MyMedR

Displaying publications 1 - 20 of 41 in total

Abstract:

Sort:

Real-time signal processing for fetal heart rate monitoring

Ibrahimy MI, Ahmed F, Mohd Ali MA, Zahedi E

IEEE Trans Biomed Eng, 2003 Feb;50(2):258-62.
PMID: 12665042

An algorithm based on digital filtering, adaptive thresholding, statistical properties in the time domain, and differencing of local maxima and minima has been developed for the simultaneous measurement of the fetal and maternal heart rates from the maternal abdominal electrocardiogram during pregnancy and labor for ambulatory monitoring. A microcontroller-based system has been used to implement the algorithm in real-time. A Doppler ultrasound fetal monitor was used for statistical comparison on five volunteers with low risk pregnancies, between 35 and 40 weeks of gestation. Results showed an average percent root mean square difference of 5.32% and linear correlation coefficient from 0.84 to 0.93. The fetal heart rate curves remained inside a +/- 5-beats-per-minute limit relative to the reference ultrasound method for 84.1% of the time.

Matched MeSH terms: Models, Cardiovascular
Simulation of the generation and processing of Doppler ultrasound fetal heart signals to obtain directional motion information

Mansor W, Crowe JA, Woolfson M, Hayes-Gill BR, Blanchfield P, Bister M

Conf Proc IEEE Eng Med Biol Soc, 2007 10 20;2006:1383-6.
PMID: 17945640

In fetal heart monitoring using Doppler ultrasound signals the cardiac information is commonly extracted from non-directional signals. As a consequence often some of the cardiac events cannot be observed clearly which may lead to the incorrect detection of the valve and wall motions. Here, directional signals were simulated to investigate their enhancement of cardiac events, and hence provide clearer information regarding the cardiac activities. First, fetal Doppler ultrasound signals were simulated with signals encoding forward and reverse motion then obtained using a pilot frequency. The simulation results demonstrate that the model has the ability to produce realistic Doppler ultrasound signals and a pilot frequency can be used in the mixing process to produce directional signals that allow the simulated cardiac events to be distinguished clearly and correctly.

Matched MeSH terms: Models, Cardiovascular*
A method for control of an implantable rotary blood pump for heart failure patients using noninvasive measurements

Lim E, Alomari AH, Savkin AV, Dokos S, Fraser JF, Timms DL, et al.

Artif Organs, 2011 Aug;35(8):E174-80.
PMID: 21843286 DOI: 10.1111/j.1525-1594.2011.01268.x

We propose a deadbeat controller for the control of pulsatile pump flow (Q(p) ) in an implantable rotary blood pump (IRBP). Noninvasive measurements of pump speed and current are used as inputs to a dynamical model of Q(p) estimation, previously developed and verified in our laboratory. The controller was tested using a lumped parameter model of the cardiovascular system (CVS), in combination with the stable dynamical models of Q(p) and differential pressure (head) estimation for the IRBP. The control algorithm was tested with both constant and sinusoidal reference Q(p) as input to the CVS model. Results showed that the controller was able to track the reference input with minimal error in the presence of model uncertainty. Furthermore, Q(p) was shown to settle to the desired reference value within a finite number of sampling periods. Our results also indicated that counterpulsation yields the minimum left ventricular stroke work, left ventricular end diastolic volume, and aortic pulse pressure, without significantly affecting mean cardiac output and aortic pressure.

Matched MeSH terms: Models, Cardiovascular*
Numerical optimization studies of cardiovascular-rotary blood pump interaction

Lim E, Dokos S, Salamonsen RF, Rosenfeldt FL, Ayre PJ, Lovell NH

Artif Organs, 2012 May;36(5):E110-24.
PMID: 22489799 DOI: 10.1111/j.1525-1594.2012.01449.x

A heart-pump interaction model has been developed based on animal experimental measurements obtained with a rotary blood pump in situ. Five canine experiments were performed to investigate the interaction between the cardiovascular system and the implantable rotary blood pump over a wide range of operating conditions, including variations in cardiac contractility and heart rate, systemic vascular resistance (SVR), and total blood volume (V(total) ). It was observed in our experiments that SVR decreased with increasing mean pump speed under the healthy condition, but was relatively constant during the speed ramp study under reduced cardiac contractility conditions. Furthermore, we also found a significant increase in pulmonary vascular resistance with increasing mean pump speed and decreasing total blood volume, despite a relatively constant SVR. Least squares parameter estimation methods were utilized to fit a subset of model parameters in order to achieve better agreement with the experimental data and to evaluate the robustness and validity of the model under various operating conditions. The fitted model produced reasonable agreement with the experimental measurements, both in terms of mean values and steady-state waveforms. In addition, all the optimized parameters were within physiological limits.

