Non-invasive Detection and Compression of Fetal Electrocardiogram

Noninvasive detection of fetal electrocardiogram (FECG) from abdominal ECG recordings is highly dependent on typical statistical signal processing techniques such as independent component analysis (ICA), adaptive noise filtering, and multichannel blind deconvolution. In contrast to the previous multichannel FECG extraction methods, several recent schemes for single‐channel FECG extraction such as the extended Kalman filter (EKF), extended Kalman smoother (EKS), template subtraction (TS), and support vector regression (SVR) for detecting R waves on ECG, are evaluated via the quantitative metrics such as sensitivity (SE), positive predictive value (PPV), F‐score, detection error rate (DER), and range of accuracy. A correlation predictor that combines with multivariable gray model (GM) is also proposed for sequential ECG data compression, which displays better percent root mean-square difference (PRD) than those of Sabah’s scheme for fixed and predicted compression ratio (CR). Automatic calculation on fetal heart rate (FHR) on the reconstructed FECG from mixed signals of abdominal ECG recordings is also experimented with sample synthetic ECG data. Sample data on FHR and T/QRS for both physiological case and pathological case are simulated in a 10-min time sequence

Non-Invasive Assessment of Right Ventricular Function in Health and in Acute and Chronic Pulmonary Arterial Hypertension

This thesis investigates the utility of cardiac magnetic resonance imaging (CMR) to assess right ventricular function and dynamic right ventricular (RV) reserve, in health and in acute and chronic pulmonary hypertension. Right ventricular function is a strong predictor of prognosis, in patients with pulmonary arterial hypertension (PAH), but there are currently no available clinical tests that can predict which right ventricle is destined to fail, despite medical therapy. RV reserve, or the ability of the RV to augment during exercise, has recently gained more attention as a potential marker vascular-ventricular uncoupling, and CMR potentially offers a novel, accurate and reproducible method to assess this. Exercise CMR is in its developmental stages, and while several groups have used it in healthy volunteers and patients to study dynamic biventricular function, approaches have varied. We set out to develop a novel and robust exercise CMR methodology and demonstrate its accuracy and reproducibility. Furthermore, we aimed to show how timing of acquisition and respiratory variation, are important considerations, potentially affect key pathophysiological changes. In Chapter 3, we outline the developmental considerations and demonstrate intra-observer, inter-observer, inter-study and inter-test reproducibility. In Chapter 4, we show how the RV remodels after pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension, in a retrospective analysis of CMRs acquired before and after surgery. Importantly, we demonstrate how biventricular interactions, expressed as a composite measure of RV end diastolic volume to left ventricular (LV) end diastolic volume ratio, correlates with change in 6MWD, but parameters of each ventricular alone do not. Furthermore, we demonstrate a correlation between left atrial size and left ventricular end diastolic index, showing that under-filling is likely to be an important pathophysiological explanation of a reduction in LV size, in these patients. LV under-filling from increased RV pressure, and biventricular interactions, continue to remain key themes throughout the following experiments. While exercise CMR is a new technique, so is assessment of RV reserve and there are no normal values available. Furthermore, there is conflicting evidence in the literature, as to normal cardiovascular changes that occur during exercise in normal hearts. We demonstrate in Chapter 5 that an increase in RV forward flow is due to a decrease in RV end systolic volume and an increase in RV ejection fraction, leading to an increase in LV end diastolic volume. LV ejection fraction increases as a result of an increase in left ventricular end diastolic volume and a decrease in left ventricular end systolic volume. Understanding normal exercise physiology, during continuous steady state exercise, is key to interpreting pathophysiological changes. Acute normobaric hypoxia causes hypoxic pulmonary vasoconstriction and an increase in pulmonary vascular resistance and pulmonary pressures. It offers a model in which RV reserve in healthy controls can be studied. It has been hypothesised that the reduction in VO2 max in acute hypoxic exercise is a consequence of a reduction in RV forward flow, however this has never been definitively documented in an imaging study. We show, for the first time using exercise CMR in Chapter 6, that exercise during acute hypoxia leads to a reduction in RV forward flow, a blunting of the rise in RV ejection fraction and LV under-filling with a reduction in LV forward flow. We also show that there is a blunting of the rise in MPA average blood velocity on exercise during acute hypoxia, and hypothesise that this could be a novel CMR parameter to assess pulmonary vascular distensibility. Identifying patients whose RV will continue to fail despite medical therapy has remained elusive. We go on to demonstrate in Chapter 7 that our approach to exercise CMR is not only feasible in patients with pulmonary arterial hypertensoin, but that exercise in these patients, considered stable on medical therapy with normal resting RV ejection fraction, unmasks impaired right ventricular reserve. Furthermore, we demonstrate that there is heterogeneity of response that cannot be predicted by routine clinical tests and resting biventricular function. This information could potentially be clinically valuable, and we outline where this research will take us to next in Chapter 8, where we hope to demonstrate change in right ventricular reserve before and after medical therapy, in patients with inoperable chronic thromboembolic pulmonary hypertension, predicts long term clinical outcomes on follow up. Together, these studies demonstrate how CMR can accurately and non-invasively assess RV remodeling and RV reserve, its impact on the LV, and unmask right ventricular – vascular uncoupling which is otherwise not present at rest, in patients with acute and/or chronic pulmonary arterial hypertension

