Tato diplomová práce se zabývá vytvořením modelu signálu impedančního měření srdce (ICG signál). Impedanční kardiografie podává informaci o změně srdečního objemu během srdečního cyklu. Modelování signálu předchází statistická analýza vzájemné pozice ICG signálu vzhledem k dalším mechanickým srdečním signálům. Konstrukce modelu vychází z reálných nasnímaných signálů. Konečný ICG model je začleněn do již existujícího modelu mechanických interakcí mezi srdcem a plícemi. Výsledkem je funkční model kardio-respiračních interakcí, který bude sloužit v dalších částech výzkumu laboratoře PRETA.

Darbo tikslas: Sukurti kiekybinius signalų morfologijos, atspindinčių širdies veiklos reguliavimą, jos audinių gyvybingumą bei centrinę hemodinamiką, vertinimo metodus. Uždaviniai: 1. Ištirti signalų dekompozicijos baigtiniu bazinių funkcijų rinkiniu (truncated signal representation) metodų tinkamum��, širdies veiklą, jos audinių gyvybingumą bei centrinę hemodinamiką aprašančių signalų, morfologijos analizei; 2. Sukurti signalų, atspindinčių širdies audinių gyvybingumą, optimalaus aprašymo metodą; 3. Sukurti centrinę hemodinamiką atspindinčio krūtinės ląstos impedanso signalo struktūrinės bei morfologinės analizės metodą; 4. Sukurti elektrokardiogramos P-bangos morfologijos dinamikos, atspindinčios širdies veiklos autonominį reguliavimą, kiekybinio įvertinimo metodą. / The aim: To elaborate the quantitative methods for evaluation of morphology of the signals reflecting viability of heart tissue, heart function control and central/peripheral hemodynamics. Objectives: 1. Investigation of usefulness truncated signal representation methods for analysis of morphology of the signals reflecting viability of heart tissue, heart function control and central/peripheral hemodynamics; 2. Elaboration of method for optimal representation of signals reflecting heart tissue viability; 3. Elaboration of method for quantitative evaluation of ECG P-wave morphology dynamics reflecting autonomous heart function control; 4. Elaboration of method for structural and morphological analysis of the chest impedance signals reflecting central hemodynamics.

Disertacijoje iškelta sergančiųjų ūminiu miokardo infarktu ir cukriniu diabetu asmenų nepalankios ligos eigos problema bei apžvelgos galimybės prognozuoti tokių asmenų ligos baigtis.Darbo uždaviniais buvo: 1) įvertinti širdies ritmo variabilumo ir hemodinamikos žymenis sergantiesiems ūminiu miokardo infarktu bei cukriniu diabetu priklausomai nuo ligos eigos ir baigčių, palyginti juos su nesergančiųjų cukrininu diabetu atitinkamais žymenimis; 2) nustatyti sergančiųjų miokardo infarktu prognozinę širdies ritmo variabilumo ir hemodinamikos žymenų vertę mirties, skilvelinės aritmijos, grįžtamosios išemijos išsivystymui ar jungtinei vertinamajai baigčiai stacionare; 3) nustatyti prognozinę širdies ritmo variabilumo ir hemodinamikos žymenų vertę per 1 metus ir per 5 metus po persirgto miokardo infarkto įvykusiems: mirčiai dėl bet kokios ir dėl širdinės priežasties, pakartotino miokardo infarkto išsivystymui, neplanuotos širdies revaskuliarizacijos procedūros atlikimui, nekomplikuotos išeminės širdies ligos eigos buvimui; 4) nustatyti ar prognozinė širdies ritmo variabilumo ir hemodinamikos žymenų vertė analizuojamoms baigtims skiriasi tiriamųjų grupėse: a) cukriniu diabetu sergančiųjų asmenų, b) cukriniu diabetu nesergančiųjų asmenų; 5) gautų prognozinių modelių diskriminuojančias savybes palyginti tarpusavyje ir su pripažintais ūminio miokardo infarkto rizikos vertinimo kriterijais (kairiojo skilvelio išstūmio frakcija, GRACE ir TIMI rizikos vertinimo skalėmis). / Unfavourable outcomes of the diabetic patients with acute myocardial infarction were analysed in the dissertation and possibilities to predict the course of the disease was reviewed. The objectives of the study were: 1) to evaluate the measures of heart rate variability and impedance cardiography for the patients with acute myocardial infarction, and their alterations in reliance on the different outcomes, according to the patients’ status of diabetes mellitus; 2) to determine prognostic value of combined assessment of heart rate variability and impedance cardiographymeasures for in-hospital outcomes of myocardial infarction: in-hospital mortality, ventricular arrhythmia, recurrent ischemia and complicated in-hospital course; 3) to determine prognostic value of combined assessment of heart rate variability and impedance cardiography measures for long-term (1 and 5 years) outcomes after myocardial infarction: mortality (both all-cause death and cardiac death), ischemic complications (recurrent non-fatal myocardial infarction and need for revascularization procedures) and uncomplicated long-term course; 4) to assess whether prognostic value of combined heart rate variability and hemodynamic measures differs in separate patient groups: diabetic or non-diabetic; 5) to compare the discriminative power of the obtained prognostic models and widely recognized risk markers, such as ejection fraction of the left ventricle, GRACE and TIMI scores.