Matched MeSH terms: Models, Cardiovascular*
Effect of parameter variations on the hemodynamic response under rotary blood pump assistance

Lim E, Dokos S, Salamonsen RF, Rosenfeldt FL, Ayre PJ, Lovell NH

Artif Organs, 2012 May;36(5):E125-37.
PMID: 22489771 DOI: 10.1111/j.1525-1594.2012.01448.x

Numerical models, able to simulate the response of the human cardiovascular system (CVS) in the presence of an implantable rotary blood pump (IRBP), have been widely used as a predictive tool to investigate the interaction between the CVS and the IRBP under various operating conditions. The present study investigates the effect of alterations in the model parameter values, that is, cardiac contractility, systemic vascular resistance, and total blood volume on the efficiency of rotary pump assistance, using an optimized dynamic heart-pump interaction model previously developed in our laboratory based on animal experimental measurements obtained from five canines. The effect of mean pump speed and the circulatory perturbations on left and right ventricular pressure volume loops, mean aortic pressure, mean cardiac output, pump assistance ratio, and pump flow pulsatility from both the greyhound experiments and model simulations are demonstrated. Furthermore, the applicability of some of the previously proposed control parameters, that is, pulsatility index (PI), gradient of PI with respect to pump speed, pump differential pressure, and aortic pressure are discussed based on our observations from experimental and simulation results. It was found that previously proposed control strategies were not able to perform well under highly varying circulatory conditions. Among these, control algorithms which rely on the left ventricular filling pressure appear to be the most robust as they emulate the Frank-Starling mechanism of the heart.

Matched MeSH terms: Models, Cardiovascular*
Numerical simulations of flow through the aorta using both ideal and realistic geometrical models

Wan Ab Naim WN, Ganesan P, Al Abed A, Lim E

Annu Int Conf IEEE Eng Med Biol Soc, 2012;2012:653-6.
PMID: 23365977 DOI: 10.1109/EMBC.2012.6346016

The effects of curvature and tapering on the flow progression in the aorta were studied using numerical simulations on a realistic geometrical model of the aorta and three different versions of the ideal aorta models. The results showed that tapering increases velocity magnitude and wall shear stress while local curvatures affect the skewness of the velocity profile, the thickness of the boundary layer as well as the recirculation regions. Wall shear stress distribution in the aorta serves as an important determinant in the progression of arterial disease.

Matched MeSH terms: Models, Cardiovascular*
Evaluation of functional severity of coronary artery disease and fluid dynamics' influence on hemodynamic parameters: A review

Govindaraju K, Badruddin IA, Viswanathan GN, Ramesh SV, Badarudin A

Phys Med, 2013 May;29(3):225-32.
PMID: 22704601 DOI: 10.1016/j.ejmp.2012.03.008

Coronary Artery Disease (CAD) is responsible for most of the deaths in patients with cardiovascular diseases. Diagnostic coronary angiography analysis offers an anatomical knowledge of the severity of the stenosis. The functional or physiological significance is more valuable than the anatomical significance of CAD. Clinicians assess the functional severity of the stenosis by resorting to an invasive measurement of the pressure drop and flow. Hemodynamic parameters, such as pressure wire assessment fractional flow reserve (FFR) or Doppler wire assessment coronary flow reserve (CFR) are well-proven techniques to evaluate the physiological significance of the coronary artery stenosis in the cardiac catheterization laboratory. Between the two techniques mentioned above, the FFR is seen as a very useful index. The presence of guide wire reduces the coronary flow which causes the underestimation of pressure drop across the stenosis which leads to dilemma for the clinicians in the assessment of moderate stenosis. In such condition, the fundamental fluid mechanics is useful in the development of new functional severity parameters such as pressure drop coefficient and lesion flow coefficient. Since the flow takes place in a narrowed artery, the blood behaves as a non-Newtonian fluid. Computational fluid dynamics (CFD) allows a complete coronary flow simulation to study the relationship between the pressure and flow. This paper aims at explaining (i) diagnostic modalities for the evaluation of the CAD and valuable insights regarding FFR in the evaluation of the functional severity of the CAD (ii) the role of fluid dynamics in measuring the severity of CAD.

