Estudo ecocardiográfico da função ventricular esquerda em pacientes com lúpus eritematoso sistêmico juvenil através da técnica de Speckle-Tracking bidimensional

Objetivo: O principal propósito do estudo foi pesquisar a disfunção ventricular esquerda subclínica em pacientes com lúpus eritematoso sistêmico juvenil (LESJ) através da técnica de speckle-tracking bidimensional. Foi investigada ainda uma possível correlação entre o comprometimento da deformação miocárdica e o SLEDAI-2K (Systemic Lupus Erithematosus Disease Activity Index 2000), bem como a presença de fatores de risco cardiovascular, tanto tradicionais como ligados à doença. Métodos: 50 pacientes assintomáticos do ponto de vista cardiovascular e 50 controles saudáveis (14,74 vs. 14,82 anos, p=0.83) foram avaliados pelo ecocardiograma convencional e pelo speckle-tracking bidimensional. Resultados: Apesar da fração de ejeção normal, os pacientes apresentaram redução de todos os parâmetros de deformação miocárdica longitudinal e radial, quando comparados aos controles: strain de pico sistólico longitudinal [-20,3 (-11 a -26) vs. -22 (-17,8 a -30.4) %, p < 0,0001], strain rate de pico sistólico longitudinal [-1,19 ± 0,21 vs. -1,3 ± 0,25 s-1, p=0,0005], strain rate longitudinal na diástole precoce [1,7 (0,99 a 2,95) vs. 2 (1,08 a 3,00) s-1 , p=0,0034], strain de pico sistólico radial [33,09 ± 8,6 vs. 44,36 ± 8,72%, p < 0,0001], strain rate de pico sistólico radial [1,98 ± 0,53 vs. 2,49 ± 0,68 s-1, p < 0,0001] e strain rate radial na diástole precoce [-2,31 ± 0,88 vs. -2,75 ± 0,97 s-1, p=0,02]. O strain de pico sistólico circunferencial [-23,67 ± 3,46 vs. - 24,6 ± 2,86%, p=0,43] e o strain rate circunferencial na diástole precoce [2 (0,88 a 3,4) vs. 1,99 (1,19 a 3,7) s-1, p=0,88] foram semelhantes em pacientes e controles. Apenas o strain rate de pico sistólico circunferencial [-1,5 ± 0,3 vs. -1,6 ± 0,3 s-1, p=0,036] mostrou-se reduzido no LESJ. Uma correlação negativa foi identificada entre o strain de pico sistólico longitudinal e o SLEDAI-2K (r = - 0,52; p < 0,0001) e também o número de fatores de risco cardiovascular por paciente (r = -0,32, p=0,024). Conclusões: Foi evidenciada disfunção sistólica e diastólica subclínica de ventrículo esquerdo no LESJ através da técnica de speckle-tracking bidimensional. A atividade da doença e a exposição aos fatores de risco cardiovascular provavelmente contribuíram para o comprometimento da deformação miocárdica nesses pacientes

Oclusão percutânea do apêndice auricular esquerdo e estrutura auricular: efeito na função mecânica e endócrina auricular

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Área de especialização: Intervenção Cardiovascular.

Inverse identification of the bending stiffness of a braided polyethylene twine subject to large deformation: application to the identification of the mesh opening rigidity of fishing nets.

The evaluation of the mesh opening stiffness of fishing nets is an important issue in assessing the selectivity of trawls. It appeared that a larger bending rigidity of twines decreases the mesh opening and could reduce the escapement of fish. Nevertheless, netting structure is complex. A netting is made up of braided twines made of polyethylene or polyamide. These twines are tied with non-symmetrical knots. Thus, these assemblies develop contact-friction interactions. Moreover, the netting can be subject to large deformation. In this study, we investigate the responses of netting samples to different types of solicitations. Samples are loaded and unloaded with creep and relaxation stages, with different boundary conditions. Then, two models have been developed: an analytical model and a finite element model. The last one was used to assess, with an inverse identification algorithm, the bending stiffness of twines. In this paper, experimental results and a model for netting structures made up of braided twines are presented. During dry forming of a composite, for example, the matrix is not present or not active, and relative sliding can occur between constitutive fibres. So an accurate modelling of the mechanical behaviour of fibrous material is necessary. This study offers experimental data which could permit to improve current models of contact-friction interactions [4], to validate models for large deformation analysis of fibrous materials [1] on a new experimental case, then to improve the evaluation of the mesh opening stiffness of a fishing net

Modelling the large deformations in stratified media - the Cosserat continuum approach

