Dysautonomia and Clinical Outcome in Vegetative State.

A dramatic disorder tentatively attributed to diencephalic-hypothalamic damage or dysfunction, dysautonomia, affects recovery from brain injury. Its incidence, correlation with etiology, and relevance as a predictor of outcome were retrospectively surveyed in 333 patients in vegetative state (VS) for more than 2 weeks at admission. Outcome was assessed according to the Glasgow Outcome Scale. Data were treated statistically by multi-variate analyses. Dysautonomia occurred in 26.1% of patients, with greater incidence among post-traumatic (31.9%) than non-traumatic (15.8%) patients. Outcome was worse among non-traumatic than post-traumatic patients irrespective of dysautonomia, and worst among non-traumatic patients with dysautonomia. Dysautonomia proved common among patients in VS (with incidence depending on etiology and age) and influenced the patients' outcome through mechanisms still to be defined, but conceivably mediated by diencephalic-hypothalamic unbalance.

Flow velocity vector fields by ultrasound particle imaging velocimetry: in vitro comparison with optical flow velocimetry.

OBJECTIVES: We performed an in vitro study to assess the precision and accuracy of particle imaging velocimetry (PIV) data acquired using a clinically available portable ultrasound system via comparison with stereo optical PIV. METHODS: The performance of ultrasound PIV was compared with optical PIV on a benchmark problem involving vortical flow with a substantial out-of-plane velocity component. Optical PIV is capable of stereo image acquisition, thus measuring out-of-plane velocity components. This allowed us to quantify the accuracy of ultrasound PIV, which is limited to in-plane acquisition. The system performance was assessed by considering the instantaneous velocity fields without extracting velocity profiles by spatial averaging. RESULTS: Within the 2-dimensional correlation window, using 7 time-averaged frames, the vector fields were found to have correlations of 0.867 in the direction along the ultrasound beam and 0.738 in the perpendicular direction. Out-of-plane motion of greater than 20% of the in-plane vector magnitude was found to increase the SD by 11% for the vectors parallel to the ultrasound beam direction and 8.6% for the vectors perpendicular to the beam. CONCLUSIONS: The results show a close correlation and agreement of individual velocity vectors generated by ultrasound PIV compared with optical PIV. Most of the measurement distortions were caused by out-of-plane velocity components.

Impact of pericardial adhesions on diastolic function as assessed by vortex formation time, a parameter of transmitral flow efficiency.

BACKGROUND: Pericardial adhesions are a pathophysiological marker of constrictive pericarditis (CP), which impairs cardiac filling by limiting the total cardiac volume compliance and diastolic filling function. We studied diastolic transmitral flow efficiency as a new parameter of filling function in a pericardial adhesion animal model. We hypothesized that vortex formation time (VFT), an index of optimal efficient diastolic transmitral flow, is altered by patchy pericardial-epicardial adhesions. METHODS: In 8 open-chest pigs, the heart was exposed while preserving the pericardium. We experimentally simulated early pericardial constriction and patchy adhesions by instilling instant glue into the pericardial space and using pericardial-epicardial stitches. We studied left ventricular (LV) function and characterized intraventricular blood flow with conventional and Doppler echocardiography at baseline and following the experimental intervention. RESULTS: Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. The mean VFT value decreased from 3.61 ± 0.47 to 2.26 ± 0.45 (P = 0.0002). Hemodynamic variables indicated the inhibiting effect of pericardial adhesion on both contraction (decrease in systolic blood pressure and +dP/dt decreased) and relaxation (decrease in the magnitude of -dP/dt and prolongation of Tau) function. CONCLUSION: Patchy pericardial adhesions not only negatively impact LV mechanical functioning but the decrease of VFT from normal to suboptimal value suggests impairment of transmitral flow efficiency.

Impact of acute moderate elevation in left ventricular afterload on diastolic transmitral flow efficiency: analysis by vortex formation time.

