Novel Strategies to Improve the Cardioprotective Effects of Cardioplegia.

The use of cardioprotective strategies as adjuvants of cardioplegic solutions has become an ideal alternative for the improvement of post-surgery heart recovery. The choice of the optimal cardioplegia, as well as its distribution mechanism, remains controversial in the field of cardiovascular surgery. There is still a need to search for new and better cardioprotective methods during cardioplegic procedures. New techniques for the management of cardiovascular complications during cardioplegia have evolved with new alternatives and additives, and each new strategy provides a tool to neutralize the damage after ischemia/reperfusion events. Researchers and clinicians have committed themselves to studying the effect of new strategies and adjuvant components with the potential to improve the cardioprotective effect of cardioplegic solutions in preventing myocardial ischemia/reperfusion-induced injury during cardiac surgery. The aim of this review is to explore the different types of cardioplegia, their protection mechanisms, and which strategies have been proposed to enhance the function of these solutions in hearts exposed to cardiovascular pathologies that require surgical alternatives for their corrective progression.

Successful surgical management of a combined abdominal and thoracic penetrating injury: a case report.

Penetrating rebar injuries are extremely rare occurrences, but they are very life-threatening, particularly when involving the thoracic and abdominal cavities. The surgical approach to these traumatic injuries depends upon the length and diameter of the rebar as well as the path of penetration into the abdominal and thoracic regions. Due to the highly uncommon occurrence of penetrating rebar injuries, there is very limited information and studies pertaining to this topic in the literature. In this case report, we present a 43-year-old male patient sustaining a rebar penetrating injury, with the entry site being the left flank and the exit site being the anterior left chest. Upon arrival, the patient was emergently taken to the operating room and underwent simultaneous exploratory laparotomy and a left thoracotomy. The operation was successful in removing the rebar and the patient survived.

Potential of Angiotensin-(1-7) in COVID-19 Treatment.

The new coronavirus currently named SARS-CoV-2 was announced by the World Health Organization as the virus causing the COVID-19 pandemic. The pathogenesis of SARS-CoV-2 initiates upon contact of a structural spike protein with the angiotensin II-converting enzyme receptor, leading to the induction of inflammatory mechanisms and progression to severe disease in some cases. Currently, studies have emerged linking COVID-19 with angiotensin-(1-7), demonstrating the potential of angiotensin-(1-7)/Mas Receptor axis induction to control disease severity due to its antiinflammatory, vasodilator, antioxidant, antiproliferative, anticoagulant, antiangiogenic and fibrosis inhibitory effects. The renin angiotensin-system peptide Angiotensin-(1-7) shows a high therapeutic potential for COVID-19 mainly because of its ability to counteract the adverse effects caused in various organs due to angiotensin II-converting enzyme blockade. In light of these factors, the use of convalescent plasma conjugated therapy and Ang (1-7) agonists for the treatment of COVID-19 patients could be recommended. The differential expression of ACE2 and the varied response to SARSCoV- 2 are thought to be connected. According to several investigations, ACE2 antibodies and pharmacological inhibitors might be used to prevent viral entry. Given its capacity to eliminate the virus while ensuring lung and cardiovascular protection by regulating the inflammatory response, angiotensin-( 1-7) is expected to be a safe choice. However, more clinical evidence is required to clarify the therapeutic usage of this peptide. The aim of this review article is to present an update of scientific data and clinical trials on the therapeutic potential of angiotensin-(1-7) in patients with COVID-19.

Electrochemical and Electroconductive Behavior of Silk Fibroin Electrospun Membrane Coated with Gold or Silver Nanoparticles.

The surface modification of materials obtained from natural polymers, such as silk fibroin with metal nanoparticles that exhibit intrinsic electrical characteristics, allows the obtaining of biocomposite materials capable of favoring the propagation and conduction of electrical impulses, acting as communicating structures in electrically isolated areas. On that basis, this investigation determined the electrochemical and electroconductive behavior through electrochemical impedance spectroscopy of a silk fibroin electrospun membrane from silk fibrous waste functionalized with gold or silver nanoparticles synthetized by green chemical reduction methodologies. Based on the results obtained, we found that silk fibroin from silk fibrous waste (SFw) favored the formation of gold (AuNPs-SFw) and silver (AgNPs-SFw) nanoparticles, acting as a reducing agent and surfactant, forming a micellar structure around the individual nanoparticle. Moreover, different electrospinning conditions influenced the morphological properties of the fibers, in the presence or absence of beads and the amount of sample collected. Furthermore, treated SFw electrospun membranes, functionalized with AuNPs-SFw or AgNPS-SFw, allowed the conduction of electrical stimuli, acting as stimulators and modulators of electric current.

