Search results for: Coronary artery disease

Authors: Syed Dawood Md. Taimur, Md. Hasanur Rahman, Syeda Fahmida Afrin, Farzana Islam

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The concept of myocardial injury, although first recognized from animal studies, is now recognized as a clinical phenomenon that may result in microvascular damage, no-reflow phenomenon, myocardial stunning, myocardial hibernation and ischemic preconditioning. The final consequence of this event is left ventricular (LV) systolic dysfunction leading to increased morbidity and mortality. The typical clinical case of reperfusion injury occurs in acute myocardial infarction (MI) with ST segment elevation in which an occlusion of a major epicardial coronary artery is followed by recanalization of the artery. This may occur spontaneously or by means of thrombolysis and/or by primary percutaneous coronary intervention (PCI) with efficient platelet inhibition by aspirin (acetylsalicylic acid), clopidogrel and glycoprotein IIb/IIIa inhibitors. In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.

Keywords: Coronary artery disease, Percutaneous coronary intervention, Myocardial injury, Pharmacology.

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Authors: Weronika Kurowska-Nouyrigat, Jacek Szumbarski

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Nowadays, cardiac disease is one of the most common cause of death. Each year almost one million of angioplasty interventions and stents implantations are made all over the world. Unfortunately, in 20-30% of cases neointimal proliferations leads to restenosis occurring within the following period of 3-6 months. Three major factors are believed to contribute mostly to the edge restenosis: (a) mechanical damage of the artery-s wall caused by the stent implantation, (b) interaction between the stent and the blood constituents and (c) endothelial growth stimulation by small (lower that 1.5 Pa) and oscillating wall shear stress. Assuming that this last actor is particularly important, a numerical model of restenosis basing on wall shear stress distribution in the stented artery was elaborated. A numerical simulations of the development of in-stent restenosis have been performed and realistic geometric patterns of a progressing lumen reduction have been obtained

Keywords: Coronary artery disease, coronary blood flow, instent restenosis.

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Authors: Radhe Tado, Ashish B. Deoghare, K. M. Pandey

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The aim of this study is to estimate the effect of blood flow through the coronary artery in human heart so as to assess the coronary artery disease.Velocity, wall shear stress (WSS), strain rate and wall pressure distribution are some of the important hemodynamic parameters that are non-invasively assessed with computational fluid dynamics (CFD). These parameters are used to identify the mechanical factors responsible for the plaque progression and/or rupture in left coronary arteries (LCA) in coronary arteries.The initial step for CFD simulations was the construction of a geometrical model of the LCA. Patient specific artery model is constructed using computed tomography (CT) scan data with the help of MIMICS Research 19.0. For CFD analysis ANSYS FLUENT-14.5 is used.Hemodynamic parameters were quantified and flow patterns were visualized both in the absence and presence of coronary plaques. The wall pressure continuously decreased towards distal segments and showed pressure drops in stenotic segments. Areas of high WSS and high flow velocities were found adjacent to plaques deposition.

Keywords: Computational fluid dynamics, hemodynamics, velocity, strain rate, wall pressure, wall shear stress.

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Authors: S. Fallah, M. Seifi, M. Firoozrai, T. Godarzi, M. Jafarzadeh, L. H. Ghohari

Abstract:

The ε4 allele of the ε2, ε3 and ε4 protein isoform polymorphism in the gene encoding apolipoprotein E (Apo E) has previously been associated with increased cardiac artery disease (CAD); therefore to investigate the significance of this polymorphism in pathogenesis of CAD in Iranian patients with stenosis and control subjects. To investigate the association between  Apo E polymorphism and coronary artery disease we performed a comparative case control study of the frequency of Apo E  polymorphism in One hundred CAD patients with stenosis who underwent coronary angiography (>50% stenosis) and 100 control subjects (<10% stenosis). The Apo E alleles and genotypes were determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). We observed an association between the Apo E polymorphism and CAD in this study. These data suggest that the Apo ε4 and ε2 alleles increase the risk for CAD in Iranian population (χ2 =4.26, p= 0.05, OR=2 and χ2 =0.38, p=0.53, OR=1.2). These results suggest that ε4 and ε2 alleles are risk factors for stenosis.

Keywords: Arterial blood vessels, atherosclerosis, cholesterol.

