Citations

PurposeAutoantibodies are implicated in the pathogenesis of cardiovascular diseases and cardiac arrhythmias. In this pilot study, we tested the hypothesis that autoantibodies are present in patients with postural orthostatic tachycardia syndrome (POTS).Experimental designSeven control subjects (6 F:1 M, average age 36.1 years) and ten patients with the diagnosis of POTS (7 F: 3 M, average age 35.1 years) provided informed consent and 30 mL of venous blood. Human heart membrane proteins were resolved by 2DE and immunoblotted against purified IgGs from controls and patients.ResultsEighteen protein spots immunoreactive specifically against patient IgGs were detected and they were excised from gels, trypsin‐digested, and analyzed by nanoLC‐electrospray MS/MS. Forty unique proteins were identified and these include proteins that are associated with cardiac hypertrophy (mimecan, myozenin), cardiac remodeling (periostin), cardiomyopathy (desmin, desmoplakin), cell survival (laminin), structural integrity (filamin), chaperone proteins (crystalline, HSP70), mitochondrial enzymes, and channel proteins. Ingenuity Pathway Analysis showed multiple pathways were involved including those that regulate energy metabolism, redox, fibrosis, cardiac hypertrophy, and degeneration.Conclusions and clinical relevanceAutoantibodies are present in patients with POTS. These autoantibodies cross‐react with a wide range of cardiac proteins and may induce alterations in cardiac function. Autoimmune pathogenetic mechanisms should be further explored in these patients.

SummaryObjectivesTo describe the experience of a single, tertiary care institution in the care of patients with Fontan physiology undergoing anesthesia for noncardiac surgery.BackgroundThe Fontan procedure was developed in 1971 to palliate patients with univentricular cardiac physiology leading to long‐term survival of these patients, who may now present as adults for noncardiac surgery.MethodsWe retrospectively reviewed the medical records of Fontan patients 16 years and older who underwent general anesthesia for noncardiac surgery at Mayo Clinic in Rochester, Minnesota. Preoperative data, perioperative course, intraoperative and postoperative hemodynamic, pulmonary, cardiovascular, and renal complications were described.ResultsThirty‐nine general anesthetics were administered to 31 patients for noncardiac surgery after Fontan palliation. Perioperative complications occurred in 12 of the 39 (31%) noncardiac surgeries, and there was one postoperative death that occurred on day 13 after ventral hernia repair. The two patients who had complications that did not resolve (long‐term dialysis and death) had ejection fractions well below the mean for the group (22% and 28%).ConclusionIt may be more appropriate for Fontan patients to undergo anesthesia for noncardiac surgery in a tertiary institution, particularly patients with an ejection fraction of <30%. Intraoperative arterial blood pressure monitoring and overnight admission are likely appropriate for most cases.

Many methods in the field of elasticity imaging use shear waves to investigate the material properties of various soft tissues. The accurate and robust measurement of the shear wave speed is necessary for reliable clinical measurements. We propose using the Radon transformation on the spatiotemporal shear wave data to estimate the shear wave speed. A similar algorithm called the Radon sum transformation was proposed by Rouze, et al (IEEE Trans. Ultrasonics Ferroelectr. Freq. Control. 2010. pp. 2662-70), but this algorithm requires different input parameters that can affect the results. The use of the full Radon transform allows for the differentiation of waves that are traveling in different directions, thus this method can be used as a directional filter. We will also demonstrate the connection between estimating shear wave speeds in the Radon transform domain and estimating shear wave speeds from Fourier transform k-space. Results from shear wave measurements using shear waves induced by ultrasound radiation force will be shown. We will examine the accuracy of measurements made in calibrated elasticity phantoms, and show examples of shear wave speed estimation in arteries and kidneys. [This research was supported in part by NIH grants EB002640 and DK082408.]

Acoustoelasticity is a technique that allows quantification of the elastic nonlinearity coefficients (the so-called third-order moduli) of a material by measuring the variation of the sound speed in different directions (and/or polarizations) versus the applied uniaxial static stress. When dealing with nominally isotropic solids, the variation of the shear wave speed in two orthogonal directions with the applied stress permits the computation of two out of three independent nonlinearity coefficients. To generate the shear wave in an experimental setting, the acoustic radiation force pulse was applied to uniaxially deformed phantoms with strains of up to 30%. The results demonstrate that the compressional-shear coefficient C, which governs the variation of the (linear) shear modulus with hydrostatic pressure was found to vary substantially from one phantom to another, with the highest value observed in an agarose-based phantom. The importance of this nonlinearity parameter resides in the fact that the magnitude of the acoustic radiation force (ARF) in soft solids is proportional to C-1. For consistency, the values of C obtained from the acoustoelasticity experiment are compared to those deduced from the shear wave amplitude via its relationship to the magnitude of the ARF used to generate the shear wave.

