  18. Comparison of myocardial function between post-menopausal and pre-menopausal women: evaluation by gated myocardial SPECT

    International Nuclear Information System (INIS)

    Hwang, K. H.; Choa, Won Sick; Yoon, Min Ki

    2005-01-01

    In addition to inhibiting coronary atherosclerosis, estrogen is expected to have protective effects on cardiac myocytes. We investigated the difference in myocardial functional parameters evaluated by gated myocardial SPECT after adenosine-stress between post-menopausal and pre-menopausal healthy women. This study included 22 healthy post-menopausal women (mean age: 53.0 yr) and 20 pre-menopausal women (mean age: 43.0 yr) who performed Tc-99m tetrofosmin gated myocardial SPECT after adenosine-stress. Measured hemodynamic parameters, EDV, ESV, stroke volume, EF, cardiac output and cardiac index were compared between the two groups. For comparison, similar-aged two male groups with matched numbers were also studied. There was no significant difference in hemodynamic parameters. EDV, ESV, stroke volume, EF, or cardiac output between the post-menopausal and pre-menopausal women. However, post-menopausal women have a smaller cardiac index (mean: 1.95 L/min/m2 vs 2.20 L/min/m2; p=0.045) and adenosine-induced HR increase (mean : 80.5/min vs 89.7/min ; p=0.03), compared to the pre-menopausal women. On the contrary, the two male groups of the same age range and numbers with the women groups showed no significant difference in any myocardial parameters. These results suggest that menopause may be correlated with reduced increase in cardiac index and HR increase after adenosine-stress

  19. Comparison of myocardial function between post-menopausal and pre-menopausal women: evaluation by gated myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, K. H.; Choa, Won Sick; Yoon, Min Ki [Gachon Medical School, Gil Hospital, Incheon (Korea, Republic of)

    2005-07-01

    In addition to inhibiting coronary atherosclerosis, estrogen is expected to have protective effects on cardiac myocytes. We investigated the difference in myocardial functional parameters evaluated by gated myocardial SPECT after adenosine-stress between post-menopausal and pre-menopausal healthy women. This study included 22 healthy post-menopausal women (mean age: 53.0 yr) and 20 pre-menopausal women (mean age: 43.0 yr) who performed Tc-99m tetrofosmin gated myocardial SPECT after adenosine-stress. Measured hemodynamic parameters, EDV, ESV, stroke volume, EF, cardiac output and cardiac index were compared between the two groups. For comparison, similar-aged two male groups with matched numbers were also studied. There was no significant difference in hemodynamic parameters. EDV, ESV, stroke volume, EF, or cardiac output between the post-menopausal and pre-menopausal women. However, post-menopausal women have a smaller cardiac index (mean: 1.95 L/min/m2 vs 2.20 L/min/m2; p=0.045) and adenosine-induced HR increase (mean : 80.5/min vs 89.7/min ; p=0.03), compared to the pre-menopausal women. On the contrary, the two male groups of the same age range and numbers with the women groups showed no significant difference in any myocardial parameters. These results suggest that menopause may be correlated with reduced increase in cardiac index and HR increase after adenosine-stress.

  20. Output

    DEFF Research Database (Denmark)

    Mehlsen, Camilla

    2010-01-01

    Hvad får vi egentlig ud af internationale komparative undersøgelser som PISA, PIRLS og TIMSS? Hvordan påvirker de dansk uddannelsespolitik? Asterisk har talt med tre forskere med ekspertise på området.......Hvad får vi egentlig ud af internationale komparative undersøgelser som PISA, PIRLS og TIMSS? Hvordan påvirker de dansk uddannelsespolitik? Asterisk har talt med tre forskere med ekspertise på området....

  1. Multi-model MPC with output feedback

    Directory of Open Access Journals (Sweden)

    J. M. Perez

    2014-03-01

    Full Text Available In this work, a new formulation is presented for the model predictive control (MPC of a process system that is represented by a finite set of models, each one corresponding to a different operating point. The general case is considered of systems with stable and integrating outputs in closed-loop with output feedback. For this purpose, the controller is based on a non-minimal order model where the state is built with the measured outputs and the manipulated inputs of the control system. Therefore, the state can be considered as perfectly known and, consequently, there is no need to include a state observer in the control loop. This property of the proposed modeling approach is convenient to extend previous stability results of the closed loop system with robust MPC controllers based on state feedback. The controller proposed here is based on the solution of two optimization problems that are solved sequentially at the same time step. The method is illustrated with a simulated example of the process industry. The rigorous simulation of the control of an adiabatic flash of a multi-component hydrocarbon mixture illustrates the application of the robust controller. The dynamic simulation of this process is performed using EMSO - Environment Model Simulation and Optimization. Finally, a comparison with a linear MPC using a single model is presented.

  2. Left-sided cardiac chamber evaluation using single-phase mid-diastolic coronary computed tomography angiography: derivation of normal values and comparison with conventional end-diastolic and end-systolic phases

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Jonathan R. [Technion-Israel Institute of Technology, Haifa (Israel); Abadi, Sobhi [Rambam Health Care Campus, Medical Imaging Department, Haifa (Israel); Solomonica, Amir [Rambam Health Care Campus, Cardiology Department, Haifa (Israel); Mutlak, Diab; Aronson, Doron; Agmon, Yoram; Lessick, Jonathan [Rambam Health Care Campus, Cardiology Department, Haifa (Israel); Technion-Israel Institute of Technology, Haifa (Israel)

    2016-10-15

    With increasing use of prospective scanning techniques for cardiac computed tomography (CT), meaningful evaluation of chamber volumes is no longer possible due to lack of normal values. We aimed to define normal values for mid-diastolic (MD) chamber volumes and to determine their significance in comparison to maximum volumes. Normal ranges at MD for left ventricular (LV) volume and mass and left atrial (LA) volume were determined from 101 normal controls. Thereafter, 109 consecutive CT scans, as well as 21 post-myocardial infarction patients, were analysed to determine the relationship between MD and maximum volumes. MD volumes correlated closely with maximal volumes (r = 0.99) for both LV and LA, and could estimate maximum volumes accurately. LV mass, measured at ED or MD, were very similar (r = 0.99). Abnormal MD volumes had excellent sensitivity and specificity to detect chamber enlargement based on maximal volumes (LV 86 %, 100 %, respectively; LA 100 %, 92 %, respectively). A single MD phase can identify patients with cardiomegaly or LV hypertrophy with a high degree of accuracy and MD volumes can give an accurate estimate of maximum LV and LA volumes. circle Traditionally, helical cardiac CT provided clinically important information from chamber volume analysis. (orig.)

  3. A comparison of the hourly output between the Ambu® Smart-Infuser™ Pain Pump and the On-Q Pump® with Select-A-Flow™ Variable Rate Controller with standard and overfill volumes.

    Science.gov (United States)

    Iliev, Peter; Bhalla, Tarun; Tobias, Joseph D

    2016-04-01

    The Ambu Smart-Infuser Pain Pump and the On-Q Pump with Select-a-Flow Variable Rate Controller are elastomeric devices with a flow regulator that controls the rate of infusion of a local anesthetic agent through a peripheral catheter. As a safety evaluation, we evaluated the infusion characteristics of these two devices when filled with manufacturer recommended standard volumes and when overfilled with a volume 50% in excess of that which is recommended. Nineteen disposable devices from the two manufacturers were used in this study. Nine were filled with 0.9% normal saline according to the respective manufacturers' recommendations (four Ambu pumps were filled with 650 ml and five On-Q pumps were filled with 550 ml) and 10 devices were 150% overfilled (five Ambu pumps were filled with 975 ml and five On-Q pumps were filled with 825 ml). All of the devices were set to infuse at 10 ml · h(-1) at room temperature (21°C) for 12 h. The fluid delivered during each 2-h period was measured using a graduated column. The On-Q pump (in the settings of normal fill and 150% overfill) delivered a significantly higher output per hour than the set rate during the first 8 h, while the Ambu pump delivered a value close to the set rate of 10 ml · h(-1). No significant difference in the hourly delivered output was noted for either device when comparing the normal fill to the 150% overfill groups. This investigation demonstrates that no change in the hourly output occurs with overfilling of these home infusion devices. However, as noted previously, the hourly output from the On-Q device is significantly higher than the set rate during the initial 8 h of infusion which could have potential clinical implications. © 2016 John Wiley & Sons Ltd.

  4. Cardiac magnetic resonance and the need for routine cardiac catheterization in single ventricle patients prior to Fontan: a comparison of 3 groups: pre-Fontan CMR versus cath evaluation.

    Science.gov (United States)

    Fogel, Mark A; Pawlowski, Thomas W; Whitehead, Kevin K; Harris, Matthew A; Keller, Marc S; Glatz, Andrew C; Zhu, Winnie; Shore, David; Diaz, Laura K; Rome, Jonathan J

    2012-09-18

    This study investigated whether cardiac magnetic resonance (CMR) and echocardiography (echo) can replace catheterization (cath) for routine evaluation prior to Fontan and under what circumstances CMR and cath are used together. Routine cath prior to Fontan has been utilized for years; noninvasive methods, however, may be sufficient. This study reviews clinical data in 119 consecutive patients investigating 3 groups: those who underwent CMR alone (MR; n = 41), cath alone (C; n = 41), or both cath and CMR (C+M; n = 37) prior to Fontan. No clinically significant differences were noted in patient characteristics, hemodynamics, or clinical status prior to or after surgery between the C and MR groups. CMR added information in 82%. There were no discrepant findings between CMR and cath data in the C+M group. Diagnostic success was ≥95% in all groups. Of those undergoing Fontan completion, the C+M group had similar outcomes to C and MR; C and CMR were utilized in combination to assess aortopulmonary collaterals or the need for an intervention or evaluate its success. Echo could not delineate pulmonary arterial anatomy in 46% to 53% of patients. The C+M and C groups were exposed to 6.8 ± 4.1 mSv of radiation. Single ventricle patients not requiring an intervention can undergo successful Fontan completion with CMR and echo alone with similar short-term outcomes to C, which was used as a control, preventing an invasive test and exposure to radiation. CMR can add information in a significant number of patients. Cath and CMR are utilized together for interventions and assessment of aortopulmonary collaterals. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Comparison of cardiac troponins I and T measured with high-sensitivity methods for evaluation of prognosis in atrial fibrillation: an ARISTOTLE substudy.

    Science.gov (United States)

    Hijazi, Ziad; Siegbahn, Agneta; Andersson, Ulrika; Lindahl, Bertil; Granger, Christopher B; Alexander, John H; Atar, Dan; Gersh, Bernard J; Hanna, Michael; Harjola, Veli-Pekka; Horowitz, John; Husted, Steen; Hylek, Elaine M; Lopes, Renato D; McMurray, John J V; Wallentin, Lars

    2015-02-01

    Although cardiac troponin is associated with outcomes in atrial fibrillation (AF), the complementary prognostic information provided by cardiac troponin I (cTnI) and cTnT is unknown. This study investigated the distribution, determinants, and prognostic value of cTnI and cTnT concentrations in patients with AF. Samples were collected. At the time of randomization, we analyzed cTnI and cTnT concentrations of 14806 AF patients in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial using high-sensitivity assays. Correlations (Spearman), determinants (multivariable linear regression), and outcomes (adjusted Cox models and c-statistics) were investigated. Concentrations of cTnI and cTnT were correlated (r = 0.70) and measurable in most participants [cTnI 98.5% (median 5.4 ng/L, ≥99th percentile in 9.2%) and cTnT 93.5% (median 10.9 ng/L, ≥99th percentile in 34.4%)]. Renal impairment was the most important factor affecting the concentrations of both troponins. cTnI increase was more associated with heart failure, vascular disease, and persistent/permanent AF, and cTnT with age, male sex, and diabetes. Over a median 1.9 years of follow-up, patients with both troponins above the median had significantly higher risk for stroke/systemic embolism [hazard ratio (HR) 1.72 (95% CI 1.31-2.27)], cardiac death [3.14 (2.35-4.20)], and myocardial infarction [2.99 (1.78-5.03)] than those with both troponins below median (all P Chemistry.

  6. Accurate estimation of global and regional cardiac function by retrospectively gated multidetector row computed tomography. Comparison with cine magnetic resonance imaging

    International Nuclear Information System (INIS)

    Belge, Benedicte; Pasquet, Agnes; Vanoverschelde, Jean-Louis J.; Coche, Emmanuel; Gerber, Bernhard L.

    2006-01-01

    Retrospective reconstruction of ECG-gated images at different parts of the cardiac cycle allows the assessment of cardiac function by multi-detector row CT (MDCT) at the time of non-invasive coronary imaging. We compared the accuracy of such measurements by MDCT to cine magnetic resonance (MR). Forty patients underwent the assessment of global and regional cardiac function by 16-slice MDCT and cine MR. Left ventricular (LV) end-diastolic and end-systolic volumes estimated by MDCT (134±51 and 67±56 ml) were similar to those by MR (137±57 and 70±60 ml, respectively; both P=NS) and strongly correlated (r=0.92 and r=0.95, respectively; both P<0.001). Consequently, LV ejection fractions by MDCT and MR were also similar (55±21 vs. 56±21%; P=NS) and highly correlated (r=0.95; P<0.001). Regional end-diastolic and end-systolic wall thicknesses by MDCT were highly correlated (r=0.84 and r=0.92, respectively; both P<0.001), but significantly lower than by MR (8.3±1.8 vs. 8.8±1.9 mm and 12.7±3.4 vs. 13.3±3.5 mm, respectively; both P<0.001). Values of regional wall thickening by MDCT and MR were similar (54±30 vs. 51±31%; P=NS) and also correlated well (r=0.91; P<0.001). Retrospectively gated MDCT can accurately estimate LV volumes, EF and regional LV wall thickening compared to cine MR. (orig.)

  7. Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Bastarrika, Gorka [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Cardiac Imaging Unit, Clinica Univ. de Navarra, Pamplona (Spain)], e-mail: bastarrika@unav.es

    2012-06-15

    Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 {+-} 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 {+-} 58.3 mL) with respect to ECG-gated CT (142.7 {+-} 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 {+-} 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols.

  8. Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT).

    Science.gov (United States)

    Rijkenberg, Saskia; Stilma, Willemke; Bosman, Robert J; van der Meer, Nardo J; van der Voort, Peter H J

    2017-08-01

    The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery. A prospective, observational cohort study. A 20-bed closed-format intensive care unit with mixed medical, surgical, and cardiac surgery patients in a teaching hospital in Amsterdam, The Netherlands. The study comprised 72 consecutive intubated and mechanically ventilated patients after cardiac surgery who were not able to self-report pain. Two nurses assessed the BPS and CPOT simultaneously and independently at the following 4 moments: rest, a nonpainful procedure (oral care), rest, and a painful procedure (turning). Both scores showed a significant increase of 2 points between rest and turning. The median BPS score of nurse 1 showed a significant increase of 1 point between rest and the nonpainful procedure (oral care), whereas both median CPOT scores did not change. The interrater reliability of the BPS and CPOT showed fair-to-good agreement of 0.74 overall. During the periods of rest 1 and rest 2, values ranged from 0.24 to 0.46. Cronbach's alpha values for the BPS were 0.62 (nurse 1) and 0.59 (nurse 2) compared with 0.65 and 0.58, respectively, for the CPOT. The BPS and CPOT are reliable and valid pain assessment tools in a daily clinical setting. However, the discriminant validation of both scores seems less satisfactory in sedated or agitated patients and this topic requires further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

    International Nuclear Information System (INIS)

    Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria; Bastarrika, Gorka

    2012-01-01

    Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 ± 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 ± 58.3 mL) with respect to ECG-gated CT (142.7 ± 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 ± 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols

  10. Cardiac regeneration therapy: connections to cardiac physiology.

    Science.gov (United States)

    Takehara, Naofumi; Matsubara, Hiroaki

    2011-12-01

    Without heart transplantation, a large number of patients with failing hearts worldwide face poor outcomes. By means of cardiomyocyte regeneration, cardiac regeneration therapy is emerging with great promise as a means for restoring loss of cardiac function. However, the limited success of clinical trials using bone marrow-derived cells and myoblasts with heterogeneous constituents, transplanted at a wide range of cell doses, has led to disagreement on the efficacy of cell therapy. It is therefore essential to reevaluate the evidence for the efficacy of cell-based cardiac regeneration therapy, focusing on targets, materials, and methodologies. Meanwhile, the revolutionary innovation of cardiac regeneration therapy is sorely needed to help the millions of people who suffer heart failure from acquired loss of cardiomyocytes. Cardiac regeneration has been used only in limited species or as a developing process in the rodent heart; now, the possibility of cardiomyocyte turnover in the human heart is being revisited. In the pursuit of this concept, the use of cardiac stem/progenitor stem cells in the cardiac niche must be focused to usher in a second era of cardiac regeneration therapy for the severely injured heart. In addition, tissue engineering and cellular reprogramming will advance the next era of treatment that will enable current cell-based therapy to progress to "real" cardiac regeneration therapy. Although many barriers remain, the prevention of refractory heart failure through cardiac regeneration is now becoming a realistic possibility.

  11. Débito cardíaco diminuído: revisão sistemática das características definidoras Débito cardíaco disminuído: revisión sistemática de las características definidoras Decreased cardiac output: a systematic review of the defining characteristics

    Directory of Open Access Journals (Sweden)

    Vanessa de Souza

    2011-01-01

    explorada. Se constató la importancia del examen físico, la utilización de técnicas menos invasivas y la necesidad de revisar las características definidoras propuestas a fin de proporcionar claridad y objetividad en la identificación de ese diagnóstico de enfermeríaOBJECTIVES: To characterize the scientific articles related to the NANDA-I nursing diagnosis, decreased cardiac output. Verify those articles that describe the behavior of the defining characteristics of this diagnosis, identifying those that occur with the highest frequency. METHODS: A systematic review of literature published between the years 1985 - 2008 was conducted, using the following databases: Lilacs, SciELO, EMBASE, Medline, Pubmed and Cochrane. RESULTS: The sample included 13 articles which identified 50 defining characteristics. Ten characteristics were noted to occur with high frequency: altered heart rate/rhythm, dyspnea, labile blood pressure, rales, oliguria / anuria, edema, cold skin, fatigue / weakness, decreased peripheral pulses and decreased peripheral perfusion. CONCLUSION: This subject has not been explored in depth in the literature. The importance of physical examination, the use of less invasive techniques, and the need to review the proposed defining characteristics to provide clarity and objectivity in the identification of this nursing diagnosis was identified

  12. Influence of the low thyroid state in diabetes mellitus on cardiac function and inotropic responsiveness to alpha 1-adrenoceptor stimulation: comparison with the role of hypothyroidism alone.

    Science.gov (United States)

    Beenen, O H; Pfaffendorf, M; van Zwieten, P A

    1996-10-01

    The hypothyroid state accompanying diabetes mellitus has been suggested to be partly responsible for the diabetes-induced metabolic, hemodynamic, and pharmacological cardiovascular changes. We assessed the effectivity of streptozotocin (STZ) to induce diabetes mellitus and a hypothyroid state. Furthermore, we investigated the influence of diabetes and hypothyrodism on cardiac function and the inotropic responsiveness to the alpha 1-adrenoceptor agonist cirazoline in isolated perfused hearts. Fasted or nonfasted Wistar rats were made diabetic with STZ 20, 40 or 60 mg/kg intravenously (i.v.). Another group was made hypothyroid by addition of 6-n-propyl-2-thiouracil (PTU) to their drinking water. Rats receiving PTU became hypothyroid, whereas rats receiving STZ became simultaneously diabetic and hypothyroid. Basal functional parameters obtained in isolated perfused hearts were not influenced by diabetes, whereas maximal contractility was reduced in hearts obtained from hypothyroid animals. Cardiac inotropic responses to cirazoline were increased in diabetic rats, whereas responses in hypothyroid rats were not different from those in hearts obtained from control animals. Although diabetes mellitus and hypothyroidism are associated with various similar metabolic and haemodynamic parameters, the increased inotropic response to alpha 1-adrenoceptor stimulation as observed in isolated perfused hearts of diabetic rats cannot be explained by the decrease in serum thyroxine levels.

  13. Redesign lifts prep output 288%

    Energy Technology Data Exchange (ETDEWEB)

    Hamric, J

    1987-02-01

    This paper outlines the application of engineering creativity and how it brought output at an Ohio coal preparation plant up from 12,500 tpd to nearly four times that figure, 48,610 tpd. By streamlining the conveyor systems, removing surplus belt length and repositioning subplants the whole operation was able to run far more efficiently with a greater output. Various other alterations including the raw material supply and management and operating practices were also undertaken to provide a test for the achievements possible with such reorganization. The new developments have been in the following fields: fine coal cleaning, heavy media cyclones, feeders, bins, filter presses, dewatering equipment and settling tanks. Output is now limited only by the reduced demand by the Gavin power station nearby.