Methods employing continuum approximation in describing the deformation of layered materials possess a clear advantage over explicit models, However, the conventional implicit models based on the theory of anisotropic continua suffers from certain difficulties associated with interface slip and internal instabilities. These difficulties can be remedied by considering the bending stiffness of the layers. This implies the introduction of moment (couple) stresses and internal rotations, which leads to a Cosserat-type theory. In the present model, the behaviour of the layered material is assumed to be linearly elastic; the interfaces are assumed to be elastic perfectly plastic. Conditions of slip or no slip at the interfaces are detected by a Coulomb criterion with tension cut off at zero normal stress. The theory is valid for large deformation analysis. The model is incorporated into the finite element program AFENA and validated against analytical solutions of elementary buckling problems in layered medium. A problem associated with buckling of the roof and the floor of a rectangular excavation in jointed rock mass under high horizontal in situ stresses is considered as the main application of the theory. Copyright (C) 1999 John Wiley & Sons, Ltd.

Impacto da infecção do Vírus da Imunodeficiência Humana na deformação miocárdica: projecto de investigação

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de especialização: Ultrassonografia Cardiovascular.

Estudo da função sistólica do ventrículo direito por ecocardiografia transtorácica: relatório de projecto

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de especialização - Ultrassonografia Cardiovascular

Avaliação da torção miocárdica, por Spekle Tracking, em doentes com HTA

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Ramo de especialização: Ultrassonografia Cardiovascular

Estudo da deformação miocárdica para detecção precoce de disfunção ventricular esquerda em doentes submetidos a quimioterapia com antraciclinas

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular - Área de especialização: Ultrassonografia cardiovascular

Combined functional and viability cardiac MR imaging in a single breathhold

The combination of cardiac viability and functional information enhances the identification of different heart tissues in the setting of ischemic heart disease. A method has recently been proposed for obtaining black-blood delayed-enhancement (DE) viability images using the stimulated-echo acquisition mode (STEAM) MRI pulse sequence in a single short breathhold. The method was validated against conventional inversion-recovery (IR) DE images for identifying regions of myocardial infarction (MI). The method was based on the acquisition of three consecutive images of the same anatomical slice. One image has T(1)-weighted contrast in which infarction appears bright. The two other images are used to construct an anatomical image of the heart, which is combined with the first image to produce a black-blood viability image. However, using appropriate modulation and demodulation frequencies, the latter two images bear useful information about myocardial deformation that results in a cardiac strain-encoding (SENC) functional image. In this work, a method is proposed for obtaining three consecutive SENC images in a single acquisition that can be combined to produce a composite image of the heart, which shows both functional and viability information. The proposed technique reduces scan time by one-half, compared with separate acquisitions of functional and viability images, and alleviates misregistration problems caused by separate breathholds.

Influence of heart motion on cardiac output estimation by means of electrical impedance tomography: a case study.

Electrical impedance tomography (EIT) is a non-invasive imaging technique that can measure cardiac-related intra-thoracic impedance changes. EIT-based cardiac output estimation relies on the assumption that the amplitude of the impedance change in the ventricular region is representative of stroke volume (SV). However, other factors such as heart motion can significantly affect this ventricular impedance change. In the present case study, a magnetic resonance imaging-based dynamic bio-impedance model fitting the morphology of a single male subject was built. Simulations were performed to evaluate the contribution of heart motion and its influence on EIT-based SV estimation. Myocardial deformation was found to be the main contributor to the ventricular impedance change (56%). However, motion-induced impedance changes showed a strong correlation (r = 0.978) with left ventricular volume. We explained this by the quasi-incompressibility of blood and myocardium. As a result, EIT achieved excellent accuracy in estimating a wide range of simulated SV values (error distribution of 0.57 ± 2.19 ml (1.02 ± 2.62%) and correlation of r = 0.996 after a two-point calibration was applied to convert impedance values to millilitres). As the model was based on one single subject, the strong correlation found between motion-induced changes and ventricular volume remains to be verified in larger datasets.