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Authors: M. Seifi, S. Fallah, M. Firoozrai

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Matrix metalloproteinase-3 (MMP3) is key member of the MMP family, and is known to be present in coronary atherosclerotic. Several studies have demonstrated that MMP-3 5A/6A polymorphism modify each transcriptional activity in allele specific manner. We hypothesized that this polymorphism may play a role as risk factor for development of coronary stenosis. The aim of our study was to estimate MMP-3 (5A/6A) gene polymorphism on interindividual variability in risk for coronary stenosis in an Iranian population.DNA was extracted from white blood cells and genotypes were obtained from coronary stenosis cases (n=95) and controls (n=100) by PCR (polymerase chain reaction) and restriction fragment length polymorphism techniques. Significant differences between cases and controls were observed for MMP3 genotype frequencies (X2=199.305, p< 0.001); the 6A allele was less frequently seen in the control group, compared to the disease group (85.79 vs. 78%, 6A/6A+5A/6A vs. 5A/5A, P≤0.001). These data imply the involvement of -1612 5A/6A polymorphism in coronary stenosis, and suggest that probably the 6A/6A MMP-3 genotype is a genetic susceptibility factor for coronary stenosis.

Keywords: Coronary artery stenosis, matrixmetalloproteinase-3, polymorphism, polymerase chain reaction.

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Authors: Mohammadreza Nezamirad, Nasim Sabetpour, Azadeh Yazdi, Amirmasoud Hamedi

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In this study OpenFOAM 4.4.2 was used to investigate flow inside the coronary artery of the heart. This step is the first step of our future project, which is to include conjugate heat transfer of the heart with three main coronary arteries. Three different velocities were used as inlet boundary conditions to see the effect of velocity increase on velocity, pressure, and wall shear of the coronary artery. Also, three different fluids, namely the University of Wisconsin solution, gelatin, and blood was used to investigate the effect of different fluids on flow inside the coronary artery. A code based on Reynolds Stress Navier Stokes (RANS) equations was written and implemented with the real boundary condition that was calculated based on MRI images. In order to improve the accuracy of the current numerical scheme, hex dominant mesh is utilized. When the inlet velocity increases to 0.5 m/s, velocity, wall shear stress, and pressure increase at the narrower parts.

Keywords: CFD, heart, simulation, OpenFOAM.

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Authors: A. Ben Abdallah, H. Essabbah, M. H. Bedoui

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The myocardial sintigraphy is an imaging modality which provides functional informations. Whereas, coronarography modality gives useful informations about coronary arteries anatomy. In case of coronary artery disease (CAD), the coronarography can not determine precisely which moderate lesions (artery reduction between 50% and 70%), known as the “gray zone", are haemodynamicaly significant. In this paper, we aim to define the relationship between the location and the degree of the stenosis in coronary arteries and the observed perfusion on the myocardial scintigraphy. This allows us to model the impact evolution of these stenoses in order to justify a coronarography or to avoid it for patients suspected being in the gray zone. Our approach is decomposed in two steps. The first step consists in modelling a coronary artery bed and stenoses of different location and degree. The second step consists in modelling the left ventricle at stress and at rest using the sphercical harmonics model and myocardial scintigraphic data. We use the spherical harmonics descriptors to analyse left ventricle model deformation between stress and rest which permits us to conclude if ever an ischemia exists and to quantify it.

Keywords: Spherical harmonics model, vascular bed, 3D reconstruction, left ventricle, myocardial scintigraphy.

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Authors: Syed Dawood Md. Taimur, Saidur Rahman Khan, Farzana Islam