  14. Output factors and scatter ratios

    Energy Technology Data Exchange (ETDEWEB)

    Shrivastava, P N; Summers, R E; Samulski, T V; Baird, L C [Allegheny General Hospital, Pittsburgh, PA (USA); Ahuja, A S; Dubuque, G L; Hendee, W R; Chhabra, A S

    1979-07-01

    Reference is made to a previous publication on output factors and scatter ratios for radiotherapy units in which it was suggested that the output factor should be included in the definitions of scatter-air ratio and tissue-maximum ratio. In the present correspondence from other authors and from the authors of the previous publication, the original definitions and the proposed changes are discussed. Radiation scatter from source and collimator degradation of beam energy and calculation of dose in tissue are considered in relation to the objective of accurate dosimetry.

  15. Physiologic stress interventions in cardiac imaging

    International Nuclear Information System (INIS)

    Buda, A.J.

    1985-01-01

    Physiologic stress interventions are designed to assess the reserve capability of coronary flow and myocardial function. In the normal individual, a sufficiently intense physiologic stress may increase coronary flow and cardiac output by 500% to 600%. However, in patients with cardiac disease, these reserve responses may be absent, or considerably blunted. Thus, physiologic stress testing has proved extremely helpful in detecting cardiac abnormalities when resting cardiac function appears normal. Although dynamic exercise remains the standard approach to physiologic stress testing, a number of other interventions have been used, including: (1) isometric exercise, (2) atrial pacing, (3) cold pressor testing, (4) postextrasystolic potentiation, (5) volume loading, and (6) negative intrathoracic pressure. Each of these may be considered an alternative physiologic intervention whenever dynamic exercise is not feasible. These alternative approaches are important since, in our experience, 20% to 30% of subjects are unable to perform dynamic exercise, or exercise inadequately to produce a sufficiently intense cardiac stress. This chapter reviews physiologic considerations, indications, contraindications, protocols, and results of these physiologic stress interventions when used in combination with cardiac radionuclide procedures

  16. Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative.

    Science.gov (United States)

    Pearson, David A; Darrell Nelson, R; Monk, Lisa; Tyson, Clark; Jollis, James G; Granger, Christopher B; Corbett, Claire; Garvey, Lee; Runyon, Michael S

    2016-08-01

    Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown. To determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR. This retrospective cohort analysis of NC EMS agencies reporting data to the Cardiac Arrest Registry for Enhanced Survival (CARES) database from January 2010 to June 2014 included adult, non-traumatic OHCA with presumed cardiac etiology where EMS performed CPR or patient received defibrillation. Exclusions were arrest terminated per EMS policy or DNR. EMS agencies self-reported the TFCPR implementation dates. Patients were categorized as receiving either TFCPR or standard CPR. The primary outcome was good neurologic outcome at time of hospital discharge defined as Pittsburgh Cerebral Performance Category (CPC) 1-2. Of 14,994 OHCAs, 14,129 patients were included for analysis with a mean age 65 (IQR 50-81) years, 61% male, 7.3% with good neurologic outcome, 24.3% with shockable initial rhythm, and 71.5% receiving TFCPR. Of the 3427 (24.3%) with an initial shockable rhythm, 739 (71.9%) had a good neurological outcome. Good neurologic outcome was higher with TFCPR [836 (8.3%, 95%CI 7.7-8.8%)] vs. standard CPR [193 (4.8%, 95%CI 4.2-5.5%)]. Logistic regression controlling for demographic and arrest characteristics revealed TFCPR (OR 1.5), witnessed arrest (OR 4.3), initial shockable rhythm (OR 7.1), and in-hospital hypothermia (OR 3.3) were associated with good neurologic outcome. Mechanical CPR device (OR 0.68), CPR

  17. Comparison and usefulness of cardiac magnetic resonance versus computed tomography in infants six months of age or younger with aortic arch anomalies without deep sedation or anesthesia.

    Science.gov (United States)

    Fogel, Mark A; Pawlowski, Thomas W; Harris, Matthew A; Whitehead, Kevin K; Keller, Marc S; Wilson, Justine; Tipton, Deanna; Harris, Christine

    2011-07-01

    The present project investigated whether cardiac magnetic resonance (CMR) of aortic arch anomalies can be performed successfully in infants <6 months of age without the use of cardiac anesthesia or deep sedation. We performed a retrospective review of infants ≤6 months old from 2005 to 2009 who underwent either CMR or computed tomography angiography to investigate aortic arch abnormalities. The CMR procedure used a "feed and swaddle" protocol without deep sedation or cardiac anesthesia. Of the 52 infants referred for CMR, 24 underwent the feed and swaddle protocol (aged 2.6 ± 1.4 months). One patient awoke during the study, and examination of the remaining 23 yielded a definitive diagnosis (success rate 96%). The scanning time was 6.2 ± 3.1 minutes, with the large airways evaluation accounting for 1/2 the time. Single-shot axial steady-state free precession, in which the definitive diagnosis was made, accounted for 0.59 ± 0.3 minutes. Fifteen infants were diagnosed with a vascular ring. Of the 8 infants who underwent surgery, the diagnostic accuracy was 100%. During the same period, 19 patients, who had undergone computed tomography angiography (aged 1.67 ± 1.20 months), were referred for aortic arch evaluation. Of these 19 patients, 6 (32%) underwent sedation or anesthesia. The imaging time was 0.08 ± 0.06 minutes, significantly different from the CMR times (p <0.01). However, the overall room times (31.3 ± 22.3 and 35.8 ± 3.86 minutes, respectively) were not different between the CMR and angiographic groups. The radiation dose was 1.41 ± 1.03 mSv. In conclusion, CMR evaluation of aortic arch anomalies in children <6 months old can be successfully completed quickly using a feed and swaddle approach with high diagnostic accuracy. This protocol avoids the risks of sedation, as well as the radiation associated with computed tomography angiography. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. World Input-Output Network.

    Directory of Open Access Journals (Sweden)

    Federica Cerina

    Full Text Available Production systems, traditionally analyzed as almost independent national systems, are increasingly connected on a global scale. Only recently becoming available, the World Input-Output Database (WIOD is one of the first efforts to construct the global multi-regional input-output (GMRIO tables. By viewing the world input-output system as an interdependent network where the nodes are the individual industries in different economies and the edges are the monetary goods flows between industries, we analyze respectively the global, regional, and local network properties of the so-called world input-output network (WION and document its evolution over time. At global level, we find that the industries are highly but asymmetrically connected, which implies that micro shocks can lead to macro fluctuations. At regional level, we find that the world production is still operated nationally or at most regionally as the communities detected are either individual economies or geographically well defined regions. Finally, at local level, for each industry we compare the network-based measures with the traditional methods of backward linkages. We find that the network-based measures such as PageRank centrality and community coreness measure can give valuable insights into identifying the key industries.

  19. Remote input/output station

    CERN Multimedia

    1972-01-01

    A general view of the remote input/output station installed in building 112 (ISR) and used for submitting jobs to the CDC 6500 and 6600. The card reader on the left and the line printer on the right are operated by programmers on a self-service basis.

  20. Compact Circuit Preprocesses Accelerometer Output

    Science.gov (United States)

    Bozeman, Richard J., Jr.

    1993-01-01

    Compact electronic circuit transfers dc power to, and preprocesses ac output of, accelerometer and associated preamplifier. Incorporated into accelerometer case during initial fabrication or retrofit onto commercial accelerometer. Made of commercial integrated circuits and other conventional components; made smaller by use of micrologic and surface-mount technology.

  1. The interest of the C15O2 method for the left to right cardiac shunts evaluation. A comparison with the sup(99m)Tc pertechnetate method

    International Nuclear Information System (INIS)

    Therain, F.; Gros, J.; Debrun, D.; Blond, M.T.; Valois, M.

    1982-01-01

    99mTc pertechnetate dilution method (TcM) is a reference for the left to right shunts (L→RS) evaluation as well as oxymetry is. Another radionuclide method using C 15 O 2 (CO 2 M) was compared with TcM. The results obtained with CO 2 M confirm the reliability of the CO 2 M for the L→RS investigation. Characteristics of both non invasive radionuclide methods are summarized. The advantages of CO 2 M are that it is always available even in presence of valvular insufficiency, severe congestive heart failure, multiple cardiac lesions and that it is always repeatable giving an intra assay control unaccessible to TcM and finally it produces a much lower radiation absorbed dose with a special interest for children investigations

  2. Estimation of diastolic filling pressure with cardiac CT in comparison with echocardiography using tissue doppler imaging: Determination of optimal CT reconstruction parameters

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji Sun; Suh, Jon; Lee, Heon [Soonchunhyang University Hospital Bucheon, Bucheon (Korea, Republic of); Lee, Bora [Dept. of Biostatistics, Soonchunhyang University College of Medicine, Seoul (Korea, Republic of); Lee, Soo Jeong [Terarecon Korea, Seoul (Korea, Republic of); Jou, Sung Shick [Dept. of Radiology, Soonchunhyang University Hospital Cheonan, Cheonan (Korea, Republic of); Lim, Hyun Kyung [Dept. of Radiology, Soonchunhyang University Hospital Seoul, Seoul (Korea, Republic of)

    2017-08-01

    To determine the optimal CT image reconstruction parameters for the measurement of early transmitral peak velocity (E), early peak mitral septal tissue velocity (E′), and E / E′. Forty-six patients underwent simultaneous cardiac CT and echocardiography on the same day. Four CT datasets were reconstructed with a slice thickness/interval of 0.9/0.9 mm or 3/3 mm at 10 (10% RR-interval) or 20 (5% RR-interval) RR-intervals. The E was calculated by dividing the peak transmitral flow (mL/s) by the corresponding mitral valve area (cm{sup 2}). E′ was calculated from the changes in the left ventricular length per cardiac phase. E / E′ was then estimated and compared with that from echocardiography. For assessment of E / E′, CT and echocardiography were more strongly correlated (p < 0.05) with a slice thickness of 0.9 mm and 5% RR-interval (r = 0.77) than with 3 mm or 10% RR-interval. The diagnostic accuracy of predicting elevated filling pressure (E / E′ ≥ 13, n = 14) was better with a slice thickness of 0.9 mm and 5% RR-interval (87.0%) than with 0.9 mm and 10% RR-interval (71.7%) (p = 0.123) and significantly higher than that with a slice thickness of 3 mm with 5% (67.4%) and 10% RR-interval (63.0%), (p < 0.05), respectively. Data reconstruction with a slice thickness of 0.9 mm at 5% RR-interval is superior to that with a slice thickness of 3 mm or 10% RR-interval in terms of the correlation of E / E′ between CT and echocardiography. Thin slices and frequent sampling also allow for more accurate prediction of elevated filling pressure.

  3. Comparison of a conventional cardiac-triggered dual spin-echo and a fast STIR sequence in detection of spinal cord lesions in multiple sclerosis

    International Nuclear Information System (INIS)

    Bot, J.C.J.; Barkhof, F.; Lycklama a Nijeholt, G.J.; Bergers, E.; Castelijns, J.A.; Polman, C.H.; Ader, H.J.

    2000-01-01

    The current optimal imaging protocol in spinal cord MR imaging in patients with multiple sclerosis includes a long TR conventional spin-echo (CSE) sequence, requiring long acquisition times. Using short tau inversion recovery fast spin-echo (fast STIR) sequences both acquisition time can be shortened and sensitivity in the detection of multiple sclerosis (MS) abnormalities can be increased. This study compares both sequences for the potential to detect both focal and diffuse spinal abnormalities. Spinal cords of 5 volunteers and 20 MS patients were studied at 1.0 T. Magnetic resonance imaging included cardiac-gated sagittal dual-echo CSE and a cardiac-gated fast STIR sequence. Images were scored regarding number, size, and location of focal lesions, diffuse abnormalities and presence/hindrance of artifacts by two experienced radiologists. Examinations were scored as being definitely normal, indeterminate, or definitely abnormal. Interobserver agreement regarding focal lesions was higher for CSE (κ=0.67) than for fast STIR (κ=0.57) but did not differ significantly. Of all focal lesions scored in consensus, 47 % were scored on both sequences, 31 % were only detected by fast STIR, and 22 % only by dual-echo CSE (n. s.). Interobserver agreement for diffuse abnormalities was lower with fast STIR (κ=0.48) than dual-echo CSE (κ=0.65; n. s.). After consensus, fast STIR showed in 10 patients diffuse abnormalities and dual-echo CSE in 3. After consensus, in 19 of 20 patients dual-echo CSE scans were considered as definitely abnormal compared with 17 for fast STIR. The fast STIR sequence is a useful adjunct to dual-echo CSE in detecting focal abnormalities and is helpful in detecting diffuse MS abnormalities in the spinal cord. Due to the frequent occurrence of artifacts and the lower observer concordance, fast STIR cannot be used alone. (orig.)

  4. Comparison of health-related quality of life and functional recovery measurement tools in out-of-hospital cardiac arrest survivors.

    Science.gov (United States)

    Andrew, Emily; Nehme, Ziad; Bernard, Stephen; Smith, Karen

    2016-10-01

    Although a number of validated health-related quality of life (HR-QOL) instruments exist for critical care populations, a standardised approach to assessing the HR-QOL of out-of-hospital cardiac arrest (OHCA) survivors has not been developed. We sought to compare the responses of 12-month OHCA survivors to three HR-QOL and functional recovery instruments, and assess instrument validity. The Victorian Ambulance Cardiac Arrest Registry invited 12-month OHCA survivors to participate in telephone follow-up between January 2011 and December 2015. Responders provided answers to the 12 Item Short Form Health Survey (SF-12), Three-Level EuroQol-5D (EQ-5D-3L) and the Glasgow Outcome Scale-Extended (GOSE). The SF-12 was also used to derive the SF-6D. Responses were used to assess the interpretability and construct validity of the instruments. A total of 1188 patients and proxies responded. Large ceiling effects were observed for the EQ-5D-3L (patients=46%, proxies=23%). Substantial variability was also observed in SF-6D responses for patients who reported full health according to the EQ-5D-3L. For patient responders, the strongest correlations were observed between the EQ-5D-3L index score and SF-6D (ρ=0.65, pGOSE outcome and lower or upper good recovery (pGOSE suggest that these may be useful measures of HR-QOL and functional recovery in OHCA survivors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Left atrial volume assessment in atrial fibrillation using multimodality imaging: a comparison of echocardiography, invasive three-dimensional CARTO and cardiac magnetic resonance imaging.

    Science.gov (United States)

    Rabbat, Mark G; Wilber, David; Thomas, Kevin; Malick, Owais; Bashir, Atif; Agrawal, Anoop; Biswas, Santanu; Sanagala, Thriveni; Syed, Mushabbar A

    2015-06-01

    Left atrial size in atrial fibrillation is a strong predictor of successful ablation and cardiovascular events. Cardiac magnetic resonance multislice method (CMR-MSM) is the current gold standard for left atrial volume (LAV) assessment but is time consuming. We investigated whether LAV with more rapid area-length method by echocardiography (Echo-AL) or cardiac magnetic resonance (CMR-AL) and invasive measurement by 3D-CARTO mapping during ablation correlate with the CMR-MSM. We studied 250 consecutive patients prior to atrial fibrillation ablation. CMR images were acquired on 3T scanner to measure LAV by MSM and biplane area-length method. Standard echocardiography views were used to calculate LAV by biplane area-length method. LAV during ablation was measured by 3D-CARTO mapping. LAV was compared using intra-class correlation (ICC), Pearson's correlation and Bland-Altman plots. CMR-MSM was used as the reference standard. Mean LAV using CMR-MSM was 112.7 ± 36.7 ml. CMR-AL method overestimated LAV by 13.3 ± 21.8 ml (11.2%, p atrial fibrillation. CMR-AL and 3D-CARTO correlated and agreed well with CMR-MSM (r = 0.87 and 0.74, ICC = 0.80 and 0.77 respectively). However, Echo-AL had poor correlation and agreement with CMR-MSM (r = 0.66 and ICC = 0.48). Bland-Altman plots confirmed these findings. CMR-AL method may be used as an alternative to CMR-MSM, as it is non-invasive, rapid, and correlates well with CMR-MSM. LAV by different modalities should not be used interchangeably.

  6. MR-based attenuation correction for cardiac FDG PET on a hybrid PET/MRI scanner: comparison with standard CT attenuation correction

    Energy Technology Data Exchange (ETDEWEB)

    Vontobel, Jan; Liga, Riccardo; Possner, Mathias; Clerc, Olivier F.; Mikulicic, Fran; Veit-Haibach, Patrick; Voert, Edwin E.G.W. ter; Fuchs, Tobias A.; Stehli, Julia; Pazhenkottil, Aju P.; Benz, Dominik C.; Graeni, Christoph; Gaemperli, Oliver; Herzog, Bernhard; Buechel, Ronny R.; Kaufmann, Philipp A. [University Hospital Zurich, Department of Nuclear Medicine, Zurich (Switzerland)

    2015-09-15

    The aim of this study was to evaluate the feasibility of attenuation correction (AC) for cardiac {sup 18}F-labelled fluorodeoxyglucose (FDG) positron emission tomography (PET) using MR-based attenuation maps. We included 23 patients with no known cardiac history undergoing whole-body FDG PET/CT imaging for oncological indications on a PET/CT scanner using time-of-flight (TOF) and subsequent whole-body PET/MR imaging on an investigational hybrid PET/MRI scanner. Data sets from PET/MRI (with and without TOF) were reconstructed using MR AC and semi-quantitative segmental (20-segment model) myocardial tracer uptake (per cent of maximum) and compared to PET/CT which was reconstructed using CT AC and served as standard of reference. Excellent correlations were found for regional uptake values between PET/CT and PET/MRI with TOF (n = 460 segments in 23 patients; r = 0.913; p < 0.0001) with narrow Bland-Altman limits of agreement (-8.5 to +12.6 %). Correlation coefficients were slightly lower between PET/CT and PET/MRI without TOF (n = 460 segments in 23 patients; r = 0.851; p < 0.0001) with broader Bland-Altman limits of agreement (-12.5 to +15.0 %). PET/MRI with and without TOF showed minimal underestimation of tracer uptake (-2.08 and -1.29 %, respectively), compared to PET/CT. Relative myocardial FDG uptake obtained from MR-based attenuation corrected FDG PET is highly comparable to standard CT-based attenuation corrected FDG PET, suggesting interchangeability of both AC techniques. (orig.)

  7. Comparison of cardiovascular risk factors and biochemical profile in patients with cardiac syndrome X and obstructive coronary artery disease: A propensity score-matched study

    Directory of Open Access Journals (Sweden)

    Ali Vasheghani-Farahani

    2013-09-01

    Full Text Available Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 BACKGROUND: This study was designed to compare the frequency of conventional cardiovascular disease risk factors and clinical biochemistry profile in patients with cardiac syndrome X (CSX and obstructive coronary artery disease (CAD. METHODS: A cross-sectional study was conducted on patients with typical angina and positive exercise tolerance test undergoing coronary angiography in our center. 342 consecutive patients with CSX were enrolled into this study and were matched regarding age and sex with 342 patients with acute coronary syndrome (ACS and also 342 patients with chronic stable angina (SA. Cardiovascular risk factors as well as biochemistry profile of the patients were recorded. RESULTS: Mean age of the studied patients was 53.0 years and 41.5% were male. There was no significant difference between the CSX patients and CAD patients regarding body mass index (BMI. Frequency of diabetes mellitus, hyperlipidemia, smoking, family history of premature CAD and hypertension was significantly lower in patients with CSX than ACS and SA patients. Patients with CSX had significantly higher levels of high-density lipoprotein cholesterol (HDL-cholesterol than comparators while the levels of low-density lipoprotein cholesterol (LDL-cholesterol, total cholesterol, triglyceride and fasting blood sugar (FBS were significantly lower in patients with CSX than CAD patients. CONCLUSION: The present study demonstrated that CSX patients had substantially lower frequency of all conventional CVD risk factors than patients with obstructive CAD. This might aid in developing novel scoring systems or appropriateness criteria for angiographic evaluation of patients with typical angina and positive exercise test in order to reduce the rate of negative results.   Keywords: Cardiac Syndrome X, Microvascular Dysfunction

  8. Comparison of the effects of sternal and tibial intraosseous administered resuscitative drugs on return of spontaneous circulation in a swine model of cardiac arrest.