Coronary Angiography

In the intervening 10 years tremendous advances in the field of cardiac computed tomography have occurred. We now can legitimately claim that computed tomography angiography (CTA) of the coronary arteries is available. In the evaluation of patients with suspected coronary artery disease (CAD), many guidelines today consider CTA an alternative to stress testing. The use of CTA in primary prevention patients is more controversial in considering diagnostic test interpretation in populations with a low prevalence to disease. However the nuclear technique most frequently used by cardiologists is myocardial perfusion imaging (MPI). The combination of a nuclear camera with CTA allows for the attainment of coronary anatomic, cardiac function and MPI from one piece of equipment. PET/SPECT cameras can now assess perfusion, function, and metabolism. Assessing cardiac viability is now fairly routine with these enhancements to cardiac imaging. This issue is full of important information that every cardiologist needs to now

Analysis of Blood Flow in Patient-specific Models of Type B Aortic Dissection

Aortic dissection is the most common acute catastrophic event affecting the aorta. The majority of patients presenting with an uncomplicated type B dissection are treated medically, but 25% of these patients develop subsequent dilatation and aortic aneurysm formation. The reasons behind the long‐term outcomes of type B aortic dissection are poorly understood. As haemodynamic factors have been involved in the development and progression of a variety of cardiovascular diseases, the flow phenomena and environment in patient‐specific models of type B aortic dissection have been studied in this thesis by applying computational fluid dynamics (CFD) to in vivo data. The present study aims to gain more detailed knowledge of the links between morphology, flow characteristics and clinical outcomes in type B dissection patients. The thesis includes two parts of patient‐specific study: a multiple case cross‐sectional study and a single case longitudinal study. The multiple cases study involved a group of ten patients with classic type B aortic dissection with a focus on examining the flow characteristics as well as the role of morphological factors in determining the flow patterns and haemodynamic parameters. The single case study was based on a series of follow‐up scans of a patient who has a stable dissection, with an aim to identify the specified haemodynamic factors that are associated with the progression of aortic dissection. Both studies were carried out based on computed tomography images acquired from the patients. 4D Phase‐contrast magnetic resonance imaging was performed on a typical type B aortic dissection patient to provide detailed flow data for validation purpose. This was achieved by qualitative and quantitative comparisons of velocity‐encoded images with simulation results of the CFD model. The analysis of simulation results, including velocity, wall shear stress and turbulence intensity profiles, demonstrates certain correlations between the morphological features and haemodynamic factors, and also their effects on long‐term outcomes of type B aortic dissections. The simulation results were in good agreement with in vivo MR flow data in the patient‐specific validation case, giving credence to the application of the computational model to the study of flow conditions in aortic dissection. This study made an important contribution by identifying the role of certain morphological and haemodynamic factors in the development of type B aortic dissection, which may help provide a better guideline to assist surgeons in choosing optimal treatment protocol for individual patient

