Normalized left ventricular workload using phase-contrast magnetic resonance imaging in patients with aortic stenosis.

Aortic stenosis (AS) severity contributes to the left ventricle (LV) deterioration due to the aortic valve narrowing and the alteration of systemic hemodynamic load. This load increment may also increase the LV stroke work (SW) which represent the required energy to deliver the blood at ejection. In this study, SW was derived from in-vivo cardiovascular magnetic resonance (CMR) velocity measurements (n=57) using a lumped-parametric model. Furthermore, normalized SW (N-SW) was evaluated as AS severity parameter. SW differentiated from normal flow (>35 mL/m(2)) and low flow (<35 mL/m(2)) states (p<0.05). N-SW showed a good association with valve effective orifice area (EOA, r=-0.5, p<0.001) and valvulo-arterial impedance (ZVA, r=0.65, p<0.001). A severity threshold for N-SW (1.5 cJ/mL) was found using an EOA=1 cm(2) as AS severity marker. CMR-derived SW and N-SW may be useful to the assessment and grading of AS patients.

On the evaluation of vorticity using cardiovascular magnetic resonance velocity measurements.

Vorticity and vortical structures play a fundamental role affecting the evaluation of energetic aspects (mainly left ventricle work) of cardiovascular function. Vorticity can be derived from cardiovascular magnetic resonance (CMR) imaging velocity measurements. However, several numerical schemes can be used to evaluate the vorticity field. The main objective of this work is to assess different numerical schemes used to evaluate the vorticity field derived from CMR velocity measurements. We compared the vorticity field obtained using direct differentiation schemes (eight-point circulation and Chapra) and derivate differentiation schemes (Richardson 4* and compact Richardson 4*) from a theoretical velocity field and in vivo CMR velocity measurements. In all cases, the effect of artificial spatial resolution up-sampling and signal-to-noise ratio (SNR) on vorticity computation was evaluated. Theoretical and in vivo results showed that the eight-point circulation method underestimated vorticity. Up-sampling evaluation showed that the artificial improvement of spatial resolution had no effect on mean absolute vorticity estimation but it affected SNR for all methods. The Richardson 4* method and its compact version were the most accurate and stable methods for vorticity magnitude evaluation. Vorticity field determination using the eight-point circulation method, the most common method used in CMR, has reduced accuracy compared to other vorticity schemes. Richardson 4* and its compact version showed stable SNR using both theoretical and in vivo data.

Modeling the impact of concomitant aortic stenosis and coarctation of the aorta on left ventricular workload.

Coarctation of the aorta (COA) is an obstruction of the aorta and is usually associated with bicuspid and tricuspid aortic valve stenosis (AS). When COA coexists with AS, the left ventricle (LV) is facing a double hemodynamic load: a valvular load plus a vascular load. The objective of this study was to develop a lumped parameter model, solely based on non-invasive data, allowing the description of the interaction between LV, COA, AS and the arterial system. First, a formulation describing the instantaneous net pressure gradient through the COA was introduced and the predictions were compared to in vitro results. The model was then used to determine LV work induced by coexisting AS and COA with different severities. The results show that LV stroke work varies from 0.98J (no-AS; no-COA) up to 2.15J (AS: 0.61cm(2)+COA: 90%). Our results also show that the proportion of the total flow rate that will cross the COA is significantly reduced with the increasing COA severity (from 85% to 40%, for a variation of COA severity from 0% to 90%, respectively). Finally, we introduced simple formulations capable of, non-invasively, estimating both LV peak systolic pressure and workload. As a conclusion, this study allowed the development of a lumped parameter model, based on non-invasive measurements, capable of accurately investigating the impact of coexisting AS and COA on LV workload. This model can be used to optimize the management of patients with COA and AS in terms of the sequence of lesion repair.

Postseismic relaxation along the San Andreas fault at Parkfield from continuous seismological observations.

Seismic velocity changes and nonvolcanic tremor activity in the Parkfield area in California reveal that large earthquakes induce long-term perturbations of crustal properties in the San Andreas fault zone. The 2003 San Simeon and 2004 Parkfield earthquakes both reduced seismic velocities that were measured from correlations of the ambient seismic noise and induced an increased nonvolcanic tremor activity along the San Andreas fault. After the Parkfield earthquake, velocity reduction and nonvolcanic tremor activity remained elevated for more than 3 years and decayed over time, similarly to afterslip derived from GPS (Global Positioning System) measurements. These observations suggest that the seismic velocity changes are related to co-seismic damage in the shallow layers and to deep co-seismic stress change and postseismic stress relaxation within the San Andreas fault zone.

In vivo velocity and flow errors quantification by phase-contrast magnetic resonance imaging.

Magnetic resonance imaging is a very efficient tool for assessing velocity and flow in the cardiovascular system under normal and pathological conditions. However, this technique still has some limitations that produce different type of errors. In this study, velocities and flow were measured in vivo using phase-contrast method to determine the optimal number of phases allowing the minimization of the errors. The effect of velocity encoding upsampling was also investigated. The results showed that a number of phases between 16-24 is a good compromise to accurately estimate both ejection and regurgitant flows. Furthermore, a time shift effect caused by velocity encoding upsampling was found and a corrective linear model was proposed. These considerations may reduce flow and velocity measurement errors in normal and pathological conditions.

Weak localization of seismic waves.

We report the observation of weak localization of seismic waves in a natural environment. It emerges as a doubling of the seismic energy around the source within a spot of the width of a wavelength, which is several tens of meters in our case. The characteristic time for its onset is the scattering mean-free time that quantifies the internal heterogeneity.

Prolonged distress and clinical deterioration before pericardial drainage in patients with cardiac tamponade.

OBJECTIVE: To determine whether patients with cardiac tamponade are subject to delays and clinical deterioration before undergoing echocardiography and pericardial drainage. DESIGN: Retrospective study. SETTING: The Montreal Heart Institute, Montreal, Quebec, a cardiology referral centre. PATIENTS: The charts of 50 patients who presented with tamponade were reviewed. Intervals between the appearance of symptoms, consultation, echocardiography and drainage were noted. The presence of clinical deterioration before drainage was evaluated. Causes for delays were investigated. RESULTS: Previous cardiac surgery (74%) was the most common etiology of tamponade. Symptoms were present 6.6+/-5.8 days before consultation. The delay between consultation and echocardiography was 1.2+/-2.0 days (range 0 to 12), and that between echocardiography and drainage was 0.8+/-0.9 days (range 0 to four). Patients underwent drainage 1. 9+/-2.5 days (range 0 to 16) after the initial consultation. Deterioration of the clinical status was noted in 34% of patients before pericardial drainage. An error in the initial diagnosis was present in 36% of patients; the majority of these were incorrectly diagnosed with heart failure. Another 44% of patients had no mention of either a working diagnosis in the chart at admission or the desire to rule out tamponade on the request for echocardiography. CONCLUSION: The proper diagnosis does not appear to be initially considered in up to 80% of patients who present with cardiac tamponade. Clinical deterioration occurs in approximately a third of patients during the interval between consultation and pericardial drainage.