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To evaluate the factors which predetermine the coronary artery disease in patients having positive Exercise Tolerance Test (ETT) that is treadmill results and coronary artery findings. This descriptive study was conducted at Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from 1st January, 2014 to 31st August, 2014. All patients who had done ETT (treadmill) for chest pain diagnosis were studied. One hundred and four patients underwent coronary angiogram after positive treadmill result. Patients were divided into two groups depending upon the angiographic findings, i.e. true positive and false positive. Positive treadmill test patients who have coronary artery involvement these are called true positive and who have no involvement they are called false positive group. Both groups were compared with each other. Out of 104 patients, 81 (77.9%) patients had true positive ETT and 23 (22.1%) patients had false positive ETT. The mean age of patients in positive ETT was 53.46± 8.06 years and male mean age was 53.63±8.36 years and female was 52.87±7.0 years. Sixty nine (85.19%) male patients and twelve (14.81%) female patients had true positive ETT, whereas 15 (65.21%) males and 8 (34.79%) females had false positive ETT, this was statistically significant (p<0.032) in the two groups (sex) in comparison of true and false positive ETT. The risk factors of these patients like diabetes mellitus, hypertension, dyslipidemia, family history and smoking were seen among these patients. Hypertensive patients having true positive which were statistically significant (p<0.004) and diabetic, dyslipidemic patients having true positive which were statistically significant (p<0.032 & 0.030).True positive patients had family history were 68(83.95%) and smoking were 52 (64.20%), where family history patients had statistically significant (p<0.017) between two groups of patients and smokers were significant (p<0.012). 46 true positive patients achieved THR which was not statistically significant (P<0.138) and 79 true patients had abnormal resting ECG whether it was significant (p<0.036). Amongst the vessels involvement the most common was LAD 55 (67.90 %) followed by LCX 42 (51.85%), RCA 36 (44.44%), and the LMCA was 9 (11.11%). 40 patients (49.38%) had SVD, 26 (30.10%) had DVD, 15(18.52%) had TVD and 23 had normal coronary arteries. It can be concluded that among the female patients who have positive ETT with normal resting ECG, who had achieved target heart rate are likely to have a false positive test result. Conversely male patients, resting abnormal ECG who had not achieved THR, symptom limited ETT, have a hypertension, diabetes, dyslipidemia, family history and smoking are likely to have a true positive treadmill test result.

Keywords: Exercise tolerance test, Coronary artery disease, Coronary angiography, True positive, False positive.

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Authors: Hala O. El-Mesallamy, Salwa M. Suwailem, Mae M. Seleem

Abstract:

Visfatin and apelin are two new adipokines that recently gained a special interest in diabetes research. This study was conducted to study the interplay between these two adipokines and their correlation with other inflammatory and biochemical parameters in type 2 diabetic (T2D) postmenopausal women with CAD. Visfatin and apelin were measured by enzyme-linked immunoassay (ELISA). Visfatin was found to be significantly higher in the following groups: T2D patients without CAD, non-obese and obese T2D patients with CAD when compared to control group. Apelin was found to be significantly lower in non-obese and obese T2D patients with CAD when compared to control group. Visfatin and apelin were found to be significantly associated with each other and with other biochemical parameters. The current study provides evidence for the interplay between visfatin and apelin through the inflammatory milieu characteristic of T2D and their possible role in the pathogenesis of CAD complication of T2D. 

Keywords: Apelin, Coronary artery disease, Inflammation, Type 2 diabetes, Visfatin.

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Authors: Mahdi Mazinani, S. D. Qanadli, Rahil Hosseini, Tim Ellis, Jamshid Dehmeshki

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Segmentation and quantification of stenosis is an important task in assessing coronary artery disease. One of the main challenges is measuring the real diameter of curved vessels. Moreover, uncertainty in segmentation of different tissues in the narrow vessel is an important issue that affects accuracy. This paper proposes an algorithm to extract coronary arteries and measure the degree of stenosis. Markovian fuzzy clustering method is applied to model uncertainty arises from partial volume effect problem. The algorithm employs: segmentation, centreline extraction, estimation of orthogonal plane to centreline, measurement of the degree of stenosis. To evaluate the accuracy and reproducibility, the approach has been applied to a vascular phantom and the results are compared with real diameter. The results of 10 patient datasets have been visually judged by a qualified radiologist. The results reveal the superiority of the proposed method compared to the Conventional thresholding Method (CTM) on both datasets.

Keywords: 3D coronary artery tree extraction, segmentation, quantification, fuzzy clustering, and Markov random field

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Authors: Wahyu Widowati, Hana Ratnawati, Tjandrawati Mozefis, Dwiyati Pujimulyani, Yelliantty Yelliantty