    Science.gov (United States)

    O'Sullivan, Mara; Martinez, Andre; Long, Audrey; Johnson, Michelle; Blouin, Dawn; Johnson, Arthur D; Burgert, James M

    2016-01-01

    Compare vasopressin, amiodarone, and epinephrine administration by sternal intraosseous (SIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine model of cardiac arrest. Prospective, randomized, between subjects, experimental design. Laboratory. Male Yorkshire-cross swine (N = 35), seven per group. Swine were randomized to SIO, TIO, IV, cardiopulmonary resuscitation (CPR) with defibrillation, or CPR-only groups. Ventricular fibrillation (VF) was induced under general anesthesia. Mechanical CPR began 2 minutes postarrest. Vasopressin (40 U) was administered to the SIO, TIO, and IV groups 4 minutes postarrest. Defibrillation was performed and amiodarone (300 mg) was administered 6 minutes postarrest. Defibrillation was repeated, and epinephrine (1 mg) was administered 10 minutes postarrest. Defibrillation was repeated every 2 minutes and epinephrine repeated every 4 minutes until return of spontaneous circulation (ROSC) or 26 postarrest minutes elapsed. Rate of ROSC, time to ROSC, and odds of ROSC. There were no significant differences in rate of ROSC between the SIO and TIO (p = 0.22) or IV groups (p = 1.0). Time to ROSC was five times less in the SIO group than the TIO group (p = 0.003) but not compared to IV (p = 0.125). Time to ROSC in the IV group was significantly less than the TIO group (p = 0.04). Odds of ROSC for the SIO group were five times higher compared to the TIO group but same as IV. Odds of ROSC in the IV group were higher than the TIO group. There was a statistically significant delay in the time to ROSC and a clinically significant difference in odds of ROSC when resuscitative drugs, including lipophilic amiodarone, were administered by the TIO route compared to the SIO and IV routes in a swine model of sudden cardiac arrest. Further investigations are warranted to isolate the mechanism behind these findings.

  9. Late gadolinium enhancement cardiac imaging on a 3T scanner with parallel RF transmission technique: prospective comparison of 3D-PSIR and 3D-IR

    International Nuclear Information System (INIS)

    Schultz, Anthony; Caspar, Thibault; Schaeffer, Mickael; Labani, Aissam; Jeung, Mi-Young; El Ghannudi, Soraya; Roy, Catherine; Ohana, Mickael

    2016-01-01

    To qualitatively and quantitatively compare different late gadolinium enhancement (LGE) sequences acquired at 3T with a parallel RF transmission technique. One hundred and sixty participants prospectively enrolled underwent a 3T cardiac MRI with 3 different LGE sequences: 3D Phase-Sensitive Inversion-Recovery (3D-PSIR) acquired 5 minutes after injection, 3D Inversion-Recovery (3D-IR) at 9 minutes and 3D-PSIR at 13 minutes. All LGE-positive patients were qualitatively evaluated both independently and blindly by two radiologists using a 4-level scale, and quantitatively assessed with measurement of contrast-to-noise ratio and LGE maximal surface. Statistical analyses were calculated under a Bayesian paradigm using MCMC methods. Fifty patients (70 % men, 56yo ± 19) exhibited LGE (62 % were post-ischemic, 30 % related to cardiomyopathy and 8 % post-myocarditis). Early and late 3D-PSIR were superior to 3D-IR sequences (global quality, estimated coefficient IR > early-PSIR: -2.37 CI = [-3.46; -1.38], prob(coef > 0) = 0 % and late-PSIR > IR: 3.12 CI = [0.62; 4.41], prob(coef > 0) = 100 %), LGE surface estimated coefficient IR > early-PSIR: -0.09 CI = [-1.11; -0.74], prob(coef > 0) = 0 % and late-PSIR > IR: 0.96 CI = [0.77; 1.15], prob(coef > 0) = 100 %. Probabilities for late PSIR being superior to early PSIR concerning global quality and CNR were over 90 %, regardless of the aetiological subgroup. In 3T cardiac MRI acquired with parallel RF transmission technique, 3D-PSIR is qualitatively and quantitatively superior to 3D-IR. (orig.)

  10. A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest.

    Science.gov (United States)

    Drennan, Ian R; Case, Erin; Verbeek, P Richard; Reynolds, Joshua C; Goldberger, Zachary D; Jasti, Jamie; Charleston, Mark; Herren, Heather; Idris, Ahamed H; Leslie, Paul R; Austin, Michael A; Xiong, Yan; Schmicker, Robert H; Morrison, Laurie J

    2017-02-01

    The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some Emergency Medical Service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination. To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC. Lastly, to compare the impact of time to ROSC as a marker of futility to the Universal TOR Guideline. Retrospective, observational cohort study. Non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS providers. ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011. Primary outcome was survival to hospital discharge and the secondary outcome was functional survival. We used multivariable regression to evaluate factors associated with survival in patients transported without a ROSC. 36,543 treated OHCAs occurred of which 9467 (26%) were transported to hospital without a ROSC. Patients transported without a ROSC who met the Universal TOR Guideline for transport had a survival of 3.0% (95% CI 2.5-3.4%) compared to 0.7% (95% CI 0.4-0.9%) in patients who met the Universal TOR Guideline for termination. The Universal TOR Guideline identified 99% of survivors requiring continued resuscitation and transportation to hospital including early identification of survivors who sustained a ROSC after extended durations of CPR. Using absence of ROSC as a sole predictor of futility misses potential survivors. The Universal TOR Guideline remains a strong predictor of survival. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Comparação de critérios diagnósticos de insuficiência renal aguda em cirurgia cardíaca Comparison of diagnostic criteria for acute kidney injury in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Márcio Campos Sampaio

    2013-01-01

    . METHODS: Cross-sectional study that included 321 consecutively patients (median age 62 [53-71] years; 140 men undergoing cardiac surgery between June 2011 and January 2012. The patients were followed for up to 30 days, for a composite outcome (mortality, need for dialysis and extended hospitalization. RESULTS: The incidence of AKI ranged from 15% - 51%, accordingly to the diagnostic criterion adopted. While age was associated with risk of AKI in the three criteria, there were variations in the remaining risk factors. During follow-up, 89 patients developed the outcome and all criteria were associated with increased risk in the univariate Cox analysis and after adjustment for age, gender, diabetes, and type of surgery. However, after further adjustment for extracorporeal circulation and the presence of low cardiac output, only AKI diagnosed by the KDIGO criterion maintained this significant association (HR= 1.89 [95% CI: 1.18 - 3.06]. CONCLUSION: The incidence and risk factors for AKI after cardiac surgery vary significantly according to the diagnostic criteria used. In our analysis, AKI the KDIGO criterion was superior to AKIN and RIFLE with regard its prognostic power.

  12. Cardiac contractility, central haemodynamics and blood pressure regulation during semistarvation

    DEFF Research Database (Denmark)

    Stokholm, K H; Breum, L; Astrup, A

    1991-01-01

    pressure (BP) declined. The fall in BP was caused by the reduction in cardiac output as the total peripheral resistance was unchanged. Finally, the decline in total blood volume was not significant. These findings together with a reduction in heart rate indicated that a reduced sympathetic tone via......Eight obese patients were studied before and after 2 weeks of treatment by a very-low-calorie diet (VLCD). Cardiac output and central blood volume (pulmonary blood volume and left atrial volume) were determined by indicator dilution (125I-albumin) and radionuclide angiocardiography (first pass...... and equilibrium technique by [99Tcm]red blood cells). Cardiac output decreased concomitantly with the reduction in oxygen uptake as the calculated systemic arteriovenous difference of oxygen was unaltered. There were no significant decreases in left ventricular contractility indices, i.e. the ejection fraction...

  13. Relationship between cardiac function and resting cerebral blood flow: MRI measurements in healthy elderly subjects.

    Science.gov (United States)

    Henriksen, Otto M; Jensen, Lars T; Krabbe, Katja; Larsson, Henrik B W; Rostrup, Egill

    2014-11-01

    Although both impaired cardiac function and reduced cerebral blood flow are associated with ageing, current knowledge of the influence of cardiac function on resting cerebral blood flow (CBF) is limited. The aim of this study was to investigate the potential effects of cardiac function on CBF. CBF and cardiac output were measured in 31 healthy subjects 50-75 years old using magnetic resonance imaging techniques. Mean values of CBF, cardiac output and cardiac index were 43.6 ml per 100 g min(-1), 5.5 l min(-1) and 2.7 l min(-1) m(-2), respectively, in males, and 53.4 ml per 100 g min(-1), 4.3 l min(-1) and 2.4 l min(-1) m(-2), respectively, in females. No effects of cardiac output or cardiac index on CBF or structural signs of brain ageing were observed. However, fractional brain flow defined as the ratio of total brain flow to cardiac output was inversely correlated with cardiac index (r(2) = 0.22, P = 0.008) and furthermore lower in males than in females (8.6% versus 12.5%, P = 0.003). Fractional brain flow was also inversely correlated with cerebral white matter lesion grade, although this effect was not significant when adjusted for age. Frequency analysis of heart rate variability showed a gender-related inverse association of increased low-to-high-frequency power ratio with CBF and fractional brain flow. The findings do not support a direct effect of cardiac function on CBF, but demonstrates gender-related differences in cardiac output distribution. We propose fractional brain flow as a novel index that may be a useful marker of adequate brain perfusion in the context of ageing as well as cardiovascular disease. © 2013 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  14. Diffuse infiltrative cardiac tuberculosis

    International Nuclear Information System (INIS)

    Gulati, Gurpreet S; Kothari, Shyam S

    2011-01-01

    We present the cardiac magnetic resonance images of an unusual form of cardiac tuberculosis. Nodular masses in a sheet-like distribution were seen to infiltrate the outer myocardium and pericardium along most of the cardiac chambers. The lesions showed significant resolution on antitubercular therapy

  15. UFO - The Universal FEYNRULES Output

    Science.gov (United States)

    Degrande, Céline; Duhr, Claude; Fuks, Benjamin; Grellscheid, David; Mattelaer, Olivier; Reiter, Thomas

    2012-06-01

    We present a new model format for automatized matrix-element generators, the so-called Universal FEYNRULES Output (UFO). The format is universal in the sense that it features compatibility with more than one single generator and is designed to be flexible, modular and agnostic of any assumption such as the number of particles or the color and Lorentz structures appearing in the interaction vertices. Unlike other model formats where text files need to be parsed, the information on the model is encoded into a PYTHON module that can easily be linked to other computer codes. We then describe an interface for the MATHEMATICA package FEYNRULES that allows for an automatic output of models in the UFO format.

  16. Aggregate Supply and Potential Output

    OpenAIRE

    Razin, Assaf

    2004-01-01

    The New-Keynesian aggregate supply derives from micro-foundations an inflation-dynamics model very much like the tradition in the monetary literature. Inflation is primarily affected by: (i) economic slack; (ii) expectations; (iii) supply shocks; and (iv) inflation persistence. This paper extends the New Keynesian aggregate supply relationship to include also fluctuations in potential output, as an additional determinant of the relationship. Implications for monetary rules and to the estimati...

  17. A comparison of MCNP6-1.0 and GEANT 4-10.1 when evaluating the neutron output of a complex real world nuclear environment: The thermal neutron facility at the Tri Universities Meson facility

    Energy Technology Data Exchange (ETDEWEB)

    Monk, S.D., E-mail: s.monk@lancaster.ac.uk [Department of Engineering, Lancaster University, Lancaster LA1 4YW (United Kingdom); Shippen, B.A. [Department of Engineering, Lancaster University, Lancaster LA1 4YW (United Kingdom); Colling, B.R. [Department of Engineering, Lancaster University, Lancaster LA1 4YW (United Kingdom); Culham Centre for Fusion Energy, Culham Science Centre, Abingdon OX14 3DB (United Kingdom); Cheneler, D.; Al Hamrashdi, H.; Alton, T. [Department of Engineering, Lancaster University, Lancaster LA1 4YW (United Kingdom)

    2017-05-15

    Highlights: • Comparison of the use of MCNP6 and GEANT4 Monte Carlo software when large distances and thicknesses are considered. • The Thermal Neutron Facility (TNF) at TRIUMF used as an example real life example location. • The effects of water, aluminium, iron and lead considered over various thicknesses up to 3 m. - Abstract: A comparison of the Monte Carlo based simulation codes MCNP6-1.0 and GEANT4-10.1 as used for modelling large scale structures is presented here. The high-energy neutron field at the Tri Universities Meson Facility (TRIUMF) in Vancouver, British Columbia is the structure modelled in this work. Work with the emphasis on the modelling of the facility and comparing with experimental results has been published previously, whereas this work is focussed on comparing the performance of the codes over relatively high depths of material rather than the accuracy of the results themselves in comparison to experimental data. Comparisons of three different locations within the neutron facility are modelled and presented using both codes as well as analysis of the transport of typical neutrons fields through large blocks of iron, water, lead and aluminium in order to determine where any deviations are likely to have occurred. Results indicate that over short distances, results from the two codes are in broad agreement – although over greater distances and within more complex geometries, deviation increases dramatically. The conclusions reached are that it is likely the deviations between the codes is caused by both the compounding effect of slight differences between the cross section files used by the two codes to determine the neutron transport through iron, and differences in the processes used by both codes.

  18. Turbulent Output-Based Anisotropic Adaptation

    Science.gov (United States)

    Park, Michael A.; Carlson, Jan-Renee

    2010-01-01

    Controlling discretization error is a remaining challenge for computational fluid dynamics simulation. Grid adaptation is applied to reduce estimated discretization error in drag or pressure integral output functions. To enable application to high O(10(exp 7)) Reynolds number turbulent flows, a hybrid approach is utilized that freezes the near-wall boundary layer grids and adapts the grid away from the no slip boundaries. The hybrid approach is not applicable to problems with under resolved initial boundary layer grids, but is a powerful technique for problems with important off-body anisotropic features. Supersonic nozzle plume, turbulent flat plate, and shock-boundary layer interaction examples are presented with comparisons to experimental measurements of pressure and velocity. Adapted grids are produced that resolve off-body features in locations that are not known a priori.

  19. Comparison of cardiac and lung doses for breast cancer patients with free breathing and deep inspiration breath hold technique in 3 dimensional conformal radiotherapy - a dosimetric study

    Science.gov (United States)

    Raj Mani, Karthick; Poudel, Suresh; Maria Das, K. J.

    2017-12-01

    Purpose: To investigate the cardio-pulmonary doses between Deep Inspiration Breath Hold (DIBH) and Free Breathing (FB) technique in left sided breast irradiation. Materials & Methods: DIBH CT and FB CT were acquired for 10 left sided breast patients who underwent whole breast irradiation with or without nodal irradiation. Three fields single isocenter technique were used for patients with node positive patients along with two tangential conformal fields whereas only two tangential fields were used in node negative patients. All the critical structures like lungs, heart, esophagus, thyroid, etc., were delineated in both DIBH and FB scan. Both DIBH and FB scans were fused with the Dicom origin as they were acquired with the same Dicom coordinates. Plans were created in the DIBH scan for a dose range between 50 Gy in 25 fractions. Critical structures doses were recorded from the Dose Volume Histogram for both the DIBH and FB data set for evaluation. Results: The average mean heart dose in DIBH vs FB was 13.18 Gy vs 6.97 Gy, (p = 0.0063) significantly with DIBH as compared to FB technique. The relative reduction in average mean heart dose was 47.12%. The relative V5 reduced by 14.70% (i.e. 34.42% vs 19.72%, p = 0.0080), V10 reduced by 13.83% (i.e. 27.79 % vs 13.96%, p = 0.0073). V20 reduced by 13.19% (i.e. 24.54 % vs 11.35%, p = 0.0069), V30 reduced by 12.38% (i.e. 22.27 % vs 9.89 %, p = 0.0073) significantly with DIBH as compared to FB. The average mean left lung dose reduced marginally by 1.43 Gy (13.73 Gy vs 12.30 Gy, p = 0.4599) but insignificantly with DIBH as compared to FB. Other left lung parameters (V5, V10, V20 and V30) shows marginal decreases in DIBH plans compare to FB plans. Conclusion: DIBH shows a substantial reduction of cardiac doses but slight and insignificant reduction of pulmonary doses as compared with FB technique. Using the simple DIBH technique, we can effectively reduce the cardiac morbidity and at the same time radiation induced lung

  20. Flipping the advanced cardiac life support classroom with team-based learning: comparison of cognitive testing performance for medical students at the University of California, Irvine, United States

    Directory of Open Access Journals (Sweden)

    Megan Boysen-Osborn

    2016-02-01

    Full Text Available Purpose: It aimed to find if written test results improved for advanced cardiac life support (ACLS taught in flipped classroom/team-based Learning (FC/TBL vs. lecture-based (LB control in University of California-Irvine School of Medicine, USA. Methods: Medical students took 2010 ACLS with FC/TBL (2015, compared to 3 classes in LB (2012-14 format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours, and 20 (12 lecture, simulation 8 hours in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14 or podcast (2015 as was testing: 50 multiple-choice questions (MCQ, 20 rhythm matchings, and 7 fill-in clinical cases. Results: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015. Two of 3 tests (MCQ and fill-in improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4 to 95.1% (92.8, 96.7, P=0.0001. For the fill-in test: 94.1% for LB (89.6, 97.2 to 96.6% for FC/TBL (92.4, 99.20 P=0.0001. For MC: 88% for LB (84, 92 to 90% for FC/TBL (86, 94, P=0.0002. For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%, and 2 or 3 components (8.1% vs. 3.2%, P=0.006. Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%. Conclusion: A FC/TBL format for ACLS marginally improved written test results.

  1. Roles of PDE1 in Pathological Cardiac Remodeling and Dysfunction.

    Science.gov (United States)

    Chen, Si; Knight, Walter E; Yan, Chen

    2018-04-23

    Pathological cardiac hypertrophy and dysfunction is a response to various stress stimuli and can result in reduced cardiac output and heart failure. Cyclic nucleotide signaling regulates several cardiac functions including contractility, remodeling, and fibrosis. Cyclic nucleotide phosphodiesterases (PDEs), by catalyzing the hydrolysis of cyclic nucleotides, are critical in the homeostasis of intracellular cyclic nucleotide signaling and hold great therapeutic potential as drug targets. Recent studies have revealed that the inhibition of the PDE family member PDE1 plays a protective role in pathological cardiac remodeling and dysfunction by the modulation of distinct cyclic nucleotide signaling pathways. This review summarizes recent key findings regarding the roles of PDE1 in the cardiac system that can lead to a better understanding of its therapeutic potential.

  2. Comparison of acid-detergent lignin, alkaline-peroxide lignin, and acid-detergent insoluble ash as internal markers for predicting fecal output and digestibility by cattle offered bermudagrass hays of varying nutrient composition.

    Science.gov (United States)

    Kanani, Juvenal; Philipp, Dirk; Coffey, Kenneth P; Kegley, Elizabeth B; West, Charles P; Gadberry, Shane; Jennings, John; Young, Ashley N; Rhein, Robert T

    2014-01-13

    The potential for acid-detergent insoluble ash (ADIA), alkaline-peroxide lignin (APL), and acid-detergent lignin (ADL) to predict fecal output (FO) and dry matter digestibility (DMD) by cattle offered bermudagrass [Cynodon dactylon (L.) Pers.] hays of different qualities was evaluated. Eight ruminally cannulated cows (594 ± 35.5 kg) were allocated randomly to 4 hay diets: low (L), medium low (ML), medium high (MH), and high (H) crude protein (CP) concentration (79, 111, 131, and 164 g CP/kg on a DM basis, respectively). Diets were offered in 3 periods with 2 diet replicates per period and were rotated across cows between periods. Cows were individually fed 20 g DM/kg of body weight in equal feedings at 08:00 and 16:00 h for a 10-d adaptation followed by a 5-d total fecal collection. Actual DM intake (DMI), DMD, and FO were determined based on hay offered, ort, and feces excreted. These components were then analyzed for ADL, APL, and ADIA concentration to determine marker recovery and marker-based estimates of FO and DMD. Forage DMI was affected by diet (P = 0.02), and DMI from MH and H was greater (P forages. Results from such studies may be used to develop improved equations to predict energy values of forages based on the relationship of dietary components to digestibility across a wide range of forages.

  3. Robotic cardiac surgery: an anaesthetic challenge.

    Science.gov (United States)

    Wang, Gang; Gao, Changqing

    2014-08-01

    Robotic cardiac surgery with the da Vinci robotic surgical system offers the benefits of a minimally invasive procedure, including a smaller incision and scar, reduced risk of infection, less pain and trauma, less bleeding and blood transfusion requirements, shorter hospital stay and decreased recovery time. Robotic cardiac surgery includes extracardiac and intracardiac procedures. Extracardiac procedures are often performed on a beating heart. Intracardiac procedures require the aid of peripheral cardiopulmonary bypass via a minithoracotomy. Robotic cardiac surgery, however, poses challenges to the anaesthetist, as the obligatory one-lung ventilation (OLV) and CO2 insufflation may reduce cardiac output and increase pulmonary vascular resistance, potentially resulting in hypoxaemia and haemodynamic compromise. In addition, surgery requires appropriate positioning of specialised cannulae such as an endopulmonary vent, endocoronary sinus catheter, and endoaortic clamp catheter under the guidance of transoesophageal echocardiography. Therefore, cardiac anaesthetists should have a working knowledge of these systems, OLV and haemodynamic support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Judicial Influence on Policy Outputs?

    DEFF Research Database (Denmark)

    Martinsen, Dorte Sindbjerg

    2015-01-01

    to override unwanted jurisprudence. In this debate, the Court of Justice of the European Union (CJEU) has become famous for its central and occasionally controversial role in European integration. This article examines to what extent and under which conditions judicial decisions influence European Union (EU......) social policy outputs. A taxonomy of judicial influence is constructed, and expectations of institutional and political conditions on judicial influence are presented. The analysis draws on an extensive novel data set and examines judicial influence on EU social policies over time, that is, between 1958...

