Discrepancy Between LGE-MRI and Electro-Anatomical Mapping for Regional Detection of Pathological Atrial Substrate

Atrial fibrillation (AF) is the most common sustained arrhythmia posing a significant burden to patients and leading to an increased risk of stroke and heart failure. Additional ablation of areas of arrhythmogenic substrate in the atrial body detected by either late gadolinium enhancement magnetic resonance imaging (LGE-MRI) or electroanatomical mapping (EAM) may increase the success rate of restoring and maintaining sinus rhythm compared to the standard treatment procedure of pulmonary vein isolation (PVI). To evaluate if LGE-MRI and EAM identify equivalent substrate as potential ablation targets, we divided the left atrium (LA) into six clinically important regions in ten patients. Then, we computed the correlation between both modalities by analyzing the regional extents of identified pathological tissue. In this regional analysis, we observed no correlation between late gadolinium enhancement (LGE) and low voltage areas (LVA), neither in any region nor with regard to the entire atrial surface (-0.3<r<0.3). Instead, the regional extents identified as pathological tissue varied significantly between both modalities. An increased extent of LVA compared to LGE was observed in the septal wall of the LA ($\tilde{a}_{sept}.,_{LVA}$= 19.63% and $\tilde{a}_{sept.,LGE}$= 3.94%, with = median of the extent of pathological tissue in the corresponding region). In contrast, in the inferior and lateral wall, the extent of LGE was higher than the extent of LVA for most geometries ($\tilde{a}_{inf.,LGE}$= 27.22% and $\tilde{a}_{lat.,LGE}$= 32.70% compared to $\tilde{a}_{inf.,LVA}$= 9.21% and $\tilde{a}_{lat.,LVA}$= 6.69%). Since both modalities provided discrepant results regarding the detection of arrhythmogenic substrate using clinically established thresholds, further investigations regarding their constraints need to be performed in order to use these modalities for patient stratification and treatment planning

Scar-Related Ventricular Arrhythmia Prediction from Imaging Using Explainable Deep Learning

International audienceThe aim of this study is to create an automatic frameworkfor sustained ventricular arrhythmia (VA) prediction using cardiac com-puted tomography (CT) images. We built an image processing pipelineand a deep learning network to explore the relation between post-infarctleft ventricular myocardium thickness and previous occurrence of VA.Our pipeline generated a 2D myocardium thickness map (TM) from the3D imaging input. Our network consisted of a conditional variationalautoencoder (CVAE) and a classifier model. The CVAE was used tocompress the TM into a low dimensional latent space, then the classifierutilised the latent variables to predict between healthy and VA patient.We studied the network on a large clinical database of 504 healthy and182 VA patients. Using our method, we achieved a mean classificationaccuracy of 75%±4 on the testing dataset, compared to 71%±4 from theclassification using the classical left ventricular ejection fraction (LVEF)

Multi-modality cardiac image computing: a survey

Multi-modality cardiac imaging plays a key role in the management of patients with cardiovascular diseases. It allows a combination of complementary anatomical, morphological and functional information, increases diagnosis accuracy, and improves the efficacy of cardiovascular interventions and clinical outcomes. Fully-automated processing and quantitative analysis of multi-modality cardiac images could have a direct impact on clinical research and evidence-based patient management. However, these require overcoming significant challenges including inter-modality misalignment and finding optimal methods to integrate information from different modalities. This paper aims to provide a comprehensive review of multi-modality imaging in cardiology, the computing methods, the validation strategies, the related clinical workflows and future perspectives. For the computing methodologies, we have a favored focus on the three tasks, i.e., registration, fusion and segmentation, which generally involve multi-modality imaging data, either combining information from different modalities or transferring information across modalities. The review highlights that multi-modality cardiac imaging data has the potential of wide applicability in the clinic, such as trans-aortic valve implantation guidance, myocardial viability assessment, and catheter ablation therapy and its patient selection. Nevertheless, many challenges remain unsolved, such as missing modality, modality selection, combination of imaging and non-imaging data, and uniform analysis and representation of different modalities. There is also work to do in defining how the well-developed techniques fit in clinical workflows and how much additional and relevant information they introduce. These problems are likely to continue to be an active field of research and the questions to be answered in the future

Nonlinear physics of electrical wave propagation in the heart: a review

The beating of the heart is a synchronized contraction of muscle cells (myocytes) that are triggered by a periodic sequence of electrical waves (action potentials) originating in the sino-atrial node and propagating over the atria and the ventricles. Cardiac arrhythmias like atrial and ventricular fibrillation (AF,VF) or ventricular tachycardia (VT) are caused by disruptions and instabilities of these electrical excitations, that lead to the emergence of rotating waves (VT) and turbulent wave patterns (AF,VF). Numerous simulation and experimental studies during the last 20 years have addressed these topics. In this review we focus on the nonlinear dynamics of wave propagation in the heart with an emphasis on the theory of pulses, spirals and scroll waves and their instabilities in excitable media and their application to cardiac modeling. After an introduction into electrophysiological models for action potential propagation, the modeling and analysis of spatiotemporal alternans, spiral and scroll meandering, spiral breakup and scroll wave instabilities like negative line tension and sproing are reviewed in depth and discussed with emphasis on their impact in cardiac arrhythmias.Peer ReviewedPreprin

