Myocardial Motion Estimation: An Evaluation of Optical Flow Computation Techniques on Echocardiographic Images

The use of image processing technique for cardiac motion analysis has been an active research in the past decade. The estimation of myocardial motion eases the cardiologist in diagnosing cardiac abnormalities. In term of movement analysis, optical flow is the most popular technique that has been used by researchers. This paper describes the implementation and evaluation of three optical flow computation techniques to estimate the myocardial motion using echocardiographic images. The three techniquesare the global smoothness method (GSM), the local smoothness method (LSM) and warping technique (WT). Optical flow field is computed based on healthy cardiac video on parasternal short axes view. These techniques look promising since the optical flow fields can be utilized to estimate the myocardial movement and comply with its true movement. The performances of each technique in terms of the direction, homogeneity and computing time, are also discussed

Automatic selection of initial points for exploratory vessel tracing in fluoroscopic images

Automatic extraction of vessel centerlines has been an essential process in most of the image guided diagnosis and therapy applications. Among a considerable number of methods, direct exploratory tracing method is known to be an efficient solution for reliable extraction of vessel features from two-dimensional fluoroscopic images. The first step of most automatic exploratory tracing algorithms is collecting a number of candidate initial seed points and their initial tracing directions. To detect reliable initial points, a validation step is required to filter out the false candidates and avoid unnecessary tracing. Staring from reliable initial points, the algorithm efficiently extracts the centerline points along the initial direction until certain pre-defined criteria are satisfied. However, most of these algorithms suffer from incomplete results due to inappropriate selection of the initial seed points. The conventional seed point selection algorithms either rely merely on signal-to-noise ratio analysis, which results in a large number of false traces, or impose a set of strict geometrical validation rules that lead to more false negatives and require more computation time. This paper presents a new method for efficient selection of initial points for exploratory tracing algorithms. The proposed method improves the performance upon existing methods by employing a combination of geometrical and intensity-based approaches

Image quality of coronary CT angiography (CCTA) using 640-slice scanner: qualitative and quantitative assessments of coronary arteries visibility

The purpose of this study was to evaluate the image quality and diagnostic accuracy of coronary computed tomography angiography (CCTA) using 640-slice scanner. Advancement of multidetector computed tomography (MDCT) technology with higher spatial, temporal resolution, and increasing detector array have improved the image quality and diagnostic accuracy of CCTA. A total of 25 patients (12 men and 13 women) underwent CCTA was chosen and data was acquired by 640-slice scanner. All 16 segments of coronary arteries were evaluated by two reviewers using a 4-likert scale for qualitative assessment. In quantitative assessment, the evaluation of 4 main coronary arteries were analysed in terms of signal intensity (SI), image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). All 25 patients with a mean age of 52.88 ± 14.75 years old and body mass index (BMI) of 24.24 ± 3.28 kg/m2 were analysed. In qualitative assessment, from the total of 400 segments, 379 segments (95 %) have diagnostic value while 21 segments do not have diagnostic value, which means 5 % artefact was detected. In quantitative assessment, there was no statistical differences in gender, race, and BMI (p>0.05). Overall evaluation showed that higher SI at the left main artery (LM) at 393.7 ± 47.19. Image noise was higher at right coronary artery (RCA) at 39.01 ± 13.97. SNR and CNR showed higher at left anterior descending (LAD) with 12.73 ± 5.17 and LM 9.14 ± 4.2, respectively. In conclusion, this study indicates that 640-slice MDCT has higher diagnostic value in CCTA examination with 95 % vessel visibility with 5 % artefact detection

Effects of Swedish Massage Therapy on Blood Pressure, Heart Rate, and Inflammatory Markers in Hypertensive Women

Swedish Massage Therapy (SMT) is known for its therapeutic relaxation effects. Hypertension is associated with stress and elevated endothelial inflammatory markers. This randomized control trial measured the effects of whole body SMT (massage group) or resting (control group) an hour weekly for four weeks on hypertensive women. Blood pressure (BP) and heart rate (HR) were measured before and after each intervention and endothelial inflammatory markers: vascular endothelial adhesion molecules 1 (VCAM-1) and intracellular adhesion molecules 1 (ICAM-1) were measured at baseline and after the last intervention. Massage group (n=8) showed significant systolic BP (SBP) reduction of 12 mmHg (P=0.01) and diastolic BP (DBP) reduction of 5 mmHg (P=0.01) after four sessions with no significant difference between groups. Reductions in HR were also seen in massage group after sessions 1, 3, and 4 with significant difference between groups. VCAM-1 showed significant reduction after four sessions: the massage group showed reduction of 998.05 ng/mL (P=0.03) and the control group of 375.70 ng/mL (P=0.01) with no significant differences between groups. There were no changes in ICAM-1. In conclusion, SMT or resting an hour weekly has effects on reducing BP, HR, and VCAM-1 in hypertensive women

Implementation of emergency-based thrombolysis : an achievable option for rural hospitals in developing countries

Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. This is only effective when instituted within a small time window and pre-hospital delay is a major concern. In a region where the mean house-to-door times can be as long as 8.5 hours, there is an urgent need to reduce the door-to-needle times. Methods Emergency-based thrombolysis was initiated at Hospital Tengku Ampuan Afzan Kuantan, a 600-bed regional hospital in Malaysia. One hundred and thirty three patients with acute ST elevation myocardial infarction patients were screened. 39 patients were recruited in the 4 months prior to the implementation date and 94 patients were recruited after. The mean house-to-door, door-to-needle times were recorded. Results The majority of patients were male 88.7%, with a mean age of 56.4 � 10.3 years. The median presentation time (house-to-door) was 117.50 minutes before and 136.00 minutes after (p � 0.213, Mann- Whitney U) minutes. The median door-to-needle time was 100.00 minutes before and 50.00 minutes after (p � 0.031). The mortality rates were 12.8% before and 11.70% (p�0.87, Fisher exact test) after mplementation of Emergency-based thrombolysis. Conclusion Implementation of Emergency-based thrombolysis has markedly improved the door-to-needle times and resulted in a trend towards reduced mortality rates in acute ST-elevation myocardial infarction

Evaluation of anti-hypertensive drug utilisation and cost in Hospital Tengku Ampuan Afzan, Kuantan

Introduction: Hypertension is one of the most important risk factors for cardiovascular disease in Malaysia. The prevalence of hypertension nearly doubled over a ten-year period (1986 – 1996). This has resulted in a significant rise in its attendant cost. We aim to review the institutional anti-hypertensive use, the cost incurred and the implications on management in our local setting. Materials and Methods: A retrospective review of the annual cost (2006) of anti-hypertensive medications was undertaken at the Department of Pharmacy, Hospital Tengku Ampuan Afzan, a 600-bed major regional hospital on the east-coast of Malaysia. The total number of prescriptions given out and the total cost per drug is then factored to give the annual cost per drug per person in a percentage of the total annual expenditure. Results: The majority of patients were on either 2 (46.5%) or 3 (25.9%) anti-hypertensives. The most frequently prescribed medications were ACE Inhibitors (33.45%), Calcium channel blockers (29.63%), diuretics (16.67%) and β-blockers (13.64%). In terms of cost however, the Calcium channel blockers constituted the greatest percentage of the annual anti-hypertensive budget (63.67%) compared to ACE Inhibitors at just 20.04% of the annual expenditure. The least costly group of drugs is the diuretic making up 16.67% of the total annual prescriptions but only constituting 1.23% of the annual cost. Conclusion: The majority of patients were on ACE Inhibitors and/or Calcium channel blockers. This has huge monetary implications as they represent a large proportion of the annual antihypertensive allocation. There may be a need to reverse the trend in the developing world due to cost restrictions

Causes of in-hospital delay for door-to-needle times in patients presenting with acute ST-Elevation Myocardial Infarct in Rural Malaysia

Study Objective: Background: In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. The Malaysian Clinical Practice Guideline on acute ST-elevation myocardial infarction advised the implementation of a 30-minute door-to-needle time. This study aims to evaluate the mean door-to-needle times and the reasons for in-hospital delays. Methods: Ninety four patients with acute ST elevation myocardial infarction patients were screened and 75 patients were recruited in this prospective observational study. The mean door-to-needle times were recorded and the reasons for delays in door-to-needle times were elucidated. Results: The majority of patients were male (89.3%), of Malay ethnicity (84%), presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The mean door-to-needle time was 80.54 � 84.8 minutes. Only 20% achieved the 30- minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle time. The reasons for late thrombolysis were quoted as late referrals from A�E (50%), hypertensive emergency (22%), resuscitation (17%) and others (11%). Conclusion: There is significant in-hospital delay in administrating thrombolytic agents for patients presenting with acute ST-elevation myocardial infarction. Some of the delays were unavoidable (hypertensive emergency and hypotension or VT/VF requiring resuscitation) but the majority of the delay is due to late referrals from A�E to attending cardiology on-call officers

Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire

Objectives: Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient’s quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting. Methods: This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument’s construct validity. Cronbach’s alpha coefficients were used to determine internal consistency. Results: A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors—psychological, physical-social and spiritual wellbeing—resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450–0.718 for psychological wellbeing (12 items), 0.394–0.740 for physical-social wellbeing (14 items) and 0.449–0.727 for spiritual wellbeing (seven items). The overall Cronbach’s alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively. Conclusion: The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF. Keywords: Heart Failure; Quality of Life; Culturally Competent Care; Ethnic Groups; Questionnaire Design; Reliability and Validity; Malaysia

Compliance with the Malaysian National critical practice guidelines on the administration of thrombolytic agents in acute st-elevation myocardial infarction

Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. In 2001, the 1st Edition of the Malaysian Clinical Practice Guideline advised the door-to-needle time of 60 minutes. This has been revised in the 2nd Edition (2007) to 30 minutes. This study aims to evaluate the mean door-to-needle times following the implementation of Emergency Department-based thrombolysis. Methods Accident and Emergency-based (A�E) thrombolysis was initiated at Hospital Tengku Ampuan Afzan Kuantan, Malaysia. Ninety four patients with acute ST elevation myocardial infarction patients were screened and 75 patients were recruited. The mean house-to-door, door-to-needle times were recorded. Results The majority of patients were male (89.3%), of Malay ethnicity (84%), presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The mean door-to-needle time was 80.54 � 84.8 minutes (116.46 � 109.00 minutes before the implementation). Only 20% achieved the 30-minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle time. The reasons for late thrombolysis were quoted as late referrals from A�E (50%), hypertensive emergency (22%), resuscitation (17%) and others (11%). Conclusion Implementation of Emergency-based thrombolysis has improved the door-to-needle times but more staff education and training is required due to the high rate ofblate A�E identification and late referrals