  5. Left Ventricular Stroke Volume Quantification by Contrast Echocardiography – Comparison of Linear and Flow-Based Methods to Cardiac Magnetic Resonance

    Science.gov (United States)

    Dele-Michael, Abiola O.; Fujikura, Kana; Devereux, Richard B; Islam, Fahmida; Hriljac, Ingrid; Wilson, Sean R.; Lin, Fay; Weinsaft, Jonathan W.

    2014-01-01

    Background Echocardiography (echo) quantified LV stroke volume (SV) is widely used to assess systolic performance after acute myocardial infarction (AMI). This study compared two common echo approaches – predicated on flow (Doppler) and linear chamber dimensions (Teichholz) – to volumetric SV and global infarct parameters quantified by cardiac magnetic resonance (CMR). Methods Multimodality imaging was performed as part of a post-AMI registry. For echo, SV was measured by Doppler and Teichholz methods. Cine-CMR was used for volumetric SV and LVEF quantification, and delayed-enhancement CMR for infarct size. Results 142 patients underwent same-day echo and CMR. On echo, mean SV by Teichholz (78±17ml) was slightly higher than Doppler (75±16ml; Δ=3±13ml, p=0.02). Compared to SV on CMR (78±18ml), mean difference by Teichholz (Δ=−0.2±14; p=0.89) was slightly smaller than Doppler (Δ−3±14; p=0.02) but limits of agreement were similar between CMR and echo methods (Teichholz: −28, 27 ml, Doppler: −31, 24ml). For Teichholz, differences with CMR SV were greatest among patients with anteroseptal or lateral wall hypokinesis (p<0.05). For Doppler, differences were associated with aortic valve abnormalities or root dilation (p=0.01). SV by both echo methods decreased stepwise in relation to global LV injury as assessed by CMR-quantified LVEF and infarct size (p<0.01). Conclusions Teichholz and Doppler calculated SV yield similar magnitude of agreement with CMR. Teichholz differences with CMR increase with septal or lateral wall contractile dysfunction, whereas Doppler yields increased offsets in patients with aortic remodeling. PMID:23488864

  6. Disappearance of myocardial perfusion defects on prone SPECT imaging: Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease

    Directory of Open Access Journals (Sweden)

    Hedén Bo

    2009-08-01

    Full Text Available Abstract Background It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem. Methods In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR with delayed-enhancement technique to confirm or exclude myocardial infarction. Results There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR. Conclusion Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.

  7. Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study

    Science.gov (United States)

    Leclercq, Christophe; Sadoul, Nicolas; Mont, Lluis; Defaye, Pascal; Osca, Joaquim; Mouton, Elisabeth; Isnard, Richard; Habib, Gilbert; Zamorano, Jose; Derumeaux, Genevieve; Fernandez-Lozano, Ignacio; Dupuis, Jean-Marc; Rouleau, Frédéric; Tassin, Aude; Bordachar, Pierre; Clémenty, Jacques; Lafitte, Stephane; Ploux, Sylvan; Reant, Patricia; Ritter, Philippe; Defaye, Pascal; Jacon, Peggy; Mondesert, Blandine; Saunier, Carole; Vautrin, Estelle; Kacet, Salem; Guedon-Moreau, Laurence; Klug, Didier; Kouakam, Claude; Marechaux, Sylvestre; Marquie, Christelle; Polge, Anne Sophie; Richardson, Marjorie; Chevallier, Philippe; De Breyne, Brigitte; Lotek, Marcin M.; Nonin, Emilie; Pineau, Julien; Deharo, Jean-Claude; Bastard, Emilie; Franceschi, Frédéric; Habib, Gilbert; Jego, Christophe; Peyrouse, Eric; Prevot, Sebastien; Saint-Joseph, Hôpital; Bremondy, Michel; Faure, Jacques; Ferracci, Ange; Lefevre, Jean; Pisapia, Andre; Davy, Jean-Marc; Cransac, Frederic; Cung, Tien Tri; Georger, Frederic; Pasquie, Jean-Luc; Raczka, Franck; Sportouch-Dukhan, Catherine; Sadoul, Nicolas; Blangy, Hugues; Bruntz, Jean-François; Freysz, Luc; Groben, Laurent; Huttin, Olivier; Bammert, Antoine; Burban, Marc; Cebron, Jean-Pierre; Gras, Daniel; Frank, Robert; Duthoit, Guillaume; Hidden-Lucet, Françoise; Himbert, Caroline; Isnard, Richard; Lacotte, Jérôme; Pousset, Françoise; Zerah, Thierry; Leclercq, Christophe; Bellouin, Annaïk; Crocq, Christophe; Deplace, Christian; Donal, Erwan; Hamon, Cécile; Mabo, Philippe; Romain, Olivier; Solnon, Aude; Frederic, Anselme; Bauer, Fabrice; Bernard, Mathieu; Godin, Benedicte; Kurtz, Baptiste; Savoure, Arnaud; Copie, Xavier; Lascault, Gilles; Paziaud, Olivier; Piot, Olivier; Touche, Thierry; Delay, Toulouse Marc; Chilon, Talia; Detis, Nicolas; Duparc, Alexandre; Hebrard, Aurélien; Massabuau, Pierre; Maury, Philippe; Mondoly, Pierre; Rumeau, Philippe; Pasteur, Clinique; Boveda, Serge; Adrover, Laurence; Combes, Nicolas; Deplagne, Antoine; Marco-Baertich, Isabelle; Fondard, Olivier; Martínez, Juan Gabriel; Ibañez Criado, José Luis; Ortuño, Diego; Mont, Lluis; Berruezo, Antonio; Eduard, Belu; Martín, Ana; Merschon, Franco M.; Sitges, Marta; Tolosana, José María; Vidal, Bárbara; Hebron, H. Valle; i Mitjans, Angel Moya; Rodriguez, Oscar Alcalde; Rodriguez Palomares, José Fernando; Rivas, Nuria; Teixidó, Gisela; de Hierro, H. Puerta; Lozano, Ignacio Fernández; Ruiz Bautista, Maria Lorena; Castro, Victor; Cavero, Miguel Angel; Gutierrez, Carlos; Ros, Natalia; de la Victoria, H. Virgen; Alzueta Rodriguez, Francisco Javier; Cabrera, Fernando; Cordero, Alberto Barrera; Peña, José Luis; de Valme Sevilla, H.; Gonzáles, Juan Lealdel Ojo; Garcia Medina, Mª Dolores; Jiménez, Ricardo Pavón; Villagomez, David; de la Salud Toledo, H. Virgen; Castellanos Martinez, Eduardo; Alcalá, Juan; Maicas, Carolina; Arias Palomares, Miguel Angel; Puchol, Alberto; Valencia, H. La Fé; OscaAsensi, Joaquim; Carmona, Anastasio Quesada; De Carranza, Mª José Sancho-Tello; De Ros, José Olagüe; Pareja, Enrique Castro; Pérez, Oscar Cano; Saez, Ana Osa; Hortega, H. Rio; Guilarte, Benito Herreros; Muñoz San Jose, Juan Francisco; Pérez Sanz, Teresa Myriam; Logeart, Damien; Gil, Maria Lopez; Leclercq, Christophe; Lozano, Ignacio Fernandez; de Hierro, H. Puerta; Derumeaux, Genevieve

    2016-01-01

    Abstract Aims Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator. Methods and results Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (−25.3 ± 39.4 mL in RVS group vs. −29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = −4.06 mL; P = 0.006 with a −20 mL non-inferiority margin). The percentage of ‘echo-responders’ defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401). Conclusion This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. ClinicalTrials. gov number NCT 00833352. PMID:26374852

  8. Comparison of traditional advanced cardiac life support (ACLS) course instruction vs. a scenario-based, performance oriented team instruction (SPOTI) method for Korean paramedic students.

    Science.gov (United States)

    Lee, Christopher C; Im, Mark; Kim, Tae Min; Stapleton, Edward R; Kim, Kyuseok; Suh, Gil Joon; Singer, Adam J; Henry, Mark C

    2010-01-01

    Current Advanced Cardiac Life Support (ACLS) course instruction involves a 2-day course with traditional lectures and limited team interaction. We wish to explore the advantages of a scenario-based performance-oriented team instruction (SPOTI) method to implement core ACLS skills for non-English-speaking international paramedic students. The objective of this study was to determine if scenario-based, performance-oriented team instruction (SPOTI) improves educational outcomes for the ACLS instruction of Korean paramedic students. Thirty Korean paramedic students were randomly selected into two groups. One group of 15 students was taught the traditional ACLS course. The other 15 students were instructed using a SPOTI method. Each group was tested using ACLS megacode examinations endorsed by the American Heart Association. All 30 students passed the ACLS megacode examination. In the traditional ACLS study group an average of 85% of the core skills were met. In the SPOTI study group an average of 93% of the core skills were met. In particular, the SPOTI study group excelled at physical examination skills such as airway opening, assessment of breathing, signs of circulation, and compression rates. In addition, the SPOTI group performed with higher marks on rhythm recognition compared to the traditional group. The traditional group performed with higher marks at providing proper drug dosages compared to the SPOTI students. However, the students enrolled in the SPOTI method resulted in higher megacode core compliance scores compared to students trained in traditional ACLS course instruction. These differences did not achieve statistical significance due to the small sample size. Copyright 2010 Elsevier Inc. All rights reserved.

  9. Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tanabe, Yuki; Kido, Teruhito; Kurata, Akira; Miyagawa, Masao; Mochizuki, Teruhito [Ehime University Graduate School of Medicine, Department of Radiology, Toon, Ehime (Japan); Uetani, Teruyoshi; Kono, Tamami; Ogimoto, Akiyoshi [Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Toon, Ehime (Japan); Soma, Tsutomu [FUJIFILM RI Pharma Co., Ltd., QMS Group, Quality Assurance Department, Tokyo (Japan); Graduate School of Medicine, University of Tokyo, Department of Radiology, Tokyo (Japan); Murase, Kenya [Osaka University Graduate School of Medicine, Department of Medical Physics and Engineering, Division of Medical Technology and Science, Faculty of Health Science, Osaka (Japan); Iwaki, Hirotaka [Ehime University Graduate School of Medicine, Center for Clinical Research Data and Biostatistics, Toon, Ehime (Japan)

    2016-11-15

    To evaluate the feasibility of myocardial blood flow (MBF) by computed tomography from dynamic CT perfusion (CTP) for detecting myocardial ischemia and infarction assessed by cardiac magnetic resonance (CMR) or single-photon emission computed tomography (SPECT). Fifty-three patients who underwent stress dynamic CTP and either SPECT (n = 25) or CMR (n = 28) were retrospectively selected. Normal and abnormal perfused myocardium (ischemia/infarction) were assessed by SPECT/CMR using 16-segment model. Sensitivity and specificity of CT-MBF (mL/g/min) for detecting the ischemic/infarction and severe infarction were assessed. The abnormal perfused myocardium and severe infarction were seen in SPECT (n = 90 and n = 19 of 400 segments) and CMR (n = 223 and n = 36 of 448 segments). For detecting the abnormal perfused myocardium, sensitivity and specificity were 80 % (95 %CI, 71-90) and 86 % (95 %CI, 76-91) in SPECT (cut-off MBF, 1.23), and 82 % (95 %CI, 76-88) and 87 % (95 %CI, 80-92) in CMR (cut-off MBF, 1.25). For detecting severe infarction, sensitivity and specificity were 95 % (95 %CI, 52-100) and 72 % (95 %CI, 53-91) in SPECT (cut-off MBF, 0.92), and 78 % (95 %CI, 67-97) and 80 % (95 %CI, 58-86) in CMR (cut-off MBF, 0.98), respectively. Dynamic CTP has a potential to detect abnormal perfused myocardium and severe infarction assessed by SPECT/CMR using comparable cut-off MBF. (orig.)

  10. Bigger is not better: cortisol-induced cardiac growth and dysfunction in salmonids

    DEFF Research Database (Denmark)

    Johansen, Ida B.; Sandblom, Erik; Skov, Peter Vilhelm

    2017-01-01

    show that rainbow trout (Oncorhynchus mykiss) treated with cortisol in the diet for 45 days have enlarged hearts with lower maximum stroke volume and cardiac output. In accordance with impaired cardiac performance, overall circulatory oxygen-transporting capacity was diminished as indicated by reduced...

  11. Stimulating endogenous cardiac regeneration

    Directory of Open Access Journals (Sweden)

    Amanda eFinan

    2015-09-01

    Full Text Available The healthy adult heart has a low turnover of cardiac myocytes. The renewal capacity, however, is augmented after cardiac injury. Participants in cardiac regeneration include cardiac myocytes themselves, cardiac progenitor cells, and peripheral stem cells, particularly from the bone marrow compartment. Cardiac progenitor cells and bone marrow stem cells are augmented after cardiac injury, migrate to the myocardium, and support regeneration. Depletion studies of these populations have demonstrated their necessary role in cardiac repair. However, the potential of these cells to completely regenerate the heart is limited. Efforts are now being focused on ways to augment these natural pathways to improve cardiac healing, primarily after ischemic injury but in other cardiac pathologies as well. Cell and gene therapy or pharmacological interventions are proposed mechanisms. Cell therapy has demonstrated modest results and has passed into clinical trials. However, the beneficial effects of cell therapy have primarily been their ability to produce paracrine effects on the cardiac tissue and recruit endogenous stem cell populations as opposed to direct cardiac regeneration. Gene therapy efforts have focused on prolonging or reactivating natural signaling pathways. Positive results have been demonstrated to activate the endogenous stem cell populations and are currently being tested in clinical trials. A potential new avenue may be to refine pharmacological treatments that are currently in place in the clinic. Evidence is mounting that drugs such as statins or beta blockers may alter endogenous stem cell activity. Understanding the effects of these drugs on stem cell repair while keeping in mind their primary function may strike a balance in myocardial healing. To maximize endogenous cardiac regeneration,a combination of these approaches couldameliorate the overall repair process to incorporate the participation ofmultiple cell players.

  12. Buck supplies output voltage ripple reduction using fuzzy control

    Directory of Open Access Journals (Sweden)

    Nicu BIZON

    2007-12-01

    Full Text Available Using the PWM control for switching power supplies the peaks EMI noise appear at the switching frequency and its harmonics. Using randomize or chaotic PWM control techniques in these systems the power spectrum is spread out in all frequencies band spectral emissions, but with a bigger ripple in the output voltage. The proposed nonlinear feedback control method, which induces chaos, is based by fuzzy rules that minimize the output voltage ripple. The feasibility and effectiveness of this relative simple method is shown by simulation. A comparison with the previous control method is included, too.

  13. Nitrates for the prevention of cardiac morbidity and mortality in patients undergoing non-cardiac surgery.

    Science.gov (United States)

    Zhao, Na; Xu, Jin; Singh, Balwinder; Yu, Xuerong; Wu, Taixiang; Huang, Yuguang

    2016-08-04

    resolved differences by discussion and, when necessary, sought help and suggestions from a third review author. We used a random-effects model for data analysis. We included 27 randomized controlled trials (RCTs) (8244 participants analysed). Investigators reported 12 different comparisons of three different nitrates (nitroglycerin, isosorbide dinitrate and nicorandil) versus no treatment, placebo or other pharmacological interventions. All participants were older than 15 years of age. More than half of the trials used general anaesthesia. Surgical procedures in most trials were at low to moderate risk for perioperative cardiac complications. Only two comparisons including three studies reported the primary outcome - all-cause mortality up to 30 days post operation. Researchers reported other morbidity outcomes and adverse events in a variable and heterogeneous way, resulting in limited available data for inclusion in the meta-analysis. We determined that the overall methodological quality of included studies was fair to low, in accordance with risk of bias in most domains.In summary, we found no difference in the primary outcome - all-cause mortality up to 30 days post operation - when nitroglycerin was compared with no treatment (one study, 60 participants, 0/30 vs 1/30; (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.01 to 7.87, very low-quality evidence based on GRADE criteria) or with placebo (two studies, 89 participants, 1/45 vs 0/44; RR 2.81, 95% CI 0.12 to 63.83, very low-quality evidence). Regarding our secondary outcomes, we noted no statistically significant differences in angina pectoris, acute myocardial infarction, acute heart failure, cardiac arrhythmia or cardiac arrest in any comparisons. In comparisons versus nitroglycerin, although more events of cardiac ischaemia were observed in participants receiving no treatment or placebo, we found no statistically significant differences in any comparisons, except the comparison of nicorandil versus placebo

  14. Characterization of Glutamatergic Neurons in the Rat Atrial Intrinsic Cardiac Ganglia that Project to the Cardiac Ventricular Wall

    Science.gov (United States)

    Wang, Ting; Miller, Kenneth E.

    2016-01-01

    The intrinsic cardiac nervous system modulates cardiac function by acting as an integration site for regulating autonomic efferent cardiac output. This intrinsic system is proposed to be composed of a short cardio-cardiac feedback control loop within the cardiac innervation hierarchy. For example, electrophysiological studies have postulated the presence of sensory neurons in intrinsic cardiac ganglia for regional cardiac control. There is still a knowledge gap, however, about the anatomical location and neurochemical phenotype of sensory neurons inside intrinsic cardiac ganglia. In the present study, rat intrinsic cardiac ganglia neurons were characterized neurochemically with immunohistochemistry using glutamatergic markers: vesicular glutamate transporters 1 and 2 (VGLUT1; VGLUT2), and glutaminase (GLS), the enzyme essential for glutamate production. Glutamatergic neurons (VGLUT1/VGLUT2/GLS) in the ICG that have axons to the ventricles were identified by retrograde tracing of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) injected in the ventricular wall. Co-labeling of VGLUT1, VGLUT2, and GLS with the vesicular acetylcholine transporter (VAChT) was used to evaluate the relationship between post-ganglionic autonomic neurons and glutamatergic neurons. Sequential labeling of VGLUT1 and VGLUT2 in adjacent tissue sections was used to evaluate the co-localization of VGLUT1 and VGLUT2 in ICG neurons. Our studies yielded the following results: (1) intrinsic cardiac ganglia contain glutamatergic neurons with GLS for glutamate production and VGLUT1 and 2 for transport of glutamate into synaptic vesicles; (2) atrial intrinsic cardiac ganglia contain neurons that project to ventricle walls and these neurons are glutamatergic; (3) many glutamatergic ICG neurons also were cholinergic, expressing VAChT. (4) VGLUT1 and VGLUT2 co-localization occurred in ICG neurons with variation of their protein expression level. Investigation of both glutamatergic and cholinergic ICG

  15. Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya.

    Science.gov (United States)

    Oyugi, Boniface; Kioko, Urbanus; Kaboro, Stephen Mbugua; Gikonyo, Shadrack; Okumu, Clarice; Ogola-Munene, Sarah; Kalsi, Shaminder; Thiani, Simon; Korir, Julius; Odundo, Paul; Baltazaar, Billy; Ranji, Moses; Muraguri, Nicholas; Nzioka, Charles

    2017-03-27

    The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility. The study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17. All the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R 2 value, representing the percentage of

  16. Quantitative assessment of primary mitral regurgitation using left ventricular volumes obtained with new automated three-dimensional transthoracic echocardiographic software: A comparison with 3-Tesla cardiac magnetic resonance.