Cell culture: a promising environment for research on cardiology / Cultivos celulares: un entorno promisorio para la investigación en cardiología

Abstract At present, tissue engineering is transforming the area of cardiovascular regenerative medicine, which combines the principles and methods of materials engineering and biological sciences, interacting with biochemical and physicochemical factors, for the understanding of their structure-function relationship. Thus, the course of diseases is reoriented by implementing methods and procedures involved in the regeneration of organs and tissues by means of the interaction with biocompatible matrices, pre-treated organs or stem cell management, among others, thus recovering the functionality in the system affected by acquired pathologies, alterations or congenital defects. Consequently, these procedures are increasingly becoming one the most promising treatment alternative for patients who suffer from any type of functional deficit. Known that all these possibilities make cell cultures a promising study environment to be used in biomedical applications, especially in tissue engineering and regenerative medicine, this manuscript presents a general reviews of established cell lines or primary tissue lines and how cell cultures serve as a model before experimental work on laboratory animals and human subjects which makes it a valuable tool for broad models of study in the research on cardiology.

Resumen En la actualidad, la ingeniería de tejidos está transformando el área de la medicina regenerativa cardiovascular, combinando los principios y métodos de la ingeniería de materiales y las ciencias biológicas, interactuando entre factores bioquímicos y fisicoquímicos, para la comprensión de su relación estructura-función. Así, el curso de las enfermedades se viene a reorientar mediante la implementación de métodos y procedimientos implicados en la regeneración de órganos y tejidos a través de la interacción con matrices biocompatibles, órganos pretratados o manejo de células madre, entre otros, recuperando así la funcionalidad en el sistema afectado por enfermedades adquiridas y alteraciones o defectos congénitos. En consecuencia, estos procedimientos se están convirtiendo en una de las alternativas de tratamiento cada vez más prometedoras para los pacientes que sufren de algún tipo de alteración funcional. Considerando que todas estas posibilidades hacen de los cultivos celulares un entorno de estudio prometedor para ser utilizado en aplicaciones biomédicas, especialmente en ingeniería de tejidos y medicina regenerativa, este manuscrito presenta una revisión general de las líneas celulares establecidas o líneas de tejido primario y cómo los cultivos celulares sirven como modelo de evaluación antes del trabajo experimental en animales de laboratorio y sujetos humanos, lo cual los convierte en una herramienta valiosa para amplios modelos de estudio en la investigación en cardiología.

Effect of Molecular Weight and Nanoarchitecture of Chitosan and Polycaprolactone Electrospun Membranes on Physicochemical and Hemocompatible Properties for Possible Wound Dressing.

Tissue engineering has focused on the development of biomaterials that emulate the native extracellular matrix. Therefore, the purpose of this research was oriented to the development of nanofibrillar bilayer membranes composed of polycaprolactone with low and medium molecular weight chitosan, evaluating their physicochemical and biological properties. Two-bilayer membranes were developed by an electrospinning technique considering the effect of chitosan molecular weight and parameter changes in the technique. Subsequently, the membranes were evaluated by scanning electron microscopy, Fourier transform spectroscopy, stress tests, permeability, contact angle, hemolysis evaluation, and an MTT test. From the results, it was found that changes in the electrospinning parameters and the molecular weight of chitosan influence the formation, fiber orientation, and nanoarchitecture of the membranes. Likewise, it was evidenced that a higher molecular weight of chitosan in the bilayer membranes increases the stiffness and favors polar anchor points. This increased Young's modulus, wettability, and permeability, which, in turn, influenced the reduction in the percentage of cell viability and hemolysis. It is concluded that the development of biomimetic bilayer nanofibrillar membranes modulate the physicochemical properties and improve the hemolytic behavior so they can be used as a hemocompatible biomaterial.

Effect of sequential electrospinning and co-electrospinning on morphological and fluid mechanical wall properties of polycaprolactone and bovine gelatin scaffolds, for potential use in small diameter vascular grafts.