Magnetic resonance coronary vessel wall imaging with highly efficient respiratory motion correction

There is a need for a noninvasive imaging technique for use in longitudinal studies of sub-clinical coronary artery disease. Magnetic resonance (MR) can be used to selectively and non-invasively image the coronary wall without the use of ionising radiation. However, high-resolution 3D studies are often time consuming and unreliable, as data acquisition is generally gated to a small window of diaphragm positions around end-expiration which results in inherently poor and variable respiratory efficiency. This thesis describes the development and application of a novel technique (beat-to-beat respiratory motion correction (B2B-RMC)) for correcting respiratory motion in 3D spiral MR coronary imaging. This technique uses motion of the epicardial fat surrounding the artery as a surrogate for the motion of the artery itself and enables retrospective motion correction with respiratory efficiency close to 100%. This thesis first describes an assessment of the performance of B2B-RMC using a purpose built respiratory motion phantom with realistic coronary artery test objects. Subsequently, MR coronary angiography studies in healthy volunteers show that the respiratory efficiency of B2B-RMC far exceeds that of conventional navigator gating, yet the respiratory motion correction is equally effective. The performance and reproducibility of 3D spiral imaging with B2B-RMC for assessment of the coronary artery vessel wall is subsequently compared to that of commonly used 2D navigator gated techniques. The results demonstrate the high performance, reproducibility and reliability of 3D spiral imaging with B2B-RMC when data acquisition is gated to alternate cardiac cycles. Using this technique, a further in-vivo study demonstrates thickening of the coronary vessel wall with age in healthy subjects and these results are shown to be consistent with outward remodelling of the vessel wall. Finally, the performance of B2B-RMC in a variety of coronary vessel wall applications, including in a small cohort of patients with confirmed coronary artery disease, is presented

On the improved correlative prediction scheme for aliased electrocardiogram (ECG) data compression

An improved scheme for aliased electrocardiogram (ECG) data compression has been constructed, where the predictor exploits the correlative characteristics of adjacent QRS waveforms. The twin-R correlation prediction and lifting wavelet transform (LWT) for periodical ECG waves exhibits feasibility and high efficiency to achieve lower distortion rates with realizable compression ratio (CR); grey predictions via GM(1, 1) model have been adopted to evaluate the parametric performance for ECG data compression. Simulation results illuminate the validity of our approach.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Development of novel methods for obtaining robust dynamic susceptibility contrast magnetic resonance imaging biomarkers from diseased brain in children

Dynamic susceptibility contrast (DSC-) MRI is an important imaging technique from which estimates of perfusion measures including cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) can be calculated. These perfusion measures can be used to indicate health in a range of diseases. However, acquisition protocol varies from centre-to-centre, which leads to variability in data quality between centres and limits the clinical applicability of DSC-MRI. Currently, the recommended process for assessing data quality is by eye, which is very time consuming and subjective between reviewers. In this work an automated processing pipeline for DSC-MRI was produced. Work to develop the pipeline demonstrated that data quality of DSC-MRI data can be assessed using machine learning classifiers, which were trained using metrics calculated from the data and the results of qualitative review. It also showed that it was possible to denoise the data using singular value decomposition (SVD) based methods, which were validated on a simulator and confirmed in patient data. The pipeline created was applied to a multicentre patient dataset where it demonstrated the importance of denoising DSC-MRI data in improving data quality and how data quality can vary with acquisition protocol. It was also applied to a single centre study of patients receiving differing treatments for brain tumours and suggested there are no significant changes in relative CBV (rCBV) in non-tumour brain between differing treatment groups. The pipeline developed during this work has wider applications in other imaging modalities and could be adapted to be applied to other perfusion imaging methods, such as dynamic contrast enhanced (DCE-) MRI, or any other imaging modality that involves analysis of a signal variation with time, such as computed tomography (CT) perfusion imaging or positron emission tomography (PET)