Matched MeSH terms: Models, Cardiovascular*
Review on CFD simulation in heart with dilated cardiomyopathy and myocardial infarction

Chan BT, Lim E, Chee KH, Abu Osman NA

Comput Biol Med, 2013 May;43(4):377-85.
PMID: 23428371 DOI: 10.1016/j.compbiomed.2013.01.013

The heart is a sophisticated functional organ that plays a crucial role in the blood circulatory system. Hemodynamics within the heart chamber can be indicative of exert cardiac health. Due to the limitations of current cardiac imaging modalities, computational fluid dynamics (CFD) have been widely used for the purposes of cardiac function assessment and heart disease diagnosis, as they provide detailed insights into the cardiac flow field. An understanding of ventricular hemodynamics and pathological severities can be gained through studies that employ the CFD method. In this research the hemodynamics of two common myocardial diseases, dilated cardiomyopathy (DCM) and myocardial infarction (MI) were investigated, during both the filling phase and the whole cardiac cycle, through a prescribed geometry and fluid structure interaction (FSI) approach. The results of the research indicated that early stage disease identification and the improvement of cardiac assisting devices and therapeutic procedures can be facilitated through the use of the CFD method.

Matched MeSH terms: Models, Cardiovascular
Fulltext Application of pattern recognition tools for classifying acute coronary syndrome: an integrated medical modeling

Salari N, Shohaimi S, Najafi F, Nallappan M, Karishnarajah I

Theor Biol Med Model, 2013 Sep 18;10:57.
PMID: 24044669 DOI: 10.1186/1742-4682-10-57

OBJECTIVE: The classification of Acute Coronary Syndrome (ACS), using artificial intelligence (AI), has recently drawn the attention of the medical researchers. Using this approach, patients with myocardial infarction can be differentiated from those with unstable angina. The present study aims to develop an integrated model, based on the feature selection and classification, for the automatic classification of ACS.
METHODS: A dataset containing medical records of 809 patients suspected to suffer from ACS was used. For each subject, 266 clinical factors were collected. At first, a feature selection was performed based on interviews with 20 cardiologists; thereby 40 seminal features for classifying ACS were selected. Next, a feature selection algorithm was also applied to detect a subset of the features with the best classification accuracy. As a result, the feature numbers considerably reduced to only seven. Lastly, based on the seven selected features, eight various common pattern recognition tools for classification of ACS were used.
RESULTS: The performance of the aforementioned classifiers was compared based on their accuracy computed from their confusion matrices. Among these methods, the multi-layer perceptron showed the best performance with the 83.2% accuracy.
CONCLUSION: The results reveal that an integrated AI-based feature selection and classification approach is an effective method for the early and accurate classification of ACS and ultimately a timely diagnosis and treatment of this disease.

Matched MeSH terms: Models, Cardiovascular*
Fulltext Sensitivity analysis of left ventricle with dilated cardiomyopathy in fluid structure simulation

Chan BT, Abu Osman NA, Lim E, Chee KH, Abdul Aziz YF, Abed AA, et al.

PLoS One, 2013;8(6):e67097.
PMID: 23825628 DOI: 10.1371/journal.pone.0067097

Dilated cardiomyopathy (DCM) is the most common myocardial disease. It not only leads to systolic dysfunction but also diastolic deficiency. We sought to investigate the effect of idiopathic and ischemic DCM on the intraventricular fluid dynamics and myocardial wall mechanics using a 2D axisymmetrical fluid structure interaction model. In addition, we also studied the individual effect of parameters related to DCM, i.e. peak E-wave velocity, end systolic volume, wall compliance and sphericity index on several important fluid dynamics and myocardial wall mechanics variables during ventricular filling. Intraventricular fluid dynamics and myocardial wall deformation are significantly impaired under DCM conditions, being demonstrated by low vortex intensity, low flow propagation velocity, low intraventricular pressure difference (IVPD) and strain rates, and high-end diastolic pressure and wall stress. Our sensitivity analysis results showed that flow propagation velocity substantially decreases with an increase in wall stiffness, and is relatively independent of preload at low-peak E-wave velocity. Early IVPD is mainly affected by the rate of change of the early filling velocity and end systolic volume which changes the ventriculo:annular ratio. Regional strain rate, on the other hand, is significantly correlated with regional stiffness, and therefore forms a useful indicator for myocardial regional ischemia. The sensitivity analysis results enhance our understanding of the mechanisms leading to clinically observable changes in patients with DCM.