BACKGROUND: Nowadays, the engineering vascular grafts with a diameter less than 6 mm by means of electrospinning, is an attracted alternative technique to create different three-dimensional microenvironments with appropriate physicochemical properties to promote the nutrient transport and to enable the bioactivity, dynamic growth and differentiation of cells. Although the performance of a well-designed porous wall is key for these functional requirements maintaining the mechanical function, yet predicting the flow rate and cellular transport are still not widely understood and many questions remain open about new configurations of wall can be used for modifying the conventional electrospun samples. The aim of the present study was to evaluate the effect of fabrication techniques on scaffolds composed of bovine gelatin and polycaprolactone (PCL) developed by sequential electrospinning and co-electrospinning, on the morphology and fluid-mechanical properties of the porous wall. METHODOLOGY: For this purpose, small diameter tubular structures were manufactured and experimental tests were performed to characterize the crystallinity, morphology, wettability, permeability, degradability, and mechanical properties. Some samples were cross-linked with Glutaraldehyde (GA) to improve the stability of the gelatin fiber. In addition, it was analyzed how the characteristics of the scaffold favored the levels of cell adhesion and proliferation in an in vitro model of 3T3 fibroblasts in incubation periods of 24, 48 and 72 h. RESULTS: It was found that in terms of the morphology of tubular scaffolds, the co-electrospun samples had a better alignment with higher values of fiber diameters and apparent pore area than the sequential samples. The static permeability was more significant in the sequential scaffolds and the hydrophilic was higher in the co-electrospun samples. Therefore, the gelatin mass losses were less in the co-electrospun samples, which promote cellular functions. In terms of mechanical properties, no significant differences were observed for different types of samples. CONCLUSION: This research concluded that the tubular scaffolds generated by sequential and co-electrospinning with modification in the microarchitecture could be used as a vascular graft, as they have better permeability and wettability, interconnected pores, and a circumferential tensile strength similar to native vessel compared to the commercial graft analyzed.

Hemolytic, Biocompatible, and Functional Effect of Cellularized Polycaprolactone-Hydrolyzed Collagen Electrospun Membranes for Possible Application as Vascular Implants.

In search of bioactive vascular prostheses that exhibit greater biocompatibility through the combination of natural and synthetic polymers, tissue engineering from a biomimetic perspective has proposed the development of three-dimensional structures as therapeutic strategies in the field of cardiovascular medicine. Techniques such as electrospinning allow obtaining of scaffolds that emulate the microarchitecture of the extracellular matrix of native vessels; thus, this study aimed to evaluate the biological influence of microarchitecture on polycaprolactone (PCL) and hydrolyzed collagen (H-Col) electrospun scaffolds, which have a homogeneous (microscale) or heterogeneous (micro-nanoscale) fibrillar structure. The hemolytic, biocompatible, and functional effect of the scaffolds in interaction with an in vitro fibroblast model was determined, in view of its potential use for vascular implants. Scaffolds were characterized by scanning electron microscopy and atomic force microscopy, Fourier transform infrared spectroscopy, wettability, static permeability, tensile test, and degradation. In addition, direct and indirect 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays were used to identify the cell viability of fibroblasts, fluorescence assays were performed to establish morphological changes of the cell nuclei, and the hemolytic effect of the scaffolds was calculated. Results showed that ethanol-treated biocompositescaffolds exhibited mass losses lower than 6.65% and slow wettability and absorption, resulting from an increase in secondary structures that contribute to the crystalline phase of H-Col. The scaffolds demonstrated stable degradation in saline during the incubation period because of the availability of soluble structures in aqueous media, and the inclusion of H-Col increased the elastic properties of the scaffold. As regards hemocompatibility, the scaffolds had hemolysis levels lower than 1%; moreover, in terms of biocompatible characteristics, scaffolds exhibited good adhesion, proliferation, and cell viability and insignificant changes in the circularity of the cell nuclei. However, scaffolds with homogeneous fibers showed cell agglomerates after 48 h of interaction. By contrast, permeability decreased as the incubation period progressed, because of the cellularization of the three-dimensional structure. In conclusion, multiscale scaffolds could exhibit a suitable behavior as a bioactive small-diameter vascular implant.

Development of endomyocardial fibrosis model using a cell patterning technique: In vitro interaction of cell coculture of 3T3 fibroblasts and RL-14 cardiomyocytes.

Cardiac functions can be altered by changes in the microstructure of the heart, i.e., remodeling of the cardiac tissue, which may activate pathologies such as hypertrophy, dilation, or cardiac fibrosis. Cardiac fibrosis can develop due to an excessive deposition of extracellular matrix proteins, which are products of the activation of fibroblasts. In this context, the anatomical-histological change may interfere with the functioning of the cardiac tissue, which requires specialized cells for its operation. The purpose of the present study was to determine the cellular interactions and morphological changes in cocultures of 3T3 fibroblasts and RL-14 cardiomyocytes via the generation of a platform an in vitro model. For this purpose, a platform emulating the biological characteristics of endomyocardial fibrosis was generated using a cell patterning technique to study morphological cellular changes in compact and irregular patterns of fibrosis. It was found that cellular patterns emulating the geometrical distributions of endomyocardial fibrosis generated morphological changes after interaction of the RL-14 cardiomyocytes with the 3T3 fibroblasts. Through this study, it was possible to evaluate biological characteristics such as cell proliferation, adhesion, and spatial distribution, which are directly related to the type of emulated endomyocardial fibrosis. This research concluded that fibroblasts inhibited the proliferation of cardiomyocytes via their interaction with specific microarchitectures. This behavior is consistent with the histopathological distribution of cardiac fibrosis; therefore, the platform developed in this research could be useful for the in vitro assessment of cellular microdomains. This would allow for the experimental determination of interactions with drugs, substrates, or biomaterials within the engineering of cardiac tissues.