    Science.gov (United States)

    Levy, Franck; Marechaux, Sylvestre; Iacuzio, Laura; Schouver, Elie Dan; Castel, Anne Laure; Toledano, Manuel; Rusek, Stephane; Dor, Vincent; Tribouilloy, Christophe; Dreyfus, Gilles

    2018-03-30

    Quantitative assessment of primary mitral regurgitation (MR) using left ventricular (LV) volumes obtained with three-dimensional transthoracic echocardiography (3D TTE) recently showed encouraging results. Nevertheless, 3D TTE is not incorporated into everyday practice, as current LV chamber quantification software products are time consuming. To investigate the accuracy and reproducibility of new automated fast 3D TTE software (HeartModel A.I. ; Philips Healthcare, Andover, MA, USA) for the quantification of LV volumes and MR severity in patients with isolated degenerative primary MR; and to compare regurgitant volume (RV) obtained with 3D TTE with a cardiac magnetic resonance (CMR) reference. Fifty-three patients (37 men; mean age 64±12 years) with at least mild primary isolated MR, and having comprehensive 3D TTE and CMR studies within 24h, were eligible for inclusion. MR RV was calculated using the proximal isovelocity surface area (PISA) method and the volumetric method (total LV stroke volume minus aortic stroke volume) with either CMR or 3D TTE. Inter- and intraobserver reproducibility of 3D TTE was excellent (coefficient of variation≤10%) for LV volumes. MR RV was similar using CMR and 3D TTE (57±23mL vs 56±28mL; P=0.22), but was significantly higher using the PISA method (69±30mL; P<0.05 compared with CMR and 3D TTE). The PISA method consistently overestimated MR RV compared with CMR (bias 12±21mL), while no significant bias was found between 3D TTE and CMR (bias 2±14mL). Concordance between echocardiography and CMR was higher using 3D TTE MR grading (intraclass correlation coefficient [ICC]=0.89) than with PISA MR grading (ICC=0.78). Complete agreement with CMR grading was more frequent with 3D TTE than with the PISA method (76% vs 63%). 3D TTE RV assessment using the new generation of automated software correlates well with CMR in patients with isolated degenerative primary MR. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  17. Estimating output fluence with MCNP4 for shaped fields and their comparison with measurements in the EPID system aS1000 for dosimetry 2D in-vivo; Estimacion de la fluencia de salida con MCNP4 para campos conformados y su comparacion con mediciones en el sistema EPID aS1000 para dosimetria in-vivo 2D

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez R, B.; Rodriguez P, X.; Sosa, M., E-mail: bhernandez@fisica.ugto.mx [Universidad de Guanajuato, Division de Ciencias e Ingenierias, Loma del Bosque No. 103, 37150 Leon, Guanajuato (Mexico)

    2015-10-15

    Full text: Radiotherapy dosimetry is a fundamental process in quality control of the treatments performed with this technique. Different systems exist to quantify radiation dose in radiotherapy, one of them is the Electronic Portal Imaging Device (EPID), which is widely used in IMRT to measure the output fluence of a radiation field for comparison with a predicted fluence in a planning system. The objective of this work was to simulate a Varian linear accelerator model Clinac i X using the MCNP4 code for obtaining curves of percentage depth dose (Pdd) and open fields dosimetric profiles of 5 x 5, 10 x 10, 20 x 20 and 30 x 30 cm{sup 2}. The simulations were validated by comparing them with measurements made with ionization chamber. Then a mannequin of solid water (30 x 30 x 20 cm{sup 3}) with an open field of 10 x 10 cm{sup 2} was irradiated to measure the output fluence with EPID aS1000 system of Varian. A simulation of the solid water mannequin under the same conditions of irradiation was conducted to estimate the output fluence. Tests of index gamma and percentage differences were calculated to compare that simulated with that measured. In all cases was found that more than 95% of the evaluated points passed the acceptance criteria (ΔD= 1% and ΔS= 1 mm for curves Pdd and profiles, and ΔD= 3% and ΔS= 3 mm for fluence two-dimensional). This paper will contribute to the implementation of in-vivo dosimetry three-dimensional with the EPID system. (Author)

  18. Integration of TMVA Output into Jupyter notebooks

    CERN Document Server

    Saliji, Albulena

    2016-01-01

    The purpose of this report is to describe the work that I have been doing during these past eight weeks as a Summer Student at CERN. The task which was assigned to me had to do with the integration of TMVA Output into Jupyter notebooks. In order to integrate the TMVA Output into the Jupyter notebook, first, improvement of the TMVA Output in the terminal was required. Once the output was improved, it needed to be transformed into HTML output and at the end it would be possible to integrate that output into the Jupyter notebook.

  19. Marketing cardiac CT programs.

    Science.gov (United States)

    Scott, Jason

    2010-01-01

    There are two components of cardiac CT discussed in this article: coronary artery calcium scoring (CACS) and coronary computed tomography angiography (CCTA).The distinctive advantages of each CT examination are outlined. In order to ensure a successful cardiac CT program, it is imperative that imaging facilities market their cardiac CT practices effectively in order to gain a competitive advantage in this valuable market share. If patients receive quality care by competent individuals, they are more likely to recommend the facility's cardiac CT program. Satisfied patients will also be more willing to come back for any further testing.

  20. Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome.

    Science.gov (United States)

    Jakimov, Tamara; Mrdović, Igor; Filipović, Branka; Zdravković, Marija; Djoković, Aleksandra; Hinić, Saša; Milić, Nataša; Filipović, Branislav

    2017-12-31

    To compare the prognostic performance of three major risk scoring systems including global registry for acute coronary events (GRACE), thrombolysis in myocardial infarction (TIMI), and prediction of 30-day major adverse cardiovascular events after primary percutaneous coronary intervention (RISK-PCI). This single-center retrospective study involved 200 patients with acute coronary syndrome (ACS) who underwent invasive diagnostic approach, ie, coronary angiography and myocardial revascularization if appropriate, in the period from January 2014 to July 2014. The GRACE, TIMI, and RISK-PCI risk scores were compared for their predictive ability. The primary endpoint was a composite 30-day major adverse cardiovascular event (MACE), which included death, urgent target-vessel revascularization (TVR), stroke, and non-fatal recurrent myocardial infarction (REMI). The c-statistics of the tested scores for 30-day MACE or area under the receiver operating characteristic curve (AUC) with confidence intervals (CI) were as follows: RISK-PCI (AUC=0.94; 95% CI 1.790-4.353), the GRACE score on admission (AUC=0.73; 95% CI 1.013-1.045), the GRACE score on discharge (AUC=0.65; 95% CI 0.999-1.033). The RISK-PCI score was the only score that could predict TVR (AUC=0.91; 95% CI 1.392-2.882). The RISK-PCI scoring system showed an excellent discriminative potential for 30-day death (AUC=0.96; 95% CI 1.339-3.548) in comparison with the GRACE scores on admission (AUC=0.88; 95% CI 1.018-1.072) and on discharge (AUC=0.78; 95% CI 1.000-1.058). In comparison with the GRACE and TIMI scores, RISK-PCI score showed a non-inferior ability to predict 30-day MACE and death in ACS patients. Moreover, RISK-PCI was the only scoring system that could predict recurrent ischemia requiring TVR.

  1. Gated SPECT evaluation of left ventricular function using a CZT camera and a fast low-dose clinical protocol: comparison to cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Giorgetti, Assuero; Masci, Pier Giorgio; Marras, Gavino; Gimelli, Alessia; Genovesi, Dario; Lombardi, Massimo [Fondazione CNR/Regione Toscana ' ' G. Monasterio' ' , Pisa (Italy); Rustamova, Yasmine K. [Azerbaijan Medical University, Department of internal medicine Central Customs Hospital, Baku (Azerbaijan); Marzullo, Paolo [Istituto di Fisiologia Clinica del CNR, Pisa (Italy)

    2013-12-15

    CZT technology allows ultrafast low-dose myocardial scintigraphy but its accuracy in assessing left ventricular function is still to be defined. The study group comprised 55 patients (23 women, mean age 63 {+-} 9 years) referred for myocardial perfusion scintigraphy. The patients were studied at rest using a CZT camera (Discovery NM530c; GE Healthcare) and a low-dose {sup 99m}Tc-tetrofosmin clinical protocol (mean dose 264 {+-} 38 MBq). Gated SPECT imaging was performed as a 6-min list-mode acquisition, 15 min after radiotracer injection. Images were reformatted (8-frame to 16-frame) using Lister software on a Xeleris workstation (GE Healthcare) and then reconstructed with a dedicated iterative algorithm. Analysis was performed using Quantitative Gated SPECT (QGS) software. Within 2 weeks patients underwent cardiac magnetic resonance imaging (cMRI, 1.5-T unit CVi; GE Healthcare) using a 30-frame acquisition protocol and dedicated software for analysis (MASS 6.1; Medis). The ventricular volumes obtained with 8-frame QGS showed excellent correlations with the cMRI volumes (end-diastolic volume (EDV), r = 0.90; end-systolic volume (ESV), r = 0.94; p < 0.001). However, QGS significantly underestimated the ventricular volumes (mean differences: EDV, -39.5 {+-} 29 mL; ESV, -15.4 {+-} 22 mL; p < 0.001). Similarly, the ventricular volumes obtained with 16-frame QGS showed an excellent correlations with the cMRI volumes (EDV, r = 0.92; ESV, r = 0.95; p < 0.001) but with significant underestimations (mean differences: EDV, -33.2 {+-} 26 mL; ESV, -17.9 {+-} 20 mL; p < 0.001). Despite significantly lower values (47.9 {+-} 16 % vs. 51.2 {+-} 15 %, p < 0.008), 8-frame QGS mean ejection fraction (EF) was closely correlated with the cMRI values (r = 0.84, p < 0.001). The mean EF with 16-frame QGS showed the best correlation with the cMRI values (r = 0.91, p < 0.001) and was similar to the mean cMRI value (49.6 {+-} 16 %, p not significant). Regional analysis showed a good

  2. Angiofibroma, a rare cardiac tumour in children

    Directory of Open Access Journals (Sweden)

    G Gayen

    2013-09-01

    Full Text Available Angiofibromas, located in any other sites than nasopharynx are unusual. Cardiac angiofibromas are a very rare cardiac tumours in comparison to rhabdomyomas which are the commonest in the children. We report a right ventricular tumour in a10 year old girl which was excised under cardiopulmonary bypass successfully and diagnosed as angiofibroma on histopathology. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 51-54 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8702  

  3. Comparison of Usefulness of N-Terminal Pro-Brain Natriuretic Peptide as an Independent Predictor of Cardiac Function Among Admission Cardiac Serum Biomarkers in Patients With Anterior Wall Versus Nonanterior Wall ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Haeck, Joost D. E.; Verouden, Niels J. W.; Kuijt, Wichert J.; Koch, Karel T.; van Straalen, Jan P.; Fischer, Johan; Groenink, Maarten; Bilodeau, Luc; Tijssen, Jan G. P.; Krucoff, Mitchell W.; de Winter, Robbert J.

    2010-01-01

    The purpose of the present study was to determine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), among other serum biomarkers, on cardiac magnetic resonance (CMR) imaging parameters of cardiac function and infarct size in patients with ST-segment elevation myocardial

  4. Observability of linear systems with saturated outputs

    NARCIS (Netherlands)

    Koplon, R.; Sontag, E.D.; Hautus, M.L.J.

    1994-01-01

    We present necessary and sufficient conditions for observability of the class of output-saturated systems. These are linear systems whose output passes through a saturation function before it can be measured.

  5. Traction force microscopy of engineered cardiac tissues.

    Science.gov (United States)

    Pasqualini, Francesco Silvio; Agarwal, Ashutosh; O'Connor, Blakely Bussie; Liu, Qihan; Sheehy, Sean P; Parker, Kevin Kit

    2018-01-01

    Cardiac tissue development and pathology have been shown to depend sensitively on microenvironmental mechanical factors, such as extracellular matrix stiffness, in both in vivo and in vitro systems. We present a novel quantitative approach to assess cardiac structure and function by extending the classical traction force microscopy technique to tissue-level preparations. Using this system, we investigated the relationship between contractile proficiency and metabolism in neonate rat ventricular myocytes (NRVM) cultured on gels with stiffness mimicking soft immature (1 kPa), normal healthy (13 kPa), and stiff diseased (90 kPa) cardiac microenvironments. We found that tissues engineered on the softest gels generated the least amount of stress and had the smallest work output. Conversely, cardiomyocytes in tissues engineered on healthy- and disease-mimicking gels generated significantly higher stresses, with the maximal contractile work measured in NRVM engineered on gels of normal stiffness. Interestingly, although tissues on soft gels exhibited poor stress generation and work production, their basal metabolic respiration rate was significantly more elevated than in other groups, suggesting a highly ineffective coupling between energy production and contractile work output. Our novel platform can thus be utilized to quantitatively assess the mechanotransduction pathways that initiate tissue-level structural and functional remodeling in response to substrate stiffness.

  6. Probabilistic Output Analysis by Program Manipulation

    DEFF Research Database (Denmark)

    Rosendahl, Mads; Kirkeby, Maja Hanne

    2015-01-01

    The aim of a probabilistic output analysis is to derive a probability distribution of possible output values for a program from a probability distribution of its input. We present a method for performing static output analysis, based on program transformation techniques. It generates a probability...

  7. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

  8. Cardiac Catheterization (For Kids)

    Science.gov (United States)

    ... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... Educators Search English Español Cardiac Catheterization KidsHealth / For Kids / Cardiac Catheterization What's in this article? What Is ...

  9. Model output: fact or artefact?

    Science.gov (United States)

    Melsen, Lieke

    2015-04-01

    As a third-year PhD-student, I relatively recently entered the wonderful world of scientific Hydrology. A science that has many pillars that directly impact society, for example with the prediction of hydrological extremes (both floods and drought), climate change, applications in agriculture, nature conservation, drinking water supply, etcetera. Despite its demonstrable societal relevance, hydrology is often seen as a science between two stools. Like Klemeš (1986) stated: "By their academic background, hydrologists are foresters, geographers, electrical engineers, geologists, system analysts, physicists, mathematicians, botanists, and most often civil engineers." Sometimes it seems that the engineering genes are still present in current hydrological sciences, and this results in pragmatic rather than scientific approaches for some of the current problems and challenges we have in hydrology. Here, I refer to the uncertainty in hydrological modelling that is often neglected. For over thirty years, uncertainty in hydrological models has been extensively discussed and studied. But it is not difficult to find peer-reviewed articles in which it is implicitly assumed that model simulations represent the truth rather than a conceptualization of reality. For instance in trend studies, where data is extrapolated 100 years ahead. Of course one can use different forcing datasets to estimate the uncertainty of the input data, but how to prevent that the output is not a model artefact, caused by the model structure? Or how about impact studies, e.g. of a dam impacting river flow. Measurements are often available for the period after dam construction, so models are used to simulate river flow before dam construction. Both are compared in order to qualify the effect of the dam. But on what basis can we tell that the model tells us the truth? Model validation is common nowadays, but validation only (comparing observations with model output) is not sufficient to assume that a

  10. Canada's helium output rising fast

    Energy Technology Data Exchange (ETDEWEB)

    1966-12-01

    About 12 months from now, International Helium Limited will be almost ready to start up Canada's second helium extraction plant at Mankota, in Saskatchewan's Wood Mountain area about 100 miles southwest of Moose Jaw. Another 80 miles north is Saskatchewan's (and Canada's) first helium plant, operated by Canadian Helium and sitting on a gas deposit at Wilhelm, 9 miles north of Swift Current. It contains almost 2% helium, some COD2U, and the rest nitrogen. One year in production was apparently enough to convince Canadian Helium that the export market (it sells most of its helium in W. Europe) can take a lot more than it's getting. Construction began this summer on an addition to the Swift Current plant that will raise its capacity from 12 to 36MMcf per yr when it goes on stream next spring. Six months later, International Helium's 40 MMcf per yr plant to be located about 4 miles from its 2 Wood Mountain wells will double Canada's helium output again.

  11. Sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Neeraj Parakh

    2015-01-01

    Full Text Available Sudden cardiac death is one of the most common cause of mortality worldwide. Despite significant advances in the medical science, there is little improvement in the sudden cardiac death related mortality. Coronary artery disease is the most common etiology behind sudden cardiac death, in the above 40 years population. Even in the apparently healthy population, there is a small percentage of patients dying from sudden cardiac death. Given the large denominator, this small percentage contributes to the largest burden of sudden cardiac death. Identification of this at risk group among the apparently healthy individual is a great challenge for the medical fraternity. This article looks into the causes and methods of preventing SCD and at some of the Indian data. Details of Brugada syndrome, Long QT syndrome, Genetics of SCD are discussed. Recent guidelines on many of these causes are summarised.

  12. CARDIAC LYMPHOMA IN DOG

    Directory of Open Access Journals (Sweden)

    G. D. Cruz

    2016-11-01

    Full Text Available Lymphoma is a lymphoid tumor that originates in hematopoietic organs such as lymph node, spleen or liver. In dogs, the overall prevalence of cardiac tumors was estimated to be only 0.19% based on the results of the survey of a large database, and lymphomas accounts for approximately 2% of all cardiac tumors. In general, the involvement of the myocardium is rarely described in canine lymphoma. Currently, there is no evidence of a viral association with primary cardiac lymphoma in dogs, but other types of immunosuppression may contribute to abnormal events, such as involvement primary cardiac. The aim of this study was to analyze a case of sudden death of a bitch, SRD, aged 10, who had the final diagnosis of cardiac lymphoma.

  13. Mathematical cardiac electrophysiology

    CERN Document Server

    Colli Franzone, Piero; Scacchi, Simone

    2014-01-01

    This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

  14. Biomaterials for cardiac regeneration

    CERN Document Server

    Ruel, Marc

    2015-01-01

    This book offers readers a comprehensive biomaterials-based approach to achieving clinically successful, functionally integrated vasculogenesis and myogenesis in the heart. Coverage is multidisciplinary, including the role of extracellular matrices in cardiac development, whole-heart tissue engineering, imaging the mechanisms and effects of biomaterial-based cardiac regeneration, and autologous bioengineered heart valves. Bringing current knowledge together into a single volume, this book provides a compendium to students and new researchers in the field and constitutes a platform to allow for future developments and collaborative approaches in biomaterials-based regenerative medicine, even beyond cardiac applications. This book also: Provides a valuable overview of the engineering of biomaterials for cardiac regeneration, including coverage of combined biomaterials and stem cells, as well as extracellular matrices Presents readers with multidisciplinary coverage of biomaterials for cardiac repair, including ...

  15. Quantification of pulmonary regurgitation and prediction of pulmonary valve replacement by echocardiography in patients with congenital heart defects in comparison to cardiac magnetic resonance imaging.

    Science.gov (United States)

    Dellas, Claudia; Kammerer, Laura; Gravenhorst, Verena; Lotz, Joachim; Paul, Thomas; Steinmetz, Michael

    2018-04-01

    Pulmonary regurgitation (PR) is common in patients with congenital heart defects (CHD) and contributes to morbidity and mortality in the long-term. We investigated in this retrospective analysis whether readily accessible echocardiographic parameters are useful for quantification of PR and for predicting pulmonary valve replacement (PVR) in comparison to the gold-standard phase contrast (PC) flow measurements from cardiovascular magnetic resonance (CMR). Continuous wave (CW) Doppler and colour flow images in echocardiograms from 53 patients with CHD were analysed. Slope and jet-to-RVOT ratio correlated significantly with CMR-assessed regurgitation fraction (RF), whereas pressure half time (PHT) showed an inverse correlation. Patients with mild PR in CMR had significantly higher PHT, lower slope and jet-to-RVOT ratio than patients with moderate or severe regurgitation. The AUC regarding PR severity was 0.778 for PHT (95% CI, 0.649-0.907; P = 0.007 for CMR-RF ≤ 35%), 0.744 for slope (95% CI, 0.603-0.885; P = 0.017 for CMR-RF > 35%) and 0.652 for jet-to-RVOT ratio (95% CI, 0.473-0.860; P = 0.168 for CMR-RF > 35%). The optimal cut-off values calculated from ROC analysis were 95 ms for PHT and 4.9 m/s 2 for slope. In logistic regression analysis, slope emerged as the most valuable parameter for predicting the indication for PVR (OR 12.9, 95% CI, 1.8-90.9, P = 0.010). In conclusion, echocardiographic assessment of PR was feasible. Both parameters, PHT and in particular slope, were predictors for PVR. Thus, echocardiography appears appropriate in the management of patients with PR.

  16. Comparison of continuous compression with regular ventilations versus 30:2 compressions-ventilations strategy during mechanical cardiopulmonary resuscitation in a porcine model of cardiac arrest.

    Science.gov (United States)

    Yang, Zhengfei; Liu, Qingyu; Zheng, Guanghui; Liu, Zhifeng; Jiang, Longyuan; Lin, Qing; Chen, Rui; Tang, Wanchun

    2017-09-01

    A compression-ventilation (C:V) ratio of 30:2 is recommended for adult cardiopulmonary resuscitation (CPR) by the current American Heart Association (AHA) guidelines. However, continuous chest compression (CCC) is an alternative strategy for CPR that minimizes interruption especially when an advanced airway exists. In this study, we investigated the effects of 30:2 mechanical CPR when compared with CCC in combination with regular ventilation in a porcine model. Sixteen male domestic pigs weighing 39±2 kg were utilized. Ventricular fibrillation was induced and untreated for 7 min. The animals were then randomly assigned to receive CCC combined with regular ventilation (CCC group) or 30:2 CPR (VC group). Mechanical chest compression was implemented with a miniaturized mechanical chest compressor. At the same time of beginning of precordial compression, the animals were mechanically ventilated at a rate of 10 breaths-per-minute in the CCC group or with a 30:2 C:V ratio in the VC group. Defibrillation was delivered by a single 150 J shock after 5 min of CPR. If failed to resuscitation, CPR was resumed for 2 min before the next shock. The protocol was stopped if successful resuscitation or at a total of 15 min. The resuscitated animals were observed for 72 h. Coronary perfusion pressure, end-tidal carbon dioxide and carotid blood flow in the VC group were similar to those achieved in the CCC group during CPR. No significant differences were observed in arterial blood gas parameters between two groups at baseline, VF 6 min, CPR 4 min and 30, 120 and 360 min post-resuscitation. Although extravascular lung water index of both groups significantly increased after resuscitation, no distinct difference was found between CCC and VC groups. All animals were successfully resuscitated and survived for 72 h with favorable neurologic outcomes in both groups. However, obviously more numbers of rib fracture were observed in CCC animals in comparison with VC animals. There was no

  17. PREVIMER : Meteorological inputs and outputs

    Science.gov (United States)

    Ravenel, H.; Lecornu, F.; Kerléguer, L.