Matched MeSH terms: Models, Cardiovascular*
Fulltext A cardiovascular mathematical model of graded head-up tilt

Lim E, Chan GS, Dokos S, Ng SC, Latif LA, Vandenberghe S, et al.

PLoS One, 2013;8(10):e77357.
PMID: 24204817 DOI: 10.1371/journal.pone.0077357

A lumped parameter model of the cardiovascular system has been developed and optimized using experimental data obtained from 13 healthy subjects during graded head-up tilt (HUT) from the supine position to [Formula: see text]. The model includes descriptions of the left and right heart, direct ventricular interaction through the septum and pericardium, the systemic and pulmonary circulations, nonlinear pressure volume relationship of the lower body compartment, arterial and cardiopulmonary baroreceptors, as well as autoregulatory mechanisms. A number of important features, including the separate effects of arterial and cardiopulmonary baroreflexes, and autoregulation in the lower body, as well as diastolic ventricular interaction through the pericardium have been included and tested for their significance. Furthermore, the individual effect of parameter associated with heart failure, including LV and RV contractility, baseline systemic vascular resistance, pulmonary vascular resistance, total blood volume, LV diastolic stiffness and reflex gain on HUT response have also been investigated. Our fitted model compares favorably with our experimental measurements and published literature at a range of tilt angles, in terms of both global and regional hemodynamic variables. Compared to the normal condition, a simulated congestive heart failure condition produced a blunted response to HUT with regards to the percentage changes in cardiac output, stroke volume, end diastolic volume and effector response (i.e., heart contractility, venous unstressed volume, systemic vascular resistance and heart rate) with progressive tilting.

Matched MeSH terms: Models, Cardiovascular*
Robust aortic valve non-opening detection for different cardiac conditions

Ooi HL, Ng SC, Lim E, Salamonsen RF, Avolio AP, Lovell NH

Artif Organs, 2014 Mar;38(3):E57-67.
PMID: 24422872 DOI: 10.1111/aor.12220

In recent years, extensive studies have been conducted in the area of pumping state detection for implantable rotary blood pumps. However, limited studies have focused on automatically identifying the aortic valve non-opening (ANO) state despite its importance in the development of control algorithms aiming for myocardial recovery. In the present study, we investigated the performance of 14 ANO indices derived from the pump speed waveform using four different types of classifiers, including linear discriminant analysis, logistic regression, back propagation neural network, and k-nearest neighbors (KNN). Experimental measurements from four greyhounds, which take into consideration the variations in cardiac contractility, systemic vascular resistance, and total blood volume were used. By having only two indices, (i) the root mean square value, and (ii) the standard deviation, we were able to achieve an accuracy of 92.8% with the KNN classifier. Further increase of the number of indices to five for the KNN classifier increases the overall accuracy to 94.6%.

Matched MeSH terms: Models, Cardiovascular*
Effect of porous media of the stenosed artery wall to the coronary physiological diagnostic parameter: a computational fluid dynamic analysis

Govindaraju K, Kamangar S, Badruddin IA, Viswanathan GN, Badarudin A, Salman Ahmed NJ

Atherosclerosis, 2014 Apr;233(2):630-635.
PMID: 24549189 DOI: 10.1016/j.atherosclerosis.2014.01.043