Magnetic Resonance Imaging haemodynamic modelling in chronic liver disease: development, validation and translation

Though haemodynamic changes underpin the pathophysiology of chronic liver disease, there are currently no robust non-invasive methods available for their assessment. I propose ‘caval subtraction’ phase contrast MRI (PCMRI) a novel method to measure total liver blood flow (TLBF) and hepatic arterial (HA) flow using PCMRI measurements of caval and portal venous (PV) flow. I validate this method at 9.4T and 3.0T to demonstrate: agreement between preclinical PCMRI and invasive transit-time ultrasound (TTUS) and fluorescent microsphere measurements of flow parameters; good consistency between clinical caval subtraction PCMRI and independent direct PCMRI measurements; encouraging correlations between PCMRI and invasive ICG clearance in patients; and good seven-day reproducibility of PCMRI derived haemodynamic parameters in normal volunteers. Using dynamic contrast enhanced (DCE) MRI on a 3.0T system, I demonstrate improved seven-day reproducibility using dual input single compartment pharmacokinetic modelling with a novel method for obtaining physiological vascular input function delays, correction of arterial input functions using PCMRI aortic flow and use of PCMRI estimations of TLBF to correct DCE MRI quantification. I also implement arterial spin labelling (ASL) at 9.4T and demonstrate a tendency for ASL to underestimate PCMRI hepatic parenchymal perfusion. Using bile-duct ligated (BDL) rats to study cirrhosis, I demonstrate that these have reduced TLBF and HA fraction at baseline, impaired HA regulation and buffer response, cirrhotic cardiomyopathy, and a failure to match hepatic circulatory demands with increased liver:body mass ratio. Acute-on-chronic liver failure (simulated using endotoxaemia) demonstrates reductions in TLBF, HA flow, absence of normal sepsis-induced hepatic hyperaemia and blunted cardiac systolic response. Studies in cirrhotic patients demonstrate increased TLBF and HA flow in higher risk portal hypertensive patients; that HA flow, HA fraction and cardiac output are important correlative parameters with hepatic venous pressure gradient and that caval subtraction PCMRI has potential in evaluating treatments for portal hypertension

Six Decades of Flight Research: An Annotated Bibliography of Technical Publications of NASA Dryden Flight Research Center, 1946-2006

Titles, authors, report numbers, and abstracts are given for nearly 2900 unclassified and unrestricted technical reports and papers published from September 1946 to December 2006 by the NASA Dryden Flight Research Center and its predecessor organizations. These technical reports and papers describe and give the results of 60 years of flight research performed by the NACA and NASA, from the X-1 and other early X-airplanes, to the X-15, Space Shuttle, X-29 Forward Swept Wing, X-31, and X-43 aircraft. Some of the other research airplanes tested were the D-558, phase 1 and 2; M-2, HL-10 and X-24 lifting bodies; Digital Fly-By-Wire and Supercritical Wing F-8; XB-70; YF-12; AFTI F-111 TACT and MAW; F-15 HiDEC; F-18 High Alpha Research Vehicle, F-18 Systems Research Aircraft and the NASA Landing Systems Research aircraft. The citations of reports and papers are listed in chronological order, with author and aircraft indices. In addition, in the appendices, citations of 270 contractor reports, more than 200 UCLA Flight System Research Center reports, nearly 200 Tech Briefs, 30 Dryden Historical Publications, and over 30 videotapes are included