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Background: Atherosclerosis is the main cause of cardiovascular disease (CVD) with complex and multifactorial process including atherogenic lipoprotein, oxidized low density lipoprotein (LDL), endothelial dysfunction, plaque stability, vascular inflammation, thrombotic and fibrinolytic disorder, exercises and genetic factor Epidemiological studies have shown tea consumption inversely associated with the development and progression of atherosclerosis. The research objectives: to elucidate hypolipidemic, antioxidant effects, as well as ability to improve coronary artery’s histopathologyof black tea extract (BTE) and quercetin in atherosclerotic rats. Methods: The antioxidant activity was determined by using Superoxide Dismutase activity (SOD) of serum and lipid peroxidation product (Malondialdehyde) of plasma and lipid profile including cholesterol total, LDL, triglyceride (TG), High Density Lipoprotein (HDL) of atherosclerotic rats. Inducing atherosclerotic, rats were given cholesterol and cholic acid in feed during ten weeks until rats indicated atherosclerotic symptom with narrowed artery and foamy cells in the artery’s wall. After rats suffered atherosclerotic, the high cholesterol feed and cholic acid were stopped and rats were given BTE 450; 300; 150 mg/kg body weight (BW) daily, quercetin 15; 10; 5 mg/kg BW daily, compared to rats were given vitamin E 60 mg/kg/BW; simvastatin 2.7 mg/kg BW, probucol 30 mg/kg BW daily for 21 days (first treatment) and 42 days (second treatment), negative control (normal feed), positive control (atherosclerotic rats). Results: BTE and quercetin could lower cholesterol total, triglyceride, LDL MDA and increase HDL, SOD were comparable with simvastatin, probucol both for 21 days and 42 days treatment, as well to improve coronary arteries histopathology. Conclusions: BTE andquercetin have hypolipidemic and antioxidant effects, as well as improve coronary arteries histopathology in atherosclerotic rats.

Keywords: Black tea, quercetin, atherosclerosis, antioxidant, hypolipidemic, cardiovascular disease.

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Authors: Vipin Kumar Verma, Praveen Saraswat

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The development of double stenosis in an artery can have serious consequences and can disrupt the normal functioning of the circulatory system. It has been realized that various hydrodynamics effects (i.e. wall shear, pressure distribution etc.) play important role in the development of this disease. Generally in the literature, the cross-section of the artery is assumed to be uniform with a single stenosis. However, in real situation the multiple stenosis develops in series along the length of artery whose cross-section varies slowly. Therefore, the flow of blood is laminar through a small diameter artery with axisymmetric identical double stenosis in series.

Keywords: Wall shear, multiple stenosis, artery.

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Authors: Yang Zhang, Jian He

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Heart disease is one of the leading causes of death in the world, and coronary heart disease (CHD) is one of the major heart diseases. Electrocardiogram (ECG) is widely used in the detection of heart diseases, but the traditional manual method for CHD prediction by analyzing ECG requires lots of professional knowledge for doctors. This paper presents sliding window and continuous wavelet transform (CWT) to transform ECG signals into images, and then ResNet and Bi-LSTM are introduced to build the ECG feature extraction network (namely ECGNet). At last, an auxiliary system for CHD prediction was developed based on modified ResNet18 and Bi-LSTM, and the public ECG dataset of CHD from MIMIC-3 was used to train and test the system. The experimental results show that the accuracy of the method is 83%, and the F1-score is 83%. Compared with the available methods for CHD prediction based on ECG, such as kNN, decision tree, VGGNet, etc., this method not only improves the prediction accuracy but also could avoid the degradation phenomenon of the deep learning network.

Keywords: Bi-LSTM, CHD, coronary heart disease, ECG, electrocardiogram, ResNet, sliding window.

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Authors: L. Ashok Kumar, C. Nagarajan

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The ultrasound imaging is very popular to diagnosis the disease because of its non-invasive nature. The ultrasound imaging slowly produces low quality images due to the presence of spackle noise and wave interferences. There are several algorithms to be proposed for the segmentation of ultrasound carotid artery images but it requires a certain limit of user interaction. The pixel in an image is highly correlated so the spatial information of surrounding pixels may be considered in the process of image segmentation which improves the results further. When data is highly correlated, one pixel may belong to more than one cluster with different degree of membership. There is an important step to computerize the evaluation of arterial disease severity using segmentation of carotid artery lumen in 2D and 3D ultrasonography and in finding vulnerable atherosclerotic plaques susceptible to rupture which can cause stroke.

Keywords: IMT measurement, Image Segmentation, common carotid artery, internal and external carotid arteries, ultrasound imaging.

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Authors: Hynek Chlup, Lukas Horny, Rudolf Zitny, Svatava Konvickova, Tomas Adamek

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Coronary artery bypass grafts (CABG) are widely studied with respect to hemodynamic conditions which play important role in presence of a restenosis. However, papers which concern with constitutive modeling of CABG are lacking in the literature. The purpose of this study is to find a constitutive model for CABG tissue. A sample of the CABG obtained within an autopsy underwent an inflation–extension test. Displacements were recoredered by CCD cameras and subsequently evaluated by digital image correlation. Pressure – radius and axial force – elongation data were used to fit material model. The tissue was modeled as onelayered composite reinforced by two families of helical fibers. The material is assumed to be locally orthotropic, nonlinear, incompressible and hyperelastic. Material parameters are estimated for two strain energy functions (SEF). The first is classical exponential. The second SEF is logarithmic which allows interpretation by means of limiting (finite) strain extensibility. Presented material parameters are estimated by optimization based on radial and axial equilibrium equation in a thick-walled tube. Both material models fit experimental data successfully. The exponential model fits significantly better relationship between axial force and axial strain than logarithmic one.

