Dans cette étude, nous abordons l'utilisation de la représentation parcimonieuse et l'apprentissage de dictionnaires pour l'aide au diagnostic dans le contexte de Maladies Cardiovasculaires. Spécifiquement, notre travail se concentre : 1) sur l'évaluation du mouvement des parois du Ventricule Gauche (VG) chez des patients souffrant d'Insuffisance Cardiaque (IC) ; 2) la détection de fibrose chez des patients présentant une Cardiomyopathie Hypertrophique (CMH). Ces types de pathologies sont étudiées par ailleurs en Imagerie par Résonance Magnétique Cardiaque (IRMC).Dans le contexte de l'IC notre contribution porte sur l'évaluation de mouvement du VG dans des séquences cine-IRMC. Nous proposons dans un premier temps, une méthode d'extraction de caractéristiques qui exploite les informations partielles obtenues à partir de toutes les phases cardiaques temporelles et des segments anatomiques, dans une représentation spatio-temporelle en cine-IRM petit axe (SAX). Les représentations proposées exploitent les informations du mouvement des parois du VG sans avoir recours à la segmentation et disposent des informations discriminatoires qui pourraient contribuer à la détection et à la caractérisation de l'asynchronisme cardiaque. L'extraction d'images spatio-temporelles a été proposée permettant la construction de trois nouveaux types de représentations : 1) profils spatio-temporels diamétraux qui montrent l'évolution temporelle de l’épicarde et de l'endocarde en même temps dans deux segments anatomiques opposés du VG, 2) profils spatio-temporels radiaux où le mouvement pariétal est observé pour chaque segment de la cavité du VG et 3) courbes de signal temps-intensité directement des profils spatio-temporels radiaux dans chaque segment anatomique. Des paramètres différents sont alors définis de ces courbes qui reflètent les informations dynamiques de la contraction du VG. Deuxièmement, nous proposons l'utilisation de ces caractéristiques comme des atomes d'entrée dans l'apprentissage de dictionnaires discriminatoires pour classifier le mouvement régional du VG dans les cas normaux ou anormaux. Nous avons proposé une évaluation globale en utilisant le statut global du sujet : Normal/Pathologique, comme l'étiquette de référence des profils spatio-temporels et une évaluation locale en utilisant les informations de déformation locales fournies par l'analyse des images échographiques de référence en clinique (2D-STE). Dans le contexte de la CMH, nous abordons le problème de détection de la fibrose en LGE-IRM-SAX en utilisant une approche de partitionnement de donnés et d'apprentissage de dictionnaires. Dans ce cadre, les caractéristiques extraites d'images de LGE-SAX sont prises comme des atomes d'entrée pour former un classifieur basé sur les codes parcimonieux obtenus avec une approche d'apprentissage de dictionnaires. Une étape de post-traitement permet la délimitation du myocarde et la localisation spatiale de la fibrose par segment anatomique. / This work concerns the use of sparse representation and Dictionary Learning (DL) in order to get insights about the diseased heart in the context of Cardiovascular Diseases (CVDs). Specifically, this work focuses on 1) assessment of Left Ventricle (LV) wall motion in patients with heart failure and 2) fibrosis detection in patients with hypertrophic cardiomyopathy (HCM). In the context of heart failure (HF) patients, the work focuses on LV wall motion analysis in cardiac cine-MRI. The first contribution in this topic is a feature extraction method that exploits the partial information obtained from all temporal cardiac phases and anatomical segments in a spatio-temporal representation from sequences cine-MRI in short-axis view. These features correspond to spatio-temporal profiles in different anatomical segments of the LV. The proposed representations exploit information of the LV wall motion without segmentation needs. Three representations are proposed : 1) diametrical spatio-temporal profiles where radial motions of LV’s walls are observed at the same time in opposite anatomical segments 2) radial spatiotemporal profiles where motion of LV’s walls is observed for each segment of the LV cavity and 3) quantitative parameters extracted from the radial spatio-temporal profiles. A second contribution involves the use of these features as input atoms in the training of discriminative dictionaries to classify normal or abnormal regional LV motion. We propose two levels of evaluation, a first one where the global status of the subject (normal/pathologic) is used as ground truth to label the proposed spatio-temporal representations, and a second one where local strain information obtained from 2D Speckle Tracking Echocardiography (STE), is taken as ground truth to label the proposed features, where a profile is classified as normal or abnormal (akinetic or hypokinetic cases). In the context of Hypertrophic cardiomyopathy (HCM), we address the problem of fibrosis detection in Late Gadolinium Enhanced LGE-Short axis (SAX) images by using a sparse-based clustering approach and DL. In this framework, random image patches are taken as input atoms in order to train a classifier based on the sparse coefficients obtained with a DL approach based on kernels. For a new test LG-SAX image, the label of each pixel is predicted by using the trained classifier allowing the detection of fibrosis. A subsequent postprocessing step allows the spatial localization of fibrosis that is represented according to the American Heart Association (AHA) 17-segment model and a quantification of fibrosis in the LV myocardium.