Functional assessment of a coronary artery stenosis severity is generally assessed by fractional flow reserve (FFR), which is calculated from pressure measurements across the stenosis. The purpose of this study is to investigate the effect of porous media of the stenosed arterial wall on this diagnostic parameter. To understand the role of porous media on the diagnostic parameter FFR, a 3D computational simulations of the blood flow in rigid and porous stenotic artery wall models are carried out under steady state and transient conditions for three different percentage area stenoses (AS) corresponding to 70% (moderate), 80% (intermediate), and 90% (severe). Blood was modeled as a non Newtonian fluid. The variations of pressure drop across the stenosis and diagnostic parameter were studied in both models. The FFR decreased in proportion to the increase in the severity of the stenosis. The relationship between the percentage AS and the FFR was non linear and inversely related in both the models. The cut-off value of 0.75 for FFR was observed at 81.89% AS for the rigid artery model whereas 83.61% AS for the porous artery wall model. This study demonstrates that the porous media consideration on the stenotic arterial wall plays a substantial role in defining the cut-off value of FFR. We conclude that the effect of porous media on FFR, could lead to misinterpretation of the functional severity of the stenosis in the region of 81.89 %-83.61% AS.

Matched MeSH terms: Models, Cardiovascular
Fulltext Numerical investigation of the effect of stenosis geometry on the coronary diagnostic parameters

Kamangar S, Kalimuthu G, Badruddin IA, Badarudin A, Ahmed NJ, Khan TM

ScientificWorldJournal, 2014;2014:354946.
PMID: 25258722 DOI: 10.1155/2014/354946

The present study deals with the functional severity of a coronary artery stenosis assessed by the fractional flow reserve (FFR). The effects of different geometrical shapes of lesion on the diagnostic parameters are unknown. In this study, 3D computational simulation of blood flow in three different geometrical shapes of stenosis (triangular, elliptical, and trapezium) is considered in steady and transient conditions for 70% (moderate), 80% (intermediate), and 90% (severe) area stenosis (AS). For a given percentage AS, the variation of diagnostic parameters which are derived from pressure drop across the stenosis was found in three different geometrical shapes of stenosis and it was observed that FFR is higher in triangular shape and lower in trapezium shape. The pressure drop coefficient (CDP) was higher in trapezium shape and lower in triangular model whereas the LFC shows opposite trend. From the clinical perspective, the relationship between percentage AS and FFR is linear and inversely related in all the three models. A cut-off value of 0.75 for FFR was observed at 76.5% AS in trapezium model, 79.5% in elliptical model, and 82.7% AS for the triangular shaped model. The misinterpretation of the functional severity of the stenosis is in the region of 76.5%-82.7 % AS from different shapes of stenosis models.

Matched MeSH terms: Models, Cardiovascular*
Hemodynamic response to exercise and head-up tilt of patients implanted with a rotary blood pump: a computational modeling study

Lim E, Salamonsen RF, Mansouri M, Gaddum N, Mason DG, Timms DL, et al.

Artif Organs, 2015 Feb;39(2):E24-35.
PMID: 25345482 DOI: 10.1111/aor.12370

The present study investigates the response of implantable rotary blood pump (IRBP)-assisted patients to exercise and head-up tilt (HUT), as well as the effect of alterations in the model parameter values on this response, using validated numerical models. Furthermore, we comparatively evaluate the performance of a number of previously proposed physiologically responsive controllers, including constant speed, constant flow pulsatility index (PI), constant average pressure difference between the aorta and the left atrium, constant average differential pump pressure, constant ratio between mean pump flow and pump flow pulsatility (ratioP I or linear Starling-like control), as well as constant left atrial pressure ( P l a ¯ ) control, with regard to their ability to increase cardiac output during exercise while maintaining circulatory stability upon HUT. Although native cardiac output increases automatically during exercise, increasing pump speed was able to further improve total cardiac output and reduce elevated filling pressures. At the same time, reduced venous return associated with upright posture was not shown to induce left ventricular (LV) suction. Although P l a ¯ control outperformed other control modes in its ability to increase cardiac output during exercise, it caused a fall in the mean arterial pressure upon HUT, which may cause postural hypotension or patient discomfort. To the contrary, maintaining constant average pressure difference between the aorta and the left atrium demonstrated superior performance in both exercise and HUT scenarios. Due to their strong dependence on the pump operating point, PI and ratioPI control performed poorly during exercise and HUT. Our simulation results also highlighted the importance of the baroreflex mechanism in determining the response of the IRBP-assisted patients to exercise and postural changes, where desensitized reflex response attenuated the percentage increase in cardiac output during exercise and substantially reduced the arterial pressure upon HUT.