Studies of rotor dynamics using a multibody simulation approach

The non-idealities in a rotor-bearing system may cause undesirable subcritical superharmonic resonances that occur when the rotating speed of the rotor is a fraction of the natural frequency of the system. These resonances arise partly from the non-idealities of the bearings. This study introduces a novel simulation approach that can be used to study the superharmonic vibrations of rotor-bearing systems. The superharmonic vibrations of complex rotor-bearing systems can be studied in an accurate manner by combining a detailed rotor and bearing model in a multibody simulation approach. The research looks at the theoretical background of multibody formulations that can be used in the dynamic analysis of flexible rotors. The multibody formulations currently in use are suitable for linear deformation analysis only. However, nonlinear formulation may arise in high-speed rotor dynamics applications due to the cenrrifugal stiffening effect. For this reason, finite element formulations that can describe nonlinear deformation are also introduced in this work. The description of the elastic forces in the absolute nodal coordinate formulation is studied and improved. A ball bearing model that includes localized and distributed defects is developed in this study. This bearing model could be used in rotor dynamics or multibody code as an interface elements between the rotor and the supporting structure. The model includes descriptions of the nonlinear Hertzian contact deformation and the elastohydrodynamic fluid film. The simulation approaches and models developed here are applied in the analysis of two example rotor-bearing systems. The first example is an electric motor supported by two ball bearings and the second is a roller test rig that consists of the tube roll of a paper machine supported by a hard-bearing-type balanceing machine. The simulation results are compared to the results available in literature as well as to those obtained by measuring the existing structure. In both practical examples, the comparison shows that the simulation model is capable of predicting the realistic responses of a rotor system. The simulation approaches developed in this work can be used in the analysis of the superharmonic vibrations of general rotor-bearing systems.

Limiting the influence of friction on the split Hopkinson pressure bar tests by using a ring specimen

The deformation of a ring under axial compression is analyzed in order to estimate a favorable ring specimen geometry capable of limiting the influence of friction on the stress-strain curve obtained from SHPB tests. The analysis shows that the use of a ring specimen with a large inner diameter and a small radial thickness offers some advantages comparing with the traditional disk sample. In particular, it can improve the reliability of the test results for ductile materials in the presence of friction. Based on the deformation analysis of a ductile ring under compression, a correction coefficient is proposed to relate the actual material stress strain curve with the reading from the SHPB. It is shown using finite element simulation that the proposed correction can be used for a wide range of conventional ductile materials. Experimental results with steel alloys indicate that the correction procedure is an effective technique for an accurate measurement of the dynamic material strength response. (C) 2012 Elsevier Ltd. All rights reserved.

Deformação miocárdica pelo speckle tracking na cardiomiopatia dilatada grave

FUNDAMENTO: A alta e crescente prevalência de Cardiomiopatia Dilatada (CMD) representa sério problema de saúde pública. Novas tecnologias vêm sendo utilizadas objetivando diagnósticos mais sofisticados, que melhorem a abordagem terapêutica. Nesse cenário, o Speckle Tracking (STE) utiliza marcadores miocárdicos naturais para analisar a deformação sistólica do Ventrículo Esquerdo (VE). OBJETIVO: Mensurar o strain transmural longitudinal global (SG) do VE através do STE em pacientes com CMD grave, comparando os resultados com indivíduos normais e com parâmetros ecocardiográficos consagrados para análise da função sistólica do VE, validando o método nessa população. MÉTODOS: Foram estudados 71 pacientes com CMD grave, (53 ± 12a, 72% homens) e 20 controles (30 ± 8a, 45% homens). Foram obtidos os volumes e a FEVE pela ecocardiografia bi e tridimensional, parâmetros do Doppler, Doppler tecidual e o SG pelo STE. RESULTADOS: Comparados ao grupo controle, os volumes do VE foram maiores no grupo CMD; entretanto, a FEVE e velocidade de pico da onda E foram menores neste último. O índice de performance miocárdica foi maior entre os pacientes. As velocidades do miocárdio pelo Doppler tecidual (S', e', a') foram consideravelmente menores e a relação E/e' foi maior no grupo CMD. O SG apresentou-se diminuído no grupo CMD (-5,5% ± 2,3%), em relação aos controles (-14,0% ± 1,8%). CONCLUSÃO: No presente estudo, o SG foi significativamente menor nos pacientes com CMD grave, abrindo novas perspectivas para abordagens terapêuticas nessa população específica.

