Delaunay triangulation based image enhancement for echocardiography images

A novel image enhancement approach for automatic echocardiography image processing is proposed. The main steps include undecimated wavelet based speckle noise reduction, edge detection, followed by a regional enhancement process that employs Delaunay triangulation based thresholding. The edge detection is performed using a fuzzy logic based center point detection and a subsequent radial search based fuzzy multiscale edge detection. The edges obtained are used as the vertices for Delaunay triangulation for enhancement purposes. This method enhances the heart wall region in the echo image. This technique is applied to both synthetic and real image sets that were obtained from a local hospital

Kolageni elastin u jetri štakora otrovanih živinim kloridom

Intoxication of rats with mercuric chloride (0.5 mg Hg/kg of body weight, daily for 10 weeks) increased the hepatic contents of soluble and insoluble collagen and elastin. The increase was associated with elevated serum aminotransferase and alkaline phosphatase activities, and decreased total protein level in serum. Inflammatory changes were found in the liver. An increase in the fibrous protein content suggests that inflammatory reaction to mercuric chloride can result in hepatic fibrosis.Trovanje štakora živinim kloridom (0,5 mg Hg/kg tjelesne težine na dan tijekom deset tjedana) imalo je za rezultat povećan sadržaj topljivog i netopljivog kolagena i elastina u jetri. Povećanje je dovedeno u vezu s povišenim aktivnostima aminotransferaze i alkalne fosfataze u serumu, i sa smanjenim nivoom ukupnog proteina u serumu. U jetri su zamijećene upalne promjene. Povišen sadržaj vlaknastog proteina upućuje na to da upalna reakcija na živin klorid može dovesti do fibroze jetre

Which patients with heart failure should receive specialist palliative care?

AIMS: We investigated which patients with heart failure (HF) should receive specialist palliative care (SPC) by first creating a definition of need for SPC in patients hospitalised with HF using patient-reported outcome measures (PROMs) and then testing this definition using the outcome of days alive and out of hospital (DAOH). We also evaluated which baseline variables predicted need for SPC and whether those with this need received SPC. METHODS AND RESULTS: PROMs assessing quality of life (QoL), symptoms, and mood were administered at baseline and every 4 months. SPC need was defined as persistently severe impairment of any PROM without improvement (or severe impairment immediately preceding death). We then tested whether need for SPC, so defined, was reflected in DAOH, a measure which combines length of stay, days of hospital re-admission, and days lost due to death. Of 272 patients recruited, 74 (27%) met the definition of SPC needs. These patients lived one third fewer DAOH than those without SPC need (and less than a quarter of QoL-adjusted DAOH). A Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score of <29 identified patients who subsequently had SPC needs (area under receiver operating characteristic curve 0.78). Twenty-four per cent of patients with SPC needs actually received SPC (n = 18). CONCLUSIONS: A quarter of patients hospitalised with HF had a need for SPC and were identified by a low KCCQ score on admission. Those with SPC need spent many fewer DAOH and their DAOH were of significantly worse quality. Very few patients with SPC needs accessed SPC services

Myocardial ischemia detection algorithm (MIDA) for automated diagnosis of heart wall damage and abnormal wall motion

This article discusses myocardial ischemia detection algorithm (MIDA) for automated diagnosis of heart wall damage and abnormal wall motion

Kolageni elastin u jetri štakora otrovanih živinim kloridom

Intoxication of rats with mercuric chloride (0.5 mg Hg/kg of body weight, daily for 10 weeks) increased the hepatic contents of soluble and insoluble collagen and elastin. The increase was associated with elevated serum aminotransferase and alkaline phosphatase activities, and decreased total protein level in serum. Inflammatory changes were found in the liver. An increase in the fibrous protein content suggests that inflammatory reaction to mercuric chloride can result in hepatic fibrosis.Trovanje štakora živinim kloridom (0,5 mg Hg/kg tjelesne težine na dan tijekom deset tjedana) imalo je za rezultat povećan sadržaj topljivog i netopljivog kolagena i elastina u jetri. Povećanje je dovedeno u vezu s povišenim aktivnostima aminotransferaze i alkalne fosfataze u serumu, i sa smanjenim nivoom ukupnog proteina u serumu. U jetri su zamijećene upalne promjene. Povišen sadržaj vlaknastog proteina upućuje na to da upalna reakcija na živin klorid može dovesti do fibroze jetre

Does “Scar” at Rest Echocardiography Predict Lack of Contractility Reserve at Dobutamine Stress Echocardiography

Background: Preliminary studies suggest that myocardial scar can be visualised by transthoracic echocardiography (TTE) using a low mechanical index (MI). Data describing the usefulness of scar imaging by TTE to predict myocardial viability are limited. Purpose: We investigated the association between myocardial scar, as imaged by low MI TTE, and viability as assessed by low-dose dobutamine stress echocardiography (DSE). Methods: We analysed 59 patients who had rest echocardiography including low MI (0.4-0.5) scans and DSEs, performed for myocardial viability between 29/04/2015 to 16/05/2018. Median age was 64 years (interquartile range 57-71), 55 (93%) were male. Left ventricular contrast opacification SonoVue (Braco) was used according to American Society of Echocardiography (ASE) standards (n = 39). Two experienced cardiologists blindly and independently performed 16-segment scar assessment at rest. Viability by DSE was used to represent the ‘gold standard’, from which sensitivity, specificity, negative and positive predictive values of viability assessed by scar at rest were calculated. Results: 42 (71%) of studies had evidence of scar at rest identified by low MI imaging. Presence of scar at rest has a sensitivity of 42%, specificity of 92%, positive and negative predictive values of 82 and 64%, respectively (Table 1). Specificity was higher in non-contrast compared to contrast images, at 97 and 90 %, respectively. The right coronary artery territory had a lower specificity compared to left anterior descending and circumflex territories. Conclusions: Presence of scar at rest has a low sensitivity but high specificity to predict non-viability on low-dose DSE. The presence of scar at rest TTE has the potential to reduce the need for low-dose DSE as these patients are unlikely to have viable myocardium in this region