Matched MeSH terms: Models, Cardiovascular*
Motion corrected LV quantification based on 3D modelling for improved functional assessment in cardiac MRI

Liew YM, McLaughlin RA, Chan BT, Abdul Aziz YF, Chee KH, Ung NM, et al.

Phys Med Biol, 2015 Apr 7;60(7):2715-33.
PMID: 25768708 DOI: 10.1088/0031-9155/60/7/2715

Cine MRI is a clinical reference standard for the quantitative assessment of cardiac function, but reproducibility is confounded by motion artefacts. We explore the feasibility of a motion corrected 3D left ventricle (LV) quantification method, incorporating multislice image registration into the 3D model reconstruction, to improve reproducibility of 3D LV functional quantification. Multi-breath-hold short-axis and radial long-axis images were acquired from 10 patients and 10 healthy subjects. The proposed framework reduced misalignment between slices to subpixel accuracy (2.88 to 1.21 mm), and improved interstudy reproducibility for 5 important clinical functional measures, i.e. end-diastolic volume, end-systolic volume, ejection fraction, myocardial mass and 3D-sphericity index, as reflected in a reduction in the sample size required to detect statistically significant cardiac changes: a reduction of 21-66%. Our investigation on the optimum registration parameters, including both cardiac time frames and number of long-axis (LA) slices, suggested that a single time frame is adequate for motion correction whereas integrating more LA slices can improve registration and model reconstruction accuracy for improved functional quantification especially on datasets with severe motion artefacts.

Matched MeSH terms: Models, Cardiovascular
Regional assessment of LV wall in infarcted heart using tagged MRI and cardiac modelling

Jahanzad Z, Liew YM, Bilgen M, McLaughlin RA, Leong CO, Chee KH, et al.

Phys Med Biol, 2015 May 21;60(10):4015-31.
PMID: 25919317 DOI: 10.1088/0031-9155/60/10/4015

A segmental two-parameter empirical deformable model is proposed for evaluating regional motion abnormality of the left ventricle. Short-axis tagged MRI scans were acquired from 10 healthy subjects and 10 postinfarct patients. Two motion parameters, contraction and rotation, were quantified for each cardiac segment by fitting the proposed model using a non-rigid registration algorithm. The accuracy in motion estimation was compared to a global model approach. Motion parameters extracted from patients were correlated to infarct transmurality assessed with delayed-contrast-enhanced MRI. The proposed segmental model allows markedly improved accuracy in regional motion analysis as compared to the global model for both subject groups (1.22-1.40 mm versus 2.31-2.55 mm error). By end-systole, all healthy segments experienced radial displacement by ~25-35% of the epicardial radius, whereas the 3 short-axis planes rotated differently (basal: 3.3°; mid: -1° and apical: -4.6°) to create a twisting motion. While systolic contraction showed clear correspondence to infarct transmurality, rotation was nonspecific to either infarct location or transmurality but could indicate the presence of functional abnormality. Regional contraction and rotation derived using this model could potentially aid in the assessment of severity of regional dysfunction of infarcted myocardium.

Matched MeSH terms: Models, Cardiovascular*
Anatomy and Physiology of Left Ventricular Suction Induced by Rotary Blood Pumps