Keywords: Constitutive model, coronary artery bypass graft, digital image correlation, fiber reinforced composite, inflation test, saphenous vein.

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Authors: Christopher C. Anyadubalu

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Biological, psychological and social experiences and perceptions of healthcare services in patients medically diagnosed of coronary heart disease were investigated using a sample of 10 participants whose responses to the in-depth interview questions were analyzed based on inter-and-intra-case analyses. The results obtained revealed that advancing age, single status, divorce and/or death of spouse and the issue of single parenting negatively impacted patients- biopsychosocial experiences. The patients- experiences of physical signs and symptoms, anxiety and depression, past serious medical conditions, use of self-prescribed medications, family history of poor mental/medical or physical health, nutritional problems and insufficient physical activities heightened their risk of coronary attack. Collectivist culture served as a big source of relieve to the patients. Patients- temperament, experience of different chronic life stresses/challenges, mood alteration, regular drinking, smoking/gambling, and family/social impairments compounded their health situation. Patients were satisfied with the biomedical services rendered by the healthcare personnel, whereas their psychological and social needs were not attended to. Effective procedural treatment model, a holistic and multidimensional approach to the treatment of heart disease patients was proposed.

Keywords: Biopsychosocial, Coronary Heart Disease, Experience, Patients, Perception, Perspective.

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Authors: Jitendra Jain, Cassandra Hidajat, Hansraj Riteesh Bookun

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Graft patency underpins long-term prognosis after coronary artery bypass grafting surgery (CABG). The benefits of the combined use of only the left internal mammary artery and radial artery, referred to as total arterial revascularisation (TAR), on long-term clinical outcomes and quality of life are relatively unknown. The aim of this study was to identify whether there were differences in long term clinical outcomes between recipients of TAR compared to a cohort of mostly arterial revascularization involving the left internal mammary, at least one radial artery and at least one saphenous vein graft. A retrospective analysis was performed on all patients who underwent TAR or were re-vascularized with supplementary saphenous vein graft from February 1996 to December 2004. Telephone surveys were conducted to obtain clinical outcome parameters including major adverse cardiac and cerebrovascular events (MACCE) and Short Form (SF-36v2) Health Survey responses. A total of 176 patients were successfully contacted to obtain postop follow up results. The mean follow-up length from time of surgery in our study was TAR 12.4±1.8 years and conventional 12.6±2.1. PCS score was TAR 45.9±8.8 vs LIMA/Rad/ SVG 44.9±9.2 (p=0.468) and MCS score was TAR 52.0±8.9 vs LIMA/Rad/SVG 52.5±9.3 (p=0.723). There were no significant differences between groups for NYHA class 3+ TAR 9.4% vs. LIMA/Rad/SVG 6.6%; or CCS 3+ TAR 2.35% vs. LIMA/Rad/SVG 0%.

Keywords: CABG, MACCEs, quality of life, total arterial revascularization.

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Authors: Ali Zifan, Panos Liatsis, Panagiotis Kantartzis, Manolis Gavaises, Nicos Karcanias, Demosthenes Katritsis

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We present a new method for the fully automatic 3D reconstruction of the coronary artery centerlines, using two X-ray angiogram projection images from a single rotating monoplane acquisition system. During the first stage, the input images are smoothed using curve evolution techniques. Next, a simple yet efficient multiscale method, based on the information of the Hessian matrix, for the enhancement of the vascular structure is introduced. Hysteresis thresholding using different image quantiles, is used to threshold the arteries. This stage is followed by a thinning procedure to extract the centerlines. The resulting skeleton image is then pruned using morphological and pattern recognition techniques to remove non-vessel like structures. Finally, edge-based stereo correspondence is solved using a parallel evolutionary optimization method based on f symbiosis. The detected 2D centerlines combined with disparity map information allow the reconstruction of the 3D vessel centerlines. The proposed method has been evaluated on patient data sets for evaluation purposes.

Keywords: Vessel enhancement, centerline extraction, symbiotic reconstruction.

