VIDEO KINEMATIC EVALUATION OF THE HEART (VI.KI.E.): AN IDEA, A PROJECT, A REALITY

Introduction: The technological development of the last 20 years pledges the intensity of efforts for implementing novel imaging contactless modalities that accelerate the translation from the research bench to the patient bedside, especially in the cardiac field. In this work, a novel intraoperative cardiac imaging approach, named Video Kinematic Evaluation (Vi.Ki.E.), is presented and explained in detail. This technology is able to monitor, contactless, the cardiac mechanics and deformation in-situ during heart surgery. Cardiac kinematics have been deeply evaluated ranging from the experimental animal approach to the human myocardial pathologies in both left and right ventricles. Methods: Vi.Ki.E. can be defined \u201cas simple as innovative\u201d. It only consists of a high-speed camera placed upon an exposed beating heart in-situ to record cardiac cycles. Afterwards a tracker software is used on the recorded video to follow the epicardial tissue movements. This tracker provides information about trajectories of the epicardium and, thanks to a custom-made algorithm, the technology supplies heart mechanical information such as: Force of contraction or cardiac fatigue, Energy expenditure, Contraction velocity, displacement of the marker and epicardial torsion. This approach has been tested on 21 rats (9 ischemia/reperfusion and/or for validation, 12 for the gender difference study) and on 37 patients who underwent different surgery between 2015 and 2019. In detail 10 patients underwent Coronary Artery Bypass Grafting, 12 underwent Valve Replacement after Tetralogy of Fallot correction surgery, 6 implanted a Left Ventricular Assist Device (1 is moved in the case study section), 6 patients with Hypoplastic Heart Syndrome underwent GLENN or FONTAN surgery, 2 patients underwent Heart Transplantation and finally 1 patient underwent double valve replacement (this patient is moved into case study section). Results: The patients\u2019 results demonstrated that the Vi.Ki.E. technology was able to discriminate, with statistic potency, the kinematic differences before and after the surgery in real-time, suggesting possible clinical implications in the treatment of the patients before the chest closure and/or in the intensive care unit. As it concerns the experimental animals, the results are the basics of the validation technology. Some of them were used as accepted model in comparison with the Vi.Ki.E. results on patients. Conclusions: In conclusion, this study has shown that Vi.Ki.E. is a safe and contactless technology with promising possible clinical application. The ease in the evaluation and the algorithm-based approach makes Video Kinematic Evaluation a widespread technique from cellular level to human cases covering the entire experimental field with in-vivo evaluation and possibly Langendorff/Working Heart approaches

VIDEO KINEMATIC EVALUATION OF THE HEART (VI.KI.E.): AN IDEA, A PROJECT, A REALITY

Introduction: The technological development of the last 20 years pledges the intensity of efforts for implementing novel imaging contactless modalities that accelerate the translation from the research bench to the patient bedside, especially in the cardiac field. In this work, a novel intraoperative cardiac imaging approach, named Video Kinematic Evaluation (Vi.Ki.E.), is presented and explained in detail. This technology is able to monitor, contactless, the cardiac mechanics and deformation in-situ during heart surgery. Cardiac kinematics have been deeply evaluated ranging from the experimental animal approach to the human myocardial pathologies in both left and right ventricles. Methods: Vi.Ki.E. can be defined \u201cas simple as innovative\u201d. It only consists of a high-speed camera placed upon an exposed beating heart in-situ to record cardiac cycles. Afterwards a tracker software is used on the recorded video to follow the epicardial tissue movements. This tracker provides information about trajectories of the epicardium and, thanks to a custom-made algorithm, the technology supplies heart mechanical information such as: Force of contraction or cardiac fatigue, Energy expenditure, Contraction velocity, displacement of the marker and epicardial torsion. This approach has been tested on 21 rats (9 ischemia/reperfusion and/or for validation, 12 for the gender difference study) and on 37 patients who underwent different surgery between 2015 and 2019. In detail 10 patients underwent Coronary Artery Bypass Grafting, 12 underwent Valve Replacement after Tetralogy of Fallot correction surgery, 6 implanted a Left Ventricular Assist Device (1 is moved in the case study section), 6 patients with Hypoplastic Heart Syndrome underwent GLENN or FONTAN surgery, 2 patients underwent Heart Transplantation and finally 1 patient underwent double valve replacement (this patient is moved into case study section). Results: The patients\u2019 results demonstrated that the Vi.Ki.E. technology was able to discriminate, with statistic potency, the kinematic differences before and after the surgery in real-time, suggesting possible clinical implications in the treatment of the patients before the chest closure and/or in the intensive care unit. As it concerns the experimental animals, the results are the basics of the validation technology. Some of them were used as accepted model in comparison with the Vi.Ki.E. results on patients. Conclusions: In conclusion, this study has shown that Vi.Ki.E. is a safe and contactless technology with promising possible clinical application. The ease in the evaluation and the algorithm-based approach makes Video Kinematic Evaluation a widespread technique from cellular level to human cases covering the entire experimental field with in-vivo evaluation and possibly Langendorff/Working Heart approaches