    2009-09-01

    PREVIMER is a pre-operational system aiming to provide a wide range of users, from private individuals to professionals, with short-term forecasts about the coastal environment along the French coastlines bordering the English Channel, the Atlantic Ocean, and the Mediterranean Sea. Observation data and digital modelling tools first provide 48-hour (probably 96-hour by summer 2009) forecasts of sea states, currents, sea water levels and temperatures. The follow-up of an increasing number of biological parameters will, in time, complete this overview of coastal environment. Working in partnership with the French Naval Hydrographic and Oceanographic Service (Service Hydrographique et Océanographique de la Marine, SHOM), the French National Weather Service (Météo-France), the French public science and technology research institute (Institut de Recherche pour le Développement, IRD), the European Institute of Marine Studies (Institut Universitaire Européen de la Mer, IUEM) and many others, IFREMER (the French public institute fo marine research) is supplying the technologies needed to ensure this pertinent information, available daily on Internet at http://www.previmer.org, and stored at the Operational Coastal Oceanographic Data Centre. Since 2006, PREVIMER publishes the results of demonstrators assigned to limited geographic areas and to specific applications. This system remains experimental. The following topics are covered : Hydrodynamic circulation, sea states, follow-up of passive tracers, conservative or non-conservative (specifically of microbiological origin), biogeochemical state, primary production. Lastly, PREVIMER provides researchers and R&D departments with modelling tools and access to the database, in which the observation data and the modelling results are stored, to undertake environmental studies on new sites. The communication will focus on meteorological inputs to and outputs from PREVIMER. It will draw the lessons from almost 3 years during

  18. The 'icon' of output efficiency

    International Nuclear Information System (INIS)

    Bligh, L.N.; Evans, S.G.; Larcos, G.; Gruenewald, S.M.

    1999-01-01

    Full text: Output efficiency (OE) is a well-validated parameter used in the assessment of hydronephrosis. Current analysis on Microdelta appears to produce few low OE values and occasional inability to produce a result. We sought an OE program which gave a reliable response over the full range of values. The aims of this study were to determine: (1) whether OE results are comparable between two computer systems; (2) a normal range for OE on an ICON; (3) inter-observer reproducibility; and (4) the correlation between the two programs and the residual cortical activity ratio (RCA), an index which assesses tracer washout from the 20 min cortical activity/peak cortical activity. Accordingly, two blinded medical radiation scientists reviewed 41 kidneys (26 native, 15 transplant) and calculated OE for each kidney on the ICON and Microdelta computers The OE on the Microdelta and the ICON had good correspondence (r = 0.6%, SEE = 6.2). The extrapolated normal range for ICON OE was 69-92% (mean 80.9%). The inter-observer reproducibility on the ICON was excellent with a CV of 8.7%. ICON OE and RCA had a strong correlation (r = - 0.77, SEE = 0.09), compared with a weaker correlation for the Microdelta (r = 0.47, SEE = 0.13). Processing on the ICON was almost half that of the Microdelta at 4 min compared with 7 min. We conclude that OE generated by these computer programs has good correlation, an established normal range, excellent interobserver reproducibility, but differing correlation with RCA. The response of the ICON program to low ranges of OE is being investigated further

  19. Endogenous Natural Complement Inhibitor Regulates Cardiac Development

    DEFF Research Database (Denmark)

    Mortensen, Simon A; Skov, Louise L; Kjaer-Sorensen, Kasper

    2017-01-01

    mechanisms during fetal development and adult homeostasis. In this article, we describe the function of an endogenous complement inhibitor, mannan-binding lectin (MBL)-associated protein (MAp)44, in regulating the composition of a serine protease-pattern recognition receptor complex, MBL-associated serine...... of MAp44 caused impaired cardiogenesis, lowered heart rate, and decreased cardiac output. These defects were associated with aberrant neural crest cell behavior. We found that MAp44 competed with MASP-3 for pattern recognition molecule interaction, and knockdown of endogenous MAp44 expression could...... be rescued by overexpression of wild-type MAp44. Our observations provide evidence that immune molecules are centrally involved in the orchestration of cardiac tissue development....

  20. Influence of cardiac cycle on the radiographic appearance of the feline heart

    International Nuclear Information System (INIS)

    Toal, R.L.; Losonsky, J.M.; Coulter, D.B.; DeNovellis, R.

    1985-01-01

    The effect of cardiac-cycle phase on the radiographic appearance of the feline heart was investigated. Results show that the size and shape changes in the cardiac silhouette due to the cardiac cycle were present in all three postural positions investigated. Cardiac size and shape changes were present more frequently and in more locations of the cardiac silhouette when patients were in ventral recumbency (DV) versus dorsal recumbency (VD). In most cases, the magnitude of differences was small and detection was facilitated by comparison viewing. It is suggested that these size and shape influences of the cardiac cycle on cardiac appearance should be kept in mind when interpreting feline radiographs for cardiac pathology

  1. In vivo cardiac glucose metabolism in the high-fat fed mouse: Comparison of euglycemic–hyperinsulinemic clamp derived measures of glucose uptake with a dynamic metabolomic flux profiling approach

    International Nuclear Information System (INIS)

    Kowalski, Greg M.; De Souza, David P.; Risis, Steve; Burch, Micah L.; Hamley, Steven; Kloehn, Joachim; Selathurai, Ahrathy; Lee-Young, Robert S.; Tull, Dedreia; O'Callaghan, Sean; McConville, Malcolm J.; Bruce, Clinton R.

    2015-01-01

    Rationale: Cardiac metabolism is thought to be altered in insulin resistance and type 2 diabetes (T2D). Our understanding of the regulation of cardiac substrate metabolism and insulin sensitivity has largely been derived from ex vivo preparations which are not subject to the same metabolic regulation as in the intact heart in vivo. Studies are therefore required to examine in vivo cardiac glucose metabolism under physiologically relevant conditions. Objective: To determine the temporal pattern of the development of cardiac insulin resistance and to compare with dynamic approaches to interrogate cardiac glucose and intermediary metabolism in vivo. Methods and results: Studies were conducted to determine the evolution of cardiac insulin resistance in C57Bl/6 mice fed a high-fat diet (HFD) for between 1 and 16 weeks. Dynamic in vivo cardiac glucose metabolism was determined following oral administration of [U- 13 C] glucose. Hearts were collected after 15 and 60 min and flux profiling was determined by measuring 13 C mass isotopomers in glycolytic and tricarboxylic acid (TCA) cycle intermediates. Cardiac insulin resistance, determined by euglycemic–hyperinsulinemic clamp, was evident after 3 weeks of HFD. Despite the presence of insulin resistance, in vivo cardiac glucose metabolism following oral glucose administration was not compromised in HFD mice. This contrasts our recent findings in skeletal muscle, where TCA cycle activity was reduced in mice fed a HFD. Similar to our report in muscle, glucose derived pyruvate entry into the TCA cycle in the heart was almost exclusively via pyruvate dehydrogenase, with pyruvate carboxylase mediated anaplerosis being negligible after oral glucose administration. Conclusions: Under experimental conditions which closely mimic the postprandial state, the insulin resistant mouse heart retains the ability to stimulate glucose metabolism. - Highlights: • Insulin clamp was used to determine the evolution of cardiac insulin

  2. In vivo cardiac glucose metabolism in the high-fat fed mouse: Comparison of euglycemic–hyperinsulinemic clamp derived measures of glucose uptake with a dynamic metabolomic flux profiling approach

    Energy Technology Data Exchange (ETDEWEB)

    Kowalski, Greg M., E-mail: greg.kowalski@deakin.edu.au [Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125 (Australia); De Souza, David P. [Metabolomics Australia, Department of Biochemistry and Molecular Biology, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria 3010 (Australia); Risis, Steve [Cellular and Molecular Metabolism Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004 (Australia); Burch, Micah L. [Brigham and Women' s Hospital, Department of Medicine, Boston, MA (United States); Hamley, Steven [Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125 (Australia); Kloehn, Joachim [Metabolomics Australia, Department of Biochemistry and Molecular Biology, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria 3010 (Australia); Selathurai, Ahrathy [Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125 (Australia); Lee-Young, Robert S. [Cellular and Molecular Metabolism Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004 (Australia); Tull, Dedreia; O' Callaghan, Sean; McConville, Malcolm J. [Metabolomics Australia, Department of Biochemistry and Molecular Biology, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria 3010 (Australia); Bruce, Clinton R. [Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125 (Australia)

    2015-08-07

    Rationale: Cardiac metabolism is thought to be altered in insulin resistance and type 2 diabetes (T2D). Our understanding of the regulation of cardiac substrate metabolism and insulin sensitivity has largely been derived from ex vivo preparations which are not subject to the same metabolic regulation as in the intact heart in vivo. Studies are therefore required to examine in vivo cardiac glucose metabolism under physiologically relevant conditions. Objective: To determine the temporal pattern of the development of cardiac insulin resistance and to compare with dynamic approaches to interrogate cardiac glucose and intermediary metabolism in vivo. Methods and results: Studies were conducted to determine the evolution of cardiac insulin resistance in C57Bl/6 mice fed a high-fat diet (HFD) for between 1 and 16 weeks. Dynamic in vivo cardiac glucose metabolism was determined following oral administration of [U-{sup 13}C] glucose. Hearts were collected after 15 and 60 min and flux profiling was determined by measuring {sup 13}C mass isotopomers in glycolytic and tricarboxylic acid (TCA) cycle intermediates. Cardiac insulin resistance, determined by euglycemic–hyperinsulinemic clamp, was evident after 3 weeks of HFD. Despite the presence of insulin resistance, in vivo cardiac glucose metabolism following oral glucose administration was not compromised in HFD mice. This contrasts our recent findings in skeletal muscle, where TCA cycle activity was reduced in mice fed a HFD. Similar to our report in muscle, glucose derived pyruvate entry into the TCA cycle in the heart was almost exclusively via pyruvate dehydrogenase, with pyruvate carboxylase mediated anaplerosis being negligible after oral glucose administration. Conclusions: Under experimental conditions which closely mimic the postprandial state, the insulin resistant mouse heart retains the ability to stimulate glucose metabolism. - Highlights: • Insulin clamp was used to determine the evolution of cardiac

  3. Engineering Cardiac Muscle Tissue: A Maturating Field of Research.

    Science.gov (United States)

    Weinberger, Florian; Mannhardt, Ingra; Eschenhagen, Thomas

    2017-04-28

    Twenty years after the initial description of a tissue engineered construct, 3-dimensional human cardiac tissues of different kinds are now generated routinely in many laboratories. Advances in stem cell biology and engineering allow for the generation of constructs that come close to recapitulating the complex structure of heart muscle and might, therefore, be amenable to industrial (eg, drug screening) and clinical (eg, cardiac repair) applications. Whether the more physiological structure of 3-dimensional constructs provides a relevant advantage over standard 2-dimensional cell culture has yet to be shown in head-to-head-comparisons. The present article gives an overview on current strategies of cardiac tissue engineering with a focus on different hydrogel methods and discusses perspectives and challenges for necessary steps toward the real-life application of cardiac tissue engineering for disease modeling, drug development, and cardiac repair. © 2017 American Heart Association, Inc.

  4. Comprehensive cardiac rehabilitation

    DEFF Research Database (Denmark)

    Kruse, Marie; Hochstrasser, Stefan; Zwisler, Ann-Dorthe O

    2006-01-01

    OBJECTIVES: The costs of comprehensive cardiac rehabilitation are established and compared to the corresponding costs of usual care. The effect on health-related quality of life is analyzed. METHODS: An unprecedented and very detailed cost assessment was carried out, as no guidelines existed...... and may be as high as euro 1.877. CONCLUSIONS: Comprehensive cardiac rehabilitation is more costly than usual care, and the higher costs are not outweighed by a quality of life gain. Comprehensive cardiac rehabilitation is, therefore, not cost-effective....

  5. Dual energy cardiac CT.

    Science.gov (United States)

    Carrascosa, Patricia; Deviggiano, Alejandro; Rodriguez-Granillo, Gastón

    2017-06-01

    Conventional single energy CT suffers from technical limitations related to the polychromatic nature of X-rays. Dual energy cardiac CT (DECT) shows promise to attenuate and even overcome some of these limitations, and might broaden the scope of patients eligible for cardiac CT towards the inclusion of higher risk patients. This might be achieved as a result of both safety (contrast reduction) and physiopathological (myocardial perfusion and characterization) issues. In this article, we will review the main clinical cardiac applications of DECT, that can be summarized in two core aspects: coronary artery evaluation, and myocardial evaluation.

  6. Cardiac function of the naked mole-rat: ecophysiological responses to working underground.

    Science.gov (United States)

    Grimes, Kelly M; Voorhees, Andrew; Chiao, Ying Ann; Han, Hai-Chao; Lindsey, Merry L; Buffenstein, Rochelle

    2014-03-01

    The naked mole-rat (NMR) is a strictly subterranean rodent with a low resting metabolic rate. Nevertheless, it can greatly increase its metabolic activity to meet the high energetic demands associated with digging through compacted soils in its xeric natural habitat where food is patchily distributed. We hypothesized that the NMR heart would naturally have low basal function and exhibit a large cardiac reserve, thereby mirroring the species' low basal metabolism and large metabolic scope. Echocardiography showed that young (2-4 yr old) healthy NMRs have low fractional shortening (28 ± 2%), ejection fraction (43 ± 2%), and cardiac output (6.5 ± 0.4 ml/min), indicating low basal cardiac function. Histology revealed large NMR cardiomyocyte cross-sectional area (216 ± 10 μm(2)) and cardiac collagen deposition of 2.2 ± 0.4%. Neither of these histomorphometric traits was considered pathological, since biaxial tensile testing showed no increase in passive ventricular stiffness. NMR cardiomyocyte fibers showed a low degree of rotation, contributing to the observed low NMR cardiac contractility. Interestingly, when the exercise mimetic dobutamine (3 μg/g ip) was administered, NMRs showed pronounced increases in fractional shortening, ejection fraction, cardiac output, and stroke volume, indicating an increased cardiac reserve. The relatively low basal cardiac function and enhanced cardiac reserve of NMRs are likely to be ecophysiological adaptations to life in an energetically taxing environment.

  7. Comparison of superior vena caval and inferior vena caval access using a radioisotope technique during normal perfusion and cardiopulmonary resuscitation

    International Nuclear Information System (INIS)

    Dalsey, W.C.; Barsan, W.G.; Joyce, S.M.; Hedges, J.R.; Lukes, S.J.; Doan, L.A.

    1984-01-01

    Recent studies of thoracic pressure changes during external cardiopulmonary resuscitation (CPR) suggest that there may be a significant difference in the rate of delivery of intravenous drugs when they are administered through the extrathoracic inferior vena cava (IVC) rather than the intrathoracic superior vena cava (SVC). Comparison of delivery of a radionuclide given using superior and inferior vena caval access sites was made during normal blood flow and during CPR. Mean times from injection to peak emission count in each ventricle were determined. There were no significant differences between mean peak times for SVC or IVC routes during normal flow or CPR. When peak times were corrected for variations in cardiac output, there were no significant differences between IVC and SVC peak times during normal flow. During CPR, however, mean left ventricular peak time, when corrected for cardiac output, was significantly shorter (P less than .05) when the SVC route was used. The mean time for the counts to reach half the ventricular peak was statistically shorter (P less than .05) in both ventricles with the SVC route during the low flow of CPR. This suggests that during CPR, increased drug dispersion may occur when drugs are infused by the IVC route and thus may modify the anticipated effect of the drug bolus. These results suggest that during CPR, both the cardiac output and the choice of venous access are important variables for drug delivery

  8. Energy and output dynamics in Bangladesh

    International Nuclear Information System (INIS)

    Paul, Biru Paksha; Uddin, Gazi Salah

    2011-01-01

    The relationship between energy consumption and output is still ambiguous in the existing literature. The economy of Bangladesh, having spectacular output growth and rising energy demand as well as energy efficiency in recent decades, can be an ideal case for examining energy-output dynamics. We find that while fluctuations in energy consumption do not affect output fluctuations, movements in output inversely affect movements in energy use. The results of Granger causality tests in this respect are consistent with those of innovative accounting that includes variance decompositions and impulse responses. Autoregressive distributed lag models also suggest a role of output in Bangladesh's energy use. Hence, the findings of this study have policy implications for other developing nations where measures for energy conservation and efficiency can be relevant in policymaking.

  9. Theoretical analysis of magnetic sensor output voltage

    International Nuclear Information System (INIS)

    Liu Haishun; Dun Chaochao; Dou Linming; Yang Weiming

    2011-01-01

    The output voltage is an important parameter to determine the stress state in magnetic stress measurement, the relationship between the output voltage and the difference in the principal stresses was investigated by a comprehensive application of magnetic circuit theory, magnetization theory, stress analysis as well as the law of electromagnetic induction, and a corresponding quantitative equation was derived. It is drawn that the output voltage is proportional to the difference in the principal stresses, and related to the angle between the principal stress and the direction of the sensor. This investigation provides a theoretical basis for the principle stresses measurement by output voltage. - Research highlights: → A comprehensive investigation of magnetic stress signal. → Derived a quantitative equation about output voltage and the principal stresses. → The output voltage is proportional to the difference of the principal stresses. → Provide a theoretical basis for the principle stresses measurement.

  10. Output Control Using Feedforward And Cascade Controllers

    Science.gov (United States)

    Seraji, Homayoun

    1990-01-01

    Report presents theoretical study of open-loop control elements in single-input, single-output linear system. Focus on output-control (servomechanism) problem, in which objective is to find control scheme that causes output to track certain command inputs and to reject certain disturbance inputs in steady state. Report closes with brief discussion of characteristics and relative merits of feedforward, cascade, and feedback controllers and combinations thereof.

  11. Cardiac Catheterization (For Parents)

    Science.gov (United States)

    ... cases, the doctor might call for a cardiac magnetic resonance imaging (MRI) scan or a CAT scan . ... first couple of days. This means no heavy lifting (more than 10 pounds) and no sports. After ...

  12. Cardiac Catheterization (For Teens)

    Science.gov (United States)

    ... doctor may also call for a cardiac MRI (magnetic resonance imaging) scan or a CT (computerized tomography) ... first couple of days. This means no heavy lifting (nothing over 10 pounds) and no sports. After ...

  13. Autonomic cardiac innervation

    Science.gov (United States)

    Hasan, Wohaib

    2013-01-01

    Autonomic cardiac neurons have a common origin in the neural crest but undergo distinct developmental differentiation as they mature toward their adult phenotype. Progenitor cells respond to repulsive cues during migration, followed by differentiation cues from paracrine sources that promote neurochemistry and differentiation. When autonomic axons start to innervate cardiac tissue, neurotrophic factors from vascular tissue are essential for maintenance of neurons before they reach their targets, upon which target-derived trophic factors take over final maturation, synaptic strength and postnatal survival. Although target-derived neurotrophins have a central role to play in development, alternative sources of neurotrophins may also modulate innervation. Both developing and adult sympathetic neurons express proNGF, and adult parasympathetic cardiac ganglion neurons also synthesize and release NGF. The physiological function of these “non-classical” cardiac sources of neurotrophins remains to be determined, especially in relation to autocrine/paracrine sustenance during development.   Cardiac autonomic nerves are closely spatially associated in cardiac plexuses, ganglia and pacemaker regions and so are sensitive to release of neurotransmitter, neuropeptides and trophic factors from adjacent nerves. As such, in many cardiac pathologies, it is an imbalance within the two arms of the autonomic system that is critical for disease progression. Although this crosstalk between sympathetic and parasympathetic nerves has been well established for adult nerves, it is unclear whether a degree of paracrine regulation occurs across the autonomic limbs during development. Aberrant nerve remodeling is a common occurrence in many adult cardiovascular pathologies, and the mechanisms regulating outgrowth or denervation are disparate. However, autonomic neurons display considerable plasticity in this regard with neurotrophins and inflammatory cytokines having a central regulatory

  14. Cardiac imaging in adults

    International Nuclear Information System (INIS)

    Jaffe, C.C.

    1987-01-01

    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority

  15. Cardiac imaging in adults

    Energy Technology Data Exchange (ETDEWEB)

    Jaffe, C.C.

    1987-01-01

    This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.

  16. Cardiac biomarkers in Neonatology

    OpenAIRE

    Vijlbrief, D.C.

    2015-01-01

    In this thesis, the role for cardiac biomarkers in neonatology was investigated. Several clinically relevant results were reported. In term and preterm infants, hypoxia and subsequent adaptation play an important role in cardiac biomarker elevation. The elevated natriuretic peptides are indicative of abnormal function; elevated troponins are suggestive for cardiomyocyte damage. This methodology makes these biomarkers of additional value in the treatment of newborn infants, separate or as a co...