Development and evaluation of anisotropic and nonlinear aortic models made from clinical images for in vitro experimentation.

In this work we developed a methodology to manufacture a new type of arterial model that could be used in experimental setting instead of excised arteries while developing new imaging modalities. CT-images of the descending aorta were used to create molds with patient specific morphology. A polyvinyl alcohol (PVA) solution with a reinforcing cotton mesh was used to generate the models. The mesh is circumferentially elastic while non-compliant longitudinally and is responsible for the non-linear anisotropic mechanical behavior of the models. Two models were fabricated following the same manufacturing procedure. Their circumferential and longitudinal mechanical properties were evaluated and compared to those of excised healthy pig aortas via tensile testing. A very good agreement was found for the circumferential direction, while the longitudinal direction showed to have a more marked anisotropic behavior compared to the excise arteries. An increase from 113 kPa at 2.5% strain, to 914 kPa at 40% strain was obtained for the models, while the arteries showed an increase from 172 kPa at 2.5% strain to 922 kPa at 38% strain. Furthermore, by plugging the models into a cardiovascular simulator their mechanical response in a more realistic setting was evaluated under static and dynamic pressure conditions by using shear wave elastography (SWE). Static and dynamic experiments showed an increase in the shear modulus as a function of pressure from 61 kPa to 263 kPa, between 20 mmHg and 150 mmHg for Model 1 (similar values within 10% were obtained for Model 2). These values are in good agreement with those reported in the literature for healthy human arteries. To our knowledge the models presented in this study are the first morphologically realistic phantoms that have demonstrated nonlinear and anisotropic elastic behaviors close to those of healthy arteries.

Electroanatomical mapping based on discrimination of electrograms clusters for localization of critical sites in atrial fibrillation.

Locating critical sites on the atrial surface during AF to guide the ablation procedures is an open problem. Electrogram-guided approaches have been proposed. However, electrograms (EGM) are complex and not well-described type of signals and anatomically-based pulmonary vein isolation remains been recommended as the cornerstone procedure. We introduce a method that builds an electroanatomical map to visualize the distribution of different morphological patterns of the EGM signals over the atrial surface. The proposed scheme uses EGM signals recorded with a commercial cardiac mapping. Likewise, two morphological and two non-linear features are computed from each single EGM. Patterns are discriminated using a semi-supervised clustering approach that does not need a priory definition of EGM morphologies or classes. The method was tested under two scenarios: a set of EGM signals recorded in AF patients and a set of signals obtained from 2D simulations of atrial conduction sustained by rotors. Our method was able to locate the clusters in a map of the atrial surface of each patient. These locations allow the specialist to study the distribution of critical AF sites. The method was able to locate the pivot point of the rotors in the 2D models. Our results suggest that the proposed method is a potential assisting tool for guided ablation procedures. Further clinical studies are needed to establish the relationship between clusters and arrhythmogenic substrates in AF, and to validate the usefulness of the method to locate critical conduction sites in patients.

Propuesta de modelo de trauma vascular mediante la caracterización mecánica de prótesis endovasculares (stents) a través del análisis estructural con técnicas FEA / Proposed model of vascular trauma by mean of mechanical characterization of endovascular prostheses (stents) based on structural analysis by FEA