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Diversas evidências comprovam que a obesidade está associada a alterações estruturais e funcionais do coração em modelos humanos e animais. Outros estudos recentes também demonstram que a obesidade humana está associada com alterações na função e na estrutura vascular, especialmente em grandes e médias artérias. Estudos epidemiológicos têm confirmado que a obesidade é um fator de risco significativo para o aparecimento de proteinúria e de doença renal terminal em uma população normal. Com o objetivo de determinar as alterações morfológicas relacionadas ao remodelamento cardíaco, vascular e renal em um modelo experimental de obesidade induzida pelo glutamato monossódico (MSG) e os efeitos da metformina sobre estes achados, foram estudados 25 ratos divididos em cinco grupos: controle com 16 e 22 semanas (CON-16 e CON-22); obeso com 16 e 22 semanas (MSG-16 e MSG-22) e obeso + metformina (MET-22) 300mg/Kg/dia por via oral. A caracterização da resistência à insulina foi feita através da medida da insulina plasmática e cálculo do índice de HOMA-IR. As análises morfológicas e quantificação do colágeno miocárdico foram feitos pelo sistema de imagem Image Pro Plus analysis. A pressão arterial sistólica foi levemente maior no grupo MSG-22, adquirindo significância estatística quando comparada com o grupo MSG-16 (1222 vs 1082 mmHg, p<0,05). Por outro lado, o grupo MET-22 mostrou níveis mais baixos de pressão arterial (1181 mmHg), sem alcançar diferença significativa. No grupo de animais obesos, foi observado aumento na relação média-lumen com 16 semanas (39,93,7 vs 30,22,0 %, p<0,05) e com 22 semanas (39,81,3 vs 29,51,2%, p<0,05), que foi reduzida com o uso da metformina (31,50,9%). O depósito de colágeno na área perivascular no ventrículo esquerdo foi significativamente maior no grupo MSG-22 (1,390,06 vs 0,830,06 % no CON-22, p<0,01), sendo atenuado pela metformina (1,020,04%). No rim, a área seccional transversa das arteríolas intrarrenais foi semelhante entre os grupos (18,52,2 no CON-16; 19,93,7 no MSG-16; 18,93,1 no CON-22; 21,81,5 no MSG-22; 20,21,4 no MET-22). Foi observado aumento da área glomerular no grupo MSG-22 (141,34,5 vs 129,50,5 m2), mas sem significância estatística. Em conclusão, nos ratos com obesidade induzida pelo MSG, com resistência à insulina, as alterações cardíacas foram mais proeminentes do que as alterações renais. No coração foram observados sinais de remodelamento vascular hipertrófico nas pequenas artérias intramiocárdicas e evidências de fibrose miocárdica mais proeminente na área perivascular, alterações que foram, pelo menos parcialmente, atenuadas com o uso de metformina durante seis semanas, mostrando que esta droga pode ser benéfica na prevenção de complicações cardíacas, vasculares e renais associadas com a obesidade. / Many evidences show that obesity is associated to structural and functional changes in the heart of human and animal models. Recent studies also show that human obesity is associated with vascular structural and functional modifications, specially at large and medium-sized arteries. Epidemiological studies have confirmed that obesity is a significant risk factor for the development of proteinuria and end-stage renal disease in a normal population. With the objective to determinate morphological changes related to cardiac, vascular and renal remodeling in an experimental model of monosodium glutamate (MSG)-induced obesity and the effect of metformin at this finding. Twenty five rats were studied and divided into five groups: control with 16 e 22 weeks (CON-16 and CON-22); obese