Claudio De Lazzari

Interactive simulator for e-Learning environments: a teaching software for health care professionals

There is an established tradition of cardiovascular simulation tools, but the application of this kind of technology in the e-Learning arena is a novel approach. This paper presents an e-Learning environment aimed at teaching the interaction of cardiovascular and lung systems to health-care professionals. Heart-lung interaction must be analyzed while assisting patients with severe respiratory problems or with heart failure in intensive care unit. Such patients can be assisted by mechanical ventilatory assistance or by thoracic artificial lung.“In silico” cardiovascular simulator was experimented during a training course given to graduate students of the School of Specialization in Cardiology at ‘Sapienza’ University in Rome.The training course employed CARDIOSIM©: a numerical simulator of the cardiovascular system. Such simulator is able to reproduce pathophysiological conditions of patients affected by cardiovascular and/or lung disease. In order to study the interactions among the cardiovascular system, the natural lung and the thoracic artificial lung (TAL), the numerical model of this device has been implemented. After having reproduced a patient’s pathological condition, TAL model was applied in parallel and hybrid model during the training course.Results obtained during the training course show that TAL parallel assistance reduces right ventricular end systolic (diastolic) volume, but increases left ventricular end systolic (diastolic) volume. The percentage changes induced by hybrid TAL assistance on haemodynamic variables are lower than those produced by parallel assistance. Only in the case of the mean pulmonary arterial pressure, there is a percentage reduction which, in case of hybrid assistance, is greater (about 40%) than in case of parallel assistance (20-30%).At the end of the course, a short questionnaire was submitted to students in order to assess the quality of the course. The feedback obtained was positive, showing good results with respect to the degree of students’ learning and the ease of use of the software simulator.

Effects of amlodipine and adenosine on coronary haemodynamics: in vivo study and numerical simulation

Amlodipine (AMLO) is a calcium channel blocker with vasodilating properties, in which the specific effects on the coronary circulation are not fully known. Coronary flow velocity–pressure (F/P) curves were obtained at rest and during administration of AMLO (10 mg to 20 mg iv) or adenosine (ADO, 1 mg ic) in 10 normal subjects (six women, age 48 ± 14 years). F/P curves were reproduced in a numerical simulator of systemic and coronary circulations (CARDIOSIM©) by adjustment of coronary resistance ( > or < 100 μm diameter vessels) and extravascular resistance applied to smaller vessels at endocardial (ENDO), middle and epicardial (EPI) myocardial layers. Best matching of in silico to in vivo curves was achieved by trial and error approach. ADO induced 170% and 250% increase in coronary flow velocity CFV and F/P diastolic slope as compared to 80% and 25–30% increase induced by AMLO, respectively. In the cardiovascular model, AMLO effects were predicted by progressive reduction of>100 μm vessels resistance from EPI to ENDO. ADO effects were mimicked by reducing resistance of both>100 μm and < 100 μm vessels, progressively from EPI to ENDO in the latter. Additional reduction in extravascular resistance avoided to impose a transmural gradient of vasodilating effect for both drugs. Numerical simulation predicts vasodilating effects of AMLO mainly on larger arteries and of ADO on both>and < 100 μm vessels. In vivo F/P loops could be completely reproduced in silico by adding extravascular resistance reduction for both drugs. Numerical simulator is useful tool for exploring the coronary effects of cardioactive drugs.

In silico study of the haemodynamic effects induced by mechanical ventilation and biventricular pacemaker

In silico modeling of the cardiovascular system (CVS) can help both in understanding pharmacological or pathophysiological process and in providing information which could not be obtained by means of traditional clinical research methods due to practical or ethical reasons. In this work the numerical CVS was used to study the effect of interaction between mechanical ventilation and biventricular pacemaker by haemodynamic and energetic point of view. Starting from literature data on patients with intra and/or inter-ventricular activation time delay and treated using biventricular pacemaker, we used in silico simulator to analyse the effects induced by mechanical ventilatory assistance (MVA). After reproducing baseline and CRT conditions, the MVA was simulated changing the mean intrathoracic pressure value. Results show that simultaneous application of CRT and MVA yields a reduction of cardiac output, left ventricular end-diastolic and end-systolic volume when positive mean intrathoracic pressure is applied. In the same conditions, when MVA is applied, left ventricular ejection fraction, mean left (right) atrial and pulmonary arterial pressure increase.

