Birgitta Janerot Sjöberg

Problems in Timing of Respiration With the Nasal Thermistor Technique

When one analyzes transvalvular and venous flow velocity patterns, it is important to relate them to respiration. For this reason a nasal thermistor technique is often used, although it is known that this signal is delayed in relation to intrathoracic pressure changes. The magnitude and variation in delay have not been investigated previously and were, therefore, studied in a model experiment in 10 normal subjects, in 10 patients with obstructive, and in 10 patients with restrictive pulmonary disease. Esophageal pressure variations measured with an air-filled balloon served as a gold standard for intrathoracic pressure changes. During basal conditions there was, for both patient groups and normal subjects, a considerable delay of the thermistor signal. The average delay for all subjects was 370 msec with a wide variation (from 120 to 720 msec). At higher breathing frequencies the delay shortened to 310 msec (P < 0.01) but there was still a wide variation (ranging from 200 to 470 msec). Theoretic calculations show that the delay caused by the respiratory system accounts for only a minor portion of the total delay. Model experiments confirmed that the response characteristics of the thermistor probes limit the accuracy in timing of respiration. The total delay with the investigated thermistor technique is too long and variable to fulfil clinical demands.

Subaortic Flow Profiles in Aortic Valve Disease: A Two-dimensional Color Doppler Study

With time-corrected color Doppler echocardiography, the aortic subvalvular spatial flow velocity profile was registered in two perpendicular planes in 10 patients with aortic valve disease and in 5 healthy control subjects. Patients with predominant aortic valve stenosis had a fairly flat profile, and the subvalvular diameter, obtained from left parasternal two-dimensional tissue imaging, provided a good estimate of the mean of the two transverse flow axes. This explains the accuracy in determination of stroke volume and aortic valve area that is reported in studies on patients with aortic valve stenosis when the continuity equation is used. However, the use of apical pulsed Doppler ultrasound registrations from the left ventricular outflow tract and parasternal two-dimensional echocardiography for flow area calculation may introduce large errors in calculated stroke volume in certain patients with aortic regurgitation and in normal subjects, because of a non-flat spatial velocity profile or an inaccurate estimate of flow area.

Two-dimensional Color Doppler Flow Velocity Profiles Can Be Time Corrected with an External ECG-delay Device

Although two-dimensional ultrasound color flow imaging is often considered to be a real-time technique, the acquisition time for two-dimensional color images may be up to 200 msec. Time correction is therefore necessary to obtain correct flow velocity profiles. We have developed a time-correction method in which a specially designed unit detects the QRS complex from the patient and creates a trig pulse that is delayed incrementally in relation to the QRS complex. This trig pulse controls the acquisition of the ultrasound images. A number of consecutively delayed images, with known incremental delay between the sweeps, can thus be stored in the memory of the echocardiograph and transferred digitally to a computer. The time-corrected flow velocity profile is obtained by interpolation of data from the time-delayed profiles. The system was evaluated in a Doppler string phantom test. With this technique it is possible to study time-corrected flow velocity profiles without the need to alter existing ultrasound Doppler equipment.

A novel method for discrimination between innocent and pathological heart murmurs

This paper presents a novel method for discrimination between innocent and pathological murmurs using the growing time support vector machine (GTSVM). The proposed method is tailored for characterizing innocent murmurs (IM) by putting more emphasis on the early parts of the signal as IMs are often heard in early systolic phase. Individuals with mild to severe aortic stenosis (AS) and IM are the two groups subjected to analysis, taking the normal individuals with no murmur (NM) as the control group. The AS is selected due to the similarity of its murmur to IM, particularly in mild cases. To investigate the effect of the growing time windows, the performance of the GTSVM is compared to that of a conventional support vector machine (SVM), using repeated random sub-sampling method. The mean value of the classification rate/sensitivity is found to be 88%/86% for the GTSVM and 84%/83% for the SVM. The statistical evaluations show that the GTSVM significantly improves performance of the classification as compared to the SVM.

In vivo estimation of cardiovascular flows with surface integration of velocity vectors from color Doppler imaging

Ultrasound can be used to noninvasively study the pumping heart. To be able to obtain more accurate flow estimates, we have designed the Surface Integration of Velocity Vectors (SIVV) echocardiographic method for angle independent determination of cardiac flow. The aim is to develop a noninvasive method for quantification of volume flows that can be used instead of the invasive methods that exist today. Using gated and time-delayed electrocardiographic acquisitions, Doppler data (Vingmed CFM 800) was collected for consecutive heart beats. Left ventricular inflow and outflow regions were studied. The SIVV analysis with velocity information from a variable number of planes as well as different wall filters and the time correction algorithm as described by Eidenvall et al. (1992), are implemented. Preliminary data from stroke volume determination agrees well (8% difference, 67 ml by SIVV versus 62 ml by the Fick equation).