Ultrasound Imaging

This book provides an overview of ultrafast ultrasound imaging, 3D high-quality ultrasonic imaging, correction of phase aberrations in medical ultrasound images, etc. Several interesting medical and clinical applications areas are also discussed in the book, like the use of three dimensional ultrasound imaging in evaluation of Asherman's syndrome, the role of 3D ultrasound in assessment of endometrial receptivity and follicular vascularity to predict the quality oocyte, ultrasound imaging in vascular diseases and the fetal palate, clinical application of ultrasound molecular imaging, Doppler abdominal ultrasound in small animals and so on

The benefits of an additional practice in descriptive geomerty course: non obligatory workshop at the Faculty of Civil Engineering in Belgrade

At the Faculty of Civil Engineering in Belgrade, in the Descriptive geometry (DG) course, non-obligatory workshops named “facultative task” are held for the three generations of freshman students with the aim to give students the opportunity to get higher final grade on the exam. The content of this workshop was a creative task, performed by a group of three students, offering free choice of a topic, i.e. the geometric structure associated with some real or imagery architectural/art-work object. After the workshops a questionnaire (composed by the professors at the course) is given to the students, in order to get their response on teaching/learning materials for the DG course and the workshop. During the workshop students performed one of the common tests for testing spatial abilities, named “paper folding". Based on the results of the questionnairethe investigation of the linkages between:students’ final achievements and spatial abilities, as well as students’ expectations of their performance on the exam, and how the students’ capacity to correctly estimate their grades were associated with expected and final grades, is provided. The goal was to give an evidence that a creative work, performed by a small group of students and self-assessment of their performances are a good way of helping students to maintain motivation and to accomplish their achievement. The final conclusion is addressed to the benefits of additional workshops employment in the course, which confirmhigherfinal scores-grades, achievement of creative results (facultative tasks) and confirmation of DG knowledge adaption

The contemporary visualization and modelling technologies and the techniques for the design of the green roofs

The contemporary design solutions are merging the boundaries between real and virtual world. The Landscape architecture like the other interdisciplinary field stepped in a contemporary technologies area focused on that, beside the good execution of works, designer solutions has to be more realistic and “touchable”. The opportunities provided by Virtual Reality are certainly not negligible, it is common knowledge that the designs in the world are already presented in this way so the Virtual Reality increasingly used. Following the example of the application of virtual reality in landscape architecture, this paper deals with proposals for the use of virtual reality in landscape architecture so that designers, clients and users would have a virtual sense of scope e.g. rooftop garden, urban areas, parks, roads, etc. It is a programming language that creates a series of images creating a whole, so certain parts can be controlled or even modified in VR. Virtual reality today requires a specific gadget, such as Occulus, HTC Vive, Samsung Gear VR and similar. The aim of this paper is to acquire new theoretical and practical knowledge in the interdisciplinary field of virtual reality, the ability to display using virtual reality methods, and to present through a brief overview the plant species used in the design and construction of an intensive roof garden in a Mediterranean climate, the basic characteristics of roofing gardens as well as the benefits they carry. Virtual and augmented reality as technology is a very powerful tool for landscape architects, when modeling roof gardens, parks, and urban areas. One of the most popular technologies used by landscape architects is Google Tilt Brush, which enables fast modeling. The Google Tilt Brush VR app allows modeling in three-dimensional virtual space using a palette to work with the use of a three dimensional brush. The terms of two "programmed" realities - virtual reality and augmented reality - are often confused. One thing they have in common, though, is VRML - Virtual Reality Modeling Language. In this paper are shown the ways on which this issue can be solved and by the way, get closer the term of Virtual Reality (VR), also all the opportunities which the Virtual reality offered us. As well, in this paper are shown the conditions of Mediterranean climate, the conceptual solution and the plant species which will be used by execution of intensive green roof on the motel “Marković”

Towards a solution of the closure problem for convective atmospheric boundary-layer turbulence

We consider the closure problem for turbulence in the dry convective atmospheric boundary layer (CBL). Transport in the CBL is carried by small scale eddies near the surface and large plumes in the well mixed middle part up to the inversion that separates the CBL from the stably stratified air above. An analytically tractable model based on a multivariate Delta-PDF approach is developed. It is an extension of the model of Gryanik and Hartmann [1] (GH02) that additionally includes a term for background turbulence. Thus an exact solution is derived and all higher order moments (HOMs) are explained by second order moments, correlation coefficients and the skewness. The solution provides a proof of the extended universality hypothesis of GH02 which is the refinement of the Millionshchikov hypothesis (quasi- normality of FOM). This refined hypothesis states that CBL turbulence can be considered as result of a linear interpolation between the Gaussian and the very skewed turbulence regimes. Although the extended universality hypothesis was confirmed by results of field measurements, LES and DNS simulations (see e.g. [2-4]), several questions remained unexplained. These are now answered by the new model including the reasons of the universality of the functional form of the HOMs, the significant scatter of the values of the coefficients and the source of the magic of the linear interpolation. Finally, the closures 61 predicted by the model are tested against measurements and LES data. Some of the other issues of CBL turbulence, e.g. familiar kurtosis-skewness relationships and relation of area coverage parameters of plumes (so called filling factors) with HOM will be discussed also

When Cardiac Biophysics Meets Groupwise Statistics: Complementary Modelling Approaches for Patient-Specific Medicine

This habilitation manuscript contains research on biophysical and statistical modeling of the heart, as well as interactions between these two approaches