Salamonsen RF, Lim E, Moloney J, Lovell NH, Rosenfeldt FL

Artif Organs, 2015 Aug;39(8):681-90.
PMID: 26146861 DOI: 10.1111/aor.12550

This study in five large greyhound dogs implanted with a VentrAssist left ventricular assist device focused on identification of the precise site and physiological changes induced by or underlying the complication of left ventricular suction. Pressure sensors were placed in left and right atria, proximal and distal left ventricle, and proximal aorta while dual perivascular and tubing ultrasonic flow meters measured blood flow in the aortic root and pump outlet cannula. When suction occurred, end-systolic pressure gradients between proximal and distal regions of the left ventricle on the order of 40-160 mm Hg indicated an occlusive process of variable intensity in the distal ventricle. A variable negative flow difference between end systole and end diastole (0.5-3.4 L/min) was observed. This was presumably mediated by variable apposition of the free and septal walls of the ventricle at the pump inlet cannula orifice which lasted approximately 100 ms. This apposition, by inducing an end-systolic flow deficit, terminated the suction process by relieving the imbalance between pump requirement and delivery from the right ventricle. Immediately preceding this event, however, unnaturally low end-systolic pressures occurred in the left atrium and proximal left ventricle which in four dogs lasted for 80-120 ms. In one dog, however, this collapse progressed to a new level and remained at approximately -5 mm Hg across four heart beats at which point suction was relieved by manual reduction in pump speed. Because these pressures were associated with a pulmonary capillary wedge pressure of -5 mm Hg as well, they indicate total collapse of the entire pulmonary venous system, left atrium, and left ventricle which persisted until pump flow requirement was relieved by reducing pump speed. We suggest that this collapse caused the whole vascular region from pulmonary capillaries to distal left ventricle to behave as a Starling resistance which further reduced right ventricular output thus contributing to a major reduction in pump flow. We contend that similar complications of manual speed control also occur in the human subject and remain a major unsolved problem in the clinical management of patients implanted with rotary blood pumps.

Matched MeSH terms: Models, Cardiovascular
Fulltext Preload-based starling-like control for rotary blood pumps: numerical comparison with pulsatility control and constant speed operation

Mansouri M, Salamonsen RF, Lim E, Akmeliawati R, Lovell NH

PLoS One, 2015;10(4):e0121413.
PMID: 25849979 DOI: 10.1371/journal.pone.0121413

In this study, we evaluate a preload-based Starling-like controller for implantable rotary blood pumps (IRBPs) using left ventricular end-diastolic pressure (PLVED) as the feedback variable. Simulations are conducted using a validated mathematical model. The controller emulates the response of the natural left ventricle (LV) to changes in PLVED. We report the performance of the preload-based Starling-like controller in comparison with our recently designed pulsatility controller and constant speed operation. In handling the transition from a baseline state to test states, which include vigorous exercise, blood loss and a major reduction in the LV contractility (LVC), the preload controller outperformed pulsatility control and constant speed operation in all three test scenarios. In exercise, preload-control achieved an increase of 54% in mean pump flow ([Formula: see text]) with minimum loading on the LV, while pulsatility control achieved only a 5% increase in flow and a decrease in mean pump speed. In a hemorrhage scenario, the preload control maintained the greatest safety margin against LV suction. PLVED for the preload controller was 4.9 mmHg, compared with 0.4 mmHg for the pulsatility controller and 0.2 mmHg for the constant speed mode. This was associated with an adequate mean arterial pressure (MAP) of 84 mmHg. In transition to low LVC, [Formula: see text] for preload control remained constant at 5.22 L/min with a PLVED of 8.0 mmHg. With regards to pulsatility control, [Formula: see text] fell to the nonviable level of 2.4 L/min with an associated PLVED of 16 mmHg and a MAP of 55 mmHg. Consequently, pulsatility control was deemed inferior to constant speed mode with a PLVED of 11 mmHg and a [Formula: see text] of 5.13 L/min in low LVC scenario. We conclude that pulsatility control imposes a danger to the patient in the severely reduced LVC scenario, which can be overcome by using a preload-based Starling-like control approach.

Matched MeSH terms: Models, Cardiovascular*
Experimental feasibility study of estimation of the normalized central blood pressure waveform from radial photoplethysmogram

Zahedi E, Sohani V, Ali MA, Chellappan K, Beng GK

J Healthc Eng, 2015;6(1):121-44.
PMID: 25708380 DOI: 10.1260/2040-2295.6.1.121

The feasibility of a novel system to reliably estimate the normalized central blood pressure (CBPN) from the radial photoplethysmogram (PPG) is investigated. Right-wrist radial blood pressure and left-wrist PPG were simultaneously recorded in five different days. An industry-standard applanation tonometer was employed for recording radial blood pressure. The CBP waveform was amplitude-normalized to determine CBPN. A total of fifteen second-order autoregressive models with exogenous input were investigated using system identification techniques. Among these 15 models, the model producing the lowest coefficient of variation (CV) of the fitness during the five days was selected as the reference model. Results show that the proposed model is able to faithfully reproduce CBPN (mean fitness = 85.2% ± 2.5%) from the radial PPG for all 15 segments during the five recording days. The low CV value of 3.35% suggests a stable model valid for different recording days.

Matched MeSH terms: Models, Cardiovascular

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links