Action observation and execution network : an extended view

The mirror mechanism is a basic mechanism that transforms sensory representations of others' behaviours into one's own motor or visceromotor representations concerning that behaviour. In this review, we examine the different functions of the mirror mechanism according to its location in the brain, with particular emphasis on recent data concerning the prefrontal cortex and the emotional centres.peer-reviewe

Cardiac kinematic parameters computed from video of in situ beating heart

Mechanical function of the heart during open-chest cardiac surgery is exclusively monitored by echocardiographic techniques. However, little is known about local kinematics, particularly for the reperfused regions after ischemic events. We report a novel imaging modality, which extracts local and global kinematic parameters from videos of in situ beating hearts, displaying live video cardiograms of the contraction events. A custom algorithm tracked the movement of a video marker positioned ad hoc onto a selected area and analyzed, during the entire recording, the contraction trajectory, displacement, velocity, acceleration, kinetic energy and force. Moreover, global epicardial velocity and vorticity were analyzed by means of Particle Image Velocimetry tool. We validated our new technique by i) computational modeling of cardiac ischemia, ii) video recordings of ischemic/reperfused rat hearts, iii) videos of beating human hearts before and after coronary artery bypass graft, and iv) local Frank-Starling effect. In rats, we observed a decrement of kinematic parameters during acute ischemia and a significant increment in the same region after reperfusion. We detected similar behavior in operated patients. This modality adds important functional values on cardiac outcomes and supports the intervention in a contact-free and non-invasive mode. Moreover, it does not require particular operator-dependent skills

Bionic for Training: Smart Framework Design for Multisensor Mechatronic Platform Validation

: Home monitoring supports the continuous improvement of the therapy by sharing data with healthcare professionals. It is required when life-threatening events can still occur after hospital discharge such as neonatal apnea. However, multiple sources of external noise could affect data quality and/or increase the misdetection rate. In this study, we developed a mechatronic platform for sensor characterizations and a framework to manage data in the context of neonatal apnea. The platform can simulate the movement of the abdomen in different plausible newborn positions by merging data acquired simultaneously from three-axis accelerometers and infrared sensors. We simulated nine apnea conditions combining three different linear displacements and body postures in the presence of self-generated external noise, showing how it is possible to reduce errors near to zero in phenomena detection. Finally, the development of a smart 8Ws-based software and a customizable mobile application were proposed to facilitate data management and interpretation, classifying the alerts to guarantee the correct information sharing without specialized skills

Synthetic recovery of impulse propagation in myocardial infarction via silicon carbide semiconductive nanowires