  17. Post cardiac injury syndrome

    DEFF Research Database (Denmark)

    Nielsen, S L; Nielsen, F E

    1991-01-01

    The post-pericardiotomy syndrome is a symptom complex which is similar in many respects to the post-myocardial infarction syndrome and these are summarized under the diagnosis of the Post Cardiac Injury Syndrome (PCIS). This condition, which is observed most frequently after open heart surgery, i...... on the coronary vessels, with cardiac tamponade and chronic pericardial exudate. In the lighter cases, PCIS may be treated with NSAID and, in the more severe cases, with systemic glucocorticoid which has a prompt effect....

  18. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  19. Donor age is a predictor of early low output after heart transplantation.

    Science.gov (United States)

    Fujino, Takeo; Kinugawa, Koichiro; Nitta, Daisuke; Imamura, Teruhiko; Maki, Hisataka; Amiya, Eisuke; Hatano, Masaru; Kimura, Mitsutoshi; Kinoshita, Osamu; Nawata, Kan; Komuro, Issei; Ono, Minoru

    2016-05-01

    Using hearts from marginal donors could be related to increased risk of primary graft dysfunction and poor long-term survival. However, factors associated with delayed myocardial recovery after heart transplantation (HTx) remain unknown. We sought to clarify risk factors that predict early low output after HTx, and investigated whether early low output affects mid-term graft dysfunction. We retrospectively analyzed patients who had undergone HTx at The University of Tokyo Hospital. We defined early low output patients as those whose cardiac index (CI) was early low output group, and the others into early preserved output group. We performed univariable logistic analysis and found that donor age was the only significant factor that predicted early low output (odds ratio 1.107, 95% confidence interval 1.034-1.210, p=0.002). CI of early low output patients gradually increased and it caught up with that of early preserved output patients at 2 weeks after HTx (2.4±0.6 L/min/m(2) in early low output group vs 2.5±0.5 L/min/m(2) in early preserved output group, p=0.684). Plasma B-type natriuretic peptide concentration of early low output patients was higher (1118.5±1250.2 pg/ml vs 526.4±399.5 pg/ml; p=0.033) at 1 week, 703.6±518.4 pg/ml vs 464.6±509.0 pg/ml (p=0.033) at 2 weeks, and 387.7±231.9 pg/ml vs 249.4±209.5 pg/ml (p=0.010) at 4 weeks after HTx, and it came down to that of early preserved output patients at 12 weeks after HTx. Donor age was a predictor of early low output after HTx. We should be careful after HTx from old donors. However, hemodynamic parameters of early low output patients gradually caught up with those of early preserved output patients. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  20. Silicon Integrated Dual-Mode Interferometer with Differential Outputs

    Directory of Open Access Journals (Sweden)

    Niklas Hoppe

    2017-09-01

    Full Text Available The dual-mode interferometer (DMI is an attractive alternative to Mach-Zehnder interferometers for sensor purposes, achieving sensitivities to refractive index changes close to state-of-the-art. Modern designs on silicon-on-insulator (SOI platforms offer thermally stable and compact devices with insertion losses of less than 1 dB and high extinction ratios. Compact arrays of multiple DMIs in parallel are easy to fabricate due to the simple structure of the DMI. In this work, the principle of operation of an integrated DMI with differential outputs is presented which allows the unambiguous phase shift detection with a single wavelength measurement, rather than using a wavelength sweep and evaluating the optical output power spectrum. Fluctuating optical input power or varying attenuation due to different analyte concentrations can be compensated by observing the sum of the optical powers at the differential outputs. DMIs with two differential single-mode outputs are fabricated in a 250 nm SOI platform, and corresponding measurements are shown to explain the principle of operation in detail. A comparison of DMIs with the conventional Mach-Zehnder interferometer using the same technology concludes this work.

  1. Direct Cardiac Reprogramming: Advances in Cardiac Regeneration

    Directory of Open Access Journals (Sweden)

    Olivia Chen

    2015-01-01

    Full Text Available Heart disease is one of the lead causes of death worldwide. Many forms of heart disease, including myocardial infarction and pressure-loading cardiomyopathies, result in irreversible cardiomyocyte death. Activated fibroblasts respond to cardiac injury by forming scar tissue, but ultimately this response fails to restore cardiac function. Unfortunately, the human heart has little regenerative ability and long-term outcomes following acute coronary events often include chronic and end-stage heart failure. Building upon years of research aimed at restoring functional cardiomyocytes, recent advances have been made in the direct reprogramming of fibroblasts toward a cardiomyocyte cell fate both in vitro and in vivo. Several experiments show functional improvements in mouse models of myocardial infarction following in situ generation of cardiomyocyte-like cells from endogenous fibroblasts. Though many of these studies are in an early stage, this nascent technology holds promise for future applications in regenerative medicine. In this review, we discuss the history, progress, methods, challenges, and future directions of direct cardiac reprogramming.

  2. DIST/AVC Out-Put Definition.

    Science.gov (United States)

    Wilkinson, Gene L.

    The first stage of development of a management information system for DIST/AVC (Division of Instructional Technology/Audio-Visual Center) is the definition of out-put units. Some constraints on the definition of output units are: 1) they should reflect goals of the organization, 2) they should reflect organizational structure and procedures, and…

  3. Fast multi-output relevance vector regression

    OpenAIRE

    Ha, Youngmin

    2017-01-01

    This paper aims to decrease the time complexity of multi-output relevance vector regression from O(VM^3) to O(V^3+M^3), where V is the number of output dimensions, M is the number of basis functions, and V

  4. Early-Transition Output Decline Revisited

    Directory of Open Access Journals (Sweden)

    Crt Kostevc

    2016-05-01

    Full Text Available In this paper we revisit the issue of aggregate output decline that took place in the early transition period. We propose an alternative explanation of output decline that is applicable to Central- and Eastern-European countries. In the first part of the paper we develop a simple dynamic general equilibrium model that builds on work by Gomulka and Lane (2001. In particular, we consider price liberalization, interpreted as elimination of distortionary taxation, as a trigger of the output decline. We show that price liberalization in interaction with heterogeneous adjustment costs and non-employment benefits lead to aggregate output decline and surge in wage inequality. While these patterns are consistent with actual dynamics in CEE countries, this model cannot generate output decline in all sectors. Instead sectors that were initially taxed even exhibit output growth. Thus, in the second part we consider an alternative general equilibrium model with only one production sector and two types of labor and distortion in a form of wage compression during the socialist era. The trigger for labor mobility and consequently output decline is wage liberalization. Assuming heterogeneity of workers in terms of adjustment costs and non-employment benefits can explain output decline in all industries.

  5. Assessing the psychological factors predicting workers' output ...

    African Journals Online (AJOL)

    The study investigated job security, communication skills, interpersonal relationship and emotional intelligence as correlates of workers' output among local government employees in Oyo State. The research adopted descriptive design of an expose facto type. The research instruments used includes Workers' output scale, ...

  6. The left ventricle as a mechanical engine: from Leonardo da Vinci to the echocardiographic assessment of peak power output-to-left ventricular mass.

    Science.gov (United States)

    Dini, Frank L; Guarini, Giacinta; Ballo, Piercarlo; Carluccio, Erberto; Maiello, Maria; Capozza, Paola; Innelli, Pasquale; Rosa, Gian M; Palmiero, Pasquale; Galderisi, Maurizio; Razzolini, Renato; Nodari, Savina

    2013-03-01

    The interpretation of the heart as a mechanical engine dates back to the teachings of Leonardo da Vinci, who was the first to apply the laws of mechanics to the function of the heart. Similar to any mechanical engine, whose performance is proportional to the power generated with respect to weight, the left ventricle can be viewed as a power generator whose performance can be related to left ventricular mass. Stress echocardiography may provide valuable information on the relationship between cardiac performance and recruited left ventricular mass that may be used in distinguishing between adaptive and maladaptive left ventricular remodeling. Peak power output-to-mass, obtained during exercise or pharmacological stress echocardiography, is a measure that reflects the number of watts that are developed by 100 g of left ventricular mass under maximal stimulation. Power output-to-mass may be calculated as left ventricular power output per 100 g of left ventricular mass: 100× left ventricular power output divided by left ventricular mass (W/100 g). A simplified formula to calculate power output-to-mass is as follows: 0.222 × cardiac output (l/min) × mean blood pressure (mmHg)/left ventricular mass (g). When the integrity of myocardial structure is compromised, a mismatch becomes apparent between maximal cardiac power output and left ventricular mass; when this occurs, a reduction of the peak power output-to-mass index is observed.

  7. Measurement method of cardiac computed tomography (CT)

    International Nuclear Information System (INIS)

    Watanabe, Shigeru; Yamamoto, Hironori; Yumura, Yasuo; Yoshida, Hideo; Morooka, Nobuhiro

    1980-01-01

    The CT was carried out in 126 cases consisting of 31 normals, 17 cases of mitral stenosis (MS), 8 cases of mitral regurgitation (MR), 11 cases of aortic stenosis (AS), 9 cases of aortic regurgitation (AR), 20 cases of myocardial infarction (MI), 8 cases of atrial septal defect (ASD) and 22 hypertensives. The 20-second scans were performed every 1.5 cm from the 2nd intercostal space to the 5th or 6th intercostal space. The computed tomograms obtained were classified into 8 levels by cross-sectional anatomy; levels of (1) the aortic arch, (2) just beneath the aortic arch, (3) the pulmonary artery bifurcation, (4) the right atrial appendage or the upper right atrium, (5) the aortic root, (6) the upper left ventricle, (7) the mid left ventricle, and (8) the lower left ventricle. The diameter (anteroposterior and transverse) and cross-sectional area were measured about ascending aorta (Ao), descending aorta (AoD), superior vena cava (SVC), inferoir vena cava (IVC), pulmonary artery branch (PA), main pulmonary artery (mPA), left atrium (LA), right atrium (RA), and right ventricular outflow tract (RVOT) on each level where they were clearly distinguished. However, it was difficult to separate cardiac wall from cardiac cavity because there was little difference of X-ray attenuation coefficient between the myocardium and blood. Therefore, on mid ventricular level, diameter and area about total cardiac shadow were measured, and then cardiac ratios to the thorax were respectively calculated. The normal range of their values was shown in table, and abnormal characteristics in cardiac disease were exhibited in comparison with normal values. In MS, diameter and area in LA were significantly larger than normal. In MS and ASD, all the right cardiac system were larger than normal, especially, RA and SVC in MS, PA and RVOT in ASD. The diameter and area of the aortic root was larger in the order of AR, AS and HT than normal. (author)

  8. The total right/left-volume index: a new and simplified cardiac magnetic resonance measure to evaluate the severity of Ebstein anomaly of the tricuspid valve: a comparison with heart failure markers from various modalities.

    Science.gov (United States)

    Hösch, Olga; Sohns, Jan Martin; Nguyen, Thuy-Trang; Lauerer, Peter; Rosenberg, Christina; Kowallick, Johannes Tammo; Kutty, Shelby; Unterberg, Christina; Schuster, Andreas; Faßhauer, Martin; Staab, Wieland; Paul, Thomas; Lotz, Joachim; Steinmetz, Michael

    2014-07-01

    The classification of clinical severity of Ebstein anomaly still remains a challenge. The aim of this study was to focus on the interaction of the pathologically altered right heart with the anatomically-supposedly-normal left heart and to derive from cardiac magnetic resonance (CMR) a simple imaging measure for the clinical severity of Ebstein anomaly. Twenty-five patients at a mean age of 26±14 years with unrepaired Ebstein anomaly were examined in a prospective study. Disease severity was classified using CMR volumes and functional measurements in comparison with heart failure markers from clinical data, ECG, laboratory and cardiopulmonary exercise testing, and echocardiography. All examinations were completed within 24 hours. A total right/left-volume index was defined from end-diastolic volume measurements in CMR: total right/left-volume index=(RA+aRV+fRV)/(LA+LV). Mean total right/left-volume index was 2.6±1.7 (normal values: 1.1±0.1). This new total right/left-volume index correlated with almost all clinically used biomarkers of heart failure: brain natriuretic peptide (r=0.691; P=0.0003), QRS (r=0.432; P=0.039), peak oxygen consumption/kg (r=-0.479; P=0.024), ventilatory response to carbon dioxide production at anaerobic threshold (r=0.426; P=0.048), the severity of tricuspid regurgitation (r=0.692; P=0.009), tricuspid valve offset (r=0.583; P=0.004), and tricuspid annular plane systolic excursion (r=0.554; P=0.006). Previously described severity indices ([RA+aRV]/[fRV+LA+LV]) and fRV/LV end-diastolic volume corresponded only to some parameters. In patients with Ebstein anomaly, the easily acquired index of right-sided to left-sided heart volumes from CMR correlated well with established heart failure markers. Our data suggest that the total right/left-volume index should be used as a new and simplified CMR measure, allowing more accurate assessment of disease severity than previously described scoring systems. © 2014 American Heart Association, Inc.

  9. Impact of hybrid iterative reconstruction on Agatston coronary artery calcium scores in comparison to filtered back projection in native cardiac CT; Einfluss der hybriden iterativen Rekonstruktion bei der nativen CT des Herzens auf die Agatston-Kalziumscores der Koronararterien

    Energy Technology Data Exchange (ETDEWEB)

    Obmann, V.C.; Heverhagen, J.T. [Inselspital - University Hospital Bern (Switzerland). University Inst. for Diagnostic, Interventional and Pediatric Radiology; Klink, T. [Wuerzburg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology; Stork, A.; Begemann, P.G.C. [Roentgeninstitut Duesseldorf, Duesseldorf (Germany); Laqmani, A.; Adam, G. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Diagnostic and Interventional Radiology

    2015-05-15

    To investigate whether the effects of hybrid iterative reconstruction (HIR) on coronary artery calcium (CAC) measurements using the Agatston score lead to changes in assignment of patients to cardiovascular risk groups compared to filtered back projection (FBP). 68 patients (mean age 61.5 years; 48 male; 20 female) underwent prospectively ECG-gated, non-enhanced, cardiac 256-MSCT for coronary calcium scoring. Scanning parameters were as follows: Tube voltage, 120 kV; Mean tube current time-product 63.67 mAs (50 - 150 mAs); collimation, 2 x 128 x 0.625 mm. Images were reconstructed with FBP and with HIR at all levels (L1 to L7). Two independent readers measured Agatston scores of all reconstructions and assigned patients to cardiovascular risk groups. Scores of HIR and FBP reconstructions were correlated (Spearman). Interobserver agreement and variability was assessed with k-statistics and Bland-Altmann-Plots. Agatston scores of HIR reconstructions were closely correlated with FBP reconstructions (L1, R = 0.9996; L2, R = 0.9995; L3, R = 0.9991; L4, R = 0.986; L5, R = 0.9986; L6, R = 0.9987; and L7, R = 0.9986). In comparison to FBP, HIR led to reduced Agatston scores between 97% (L1) and 87.4% (L7) of the FBP values. Using HIR iterations L1-L3, all patients were assigned to identical risk groups as after FPB reconstruction. In 5.4% of patients the risk group after HIR with the maximum iteration level was different from the group after FBP reconstruction. There was an excellent correlation of Agatston scores after HIR and FBP with identical risk group assignment at levels 1 - 3 for all patients. Hence it appears that the application of HIR in routine calcium scoring does not entail any disadvantages. Thus, future studies are needed to demonstrate whether HIR is a reliable method for reducing radiation dose in coronary calcium scoring.

  10. Ventilation and gas exchange management after cardiac arrest.

    Science.gov (United States)

    Sutherasan, Yuda; Raimondo, Pasquale; Pelosi, Paolo

    2015-12-01

    For several decades, physicians had integrated several interventions aiming to improve the outcomes in post-cardiac arrest patients. However, the mortality rate after cardiac arrest is still as high as 50%. Post-cardiac arrest syndrome is associated with high morbidity and mortality due to not only poor neurological outcome and cardiovascular failure but also respiratory dysfunction. To minimize ventilator-associated lung injury, protective mechanical ventilation by using low tidal volume ventilation and driving pressure may decrease pulmonary complications and improve survival. Low level of positive end-expiratory pressure (PEEP) can be initiated and titrated with careful cardiac output and respiratory mechanics monitoring. Furthermore, optimizing gas exchange by avoiding hypoxia and hyperoxia as well as maintaining normocarbia may improve neurological and survival outcome. Early multidisciplinary cardiac rehabilitation intervention is recommended. Minimally invasive monitoring techniques, that is, echocardiography, transpulmonary thermodilution method measuring extravascular lung water, as well as transcranial Doppler ultrasound, might be useful to improve appropriate management of post-cardiac arrest patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Cardiac radiology: centenary review.

    Science.gov (United States)

    de Roos, Albert; Higgins, Charles B

    2014-11-01

    During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day.

  12. High Output Piezo/Triboelectric Hybrid Generator

    Science.gov (United States)

    Jung, Woo-Suk; Kang, Min-Gyu; Moon, Hi Gyu; Baek, Seung-Hyub; Yoon, Seok-Jin; Wang, Zhong-Lin; Kim, Sang-Woo; Kang, Chong-Yun

    2015-03-01

    Recently, piezoelectric and triboelectric energy harvesting devices have been developed to convert mechanical energy into electrical energy. Especially, it is well known that triboelectric nanogenerators have a simple structure and a high output voltage. However, whereas nanostructures improve the output of triboelectric generators, its fabrication process is still complicated and unfavorable in term of the large scale and long-time durability of the device. Here, we demonstrate a hybrid generator which does not use nanostructure but generates much higher output power by a small mechanical force and integrates piezoelectric generator into triboelectric generator, derived from the simultaneous use of piezoelectric and triboelectric mechanisms in one press-and-release cycle. This hybrid generator combines high piezoelectric output current and triboelectric output voltage, which produces peak output voltage of ~370 V, current density of ~12 μA.cm-2, and average power density of ~4.44 mW.cm-2. The output power successfully lit up 600 LED bulbs by the application of a 0.2 N mechanical force and it charged a 10 μF capacitor to 10 V in 25 s. Beyond energy harvesting, this work will provide new opportunities for developing a small, built-in power source in self-powered electronics such as mobile electronics.

  13. High Output Piezo/Triboelectric Hybrid Generator

    Science.gov (United States)

    Jung, Woo-Suk; Kang, Min-Gyu; Moon, Hi Gyu; Baek, Seung-Hyub; Yoon, Seok-Jin; Wang, Zhong-Lin; Kim, Sang-Woo; Kang, Chong-Yun

    2015-01-01

    Recently, piezoelectric and triboelectric energy harvesting devices have been developed to convert mechanical energy into electrical energy. Especially, it is well known that triboelectric nanogenerators have a simple structure and a high output voltage. However, whereas nanostructures improve the output of triboelectric generators, its fabrication process is still complicated and unfavorable in term of the large scale and long-time durability of the device. Here, we demonstrate a hybrid generator which does not use nanostructure but generates much higher output power by a small mechanical force and integrates piezoelectric generator into triboelectric generator, derived from the simultaneous use of piezoelectric and triboelectric mechanisms in one press-and-release cycle. This hybrid generator combines high piezoelectric output current and triboelectric output voltage, which produces peak output voltage of ~370 V, current density of ~12 μA·cm−2, and average power density of ~4.44 mW·cm−2. The output power successfully lit up 600 LED bulbs by the application of a 0.2 N mechanical force and it charged a 10 μF capacitor to 10 V in 25 s. Beyond energy harvesting, this work will provide new opportunities for developing a small, built-in power source in self-powered electronics such as mobile electronics. PMID:25791299

  14. Factors influencing the development of low output state in patients with right ventricular infarction

    Energy Technology Data Exchange (ETDEWEB)

    Goto, Yoichi; Kanno, Kazuji; Saito, Muneyasu; Haze, Kazuo; Sumiyoshi, Tetsuya; Fukami, Kenichi; Fujiwara, Yasushi; Hiramori, Katsuhiko; Ikeda, Masao [National Cardiovascular Center, Suita, Osaka (Japan)

    1984-06-01

    Right ventricular infarction is frequently accompanied by a low output state, but the factors influencing the development of this state remain unknown. To elucidate these factors, clinical findings, hemodynamic findings and left ventricular infarct size (Tl-score) calculated from thallium-201 myocardial scintigrams by a circumferential profile method were evaluated in 147 consecutive patients with acute transmural inferior myocardial infarction. They were divided into two groups: 44 patients with right ventricular involvement (RVI group) and 103 patients without right ventricular involvement (IMI group). A low cardiac output state was defined when the cardiac index was less than 2.2 L/min/M/sup 2/. There was a good correlation between Tl-score and any of peak value of serum creatine phosphokinase (CPKmax), total released CPK (CPKr) and left ventricular ejection fraction (LVEF) (r=o.66, 0.74 and -0.54, respectively), indicating the usefulness of Tl-score as an index of left ventricular damage. Compared to the IMI group, the RVI group showed a higher average of age (p < 0.01), lower systemic blood pressure (p < 0.01), higher right atrial pressure (p < 0.001) and lower cardiac index (p < 0.01). Furthermore, the incidence of a low output state (RVI group:47.7% vs IMI group:14.6%, p < 0.001) and mortality (25.0% vs 7.8%, p < 0.01) were higher in the RVI group. However, CPKmax, CPKr, LVEF and Tl-score, which were considered to reflect the severity of left ventricular damage, were not different between the two groups. Tl-score was inversely correlated with cardiac index in the RVI group (r=-0.49, p < 0.05), and with left ventricular stroke work index in the both groups (RVI group; r=-0.46, p < 0.01, IMI group; r=-0.64, p < 0.01).