Cirurgia de revascularização miocárdica na fase aguda do infarto: análise dos fatores preditores de mortalidade intra-hospitalar

OBJETIVO: A cirurgia de revascularização miocárdica (CRM) na fase aguda do infarto do miocárdio (IAM) está associada a aumento do risco operatório. O objetivo do estudo foi determinar fatores preditores de mortalidade intra-hospitalar nos pacientes submetidos a CRM no IAM. MÉTODOS: Durante três anos, todos os pacientes submetidos a CRM no IAM foram analisados retrospectivamente, utilizando o banco de dados institucional. Sessenta variáveis por paciente foram avaliadas: 49 variáveis pré-operatórias provenientes dos escores 2000 Bernstein-Parsonnet e EuroSCORE; 4 variáveis pré-operatórias não consideradas por esses escores (tempo entre o IAM e a CRM, valor máximo de CKMB, valor máximo de troponina e supradesnivelamento do segmento ST) e 7 variáveis intraoperatórias [uso de circulação extracorpórea (CEC), tempo de CEC, tipo de cardioplegia, endarterectomia, número de enxertos, uso da artéria torácica interna e revascularização completa]. Análise univariada e multivariada para o desfecho mortalidade intra-hospitalar foram realizadas. RESULTADOS: O tempo médio entre o IAM e a CRM foi de 3,8 ± 3 dias. A mortalidade global foi 19%. Na análise multivariada: idade > 65 anos [OR 16,5 (IC 1,8-152), P=0,013]~ CEC >108 minutos [OR 40 (IC 2,7-578), P=0,007], creatinina > 2 mg/dl [OR 35,5 (IC 1,7-740), P=0,021] e pressão pulmonar sistólica > 60 mmHg [OR 31(IC 1,6-591), P=0,022] foram preditores de mortalidade intra-hospitalar. CONCLUSÃO: Variáveis pré-operatórias clássicas como idade > 65 anos, creatinina > 2 mg/dl e pressão pulmonar sistólica > 60 mmHg foram preditoras de mortalidade intra-hospitalar nos pacientes operados de revascularização miocárdica na fase aguda do infarto.

Auscultación de presas de hormigón con láser escáner terrestre y modelización de las deformaciones del paramento