Screening high school students in Italy for sudden cardiac death prevention by using a telecardiology device: a retrospective observational study

BACKGROUND In 2010, an Italian project was launched aimed at using a telecardiology device in order to perform early diagnosis of young students at risk of sudden cardiac death. METHODS Our retrospective observational study was conducted on a population of 13,016 students, aged between 16 and 19 years, in different Italian regions. It consisted of analysis of data recorded during a telecardiology pilot study. The recorded data were electrocardiograms and data concerning lifestyle habits and family history of cardiovascular diseases. In total, 14 alterations in the electrocardiogram signal have been considered in this study. Some of these alterations are as follows: ventricular ectopic beats, atrioventricular block, Brugada-like electrocardiogram pattern, left anterior/posterior fascicular block, left/right ventricular hypertrophy, long/short QT interval, left atrial enlargement, right atrial enlargement, short PQ interval, and ventricular pre-excitation Wolff-Parkinson-White syndrome. On the basis of the collected data, we implemented this retrospective observational study. RESULTS The analysed data showed that 13.60% of students had a family history for cardiovascular diseases, 22.43% reported smoking habits, 26.23% reported alcohol consumption, and 7.24% reported abuse of drugs. A total of 24% of students had at least one of the 14 electrocardiogram pathological alterations considered in our study and 32% had electrocardiogram values within the normal range. CONCLUSIONS This retrospective observational study analysed data registered during our telecardiology activity. This activity permitted to maximise data collection and minimise the costs for collecting such data. This activity of screening is being continued and in the next few years it will allow us to have a greater mass of data.

ENERGETIC VENTRICULAR BALANCE DURING CARDIAC RESYNCHRONIZATION THERAPY: NUMERICAL SIMULATION

Cardiac Resynchronization Therapy (CRT), realised using biventricular pacemaker is used to treat patients with in systolic heart failure (HF) and with prolonged QRS. The goal of CRT is to eliminate or reduce the electromechanical dyssynchrony processes often responsible of cardiac remodelling. The aim of this work is to study the effects of CRT on the energetic left ventricular variables as external work, the pressurevolume area and the potential energy. In order to study the effects produced by CRT on energetic left ventricular balance it was used the numerical model of the cardiovascular system (CARDIOSIM

A Survey of telecardiology projects in Italy

It is estimated that in Italy there are about three million people affected by chronic heart failure. Cardiology is the health care field currently getting the largest benefits from telemedicine. Transmission, using wireless devices, makes possible to achieve virtual hospitalization: it is possible to anticipate the time of discharging and the patient can be remotely controlled by the central station in the ICU of the department of Medicine. Teleconsulting (i.e. a distance consulting between physicians) is applied in telecardiology, it allows the realization of a consulting between cardiology departments and remote services in the same hospital or among far-away hospitals. In this paper some of the most significant cardiac telemonitoring projects in Italy are described. Also reported, the projects involving the applications of implantable cardiac devices which can be controlled remotely. In conclusion, we sketch out the future prospects of telecardiology research and its applications in Italy.

Telecardiology in Italy: current realizations and future prospects.

Italy has a long tradition of telemedicine experiments that may be dated back to the early Seventies and currently many different telemedicine services are implemented in the country. Cardiology is the field of health care that currently gets the greatest benefits from telemedicine and it is also a very relevant field, since it is estimated that there are about three million people affected by chronic heart failure (5% of the population). In this paper we review some of the most significant cardiac telemonitoring projects in Italy, then we show the future prospects for telecardiology and put in evidence responsibilities and legal aspects We conclude that telecardiology, by enabling a better interaction between hospital and territory by means of teleconsulting, telemonitoring, telecare and remote access to clinical information, improves the quality of the whole health system. However, it cannot and should not replace the essential home care services, but it should be integrated properly and profitably with them.

The first veterinary telemedicine study group

Profound changes are occurring in human medicine as a result of the diffusion of information and communication technologies (ICTs). Such technolgies can support team work, by improving diagnostic and therapeutic skills and learning at a distance, which in turn may improve levels of care and professional training. Similarly, the applications of ICTs in the field of veterinary medicine may also bring new opportunities for research and service. In 2007, the Italian Society of Veterinary Science (SISVet) recognised the opportunities in the veterinary field and endorsed the idea of a conference about ICT and telemedicine. One aim of the conference was to provide an opportunity for meetings between those who usually work in different sectors. The conference was also expected to stimulate awareness concerning emerging projects and ideas in the field of veterinary telemedicine in Italy.