with 16 and 22 weeks (MSG-16 e MSG-22), and obese + metformin (MET-22) 300mg/Kg/day per oral. The characterization of insulin resistance was done through measurement of plasma insulin and calculation of HOMA-IR index. The morphological analysis and the quantification of myocardial collagen were carried out by Image Pro Plus analysis system. The systolic blood pressure was slightly higher in MSG-22 group, reaching statistical significance when compared to MSG-16 group (1222 vs 1082 mmHg, p<0.05). On the other hand, the MET-22 group demonstrated lower blood pressure levels (1181 mmHg), without reaching statistical difference. The obese animals presented increase in media-to-lumen ratio with 16 weeks (39.93.7 vs 30.22.0 %, p<0.05) and with 22 weeks (39.81.3 vs 29.51.2%, p<0.05), which was reduced with use of metformin (31.50.9%). The collagen deposition in perivascular area of left ventricle was significantly greater in MSG-22 group (1.390.06 vs 0.830.06 % in CON-22, p<0.01), and attenuated by metformin (1.020.04%). In the kidney, the media cross-sectional area of intrarenal arterioles was similar among the groups (18.52.2 in CON-16; 19.93.7 in MSG-16; 18.93.1 in CON-22; 21.81.5 in MSG-22; 20.21.4 in MET-22). An increase of glomerular area was observed in MSG-22 group (141.34.5 vs 129.50.5 m2), but without statistical significance. In conclusion, rats with MSG-induced obesity and insulin resistance presented more pronounced cardiac changes than renal alterations. In the heart, there were evidences of hypertrophic vascular remodeling were observed in intramyocardial small arteries and perivascular fibrosis. These findings were, at least partially, attenuated by metformin for six weeks, suggesting that this drug may be beneficial for prevention of cardiac, vascular and renal complications associated with obesity.

Diversas evidências comprovam que a obesidade está associada a alterações estruturais e funcionais do coração em modelos humanos e animais. Outros estudos recentes também demonstram que a obesidade humana está associada com alterações na função e na estrutura vascular, especialmente em grandes e médias artérias. Estudos epidemiológicos têm confirmado que a obesidade é um fator de risco significativo para o aparecimento de proteinúria e de doença renal terminal em uma população normal. Com o objetivo de determinar as alterações morfológicas relacionadas ao remodelamento cardíaco, vascular e renal em um modelo experimental de obesidade induzida pelo glutamato monossódico (MSG) e os efeitos da metformina sobre estes achados, foram estudados 25 ratos divididos em cinco grupos: controle com 16 e 22 semanas (CON-16 e CON-22); obeso com 16 e 22 semanas (MSG-16 e MSG-22) e obeso + metformina (MET-22) 300mg/Kg/dia por via oral. A caracterização da resistência à insulina foi feita através da medida da insulina plasmática e cálculo do índice de HOMA-IR. As análises morfológicas e quantificação do colágeno miocárdico foram feitos pelo sistema de imagem Image Pro Plus analysis. A pressão arterial sistólica foi levemente maior no grupo MSG-22, adquirindo significância estatística quando comparada com o grupo MSG-16 (1222 vs 1082 mmHg, p<0,05). Por outro lado, o grupo MET-22 mostrou níveis mais baixos de pressão arterial (1181 mmHg), sem alcançar diferença significativa. No grupo de animais obesos, foi observado aumento na relação média-lumen com 16 semanas (39,93,7 vs 30,22,0 %, p<0,05) e com 22 semanas (39,81,3 vs 29,51,2%, p<0,05), que foi reduzida com o uso da metformina (31,50,9%). O depósito de colágeno na área perivascular no ventrículo esquerdo foi significativamente