BACKGROUND: The formation of a vortex alongside a diastolic jet signifies an efficient blood transport mechanism. Vortex formation time (VFT) is an index of the optimal conditions for vortex formation. It was hypothesized that left ventricular (LV) afterload impairs diastolic transmitral flow efficiency and therefore shifts the VFT out of its optimal range. METHODS: In 9 open-chest pigs, LV afterload was elevated by externally constricting the ascending aorta and increasing systolic blood pressure to 130% of baseline value for 3 minutes. RESULTS: Systolic LV function decreased, diastolic filling velocity increased only during the late (atrial) phase from 0.46 +/- 0.06 to 0.63 +/- 0.19 m/s (P = .0231), and end-diastolic LV volume and heart rate remained unchanged. VFT decreased from 4.09 +/- 0.27 to 2.78 +/- 1.03 (P = .0046). CONCLUSION: An acute, moderate elevation in LV afterload worsens conditions for diastolic vortex formation, suggesting impaired blood transport efficiency.

Increase in the late diastolic filling force is associated with impaired transmitral flow efficiency in acute moderate elevation of left ventricular afterload.

OBJECTIVE: Analysis of intraventricular flow force and efficiency is a novel concept of quantitatively assessing left ventricular (LV) hemodynamic performance. We have parametrically characterized diastolic filling flow by early inflow force, late inflow force, and total inflow force and by vortex formation time (VFT), a fundamental parameter of fluid transport efficiency. The purpose of this study was to determine what changes in inflow forces characterize a decrease in diastolic blood transport efficiency in acute moderate elevation of LV afterload. METHODS: In 8 open-chested pigs, the flow force and VFT parameters were calculated from conventional and flow Doppler echocardiographic measurements at baseline and during a brief (3-minute) moderate elevation of afterload induced by increasing the systolic blood pressure to 130% of the baseline value. RESULTS: Systolic LV function decreased significantly during elevated afterload. Early inflow force did not significantly change, whereas late inflow force increased from 5,822.09 +/- 1,656.5 (mean +/- SD) to 13,948.25 +/- 9,773.96 dyne (P = .049), and total inflow force increased from 13,783.35 +/- 4,816.58 to 21,836.67 +/- 8,635.33 dyne (P = .031). Vortex formation time decreased from 4.09 +/- 0.29 to 2.79 +/- 1.1 (P = .0068), confirming suboptimal flow transport efficiency. CONCLUSIONS: Even a brief moderate increase of LV afterload causes a significant increase in late diastolic filling force and impairs transmitral flow efficiency.

Correlation between vortex ring formation and mitral annulus dynamics during ventricular rapid filling.

One of the most important fluid phenomena observed in the left ventricle during diastole is the presence of vortex rings that develop with a strong jet entering through the mitral valve. The present study is focused on the rapid filling phase of diastole, during which the left ventricle expands and receives blood through the fully open mitral valve. The atrioventricular system during the rapid filling phase was emulated experimentally with a simplified mechanical model in which the relevant pressure decay and the dimension of mitral annulus approximate the physiologic and pathologic values. Digital particle image velocimetry measurements were correlated with the force measurements on the mitral annulus plane to analyze the relation between flow and the mitral annulus motion. The recoil force on the displaced annulus plane was computed on the basis of plane acceleration and plane velocity and correlated with the inflow jet. Measurements of the recoil force for different values of the mitral annulus diameter showed that the recoil force was generated during fluid propulsion and that it is maximal for an annulus diameter close to the normal adult value in a healthy left ventricle. We also tested annulus diameters smaller and larger than the normal one. The smaller annulus corresponds to the stenotic valves and the larger annulus exists in dilated cardiomyopathy cases. In both conditions, the recoil force was found to be smaller than in the normal case. These observations are consistent with the previously reported results for dilated cardiomyopathy and mitral stenosis clinical conditions.

Assessment of left ventricular viscoelastic components based on ventricular harmonic behavior.