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Authors: Ramya Rathan, Miral N. F. Salama

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The variations in the arteries have been drawing attention of anatomists for a long time because of their clinical significance. The brachial artery is the principal artery of the arm which is the continuation of the axillary artery from the lower border of the Teres Major. It terminates into the radial and ulnar arteries below the elbow joint at the neck radius. The present study aims at exploring the clinical significance of the high termination of the brachial artery. During the routine cadaveric dissection of the arm, for the undergraduate students of medicine at our university, we observed a high bifurcation of the radial and the ulnar artery at the midshaft of the humerus. The median nerve was seen passing between these two junctions. Further, the course and the relations of this artery were studied. The accurate knowledge regarding these kinds of variation in the blood vessels is mandatory for planning of designing. General physicians, surgeons and radiologists should keep in mind the variations in the branching pattern of the arteries in their daily medical, diagnostic and therapeutic procedures to avoid complications in diagnostic and surgical procedures.

Keywords: Brachial artery, high termination, radial artery, ulnar artery.

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Authors: Paria Soleimani, Arezoo Neshati

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Myocardial infarction is one of the leading causes of death in the world. Some of these deaths occur even before the patient reaches the hospital. Myocardial infarction occurs as a result of impaired blood supply. Because the most of these deaths are due to coronary artery disease, hence the awareness of the warning signs of a heart attack is essential. Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort, then early detection and successful treatment of these symptoms is vital to save them. Therefore, importance and usefulness of a system designing to assist physicians in early diagnosis of the acute heart attacks is obvious. The main purpose of this study would be to enable patients to become better informed about their condition and to encourage them to seek professional care at an earlier stage in the appropriate situations. For this purpose, the data were collected on 711 heart patients in Iran hospitals. 28 attributes of clinical factors can be reported by patients; were studied. Three logistic regression models were made on the basis of the 28 features to predict the risk of heart attacks. The best logistic regression model in terms of performance had a C-index of 0.955 and with an accuracy of 94.9%. The variables, severe chest pain, back pain, cold sweats, shortness of breath, nausea and vomiting, were selected as the main features.

Keywords: Coronary heart disease, acute heart attacks, prediction, logistic regression.

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Authors: Giovanni Aloisio, Lucio T. De Paolis, Luciana Provenzano, Lucio Colizzi, Gianluca Pantile

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One of the essential requirements in order to have a realistic surgical simulator is real-time interaction by means of a haptic interface is. In fact, reproducing haptic sensations increases the realism of the simulation. However, the interaction need to be performed in real-time, since a delay between the user action and the system reaction reduces the user immersion. In this paper, we present a prototype of the coronary stent implant simulator developed in the HERMES Project; this system allows real-time interactions with a artery by means of a specific haptic device; thus the user can interactively navigate in a reconstructed artery and force feedback is produced when contact occurs between the artery walls and the medical instruments

Keywords: Collision Detection, Haptic Interface, Real-Time Interaction, Surgical Simulator.

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Authors: Midiya Khademi, Ali Nikoo, Shabnam Rahimnezhad Baghche Jooghi

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Cardiovascular diseases (CVDs) are the main cause of death globally. Most CVDs can be prevented by avoiding habitual risk factors. Separate from the habitual risk factors, there are some inherent factors in each individual that can increase the risk potential of CVDs. Vessel shapes and geometry are influential factors, having great impact on the blood flow and the hemodynamic behavior of the vessels. In the present study, the influence of bifurcation angle on blood flow characteristics is studied. In order to approach this topic, by simplifying the details of the bifurcation, three models with angles 30°, 45°, and 60° were created, then by using CFD analysis, the response of these models for stable flow and pulsatile flow was studied. In the conducted simulation in order to eliminate the influence of other geometrical factors, only the angle of the bifurcation was changed and other parameters remained constant during the research. Simulations are conducted under dynamic and stable condition. In the stable flow simulation, a steady velocity of 0.17 m/s at the inlet plug was maintained and in dynamic simulations, a typical LAD flow waveform is implemented. The results show that the bifurcation angle has an influence on the maximum speed of the flow. In the stable flow condition, increasing the angle lead to decrease the maximum flow velocity. In the dynamic flow simulations, increasing the bifurcation angle lead to an increase in the maximum velocity. Since blood flow has pulsatile characteristics, using a uniform velocity during the simulations can lead to a discrepancy between the actual results and the calculated results.

Keywords: Coronary artery, cardiovascular disease, bifurcation, atherosclerosis, CFD, artery wall shear stress.