Symptom Onset in Aortic Stenosis: Relation to Sex Differences in Left Ventricular Remodeling.

OBJECTIVES: The aim of this study was to establish sex differences in remodeling and outcome in aortic stenosis (AS) and their associations with biomarkers of myocardial fibrosis. BACKGROUND: The remodeling response and timing of symptoms is highly variable in AS, and sex plays an important role. METHODS: A total of 174 patients (133 men, mean age 66.2 ± 13.3 years) with asymptomatic moderate to severe AS underwent comprehensive stress cardiac magnetic resonance imaging, transthoracic echocardiography, and biomarker analysis (matrix metalloproteinase [MMP]-2, -3, -7, -8, and -9; tissue inhibitor matrix metalloproteinases-1 and -4; syndecan-1 and -4; and N-terminal pro-B-type natriuretic peptide), and were followed up at 6-month intervals. A primary endpoint was a composite of typical AS symptoms necessitating referral for aortic valve replacement, cardiovascular death, or major adverse cardiovascular events. RESULTS: For a similar severity of AS, male patients demonstrated higher indexed left ventricular (LV) volumes and mass, more concentric remodeling (higher LV mass/volume), a trend to more late gadolinium enhancement (present in 51.1% men vs. 34.1% women; p = 0.057), and higher extracellular volume index than female patients (13.27 [interquartile range (IQR): 11.5 to 17.0] vs. 11.53 [IQR: 10.5 to 13.5] ml/m2, p = 0.017), with worse systolic and diastolic function and higher MMP-3 and syndecan-4 levels, whereas female patients had higher septal E/e'. Male sex was independently associated with indexed LV mass (β = 13.32 [IQR: 9.59 to 17.05]; p < 0.001). During median follow-up of 374 (IQR: 351 to 498) days, a primary outcome, driven by spontaneous symptom onset, occurred in 21.8% of male and 43.9% of female patients (relative risk: 0.50 [95% confidence interval: 0.31 to 0.80]; p = 0.004). Measures of AS severity were associated with the primary outcome in both sexes, whereas N-terminal pro-B-type natriuretic peptide, MMP-3, and mass/volume were only associated in men. CONCLUSIONS: In AS, women tolerate pressure overload with less concentric remodeling and myocardial fibrosis but are more likely to develop symptoms. This may be related to higher wall stress and filling pressures in women

Symptom Onset in Aortic Stenosis: Relation to Sex Differences in Left Ventricular Remodeling.

The aim of this study was to establish sex differences in remodeling and outcome in aortic stenosis (AS) and their associations with biomarkers of myocardial fibrosis.The remodeling response and timing of symptoms is highly variable in AS, and sex plays an important role.A total of 174 patients (133 men, mean age 66.2 ± 13.3 years) with asymptomatic moderate to severe AS underwent comprehensive stress cardiac magnetic resonance imaging, transthoracic echocardiography, and biomarker analysis (matrix metalloproteinase [MMP]-2, -3, -7, -8, and -9; tissue inhibitor matrix metalloproteinases-1 and -4; syndecan-1 and -4; and N-terminal pro-B-type natriuretic peptide), and were followed up at 6-month intervals. A primary endpoint was a composite of typical AS symptoms necessitating referral for aortic valve replacement, cardiovascular death, or major adverse cardiovascular events.For a similar severity of AS, male patients demonstrated higher indexed left ventricular (LV) volumes and mass, more concentric remodeling (higher LV mass/volume), a trend to more late gadolinium enhancement (present in 51.1% men vs. 34.1% women; p = 0.057), and higher extracellular volume index than female patients (13.27 [interquartile range (IQR): 11.5 to 17.0] vs. 11.53 [IQR: 10.5 to 13.5] ml/m2, p = 0.017), with worse systolic and diastolic function and higher MMP-3 and syndecan-4 levels, whereas female patients had higher septal E/e'. Male sex was independently associated with indexed LV mass (β = 13.32 [IQR: 9.59 to 17.05]; p < 0.001). During median follow-up of 374 (IQR: 351 to 498) days, a primary outcome, driven by spontaneous symptom onset, occurred in 21.8% of male and 43.9% of female patients (relative risk: 0.50 [95% confidence interval: 0.31 to 0.80]; p = 0.004). Measures of AS severity were associated with the primary outcome in both sexes, whereas N-terminal pro-B-type natriuretic peptide, MMP-3, and mass/volume were only associated in men.In AS, women tolerate pressure overload with less concentric remodeling and myocardial fibrosis but are more likely to develop symptoms. This may be related to higher wall stress and filling pressures in women