BACKGROUND: Assessment of left ventricular (LV) function with an emphasis on contractility has been a challenge in cardiac mechanics during the recent decades. The LV function is usually described by the LV pressure-volume (P-V) relationship. Based on this relationship, the ratio of instantaneous pressure to instantaneous volume is an index for LV chamber stiffness. The standard P-V diagrams are easy to interpret but difficult to obtain and require invasive instrumentation for measuring the corresponding volume and pressure data. In the present study, we introduce a technique that can estimate viscoelastic properties, not only the elastic component but also the viscous properties of the LV based on oscillatory behavior of the ventricular chamber and it can be applied non-invasively as well. MATERIALS AND METHODS: The estimation technique is based on modeling the actual long axis displacement of the mitral annulus plane toward the cardiac base as a linear damped oscillator with time-varying coefficients. Elastic deformations resulting from the changes in the ventricular mechanical properties of myocardium are represented as a time-varying spring while the viscous components of the model include a time-varying viscous damper, representing relaxation and the frictional energy loss. To measure the left ventricular axial displacement ten healthy sheep underwent left thoracotomy and sonomicrometry transducers were implanted at the apex and base of the LV. The time-varying parameters of the model were estimated by a standard Recursive Linear Least Squares (RLLS) technique. RESULTS: LV stiffness at end-systole and end-diastole was in the range of 61.86-136 dyne/gxcm and 1.25-21.02 dyne/gxcm, respectively. Univariate linear regression was performed to verify the agreement between the estimated parameters, and the measured values of stiffness. The averaged magnitude of the stiffness and damping coefficients during a complete cardiac cycle were estimated as 58.63+/-12.8 dyne/gxcm and 0 dynexs/gxcm, respectively. CONCLUSION: The results for the estimated elastic coefficients are consistent with the ones obtained from force-displacement diagram. The trend of change in the estimated parameters is also in harmony with the previous studies done using P-V diagram. The only input used in this model is the long axis displacement of the annulus plane, which can also be obtained non-invasively using tissue Doppler or MR imaging.

Estimation of elastic and viscous properties of the left ventricle based on annulus plane harmonic behavior.

Assessment of left ventricular (LV) function with an emphasis on contractility has been a challenge in cardiac mechanics during the recent decades. The LV function is usually described by the LV pressure-volume (P-V) diagram. The standard P-V diagrams are easy to interpret but difficult to obtain and require invasive instrumentation for measuring the corresponding volume and pressure data. In the present study, we introduce a technique that can estimate the viscoelastic properties of the LV based on harmonic behavior of the ventricular chamber and it can be applied non-invasively as well. The estimation technique is based on modeling the actual long axis displacement of the mitral annulus plane toward the cardiac base as a linear damped oscillator with time-varying coefficients. The time-varying parameters of the model were estimated by a standard recursive linear least squares (RLLS) technique. LV stiffness at end-systole and end diastole was in the range of 61.86-136.00 dyne/g.cm and 1.25-21.02 dyne/g.cm, respectively. The only input used in this model was the long axis displacement of the annulus plane, which can also be obtained non-invasively using tissue Doppler or MR imaging.

Self-organizing nets for optimization.

Given some optimization problem and a series of typically expensive trials of solution candidates sampled from a search space, how can we efficiently select the next candidate? We address this fundamental problem by embedding simple optimization strategies in learning algorithms inspired by Kohonen's self-organizing maps and neural gas networks. Our adaptive nets or grids are used to identify and exploit search space regions that maximize the probability of generating points closer to the optima. Net nodes are attracted by candidates that lead to improved evaluations, thus, quickly biasing the active data selection process toward promising regions, without loss of ability to escape from local optima. On standard benchmark functions, our techniques perform more reliably than the widely used covariance matrix adaptation evolution strategy. The proposed algorithm is also applied to the problem of drag reduction in a flow past an actively controlled circular cylinder, leading to unprecedented drag reduction.