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Authors: Zeinep A. Berkimbayeva, Almagul T. Mansharipova, Elmira M. Khussainova, Leyla B. Djansugurova

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It is believed that DNA damaging toxic metabolites contributes to the development of different pathological conditions. To prevent harmful influence of toxic agents, cells developed number of protecting mechanisms, such as enzymatic reaction of detoxification of reactive metabolites and repair of DNA damage. The aim of the study was to examine the association between polymorphism of GSTT1/GSTM1 and XRCC1/3 genes and coronary artery disease (CAD) incidence. To examine a polymorphism of these genes in CAD susceptibility in patients and controls, PCR based genotyping assay was performed. For GST genes, frequency of GSTM1 null genotype among CAD affected group was significantly increased than in control group (P<0.001). Frequencies of the GSTT1 null and positive alleles are almost equal in both groups (P>0.1). We found that neither XRCC1 Arg399Gln nor XRCC3 Thr241Met were associated with CAD risk. Obtained data suggests that GSTM1 null genotype carriers are more susceptible to CAD development.

Keywords: Cardiovascular disease, DNA reparation, gene polymorphism, risk factors, xenobiotic detoxification.

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Authors: B. Prashantha, S. Anish

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The aim of the present study is to computationally evaluate the hemodynamic factors which affect the formation of atherosclerosis and plaque rupture in the human artery. An increase of atherosclerosis disease in the artery causes geometry changes, which results in hemodynamic changes such as flow separation, reattachment, and adhesion of new cells (chemotactic) in the artery. Hence, geometry plays an important role in the determining the nature of hemodynamic patterns. Influence of stenosis in the non-bifurcating artery, under pulsatile flow condition, has been studied on an idealized geometry. Analysis of flow through symmetric and asymmetric stenosis in the artery revealed the significance of oscillating shear index (OSI), flow separation, low WSS zones and secondary flow patterns on plaque formation. The observed characteristic of flow in the post-stenotic region highlight the importance of plaque eccentricity on the formation of secondary stenosis on the arterial wall.

Keywords: Atherosclerotic plaque, Oscillatory Shear Index, Stenosis nature, Wall Shear Stress.

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Authors: C. De Lazzari, E. Del Prete, I. Genuini, F. Fedele

Abstract:

Cardiovascular human simulator can be a useful tool in understanding complex physiopathological process in cardiocirculatory system. It can also be a useful tool in order to investigate the effects of different drugs on hemodynamic parameters. The aim of this work is to test the potentiality of our cardiovascular numerical simulator CARDIOSIM© in reproducing flow/pressure coronary waveforms in presence of two different drugs: Amlodipine (AMLO) and Adenosine (ADO). In particular a time-varying intramyocardial compression, assumed to be proportional to the left ventricular pressure, was related to the venous coronary compliances in order to study its effects on the coronary blood flow and the flow/pressure loop. Considering that coronary circulation dynamics is strongly interrelated with the mechanics of the left ventricular contraction, relaxation, and filling, the numerical model allowed to analyze the effects induced by the left ventricular pressure on the coronary flow.

Keywords: Cardiovascular system, Coronary blood flow, Hemodynamic, Numerical simulation.

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Authors: Tahseen A. Jilani, Huda Yasin, Madiha Yasin, C. Ardil

Abstract:

In this paper we use data mining techniques to investigate factors that contribute significantly to enhancing the risk of acute coronary syndrome. We assume that the dependent variable is diagnosis – with dichotomous values showing presence or  absence of disease. We have applied binary regression to the factors affecting the dependent variable. The data set has been taken from two different cardiac hospitals of Karachi, Pakistan. We have total sixteen variables out of which one is assumed dependent and other 15 are independent variables. For better performance of the regression model in predicting acute coronary syndrome, data reduction techniques like principle component analysis is applied. Based on results of data reduction, we have considered only 14 out of sixteen factors.

Keywords: Acute coronary syndrome (ACS), binary logistic regression analyses, myocardial ischemia (MI), principle component analysis, unstable angina (U.A.).

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Authors: U. Rubins, Z. Marcinkevics, K.Volceka

Abstract:

The cardiovascular system has become the most important subject of clinical research, particularly measurement of arterial blood flow. Therefore correct determination of arterial diameter is crucial. We propose a novel, semi-automatic method for artery lumen detection. The method is based on Gaussian probability function. Usability of our proposed method was assessed by analyzing ultrasound B-mode CFA video sequences acquired from eleven healthy volunteers. The correlation coefficient between the manual and semi-automatic measurement of arterial diameter was 0.996. Our proposed method for detecting artery boundary is novel and accurate enough for the measurement of artery diameter.