Elasticity imaging is a medical imaging modality that measures tissue elasticity to aid in diagnosis of certain diseases. Shear wave-based methods have been developed to perform elasticity measurements in soft tissue. Hybrid beamforming applies both the conventional spherical and axicon focusing to produce a beam for generating a shear wave with increased depth-of-field so that measurements can be made with a plane-like shear wave. We present our aperture design and beam optimization performed using Field II simulations. We varied the number of elements devoted to spherical and axicon focusing as well as the opening angle used for axicon focusing. We tested hybrid beamforming in three elastic phantoms and an excised kidney. We evaluated the shear wave speed measurements accuracy in the phantoms as well as the depth-of-field for each hybrid beam. We compared our results with those from using beams generated using spherical and axicon focusing. Our results show that hybrid beamforming is capable of producing a long narrow beam that performs well when among the 128 elements of transducer, 48 elements are allocated to each axicon portion and 32 elements for spherical aperture while the angle of the axicon aperture is set less than 20.

We present an inverse problem methodology based on the Error in Constitutive Equations (ECE) approach for the identification of material properties in the context of frequency-domain elastodynamics. In the ECE approach, we define a cost functional based on an energy norm that connects a set of kinematically admissible displacements and a set of dynamically admissible stresses. The set of kinematically admissible displacements is composed of fields that satisfy essential boundary conditions and possess sufficient regularity (i.e. smoothness). The set of dynamically admissible stresses is composed of fields that satisfy conservation of linear momentum and natural (i.e. traction) boundary conditions. The inverse problem is solved by finding material properties along with admissible displacement and stress fields such that the ECE functional is minimized. Experimental data is introduced in the formulation as a quadratic penalty term added to the ECE functional. The talk will focus on the reconstruction of elastic and viscoelastic properties in heterogeneous materials in the context of frequency-domain dynamics. Our findings indicate that ECE methods provide faster and more accurate results than conventional least-squares minimization. We will show numerical and experimental results that demonstrate the salient features of the method.

The cardiovascular diseases such as atherosclerosis, coronary artery disease, hypertension and diastolic dysfunction have been associated with arterial stiffening and decreased ventricular compliance. Noninvasive techniques capable of quantifying elasticity and viscosity of cardiovascular tissues could facilitate early diagnosis and improve treatment. Here, we present a technique that uses focused ultrasound radiation force to excite mechanical waves in the tissue of interest and pulse echo to track the tissue deformation. Analysis of tissue deformation as a function of time using Fourier transforms allows calculation of the phase wave velocity dispersion (change of velocity as a function of frequency) of various modes of deformation. Continuum mechanics equations governing the motion of a viscoelastic plate and a tube are used to model the myocardial wall and arteries, respectively. Dispersion equations are derived for the two geometries and fit to the measured velocity dispersion to estimate tissue elasticity and viscosity. ECG-gated in vivo measurements of porcine myocardial and arterial elasticity and viscosity through a heart cycle are reported. The results show that both elasticity and viscosity increase during systole and decrease during diastole in the myocardium and arteries, consistent with underlying physiology.

Many disease processes, both focal and diffuse, cause marked changes in cell and tissue mechanical properties. Magnetic resonance elastography (MRE) is a magnetic resonance imaging-based technique for quantitatively assessing the mechanical properties of tissues based on the propagation of shear waves. Multiple studies have demonstrated MRE can be successfully implemented to assess abdominal organs with many potential applications, from detecting diffuse disease processes to characterizing tumors. The first clinical application of MRE to be well documented is the detection and characterization of hepatic fibrosis, which systematically increases the stiffness of liver tissue. In this diagnostic role, it offers a safer, less expensive, and potentially more accurate alternative to invasive liver biopsy. Emerging results also suggest that measurements of liver and spleen stiffness may provide an indirect way to assess portal hypertension. Preliminary studies have demonstrated that it is possible to use MRE to evaluate the mechanical properties of other abdominal structures, such as the pancreas and kidneys. Steady technical progress in developing practical protocols for applying MRE in the abdomen and the pelvis provides opportunities to explore many other potential applications of this emerging technology.