Resumen Objetivo Tras las evidencias acumuladas mediante el uso de técnicas de angioplastia con stents, surge la polémica sobre los factores que inciden en la respuesta final, ya que hay estudios que reportan reestenosis de la luz en el 30-40% alrededor de 6 meses luego de ser implantados, vinculándose como una de las causas al diseño del dispositivo. Este artículo propone la caracterización funcional de stents endovasculares, analizando su influencia mecánica en el sistema vascular y prediciendo los factores de trauma implícitos en el lecho de los vasos. Métodos Utilizando modelos computacionales de prótesis endovasculares tipo stents, mediante técnicas Finite Elements Analysis, se procedió al análisis estructural de dichos dispositivos con el fin de predecir el comportamiento mecánico y el trauma vascular. Para ello, las prótesis fueron consideradas estructuras tubulares compuestas por múltiples eslabones que están sometidos a cargas de presión, que se reflejan como concentradores de esfuerzos. Resultados El estudio permitió visualizar cómo se ajusta la geometría del stent a las diferentes cargas, obteniéndose una aproximación a la respuesta de interacción "sólido-sólido" entre el stent y la pared arterial. Así, se caracterizó el patrón de esfuerzos y se planteó un modelo conceptual que explica su incidencia mecánica en la interacción stent-vaso, para inferir en la funcionalidad del diseño del dispositivo. Conclusiones El modelo conceptual planteado permite determinar la relación entre las condiciones de interacción mecánicas del stent, y advierte sobre los efectos en lo que sería la operación del dispositivo en el ambiente vascular.

Abstract Objective The accumulated evidence on angioplasty techniques with stents has raised a controversy about the factors that influence the final vascular response. Indeed, several studies have shown there might be re-stenosis between 30% to 40% about 6 months after placement, relating to the design of the device as one of the main causes. This paper proposes the functional characterization of endovascular stents, analyzing its mechanical influence in the vascular system and predicting implicit traumatic factors in the vessel. Methods A structural analysis was made for several computational models of endovascular stents using Finite Element Analysis in order to predict the mechanical behavior and the vascular trauma. In this way, the stents were considered as tubular devices composed of multiple links under radial pressure loads, reflecting stress concentration effects. Results The analysis allowed to visualize how the geometry of stents is adjusted under several load conditions, in order to obtain the response of "solid-solid" interaction between the stent and the arterial wall. Thus, an analysis was performed in order to calculate stress, and a conceptual model that explains its mechanical impact on the stent-vessel interaction, was raised, to infer on the functionality from the design of the devices. Conclusions The proposed conceptual model allows to determine the relationship between the conditions of mechanical interaction of the stents, and warns about the effects in what would be the operation of the device on the vascular environment.

Segmentation and additive approach: A reliable technique to study noncovalent interactions of large molecules at the surface of single-wall carbon nanotubes.

This investigation explores a new protocol, named Segmentation and Additive approach (SAA), to study exohedral noncovalent functionalization of single-walled carbon nanotubes with large molecules, such as polymers and biomolecules, by segmenting the entire system into smaller units to reduce computational cost. A key criterion of the segmentation process is the preservation of the molecular structure responsible for stabilization of the entire system in smaller segments. Noncovalent interaction of linoleic acid (LA, C18 H32 O2 ), a fatty acid, at the surface of a (10,0) zigzag nanotube is considered for test purposes. Three smaller segmented models have been created from the full (10,0)-LA system and interaction energies were calculated for these models and compared with the full system at different levels of theory, namely ωB97XD, LDA. The success of this SAA is confirmed as the sum of the interaction energies is in very good agreement with the total interaction energy. Besides reducing computational cost, another merit of SAA is an estimation of the contributions from different sections of the large system to the total interaction energy which can be studied in-depth using a higher level of theory to estimate several properties of each segment. On the negative side, bulk properties, such as HOMO-LUMO (highest occupied molecular orbital - lowest occupied molecular orbital) gap, of the entire system cannot be estimated by adding results from segment models. © 2016 Wiley Periodicals, Inc.

[Proposed model of vascular trauma by mean of mechanical characterization of endovascular prostheses (stents) based on structural analysis by FEA]. / Propuesta de modelo de trauma vascular mediante la caracterización mecánica de prótesis endovasculares (stents) a través del análisis estructural con técnicas FEA.

OBJECTIVE: The accumulated evidence on angioplasty techniques with stents has raised a controversy about the factors that influence the final vascular response. Indeed, several studies have shown there might be re-stenosis between 30% to 40% about 6 months after placement, relating to the design of the device as one of the main causes. This paper proposes the functional characterization of endovascular stents, analyzing its mechanical influence in the vascular system and predicting implicit traumatic factors in the vessel. METHODS: A structural analysis was made for several computational models of endovascular stents using Finite Element Analysis in order to predict the mechanical behavior and the vascular trauma. In this way, the stents were considered as tubular devices composed of multiple links under radial pressure loads, reflecting stress concentration effects. RESULTS: The analysis allowed to visualize how the geometry of stents is adjusted under several load conditions, in order to obtain the response of "solid-solid" interaction between the stent and the arterial wall. Thus, an analysis was performed in order to calculate stress, and a conceptual model that explains its mechanical impact on the stent-vessel interaction, was raised, to infer on the functionality from the design of the devices. CONCLUSIONS: The proposed conceptual model allows to determine the relationship between the conditions of mechanical interaction of the stents, and warns about the effects in what would be the operation of the device on the vascular environment.