This thesis deals with the methodology of use of whole-body impedance cardiography for evaluation of pulse wave velocity. The first three chapters explain selected hemodynamic properties of the arterial system related to the issue of pulse wave propagation. At the same time the ordinary methods for estimation, its disadvantages and merits has been summarized. Points at issue of whole-body impedance evaluation methodology for pulse wave velocity are researched in second part of this thesis. In order that analysis the procedure for correct methodology has been determined. Particularly determination of reference proximal point for calculation of transit time towards aortic valve, and design and accuracy of transit distance measurement were discussed. Based on the obtained data, a calculation of representative pulse wave velocity to eight limb locations was performed.

No description available.

La plupart des maladies cardio-vasculaires sont étroitement liées à l’architecture 3D des faisceaux de cardiomyocytes du myocarde humain. Connaitre en détail cette architecture permet de lever un verrou scientifique sur l’organisation spatiale complexe des faisceaux de cardiomyocytes, et offre des pistes pour trouver des solutions pertinentes permettant de guérir ces maladies. A cause de la nature biréfringente des filaments de myosine qui se trouvent dans les cellules cardiomyocyte, l’Imagerie en Lumière Polarisée (ILP) se révèle comme la seule méthode existante permettant d’étudier en détail, l’architecture et l’orientation des faisceaux de cardiomyocytes au sein de la masse ventriculaire. Les filaments de myosine se comportent comme des cristaux uni-axiaux biréfringents, ce qui permet de les modéliser comme les cristaux uni-axiaux biréfringents. L’ILP exploite les propriétés vibratoires de la lumière car l’interaction photonique et atomique entre la lumière et la matière permet de révéler l’organisation structurelle et l’orientation 3D des cardiomyocytes. Le présent travail se base sur la modélisation des différents comportements de la lumière après avoir traversé des faisceaux de cardiomyocytes. Ainsi, un volume 100×100×500 µm3 a été décomposé en plusieurs éléments cubiques qui représentent l'équivalent de l'intersection des cellules de diamètre de 20 µm chacune. Le volume a été étudié dans différentes conditions imitant l’organisation 3D des cardiomyocytes dans différentes régions du myocarde. Les résultats montrent que le comportement du volume change suivant l’arrangement spatial des cardiomyocytes à l’intérieur du volume. Grâce à un modèle analytique développé à l’aide des simulations, il a été possible de connaitre en tout point, l’orientation 3D des cardiomyocytes dans tout le volume. Ce modèle a été implémenté dans un greffon logiciel. Puis, il a été validé avec les piliers des valves auriculo-ventriculaire en comparant les courbes obtenues en simulation numérique à celles obtenues dans la phase expérimentale. De plus, il a été possible de mesurer l’orientation 3D des faisceaux de cardiomyocytes à l’intérieur du pilier. Après cette validation, le modèle a été utilisé sur un cœur humain (sain) en entier. Puis, nous avons extrait les cartographies des orientations 3D (angle azimut, angle d’élévation) des cardiomyocytes, ainsi que la cartographie des niveaux d’homogénéité du myocarde en entier. Pour une confrontation qualitative des mesures de l’orientation 3D obtenues en ILP avec celles en IRM, un cœur humain sain d’un enfant de 14 mois a été prélevé lors de l’autopsie, fixé dans du formol, puis imagé en entier par IRM puis en ILP. Malgré la faible résolution des images en IRM, les résultats obtenus montrent que les mesures de l’orientation 3D des cardiomyocytes issues de ces deux méthodes d’imageries se révèlent quasiment identiques. / Most cardiovascular diseases are closely linked to the 3D cardiomyocytes bundles of the human myocardium. Knowing in detail this architecture allows us to overcome a scientific bottleneck on the complex spatial organization of cardiomyocytes, and offers ways to find appropriate solutions to treat these diseases. The goal of present thesis is then to develop methods and techniques that allow gaining insights into the geometric arrangement of cardiomyocytes or cardiomyocytes bundles in the myocardium. Due to the birefringent nature of myosin filaments that are found in myocardial cells, the Polarized Light Imaging (PLI) appears as the only existing method for studying in detail the architecture and cardiomyocytes bundle orientation in ventricular mass. Myosin filaments react as uniaxial birefringent crystal; thereby it has been modeled as the uniaxial birefringent crystal. The PLI uses the vibration properties of light; the photonic and atomic interaction between light and matter can reveal the structural organization and the 3D cardiomyocytes orientation of the myocardium. The present work is based on modeling the behavior of the light after passing through a cardiomyocytes bundle. Thus, a volume 100 × 100 × 500 μm3 has been decomposed in a number of cubic elements which are equivalent to cardiac cells of diameter of 20 microns. The volume was studied under different conditions to emulate the organization of cardiomyocytes in different regions in human myocardium: isotropic region, heterogeneous region, region with cardiomyocytes bundle crossing. The results showed that the behavior of the volume changes according to the spatial arrangement of cardiomyocytes within the volume. Through an analytical model developed using simulation, it has been possible to know the 3D orientation of cardiomyocytes at any region throughout the volume. This model has been implemented in software as a plugin. Then, it has been validated with the pillars of atrio-ventricular valves by comparing the curves obtained by numerical simulation with those obtained in the experimental phases. Moreover, it has been possible to measure the 3D orientation of cardiomyocytes bundles within the pillars. After validation, the model was applied to an entire human healthy heart. Then, we extracted the mapping of the 3D orientations (azimuth angle, elevation angle) of cardiomyocytes bundles, as well as the mapping of the homogeneity levels of the entire myocardium. For a qualitative comparison of the 3D orientation measurements obtained with the PLI and Magnetic Resonance Imaging (MRI), the healthy human heart of a 14 month old child was extracted at autopsy, then fixed in formalin, and finally imaged by MRI and PLI. Despite the low spatial resolution of MRI images, the results showed that the 3D orientations of cardiomyocytes bundles measured from these two imaging methods appeared almost identical.

