Computed poststenotic flow instabilities correlate phenotypically with vibrations measured using laser Doppler vibrometry : perspectives for a promising in vivo device for early detection of moderate and severe carotid stenosis

Early detection of asymptomatic carotid stenosis is crucial for treatment planning in the prevention of ischemic stroke. Auscultation, the current first-line screening methodology, comes with severe limitations that create urge for novel and robust techniques. Laser Doppler vibrometer (LDV) is a promising tool for inferring carotid stenosis by measuring stenosis-induced vibrations. The goal of the current study was to evaluate the feasibility of LDV for carotid stenosis detection. LDV measurements on a carotid phantom were used to validate our previously verified high-resolution computational fluid dynamics methodology, which was used to evaluate the impact of flowrate, flow split, and stenosis severity on the poststenotic intensity of flow instabilities (IFI). We evaluated sensitivity, specificity, and accuracy of using IFI for stenoses detection. Linear regression analyses showed that computationally derived pressure fluctuations correlated (R2 = 0.98) with LDV measurements of stenosis-induced vibrations. The flowrate of stenosed vessels correlated (R2 = 0.90) with the presence of poststenotic instabilities. Receiver operating characteristic analyses of power spectra revealed that the most relevant frequency bands for the detection of moderate (56–76%) and severe (86–96%) stenoses were 80–200 Hz and 0–40 Hz, respectively. Moderate stenosis was identified with sensitivity and specificity of 90%; values decreased to 70% for severe stenosis. The use of LDV as screening tool for asymptomatic stenosis can potentially provide improved accuracy of current screening methodologies for early detection. The applicability of this promising device for mass screening is currently being evaluated clinically

Mandelbrot's Extremism

In the sixties Mandelbrot already showed that extreme price swings are more likely than some of us think or incorporate in our models.A modern toolbox for analyzing such rare events can be found in the field of extreme value theory.At the core of extreme value theory lies the modelling of maxima over large blocks of observations and of excesses over high thresholds.The general validity of these models makes them suitable for out-of-sample extrapolation.By way of illustration we assess the likeliness of the crash of the Dow Jones on October 19, 1987, a loss that was more than twice as large as on any other single day from 1954 until 2004.exceedances;extreme value theory;heavy tails;maxima

High-frequency fluctuations in post-stenotic patient specific carotid stenosis fluid dynamics : a computational fluid dynamics strategy study

PurposeScreening of asymptomatic carotid stenoses is performed by auscultation of the carotid bruit, but the sensitivity is poor. Instead, it has been suggested to detect carotid bruit as neck's skin vibrations. We here take a first step towards a computational fluid dynamics proof-of-concept study, and investigate the robustness of our numerical approach for capturing high-frequent fluctuations in the post-stenotic flow. The aim was to find an ideal solution strategy from a pragmatic point of view, balancing accuracy with computational cost comparing an under-resolved direct numerical simulation (DNS) approach vs. three common large eddy simulation (LES) models (static/dynamic Smagorinsky and Sigma).MethodWe found a reference solution by performing a spatial and temporal refinement study of a stenosed carotid bifurcation with constant flow rate. The reference solution dwas compared against LES for both a constant and pulsatile flow.ResultsOnly the Sigma and Dynamic Smagorinsky models were able to replicate the flow field of the reference solution for a pulsatile simulation, however the computational cost of the Sigma model was lower. However, none of the sub-grid scale models were able to replicate the high-frequent flow in the peak-systolic constant flow rate simulations, which had a higher mean Reynolds number.ConclusionsThe Sigma model was the best combination between accuracy and cost for simulating the pulsatile post-stenotic flow field, whereas for the constant flow rate, the under-resolved DNS approach was better. These results can be used as a reference for future studies investigating high-frequent flow features

Functional kernel estimators of conditional extreme quantiles

We address the estimation of "extreme" conditional quantiles i.e. when their order converges to one as the sample size increases. Conditions on the rate of convergence of their order to one are provided to obtain asymptotically Gaussian distributed kernel estimators. A Weissman-type estimator and kernel estimators of the conditional tail-index are derived, permitting to estimate extreme conditional quantiles of arbitrary order.Comment: arXiv admin note: text overlap with arXiv:1107.226

Early and late systolic wall stress differentially relate to myocardial contraction and relaxation in middle-aged adults: the Asklepios study

Experimental studies implicate late systolic load as a determinant of impaired left ventricular (LV) relaxation. We aimed to assess the relationship between the myocardial loading sequence and left ventricular (LV) contraction and relaxation. Time-resolved central pressure and time-resolved LV geometry were measured with carotid tonometry and speckle-tracking echocardiography, respectively, for computation of time-resolved ejection-phase myocardial wall stress (EP-MWS) among 1,214 middle-aged adults without manifest cardiovascular disease from the general population. Early diastolic annular velocity, systolic annular velocities were measured with tissue Doppler imaging and segmentaveraged longitudinal strain was measured with speckle-tracking echocardiography. After adjustment for age, gender and potential confounders, late EP-MWS was negatively associated with early diastolic mitral annular velocity (e', standardized β=-0.25; P<0.0001) and mitral inflow propagation velocity (Vpe, standardized β=-0.13; P=0.02). In contrast, early EP-MWS was positively associated with e' (standardized β=0.18; P<0.0001) and Vpe (standardized β=0.22; P<0.0001). A higher late EP-MWS predicted a lower systolic mitral annular velocity (S', standardized β=-0.31; P<0.0001) and lesser myocardial longitudinal strain (standardized β=0.32; P<0.0001), whereas a higher early EP-MWS was associated with a higher S' (standardized β=0.16; P=0.002) and greater longitudinal strain (standardized β=-0.24; P=0.002). The loading sequence remained independently associated with e' after adjustment for S' or systolic longitudinal strain. In the context of available experimental data, our findings support the role of the myocardial loading sequence as a determinant of LV systolic and diastolic function. A loading sequence characterized by prominent late systolic wall stress was associated with lower longitudinal systolic function and diastolic relaxation

Fluid-structure interaction simulation of prosthetic aortic valves : comparison between immersed boundary and arbitrary Lagrangian-Eulerian techniques for the mesh representation

In recent years the role of FSI (fluid-structure interaction) simulations in the analysis of the fluid-mechanics of heart valves is becoming more and more important, being able to capture the interaction between the blood and both the surrounding biological tissues and the valve itself. When setting up an FSI simulation, several choices have to be made to select the most suitable approach for the case of interest: in particular, to simulate flexible leaflet cardiac valves, the type of discretization of the fluid domain is crucial, which can be described with an ALE (Arbitrary Lagrangian-Eulerian) or an Eulerian formulation. The majority of the reported 3D heart valve FSI simulations are performed with the Eulerian formulation, allowing for large deformations of the domains without compromising the quality of the fluid grid. Nevertheless, it is known that the ALE-FSI approach guarantees more accurate results at the interface between the solid and the fluid. The goal of this paper is to describe the same aortic valve model in the two cases, comparing the performances of an ALE-based FSI solution and an Eulerian-based FSI approach. After a first simplified 2D case, the aortic geometry was considered in a full 3D set-up. The model was kept as similar as possible in the two settings, to better compare the simulations' outcomes. Although for the 2D case the differences were unsubstantial, in our experience the performance of a full 3D ALE-FSI simulation was significantly limited by the technical problems and requirements inherent to the ALE formulation, mainly related to the mesh motion and deformation of the fluid domain. As a secondary outcome of this work, it is important to point out that the choice of the solver also influenced the reliability of the final results