Semi-supervised clustering of fractionated electrograms for electroanatomical atrial mapping.

BACKGROUND: Electrogram-guided ablation procedures have been proposed as an alternative strategy consisting of either mapping and ablating focal sources or targeting complex fractionated electrograms in atrial fibrillation (AF). However, the incomplete understanding of the mechanism of AF makes difficult the decision of detecting the target sites. To date, feature extraction from electrograms is carried out mostly based on the time-domain morphology analysis and non-linear features. However, their combination has been reported to achieve better performance. Besides, most of the inferring approaches applied for identifying the levels of fractionation are supervised, which lack of an objective description of fractionation. This aspect complicates their application on EGM-guided ablation procedures. METHODS: This work proposes a semi-supervised clustering method of four levels of fractionation. In particular, we make use of the spectral clustering that groups a set of widely used features extracted from atrial electrograms. We also introduce a new atrial-deflection-based feature to quantify the fractionated activity. Further, based on the sequential forward selection, we find the optimal subset that provides the highest performance in terms of the cluster validation. The method is tested on external validation of a labeled database. The generalization ability of the proposed training approach is tested to aid semi-supervised learning on unlabeled dataset associated with anatomical information recorded from three patients. RESULTS: A joint set of four extracted features, based on two time-domain morphology analysis and two non-linear dynamics, are selected. To discriminate between four considered levels of fractionation, validation on a labeled database performs a suitable accuracy (77.6 %). Results show a congruence value of internal validation index among tested patients that is enough to reconstruct the patterns over the atria to located critical sites with the benefit of avoiding previous manual classification of AF types. CONCLUSIONS: To the best knowledge of the authors, this is the first work reporting semi-supervised clustering for distinguishing patterns in fractionated electrograms. The proposed methodology provides high performance for the detection of unknown patterns associated with critical EGM morphologies. Particularly, obtained results of semi-supervised training show the advantage of demanding fewer labeled data and less training time without significantly compromising accuracy. This paper introduces a new method, providing an objective scheme that enables electro-physiologist to recognize the diverse EGM morphologies reliably.

Effect of the electrograms density in detecting and ablating the tip of the rotor during chronic atrial fibrillation: an in silico study.

AIMS: Identification in situ of arrhythmogenic mechanisms could improve the rate of ablation success in atrial fibrillation (AF). Our research group reported that rotors could be located through dynamic approximate entropy (DApEn) maps. However, it is unknown how much the spatial resolution of catheter electrodes could affect substrates localization. The present work looked for assessing the electrograms (EGMs) spatial resolution needed to locate the rotor tip using DApEn maps. METHODS AND RESULTS: A stable rotor in a two-dimensional computational model of human atrial tissue was simulated using the Courtemanche electrophysiological model and implementing chronic AF features. The spatial resolution is 0.4 mm (150 × 150 EGM). Six different lower resolution arrays were obtained from the initial mesh. For each array, DApEn maps were constructed using the inverse distance weighting (IDW) algorithm. Three simple ablation patterns were applied. The full DApEn map detected the rotor tip and was able to follow the small meander of the tip through the shape of the area containing the tip. Inverse distance weighting was able to reconstruct DApEn maps after applying different spatial resolutions. These results show that spatial resolutions from 0.4 to 4 mm accurately detect the rotor tip position. An ablation line terminates the rotor only if it crosses the tip and ends at a tissue boundary. CONCLUSION: A previous work has shown that DApEn maps successfully detected simulated rotor tips using a high spatial resolution. In this work, it was evinced that DApEn maps could be applied using a spatial resolution similar to that available in commercial catheters, by adding an interpolation stage. This is the first step to translate this tool into medical practice with a view to the detection of ablation targets.

Dynamic approximate entropy electroanatomic maps detect rotors in a simulated atrial fibrillation model.