Keywords: Ultrasound, boundary detection, artery diameter, curve fitting.

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Authors: Samuel P. Prahlow, Anthony Sciuva, Katherine Bombly, Emily Wilson, Shiv Dhiman, Savita Arya

Abstract:

A prevalence cohort study of atherosclerotic lesions within cadavers was performed to better understand and characterize the prevalence of atherosclerosis among Georgia residents within body donors in the Philadelphia College of Osteopathic Medicine (PCOM) - Georgia body donor program. We procured specimens from cadavers used for medical student, physical therapy student, and biomedical science student cadaveric anatomical dissection at PCOM - South Georgia and PCOM - Georgia. Tissues were prepared using hematoxylin and eosin (H&E) stain as histological slides by Colquitt Regional Medical Center Laboratory Services. One section from each of the following arteries was taken after cadaveric dissection at the site of most calcification palpated grossly (if present): left anterior descending coronary artery, left internal carotid artery, abdominal aorta, splenic artery, and hepatic artery. All specimens were graded and categorized according to the American Heart Association’s Modified and Conventional Standards for Atherosclerotic Lesions using x4, x10, x40 microscopic magnification. Our study cohort included 22 cadavers, with 16 females and 6 males. The average age was 72.54 and median age was 72, with a range of 52 to 90 years old. The cause of death determination listing vascular and/or cardiovascular causes were present on 6 of the 22 death certificates. 19 of 22 (86%) cadavers had at least a single artery grading > 5. Of the cadavers with at least a single artery graded at greater than 5, only 5 of 19 (26%) cadavers had a vascular or cardiovascular cause of death reported. Malignancy was listed as a cause of death on 7 (32%) of death certificates. The average atherosclerosis grading of the common hepatic, splenic and left internal carotid arteries (2.15, 3.05, and 3.36 respectively) were lower than the left anterior descending artery and the abdominal aorta (5.16 and 5.86 respectively). This prevalence study characterizes atherosclerosis found in five medium and large systemic arteries within cadavers from the state of Georgia.

Keywords: Atherosclerosis, cardiovascular, histology, pathology.

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Authors: Taewon Seo

Abstract:

The characteristics of physiological blood flow in human carotid arterial bifurcation model have been numerically studied using a fully coupled fluid-structure interaction (FSI) analysis. This computational model with the fluid-structure interaction is constructed to investigate the flow characteristics and wall shear stress in the carotid artery. As the flow begins to decelerate after the peak flow, a large recirculation zone develops at the non-divider wall of both internal carotid artery (ICA) and external carotid artery (ECA) in FSI model due to the elastic energy stored in the expanding compliant wall. The calculated difference in wall shear stress (WSS) in both Non-FSI and FSI models is a range of between 5 and 11% at the mean WSS. The low WSS corresponds to regions of carotid artery that are more susceptible to atherosclerosis.

Keywords: Carotid artery, Fluid-structure interaction, Hemodynamics, Wall shear stress.

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Authors: Amani Ashari, Julia Omar, Arif Hashim, Shahrul Hamid

Abstract:

Apolipoprotein E (APOE) gene polymorphism has influence on serum lipids which relates to cardiovascular risk. The purpose of this study was to determine the frequency distribution of APOE alleles among Malaysian Type 2 Diabetes Mellitus (DM) patients with and without coronary artery disease (CAD) and their association with serum lipid profiles. A total of 115 patients were recruited in which 78 patients had Type 2 DM without CAD and 37 patients had Type 2 DM with CAD. The APOE polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The APOE ɛ3 allele was the most common one in both groups. There was no significant association between the APOE genotypes and the CAD status in Type 2 DM using Pearson χ² test. Further analysis indicated there were no significant differences in all lipid parameters between E2, E3 and E4 subgroups in both groups. The study showed that the E4 allele carriers of Type 2 DM with CAD patients had higher LDL-C level and lower HDL-C level compared to the other allele carriers. However, analyses showed these levels were not statistically different. The study also showed that the Type 2 DM with CAD group with E2 allele had higher triglyceride (TG). In conclusion, further study with larger sample size is needed to confirm role of E4 as a marker of CAD among Type 2 DM patients in Malaysian population.

Keywords: Apolipoprotein E, diabetes mellitus, cardiovascular disease, lipids.

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