maior no grupo MSG-22 (1,390,06 vs 0,830,06 % no CON-22, p<0,01), sendo atenuado pela metformina (1,020,04%). No rim, a área seccional transversa das arteríolas intrarrenais foi semelhante entre os grupos (18,52,2 no CON-16; 19,93,7 no MSG-16; 18,93,1 no CON-22; 21,81,5 no MSG-22; 20,21,4 no MET-22). Foi observado aumento da área glomerular no grupo MSG-22 (141,34,5 vs 129,50,5 m2), mas sem significância estatística. Em conclusão, nos ratos com obesidade induzida pelo MSG, com resistência à insulina, as alterações cardíacas foram mais proeminentes do que as alterações renais. No coração foram observados sinais de remodelamento vascular hipertrófico nas pequenas artérias intramiocárdicas e evidências de fibrose miocárdica mais proeminente na área perivascular, alterações que foram, pelo menos parcialmente, atenuadas com o uso de metformina durante seis semanas, mostrando que esta droga pode ser benéfica na prevenção de complicações cardíacas, vasculares e renais associadas com a obesidade. / Many evidences show that obesity is associated to structural and functional changes in the heart of human and animal models. Recent studies also show that human obesity is associated with vascular structural and functional modifications, specially at large and medium-sized arteries. Epidemiological studies have confirmed that obesity is a significant risk factor for the development of proteinuria and end-stage renal disease in a normal population. With the objective to determinate morphological changes related to cardiac, vascular and renal remodeling in an experimental model of monosodium glutamate (MSG)-induced obesity and the effect of metformin at this finding. Twenty five rats were studied and divided into five groups: control with 16 e 22 weeks (CON-16 and CON-22); obese with 16 and 22 weeks (MSG-16 e MSG-22), and obese + metformin (MET-22) 300mg/Kg/day per oral. The characterization of insulin resistance was done through measurement of plasma insulin and calculation of HOMA-IR index. The morphological analysis and the quantification of myocardial collagen were carried out by Image Pro Plus analysis system. The systolic blood pressure was slightly higher in MSG-22 group, reaching statistical significance when compared to MSG-16 group (1222 vs 1082 mmHg, p<0.05). On the other hand, the MET-22 group demonstrated lower blood pressure levels (1181 mmHg), without reaching statistical difference. The obese animals presented increase in media-to-lumen ratio with 16 weeks (39.93.7 vs 30.22.0 %, p<0.05) and with 22 weeks (39.81.3 vs 29.51.2%, p<0.05), which was reduced with use of metformin (31.50.9%). The collagen deposition in perivascular area of left ventricle was significantly greater in MSG-22 group (1.390.06 vs 0.830.06 % in CON-22, p<0.01), and attenuated by metformin (1.020.04%). In the kidney, the media cross-sectional area of intrarenal arterioles was similar among the groups (18.52.2 in CON-16; 19.93.7 in MSG-16; 18.93.1 in CON-22; 21.81.5 in MSG-22; 20.21.4 in MET-22). An increase of glomerular area was observed in MSG-22 group (141.34.5 vs 129.50.5 m2), but without statistical significance. In conclusion, rats with MSG-induced obesity and insulin resistance presented more pronounced cardiac changes than renal alterations. In the heart, there were evidences of hypertrophic vascular remodeling were observed in intramyocardial small arteries and perivascular fibrosis. These findings were, at least partially, attenuated by metformin for six weeks, suggesting that this drug may be beneficial for prevention of cardiac, vascular and renal complications associated with obesity.