There is evidence that rotors could be drivers that maintain atrial fibrillation. Complex fractionated atrial electrograms have been located in rotor tip areas. However, the concept of electrogram fractionation, defined using time intervals, is still controversial as a tool for locating target sites for ablation. We hypothesize that the fractionation phenomenon is better described using non-linear dynamic measures, such as approximate entropy, and that this tool could be used for locating the rotor tip. The aim of this work has been to determine the relationship between approximate entropy and fractionated electrograms, and to develop a new tool for rotor mapping based on fractionation levels. Two episodes of chronic atrial fibrillation were simulated in a 3D human atrial model, in which rotors were observed. Dynamic approximate entropy maps were calculated using unipolar electrogram signals generated over the whole surface of the 3D atrial model. In addition, we optimized the approximate entropy calculation using two real multi-center databases of fractionated electrogram signals, labeled in 4 levels of fractionation. We found that the values of approximate entropy and the levels of fractionation are positively correlated. This allows the dynamic approximate entropy maps to localize the tips from stable and meandering rotors. Furthermore, we assessed the optimized approximate entropy using bipolar electrograms generated over a vicinity enclosing a rotor, achieving rotor detection. Our results suggest that high approximate entropy values are able to detect a high level of fractionation and to locate rotor tips in simulated atrial fibrillation episodes. We suggest that dynamic approximate entropy maps could become a tool for atrial fibrillation rotor mapping.

IDENTIFICACIÓN DE ZONAS SUSCEPTIBLES DE ABLACIÓN EN FIBRILACIÓN AURICULAR PERMANENTE IMPLEMENTANDO ENTROPÍA APROXIMADA EN UN MODELO 2D / IDENTIFICATION OF TARGET SITES FOR ABLATION DURING PERMANENT ATRIAL FIBRILLATION IMPLEMENTING APPROXIMATE ENTROPY IN A 2D MODEL / IDENTIFICAÇÃO DE ÁREAS SUSCETÍVEIS DE ABLAÇÃO PERMANENTE DE FIBRILAÇÃO ATRIAL NA IMPLEMENTAÇÃO ENTROPY APROXIMADO UM MODELO 2D

La fibrilación auricular (FA) es la arritmia cardiaca más común. La ablación con catéter se ha convertido en la principal estrategia terapéutica para el tratamiento de la FA paroxística, sin embargo, los resultados en FA permanente no son completamente satisfactorios. Se propone la ablación de los electrogramas auriculares complejos fragmentados (CFAE) para la terminación de un rotor como mecanismo de mantenimiento de FA permanente. El objetivo de este trabajo es caracterizar los CFAE mediante la implementación de entropía aproximada (ApEn) y correlacionarlos con el tip de un rotor simulado. Para esto, se desarrolló un modelo 2D de tejido de aurícula humana bajo condiciones de FA permanente; se registraron electrogramas unipolares durante la actividad del rotor y se desarrolló un algoritmo para la medida de ApEn. La ApEn permitió localizar los CFAE con una alta precisión y relacionarlos con el tip del rotor. Por lo que este índice podría ser muy eficaz en la identificación de zonas susceptibles de ablación.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Catheter ablation has become the main therapeutic strategy for the treatment of paroxysmal AF, however, results in permanent AF are not completely satisfactory. Ablation of complex fractionated atrial electrograms (CFAE) is proposed for the termination of a rotor as mechanism of permanent AF maintenance. The aim of this work is to characterize the CFAE by implementing approximate entropy (ApEn) and to correlate with the tip of a simulated rotor. For this, a 2D model of human atrial tissue under permanent FA conditions was developed. Unipolar electrograms were recorded during the rotor activity and an algorithm to measure ApEn was developed. The ApEn allowed locate the CFAE with high precision and relate them to the tip of the rotor. So this index could be very effective in identifying target sites for ablation.

A fibrilação atrial (FA) é a arritmia cardíaca mais comum. A ablação por cateter tornou-se a principal estratégia terapêutica para o tratamento da fibrilação atrial paroxística, no entanto, resulta em FA permanente não são completamente satisfatórios. Ablação de fones de ouvido eletrocardiogramas complexos fragmentada (CFAE) para a conclusão de um rotor como um mecanismo de manutenção da FA permanente, é proposto. O objetivo deste trabalho é caracterizar o CFAE através da implementação de entropia aproximada (ApEn) e correlacioná-los com a ponta de um rotor simulado. Para isso, um modelo em 2D do tecido atrial humano sob condições de FA permanente desenvolvido; unipolares electrogramas foram registados durante a actividade do rotor e um algoritmo para medir ApEn desenvolvido. O ApEn permitido CFAE localizar com precisão elevada e relacioná-los com a ponta do rotor. Portanto, esta taxa pode ser muito eficaz na identificação de áreas suscetíveis a ablação.