: Myocardial infarction causes 7.3 million deaths worldwide, mostly for fibrillation that electrically originates from the damaged areas of the left ventricle. Conventional cardiac bypass graft and percutaneous coronary interventions allow reperfusion of the downstream tissue but do not counteract the bioelectrical alteration originated from the infarct area. Genetic, cellular, and tissue engineering therapies are promising avenues but require days/months for permitting proper functional tissue regeneration. Here we engineered biocompatible silicon carbide semiconductive nanowires that synthetically couple, via membrane nanobridge formations, isolated beating cardiomyocytes over distance, restoring physiological cell-cell conductance, thereby permitting the synchronization of bioelectrical activity in otherwise uncoupled cells. Local in-situ multiple injections of nanowires in the left ventricular infarcted regions allow rapid reinstatement of impulse propagation across damaged areas and recover electrogram parameters and conduction velocity. Here we propose this nanomedical intervention as a strategy for reducing ventricular arrhythmia after acute myocardial infarction

Video analysis of ex vivo beating hearts during preservation on the TransMedics® organ care system

BackgroundReliable biomarkers for assessing the viability of the donor hearts undergoing ex vivo perfusion remain elusive. A unique feature of normothermic ex vivo perfusion on the TransMedics® Organ Care System (OCS™) is that the donor heart is maintained in a beating state throughout the preservation period. We applied a video algorithm for an in vivo assessment of cardiac kinematics, video kinematic evaluation (Vi.Ki.E.), to the donor hearts undergoing ex vivo perfusion on the OCS™ to assess the feasibility of applying this algorithm in this setting.MethodsHealthy donor porcine hearts (n = 6) were procured from Yucatan pigs and underwent 2 h of normothermic ex vivo perfusion on the OCS™ device. During the preservation period, serial high-resolution videos were captured at 30 frames per second. Using Vi.Ki.E., we assessed the force, energy, contractility, and trajectory parameters of each heart.ResultsThere were no significant changes in any of the measured parameters of the heart on the OCS™ device over time as judged by linear regression analysis. Importantly, there were no significant changes in contractility during the duration of the preservation period (time 0–30 min, 918 ± 430 px/s; time 31–60 min, 1,386 ± 603 px/s; time 61–90 min, 1,299 ± 617 px/s; time 91–120 min, 1,535 ± 728 px/s). Similarly, there were no significant changes in the force, energy, or trajectory parameters. Post-transplantation echocardiograms demonstrated robust contractility of each allograft.ConclusionVi.Ki.E. assessment of the donor hearts undergoing ex vivo perfusion is feasible on the TransMedics OCS™, and we observed that the donor hearts maintain steady kinematic measurements throughout the duration

The Dynamics of Sensorimotor Cortical Oscillations during the Observation of Hand Movements: An EEG Study

Background The observation of action done by others determines a desynchronization of the rhythms recorded from cortical central regions. Here, we examined whether the observation of different types of hand movements (target directed, non-target directed, cyclic and non-cyclic) elicits different EEG cortical temporal patterns. Methodology Video-clips of four types of hand movements were shown to right-handed healthy participants. Two were target directed (grasping and pointing) motor acts; two were non-target directed (supinating and clenching) movements. Grasping and supinating were performed once, while pointing and clenching twice (cyclic movements). High-density EEG was recorded and analyzed by means of wavelet transform, subdividing the time course in time bins of 200 ms. The observation of all presented movements produced a desynchronization of alpha and beta rhythms in central and parietal regions. The rhythms desynchronized as soon as the hand movement started, the nadir being reached around 700 ms after movement onset. At the end of the movement, a large power rebound occurred for all bands. Target and non-target directed movements produced an alpha band desynchronization in the central electrodes at the same time, but with a stronger desynchronization and a prolonged rebound for target directed motor acts. Most interestingly, there was a clear correlation between the velocity profile of the observed movements and beta band modulation. Significance Our data show that the observation of motor acts determines a modulation of cortical rhythm analogous to that occurring during motor act execution. In particular, the cortical motor system closely follows the velocity of the observed movements. This finding provides strong evidence for the presence in humans of a mechanism (mirror mechanism) mapping action observation on action execution motor programs

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982