Se está produciendo en la geodesia un cambio de paradigma en la concepción de los modelos digitales del terreno, pasando de diseñar el modelo con el menor número de puntos posibles a hacerlo con cientos de miles o millones de puntos. Este cambio ha sido consecuencia de la introducción de nuevas tecnologías como el escáner láser, la interferometría radar y el tratamiento de imágenes. La rápida aceptación de estas nuevas tecnologías se debe principalmente a la gran velocidad en la toma de datos, a la accesibilidad por no precisar de prisma y al alto grado de detalle de los modelos. Los métodos topográficos clásicos se basan en medidas discretas de puntos que considerados en su conjunto forman un modelo; su precisión se deriva de la precisión en la toma singular de estos puntos. La tecnología láser escáner terrestre (TLS) supone una aproximación diferente para la generación del modelo del objeto observado. Las nubes de puntos, producto del escaneo con TLS, pasan a ser tratadas en su conjunto mediante análisis de áreas, de forma que ahora el modelo final no es el resultado de una agregación de puntos sino la de la mejor superficie que se adapta a las nubes de puntos. Al comparar precisiones en la captura de puntos singulares realizados con métodos taquimétricos y equipos TLS la inferioridad de estos últimos es clara; sin embargo es en el tratamiento de las nubes de puntos, con los métodos de análisis basados en áreas, se han obtenido precisiones aceptables y se ha podido considerar plenamente la incorporación de esta tecnología en estudios de deformaciones y movimientos de estructuras. Entre las aplicaciones del TLS destacan las de registro del patrimonio, registro de las fases en la construcción de plantas industriales y estructuras, atestados de accidentes y monitorización de movimientos del terreno y deformaciones de estructuras. En la auscultación de presas, comparado con la monitorización de puntos concretos dentro, en coronación o en el paramento de la presa, disponer de un modelo continuo del paramento aguas abajo de la presa abre la posibilidad de introducir los métodos de análisis de deformaciones de superficies y la creación de modelos de comportamiento que mejoren la comprensión y previsión de sus movimientos. No obstante, la aplicación de la tecnología TLS en la auscultación de presas debe considerarse como un método complementario a los existentes. Mientras que los péndulos y la reciente técnica basada en el sistema de posicionamiento global diferencial (DGPS) dan una información continua de los movimientos de determinados puntos de la presa, el TLS permite ver la evolución estacional y detectar posibles zonas problemáticas en todo el paramento. En este trabajo se analizan las características de la tecnología TLS y los parámetros que intervienen en la precisión final de los escaneos. Se constata la necesidad de utilizar equipos basados en la medida directa del tiempo de vuelo, también llamados pulsados, para distancias entre 100 m y 300 m Se estudia la aplicación del TLS a la modelización de estructuras y paramentos verticales. Se analizan los factores que influyen en la precisión final, como el registro de nubes, tipo de dianas y el efecto conjunto del ángulo y la distancia de escaneo. Finalmente, se hace una comparación de los movimientos dados por los péndulos directos de una presa con los obtenidos del análisis de las nubes de puntos correspondientes a varias campañas de escaneos de la misma presa. Se propone y valida el empleo de gráficos patrón para relacionar las variables precisión o exactitud con los factores distancia y ángulo de escaneo en el diseño de trabajos de campo. Se expone su aplicación en la preparación del trabajo de campo para la realización de una campaña de escaneos dirigida al control de movimientos de una presa y se realizan recomendaciones para la aplicación de la técnica TLS a grandes estructuras. Se ha elaborado el gráfico patrón de un equipo TLS concreto de alcance medio. Para ello se hicieron dos ensayos de campo en condiciones reales de trabajo, realizando escaneos en todo el rango de distancias y ángulos de escaneo del equipo. Se analizan dos métodos para obtener la precisión en la modelización de paramentos y la detección de movimientos de estos: el método del “plano de mejor ajuste” y el método de la “deformación simulada”. Por último, se presentan los resultados de la comparación de los movimientos estacionales de una presa arco-gravedad entre los registrados con los péndulos directos y los obtenidos a partir de los escaneos realizados con un TLS. Los resultados muestran diferencias de milímetros, siendo el mejor de ellos del orden de un milímetro. Se explica la metodología utilizada y se hacen consideraciones respecto a la densidad de puntos de las nubes y al tamaño de las mallas de triángulos. A shift of paradigm in the conception of the survey digital models is taking place in geodesy, moving from designing a model with the fewer possible number of points to models of hundreds of thousand or million points. This change has happened because of the introduction of new technologies like the laser scanner, the interferometry radar and the processing of images. The fast acceptance of these new technologies has been due mainly to the great speed getting the data, to the accessibility as reflectorless technique, and to the high degree of detail of the models. Classic survey methods are based on discreet measures of points that, considered them as a whole, form a model; the precision of the model is then derived from the precision measuring the single points. The terrestrial laser scanner (TLS) technology supposes a different approach to the model generation of the observed object. Point cloud, the result of a TLS scan, must be treated as a whole, by means of area-based analysis; so, the final model is not an aggregation of points but the one resulting from the best surface that fits with the point cloud. Comparing precisions between the one resulting from the capture of singular points made with tachometric measurement methods and with TLS equipment, the inferiority of this last one is clear; but it is in the treatment of the point clouds, using area-based analysis methods, when acceptable precisions have been obtained and it has been possible to consider the incorporation of this technology for monitoring structures deformations. Among TLS applications it have to be emphasized those of registry of the cultural heritage, stages registry during construction of industrial plants and structures, police statement of accidents and monitorization of land movements and structures deformations. Compared with the classical dam monitoring, approach based on the registry of a set of points, the fact having a continuous model of the downstream face allows the possibility of introducing deformation analysis methods and behavior models that would improve the understanding and forecast of dam movements. However, the application of TLS technology for dam monitoring must be considered like a complementary method with the existing ones. Pendulums and recently the differential global positioning system (DGPS) give a continuous information of the movements of certain points of the dam, whereas TLS allows following its seasonal evolution and to detect damaged zones of the dam. A review of the TLS technology characteristics and the factors affecting the final precision of the scanning data is done. It is stated the need of selecting TLS based on the direct time of flight method, also called pulsed, for scanning distances between 100m and 300m. Modelling of structures and vertical walls is studied. Factors that influence in the final precision, like the registry of point clouds, target types, and the combined effect of scanning distance and angle of incidence are analyzed. Finally, a comparison among the movements given by the direct pendulums of a dam and the ones obtained from the analysis of point clouds is done. A new approach to obtain a complete map-type plot of the precisions of TLS equipment based on the direct measurement of time of flight method at midrange distances is presented. Test were developed in field-like conditions, similar to dam monitoring and other civil engineering works. Taking advantage of graphic semiological techniques, a “distance - angle of incidence” map based was designed and evaluated for field-like conditions. A map-type plot was designed combining isolines with sized and grey scale points, proportional to the precision values they represent. Precisions under different field conditions were compared with specifications. For this purpose, point clouds were evaluated under two approaches: the standar "plane-of-best-fit" and the proposed "simulated deformation”, that showed improved performance. These results lead to a discussion and recommendations about optimal TLS operation in civil engineering works. Finally, results of the comparison of seasonal movements of an arc-gravity dam between the registered by the direct pendulums ant the obtained from the TLS scans, are shown. The results show differences of millimeters, being the best around one millimeter. The used methodology is explained and considerations with respect to the point cloud density and to the size of triangular meshes are done.