Redes neuronales: aplicación de una herramienta computacional en Cardiología clínica / Neural networks: Application of a computer tool in Clinical cardiology

Si inicialmente las ciencias computacionales y los programas informáticos se introdujeron en la práctica médica solo en procedimientos básicos que incluían recolección de datos y abordajes estadísticos, de donde de la disciplina computacional solo se especulaban nuevos roles de interacción entre las ciencias técnicas y médicas, es ya un hecho que estas herramientas vienen a establecer un lazo directo con la práctica clínica, en un esquema que se centra en obtener la mayor certeza para el tratamiento correcto del paciente. Entre múltiples técnicas computacionales usadas para la valoración e intervención de estados fisiológicos y patológicos, como «wavelet transform¼, «fuzzy logic¼, «approximate entropy¼, «artificial intelligence¼ y «model-based clustering¼, las redes neuronales artificiales nacen con la expectativa de obtener un diagnóstico más preciso y oportuno, ante el incremento en la capacidad de cálculo y la utilización de datos mediante máquinas y software más robustos, que ubican al profesional de la salud frente a nuevos espacios entre la clínica y la técnica, así como entre la medicina y la enfermedad. La clínica cardiológica plantea escenarios complejos que pueden ser vistos a la luz de estas nuevas herramientas, imponiendo a los cardiólogos el reto de ingresar en otros campos del saber, cubriendo tanto áreas de las ciencias básicas como de las ciencias aplicadas, siendo este el caso de las técnicas computacionales y las redes neuronales1. La enfermedad coronaria es la patología que conlleva mayor morbimortalidad e impacto en la salud pública mundial, de ahí que su adecuado diagnóstico y tratamiento se convierta en un objetivo de primera línea para las nuevas técnicas aplicadas al sector clínico. Las multivariables a considerar en dicha patología, hacen complejo discernir entre los diversos estadios a evaluar y entre las variadas opciones terapéuticas a seguir. Por esto técnicas como las redes neuronales pueden facilitar la interpretación de distintas rutas para su manejo.

SISTEMA DE TOCOCARDIOGRAFÍA DIGITAL CON PROCESAMIENTO EN UNA FPGA PARA EL MONITOREO MATERNO-FETAL / DIGITAL CARDIOTOCHOGRAPHY SYSTEM WITH PARALLEL FPGA PROCESSING FOR MATERNAL FETAL MONITORING / SISTEMA DE TOCOCARDIOGRAFÍA DIGITAL COM PROCESSAMENTO EM UM FPGA PARA MONITORAMENTO MATERNO-FETAL

El estudio clínico fetal relaciona aspectos críticos como la intensidad de las contracciones uterinas, movimientos del feto y frecuencia cardiaca de manera simultánea para evaluar el bienestar fetal. Los cambios periódicos o transitorios de la frecuencia cardiaca son objeto de estudio y aparecen en relación a diversos estímulos fetales como movimientos espontáneos o provocados, contracciones uterinas, hipo fetal, etc. Con este propósito, en una valoración de los mismos es necesario disponer de una constante monitorización, en la que se exprese la frecuencia y la variabilidad cardiaca fetal de manera eficiente. En este artículo se presenta el desarrollo de un sistema de tococardiografía para el registro de la frecuencia cardiaca fetal y la intensidad de las contracciones uterinas compuesto por tres tarjetas electrónicas, una unidad de procesamiento digital paralela, una campana acústica y una pantalla para adquirir y procesar de manera no invasiva las señales tococardiográficas.

Clinical evaluation on fetuses is related to simultaneous critical aspects such as intensity of uterine contractions, fetal movements, and heart rate. Periodic or transient changes in heart rate are studied and appear in relation to various fetal stimuli as spontaneous or induced movements, uterine contractions, fetal hiccups, and so on. Thus, their evaluation is necessary to obtain constant monitoring in which the frequency and variability are expressed efficiently. This paper presents the development of a cardiotochography system for recording fetal heart rate and intensity of uterine contractions, which is composed by three electronic boards, a digital parallel processing unit, a sounds bell and a screen to acquire non-invasively and process tococardiography’s signals.

O estudo clinico fetal relaciona aspectos críticos, como a intensidade das contrações uterinas, movimentos fetais e batimentos cardíacos simultaneamente para avaliar o bem-estar fetal. As mudanças periódicas ou transitórias da frequência cardíaca são estudados e aparecem em relação a vários movimentos fetais espontâneas ou induzidas, as contrações uterinas, soluços fetais, etc. Para este efeito, em uma revisão do mesmo é necessário ter monitoramento constante, na que se exprese a freqüência e variabilidade do ritmo cardíaco fetal de forma eficiente. Este artigo é apresentado o desenvolvimento de um sistema de tococardiografía para registar o ritmo cardíaco fetal e intensidade das contrações uterinas composto por três placas eletrônicas, uma unidade de processamento digital paralelo, uma cabine acústica e uma tela para adquirir e processar de maneira não invasiva as sinais tococardiográficas.