This thesis deals with the possibility of using impedance cardiography for calculating cardiac output. Kubicek’s, Sramek‘s and Sramek-Bernstein‘s methods are discussed here. These methods were applied to a data set, obtained by measuring on subjects with implanted cardiostimulators. The subjects’ heart rate was being changed by the programing of cardiostimulators. Thanks to this procedure the measured data were not affected by artifacts, connected with the heart rate change caused by a body stress, or other influences. An influence of heart rate on a cardiac output value based on the statistical processing of the data set was studied.

This Mater's thesis deals with the evaluation of pulse wave velocity using multi-channel whole-body impedance cardiography. Data were taken from the group of healthy volunteers whose impedance changes were measured during rest, respiratory maneuvers, tilt and stress exercise. The result of this measurement are values of peaks of pulse wave time shifts towards R-wave. The velocity values towards the thorax electrodes were recalculated on the basis of knowledge about the pulse wave time shifts and the distances from the heart to the scanned locations, which were measured using the arterial segment's lengths.

Indiana University-Purdue University Indianapolis (IUPUI) / Gender differences in the basal function of autonomic cardiovascular control are well documented. Consistent baroreflex (BRx) studies suggest that women have higher tonic parasympathetic cardiac activation compared to men. Later in life and concomitant with menopause, a significant reduction in the capacity of the BRx in females increases their risk to develop hypertension, even exceeding that of age-matched males. Loss of sex hormones is but one factor. In female rats, we previously identified a distinct myelinated baroreceptor (BR) neuronal phenotype termed Ah-type, which exhibits functional dynamics and ionic currents that are a mix of those observed in barosensory afferents functionally identified as myelinated A-type or unmyelinated C-type. Interestingly, Ah-type afferents constitute nearly 50% of the total population of myelinated aortic BR in female but less than 2% in male rat. We hypothesized that an afferent basis for sexual dimorphism in BRx function exists. Specifically, we investigated the potential functional impact Ah-type afferents have upon the aortic BRx and what changes, if any, loss of sex hormones through ovariectomy brings upon such functions. We assessed electrophysiological and reflexogenic differences associated with the left aortic depressor nerve (ADN) from adult male, female, and ovariectomized female (OVX) Sprague-Dawley rats. Our results revealed sexually dimorphic conduction velocity (CV) profiles. A distinct, slower myelinated fiber volley was apparent in compound action potential (CAP) recordings from female aortic BR fibers, with an amplitude and CV not observed in males. Subsequent BRx studies demonstrated that females exhibited significantly greater BRx responses compared to males at myelinated-specific intensities. Ovariectomy induced an increased overall temporal dispersion in the CAP of OVX females that may have contributed to their attenuated BRx responses. Interestingly, the most significant changes in depressor dynamics occurred at electrical thresholds and frequencies most closely aligned with Ah-type BR fibers. Collectively, we provide evidence that, in females, two anatomically distinct myelinated afferent pathways contribute to the integrated BRx function, whereas in males only one exists. These functional differences may partly account for the enhanced control of blood pressure in females. Furthermore, Ah-type afferents may provide a neuromodulatory pathway uniquely associated with the hormonal regulation of BRx function.