  15. End-tidal carbon dioxide output in manual cardiopulmonary resuscitation versus active compression-decompression device during prehospital quality controlled resuscitation: a case series study.

    Science.gov (United States)

    Setälä, Piritta Anniina; Virkkunen, Ilkka Tapani; Kämäräinen, Antti Jaakko; Huhtala, Heini Sisko Annamari; Virta, Janne Severi; Yli-Hankala, Arvi Mikael; Hoppu, Sanna Elisa

    2018-05-16

    Active compression-decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO 2 ) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO 2 output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts. 10 witnessed OHCAs were resuscitated, rotating a 2 min cycle with manual CPR and a 2 min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCO 2 values were collected continuously with the defibrillator. Differences in ETCO 2 output between manual CPR and ACD-CPR were analysed using a linear mixed model where ETCO 2 output produced by a summary of the 2 min cycles was included as the dependent variable, the patient as a random factor and method as a fixed effect. These comparisons were made within each OHCA case to minimise confounding factors between the cases. Mean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCO 2 output, the interaction between the method and the patient was significant (P<0.001). ETCO 2 output was higher with manual CPR in 6 of the 10 cases. This study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCO 2 is used as a quantitative measure of CPR effectiveness. NCT00951704; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Frequency of Cardiac Arrhythmias in Patients with Aluminum Phosphide Poisoning

    Directory of Open Access Journals (Sweden)

    Umair Aziz

    2015-12-01

    Full Text Available Background: Cardiac failure is the major lethal consequence of aluminum phosphide (AlP poisoning. This study was designed to determine the frequency of cardiac arrhythmias in patients with AlP poisoning. Methods: In this prospective cross-sectional study, patients with definitive history of AlP poisoning treated at emergency department of Allied Hospital Faisalabad, Faisalabad, Pakistan, from July 2013 to November 2014 were included. On admission, twelve-lead electrocardiogram (ECG was performed for all patients. During admission, all patients underwent continuous cardiac monitoring using a cardiac monitor. If an arrhythmia was suspected on the cardiac monitor, another ECG was obtained immediately.  Results: During the study period, 100 patients with AlP poisoning (63% men were treated at Allied Hospital Faisalabad. Mean age of the patients was 26.7 ± 7.9 years ranging from 16 to 54 years. Tachycardia was detected in 68 patients and bradycardia in 12 patients. Hypotension was observed in 75 patients. Eighty patients developed cardiac arrhythmia. The most frequent arrhythmia was atrial fibrillation (31% of patients followed by ventricular fibrillation (20%, ventricular tachycardia (17%, 3rd degree AV block (7% and 2nd degree AV block (5%. In total, 78 patients died, depicting a 78% mortality rate following wheat pill poisoning. Among those who died, seventy-one patients had cardiac arrhythmia. Comparison of death rate between patients with and without cardiac arrhythmia showed a significant difference (71/80 (88.8% vs. 7/20 (35%; P < 0.001.  Conclusion: Wheat pill poisoning causes a very high mortality, and circulatory collapse is the major cause of death among these patients. Most of the patients with AlP poisoning develop cardiac arrhythmias which are invariably life threatening. Early detection of cardiac disorders and proper management of arrhythmias may reduce mortalities.

  17. Cumulative input/output balance of a mechanical-biological waste treatment plant. Comparison of construction material requirements, operating energy expenditure, and the requirement of auxiliary materials in comparison with waste combustion; Kumulative Bilanzierung der mechanisch-biologischen Restabfallbehandlung - Baumaterialien und betrieblicher Energie- und Hilfsstoffaufwand im Vergleich zur Muellverbrennung

    Energy Technology Data Exchange (ETDEWEB)

    Wallmann, R.; Fricke, K. [Ingenieurgemeinschaft Witzenhausen (Germany); Vogtmann, H. [Hessisches Landesamt fuer Regionalentwicklung und Landwirtschaft, Kassel (Germany)

    1998-12-31

    The study strikes a cumulative input/output balance of an existing waste conditioning plant considering not only operating energy demand but also the required construction materials for erecting the plant. In operation since 1996, the waste conditioning plant is entirely state of the art; hence the data obtained are up to date. The results are compared with relevant results for a waste processing plant and evaluated. (orig.) [Deutsch] Im Rahmen der vorliegenden Untersuchung erfolgt eine kumulative Bilanzierung einer bestehenden MBA-Anlage, wobei neben den betrieblichen Energieaufwendungen auch die Baumaterialien zur Herstellung der Anlage beruecksichtigt werden. Die seit 1996 in Betrieb befindliche Abfallbehandlungsanlage entspricht weitestgehend dem Stand der Technik der MBA, wodurch die Aktualitaet der Daten gegeben ist. Die Ergebnisse der Bilanzierung werden im Vergleich zu einer MVA dargestellt und bewertet. (orig.)

  18. Isolated Cardiac Hydatid Cyst

    International Nuclear Information System (INIS)

    Shakil, U.; Rehman, A. U.; Shahid, R.

    2015-01-01

    Hydatid cyst disease is common in our part of the world. Cardiac hydatid cyst is its rare manifestation. We report this case of 48-year male having isolated cardiac hydatid cyst, incidentally found on computed tomography. This patient presented in medical OPD of Combined Military Hospital, Lahore with one month history of mild retrosternal discomfort. His general physical and systemic examinations as well as ECG were unremarkable. Chest X-ray showed an enlarged cardiac shadow with mildly irregular left heart border. Contrast enhanced CT scan of the chest showed a large well defined multiloculated non-enhancing cystic lesion with multiple daughter cysts involving wall of left ventricle and overlying pericardium. Serology for echinococcus confirmed the diagnosis of hydatid cyst. Patient was offered the surgical treatment but he opted for medical treatment only. Albendezol was prescribed. His follow-up echocardiography after one month showed no significant decrease in size of the cyst. (author)

  19. Dependency of blood pressure upon cardiac filling in patients with severe postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Haedersdal, C; Stokholm, K H

    1994-01-01

    by vasoconstriction. The reduction in cardiac output resulted from reductions in left ventricular end-diastolic volumes with unchanged left ventricular ejection fractions and only moderate increments in heart rate. The study was demonstrated that blood pressure is strongly dependent upon cardiac filling in severe......Autonomic denervation of the vascular bed results theoretically in a stronger dependency of blood pressure upon intravascular volume, and the study described aimed at an investigation of the relation between cardiac filling and arterial blood pressure in patients with severe postural hypotension....... Seven patients were studied during head-up tilt at three different tilt angles using intra-arterial blood pressure recordings and estimates of left ventricular volumes by radioisotope ventriculography. Blood pressure fell dramatically during head-up tilt due to reductions in cardiac output unopposed...

  20. Dependency of blood pressure upon cardiac filling in patients with severe postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Haedersdal, C; Stokholm, K H

    1994-01-01

    Autonomic denervation of the vascular bed results theoretically in a stronger dependency of blood pressure upon intravascular volume, and the study described aimed at an investigation of the relation between cardiac filling and arterial blood pressure in patients with severe postural hypotension....... Seven patients were studied during head-up tilt at three different tilt angles using intra-arterial blood pressure recordings and estimates of left ventricular volumes by radioisotope ventriculography. Blood pressure fell dramatically during head-up tilt due to reductions in cardiac output unopposed...... by vasoconstriction. The reduction in cardiac output resulted from reductions in left ventricular end-diastolic volumes with unchanged left ventricular ejection fractions and only moderate increments in heart rate. The study was demonstrated that blood pressure is strongly dependent upon cardiac filling in severe...

  1. Quantitative cardiac computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Thelen, M.; Dueber, C.; Wolff, P.; Erbel, R.; Hoffmann, T.

    1985-06-01

    The scope and limitations of quantitative cardiac CT have been evaluated in a series of experimental and clinical studies. The left ventricular muscle mass was estimated by computed tomography in 19 dogs (using volumetric methods, measurements in two axes and planes and reference volume). There was good correlation with anatomical findings. The enddiastolic volume of the left ventricle was estimated in 22 patients with cardiomyopathies; using angiography as a reference, CT led to systematic under-estimation. It is also shown that ECG-triggered magnetic resonance tomography results in improved visualisation and may be expected to improve measurements of cardiac morphology.

  2. Systemic arteriovenous malformations as a cause of cardiac failure: Treatment with embolization

    International Nuclear Information System (INIS)

    Smith, E.J.; Hemingway, A.P.; Allison, D.J.

    1987-01-01

    Massive cogenital systemic arteriovenous malformations (AVMs) present considerable management problems for clinicians. Their size, position, and vascularity make successful surgical reaction impossible. Attempts at resection produce only temporary relief of symptoms and cause further disfigurement. Large AVMs give rise to pain, swelling, and distal ischaemia, can erode bone, and give rise to life-threatening hemorrhage, and a massive left or right shunt causes high-output cardiac failure and death. Ten patients (age range, 5-50 years; mean 26 years) have massive AVMs giving rise to high-output cardiac failure (26-28 liters). These patients (seven male, three female), have undergone a total of 43 embolization procedures. The advent of nonionic contrast media, digital subtraction angiography, steel coils, and balloons allows us to successfully treat these patients who until recently were condemned to die in high-output cardiac failure

  3. Farm-Level Determinants of output Commercialization:

    African Journals Online (AJOL)

    MARC-AB

    Ethiopian Institute of Agricultural Research. አኀፅሮተ- ... haricot bean output commercialization among smallholder farmers in moisture-stress areas of ..... the American Agricultural Economics Association Annual Meeting, Orlando, Florida, July.

  4. Endogenous Money, Output and Prices in India

    OpenAIRE

    Das, Rituparna

    2009-01-01

    This paper proposes to quantify the macroeconometric relationships among the variables broad money, lending by banks, price, and output in India using simultaneous equations system keeping in view the issue of endogeneity.

  5. Scintillation camera with improved output means

    International Nuclear Information System (INIS)

    Lange, K.; Wiesen, E.J.; Woronowicz, E.M.

    1978-01-01

    In a scintillation camera system, the output pulse signals from an array of photomultiplier tubes are coupled to the inputs of individual preamplifiers. The preamplifier output signals are coupled to circuitry for computing the x and y coordinates of the scintillations. A cathode ray oscilloscope is used to form an image corresponding with the pattern in which radiation is emitted by a body. Means for improving the uniformity and resolution of the scintillations are provided. The means comprise biasing means coupled to the outputs of selected preamplifiers so that output signals below a predetermined amplitude are not suppressed and signals falling within increasing ranges of amplitudes are increasingly suppressed. In effect, the biasing means make the preamplifiers non-linear for selected signal levels

  6. Input-output rearrangement of isolated converters

    DEFF Research Database (Denmark)

    Madsen, Mickey Pierre; Kovacevic, Milovan; Mønster, Jakob Døllner

    2015-01-01

    This paper presents a new way of rearranging the input and output of isolated converters. The new arrangement posses several advantages, as increased voltage range, higher power handling capabilities, reduced voltage stress and improved efficiency, for applications where galvanic isolation...

  7. Multiple Input - Multiple Output (MIMO) SAR

    Data.gov (United States)

    National Aeronautics and Space Administration — This effort will research and implement advanced Multiple-Input Multiple-Output (MIMO) Synthetic Aperture Radar (SAR) techniques which have the potential to improve...

  8. CORDEX Coordinated Output for Regional Evaluation

    Science.gov (United States)

    Gutowski, William; Giorgi, Filippo; Lake, Irene

    2017-04-01

    The Science Advisory Team for the Coordinated Regional Downscaling Experiment (CORDEX) has developed a baseline framework of specified regions, resolutions and simulation periods intended to provide a foundation for ongoing regional CORDEX activities: the CORDEX Coordinated Output for Regional Evaluation, or CORDEX-CORE. CORDEX-CORE was conceived in part to be responsive to IPCC needs for coordinated simulations that could provide regional climate downscaling (RCD) that yields fine-scale climate information beyond that resolved by GCMs. For each CORDEX region, a matrix of GCM-RCD experiments is designed based on the need to cover as much as possible different dimensions of the uncertainty space (e.g., different emissions and land-use scenarios, GCMs, RCD models and techniques). An appropriate set of driving GCMs can allow a program of simulations that efficiently addresses key scientific issues within CORDEX, while facilitating comparison and transfer of results and lessons learned across different regions. The CORDEX-CORE program seeks to provide, as much as possible, homogeneity across domains, so it is envisioned that a standard set of regional climate models (RCMs) and empirical statistical downscaling (ESD) methods will downscale a standard set of GCMs over all or at least most CORDEX domains for a minimum set of scenarios (high and low end). The focus is on historical climate simulations for the 20th century and projections for 21st century, implying that data would be needed minimally for the period 1950-2100 (but ideally 1900-2100). This foundational ensemble can be regionally enriched with further contributions (additional GCM-RCD pairs) by individual groups over their selected domains of interest. The RCM model resolution for these core experiments will be in the range of 10-20 km, a resolution that has been shown to provide substantial added value for a variety of climate variables and that represents a significant forward step compared in the CORDEX

  9. Thermal imagers: from ancient analog video output to state-of-the-art video streaming

    Science.gov (United States)

    Haan, Hubertus; Feuchter, Timo; Münzberg, Mario; Fritze, Jörg; Schlemmer, Harry

    2013-06-01

    The video output of thermal imagers stayed constant over almost two decades. When the famous Common Modules were employed a thermal image at first was presented to the observer in the eye piece only. In the early 1990s TV cameras were attached and the standard output was CCIR. In the civil camera market output standards changed to digital formats a decade ago with digital video streaming being nowadays state-of-the-art. The reasons why the output technique in the thermal world stayed unchanged over such a long time are: the very conservative view of the military community, long planning and turn-around times of programs and a slower growth of pixel number of TIs in comparison to consumer cameras. With megapixel detectors the CCIR output format is not sufficient any longer. The paper discusses the state-of-the-art compression and streaming solutions for TIs.

  10. Transcutaneous cervical vagal nerve stimulation modulates cardiac vagal tone and tumor necrosis factor-alpha

    DEFF Research Database (Denmark)

    Brock, C; Brock, B; Aziz, Q

    2017-01-01

    -VNS, there was an increase in cardiac vagal tone and a reduction in tumor necrosis factor-α in comparison to baseline. No change was seen in blood pressure, cardiac sympathetic index or other cytokines. These preliminary data suggest that t-VNS exerts an autonomic and a subtle antitumor necrosis factor-α effect, which...

  11. A randomized controlled trial of levosimendan to reduce mortality in high-risk cardiac surgery patients (CHEETAH): Rationale and design.

    Science.gov (United States)

    Zangrillo, Alberto; Alvaro, Gabriele; Pisano, Antonio; Guarracino, Fabio; Lobreglio, Rosetta; Bradic, Nikola; Lembo, Rosalba; Gianni, Stefano; Calabrò, Maria Grazia; Likhvantsev, Valery; Grigoryev, Evgeny; Buscaglia, Giuseppe; Pala, Giovanni; Auci, Elisabetta; Amantea, Bruno; Monaco, Fabrizio; De Vuono, Giovanni; Corcione, Antonio; Galdieri, Nicola; Cariello, Claudia; Bove, Tiziana; Fominskiy, Evgeny; Auriemma, Stefano; Baiocchi, Massimo; Bianchi, Alessandro; Frontini, Mario; Paternoster, Gianluca; Sangalli, Fabio; Wang, Chew-Yin; Zucchetti, Maria Chiara; Biondi-Zoccai, Giuseppe; Gemma, Marco; Lipinski, Michael J; Lomivorotov, Vladimir V; Landoni, Giovanni

    2016-07-01

    Patients undergoing cardiac surgery are at risk of perioperative low cardiac output syndrome due to postoperative myocardial dysfunction. Myocardial dysfunction in patients undergoing cardiac surgery is a potential indication for the use of levosimendan, a calcium sensitizer with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and anti-inflammatory), which appears effective in improving clinically relevant outcomes. Double-blind, placebo-controlled, multicenter randomized trial. Tertiary care hospitals. Cardiac surgery patients (n = 1,000) with postoperative myocardial dysfunction (defined as patients with intraaortic balloon pump and/or high-dose standard inotropic support) will be randomized to receive a continuous infusion of either levosimendan (0.05-0.2 μg/[kg min]) or placebo for 24-48 hours. The primary end point will be 30-day mortality. Secondary end points will be mortality at 1 year, time on mechanical ventilation, acute kidney injury, decision to stop the study drug due to adverse events or to start open-label levosimendan, and length of intensive care unit and hospital stay. We will test the hypothesis that levosimendan reduces 30-day mortality in cardiac surgery patients with postoperative myocardial dysfunction. This trial is planned to determine whether levosimendan could improve survival in patients with postoperative low cardiac output syndrome. The results of this double-blind, placebo-controlled randomized trial may provide important insights into the management of low cardiac output in cardiac surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Multistrip western blotting to increase quantitative data output.

    Science.gov (United States)

    Kiyatkin, Anatoly; Aksamitiene, Edita

    2009-01-01

    The qualitative and quantitative measurements of protein abundance and modification states are essential in understanding their functions in diverse cellular processes. Typical western blotting, though sensitive, is prone to produce substantial errors and is not readily adapted to high-throughput technologies. Multistrip western blotting is a modified immunoblotting procedure based on simultaneous electrophoretic transfer of proteins from multiple strips of polyacrylamide gels to a single membrane sheet. In comparison with the conventional technique, Multistrip western blotting increases the data output per single blotting cycle up to tenfold, allows concurrent monitoring of up to nine different proteins from the same loading of the sample, and substantially improves the data accuracy by reducing immunoblotting-derived signal errors. This approach enables statistically reliable comparison of different or repeated sets of data, and therefore is beneficial to apply in biomedical diagnostics, systems biology, and cell signaling research.

  13. Neonatal cardiac emergencies

    African Journals Online (AJOL)

    flow) or require intervention (surgical or catheter) within the first ... Cardiac. History. Risk factors, e.g. meconium-stained liquor, prematurity, ... 'snowman' sign for supracardiac total anomalous pulmonary venous drainage (TAPVD), cardiomegaly with plethora for ... central cyanosis and on auscultation you hear no murmurs.

  14. Comparative cardiac imaging

    International Nuclear Information System (INIS)

    Brundage, B.H.

    1990-01-01

    This book is designed to compare all major cardiac imaging techniques. All major imaging techniques - including conventional angiography, digital angiography, echocardiography and Doppler imaging, conventional radioisotope techniques, computed tomography, and magnetic resonance imaging - are covered in this text as they apply to the major cardiovascular disorders. There is brief coverage of positron emission tomography and an extensive presentation of ultrafast computed tomography

  15. Advanced Cardiac Life Support.

    Science.gov (United States)

    Kirkwood Community Coll., Cedar Rapids, IA.

    This document contains materials for an advanced college course in cardiac life support developed for the State of Iowa. The course syllabus lists the course title, hours, number, description, prerequisites, learning activities, instructional units, required text, six references, evaluation criteria, course objectives by units, course…

  16. Cardiac Pacemakers; Marcapasos Cardiacos

    Energy Technology Data Exchange (ETDEWEB)

    Fiandra, O [Universidad de la Republica, Facultad de Maedicina, Departamento de Cardiologia, Montevideo(Uruguay); Espasandin, W [Universidad de la Republica, Facultad de Medicina, Departamento de Cirugia Cardiaca, Montevideo (Uruguay); Fiandra, H [Instituto Nacional de Cirugia Cardiaca, Departamento de Hemodinamia y Marcapasos, Montevideo (Uruguay); and others

    1984-07-01

    A complete survey of physiological biophysical,clinical and engineering aspects of cardiac facing,including the history and an assessment of possible future developments.Among the topics studied are: pacemakers, energy search, heart stimulating with pacemakers ,mathematical aspects of the electric cardio stimulation chronic, pacemaker implants,proceeding,treatment and control.

  17. Nonexercise cardiac stress testing

    International Nuclear Information System (INIS)

    Vacek, J.L.; Baldwin, T.

    1989-01-01

    Many patients who require evaluation for coronary artery disease are unable to undergo exercise stress testing because of physiologic or psychological limitations. Drs Vacek and Baldwin describe three alternative methods for assessment of cardiac function in these patients, all of which have high levels of diagnostic sensitivity and specificity. 23 references

  18. Cardiac magnetic resonance imaging

    African Journals Online (AJOL)

    2011-03-06

    Mar 6, 2011 ... Cardiac magnetic resonance imaging. Cardiovascular magnetic resonance imaging is becoming a routine diagnostic technique. BRUCE s sPOTTiswOOdE, PhD. MRC/UCT Medical Imaging Research Unit, University of Cape Town, and Division of Radiology, Stellenbosch University. Bruce Spottiswoode ...