Jyothi Samanth

Automated screening of congestive heart failure using variational mode decomposition and texture features extracted from ultrasound images

Heart is an important and hardest working muscular organ of the human body. Inability of the heart to restore normal perfusion to the entire body refers to cardiac failure, which then with symptoms results in manifestation of congestive heart failure (CHF). Impairment in systolic function associated with chronic dilation of left ventricle is referred as dilated cardiomyopathy (DCM). The clinical examination, surface electrocardiogram (ECG), chest X-ray, blood markers and echocardiography play major role in the diagnosis of CHF. Though the ECG manifests chamber enlargement changes, it does not possess sensitive marker for the diagnosis of DCM, whereas echocardiographic assessment can effectively reveal the presence of asymptomatic DCM. This work proposes an automated screening method for classifying normal and CHF echocardiographic images affected due to DCM using variational mode decomposition technique. The texture features are extracted from variational mode decomposed image. These features are selected using particle swarm optimization and classified using support vector machine classifier with different kernel functions. We have validated our experiment using 300 four-chamber echocardiography images (150: normal, 150: CHF) obtained from 50 normal and 50 CHF patients. Our proposed approach yielded maximum average accuracy, sensitivity and specificity of 99.33%, 98.66% and 100%, respectively, using ten features. Thus, the developed diagnosis system can effectively detect CHF in its early stage using ultrasound images and aid the clinicians in their diagnosis.

Automated technique for coronary artery disease characterization and classification using DD-DTDWT in ultrasound images

Abstract Heart is one of the important as well as hardest working organ of human body. Cardiac ischemia is the condition where sufficient blood and oxygen will not reach the heart muscle due to narrowed arteries of the heart. This condition is called coronary artery disease. Several non-invasive diagnostic tests fail to reveal exact impact of coronary artery disease on myocardial segments. The ultrasound images can explore major impact on ventricular muscle segments due to ischemia and complication of acute coronary syndrome. Computer aided diagnosis tools can predict coronary artery disease in its early stage so that patients can undergo treatment and save their life. This paper presents a novel computer aided diagnosis system for the automated detection of coronary artery disease using echocardiography images taken from four chamber heart. Proposed method uses double density-dual tree discrete wavelet transform (DD-DTDWT) to decompose the images into different frequency sub-bands. Then various entropy features are extracted from these sub-bands. The obtained dimension of the features is reduced using marginal fisher analysis (MFA) and optimal features are selected using feature ranking methods. The proposed method achieved promising accuracy of 96.05%, sensitivity of 96.12%, and specificity of 96.00% for linear discriminant classifier using entropy ranking method with twelve features. We have also proposed coronary artery disease risk index (CADRI) to categorize diseased subjects from normal subjects using a single value. Thus, it can be used as a diagnosis tool in hospitals and polyclinics for confirming the findings of clinicians.

Respiratory variation in aortic flow peak velocity and inferior vena cava distensibility as indices of fluid responsiveness in anaesthetised and mechanically ventilated children.

Background and Aims: Dynamic parameters such as the respiratory variation in aortic flow peak velocity (ΔVpeak) and inferior vena cava distensibility index (dIVC) are accurate indices of fluid responsiveness in adults. Little is known about their utility in children. We studied the ability of these indices to predict fluid responsiveness in anaesthetised and mechanically ventilated children. Methods: This prospective study was conducted in 42 children aged between one to 14 years scheduled for elective surgery under general endotracheal anaesthesia. Mechanical ventilation was initiated with a tidal volume of 10 ml/kg. ΔVpeak, dIVC and stroke volume index (SVI) were measured before and after volume expansion (VE) with 10 ml/kg of crystalloid using transthoracic echocardiography. Patients were considered to be responders (R) and non-responders (NR) when SVI increased to either ≥15% or <15% after VE. ΔVpeak and dIVC were analysed between R and NR. Results: The best cut-off value for ΔVpeak as defined by the receiver operator characteristics (ROC) curve analysis was 12.2%, for which sensitivity, specificity, positive predictive value and negative predictive value were 100%, 94%, 96% and 100%, respectively, the area under the curve was 0.975. The best cut-off value for dIVC as defined by the ROC curve analysis was 23.5%, for which sensitivity, specificity, positive predictive value and negative predictive value were 91%, 89%, 91% and 89%, respectively, the area under the curve was 0.95. Conclusion: ΔVpeak and dIVC are reliable indices of fluid responsiveness in children.

Comparison of plasma levels of renin, vasopressin and atrial natriuretic peptide in hypertensive amlodipine induced pedal oedema, Non-Oedema and cilnidipine treated patients

INTRODUCTION Amlodipine is a third generation dihydropyridine group of calcium channel blocker and having an excellent antihypertensive profile. Pedal Oedema (PE) is the major drawback of amlodipine therapy and the incidence of Amlodipine Induced Pedal Oedema (AIPE) has been found significantly high. Several neurohumoral factors influence the incidence of oedema. AIM We aimed to compare the plasma levels of renin, vasopressin and atrial natriuretic peptide in hypertensive AIPE, non-oedema and cilnidipine treated patients. MATERIALS AND METHODS The present prospective, interventional study was conducted on 104 mild to moderate hypertensive patients (52 patients in each group), after due consideration of eligibility criteria. Plasma Renin (PR), Vasopressin (VAS), and the Atrial Natriuretic Peptide (ANP) was estimated by ELISA test and compared between the AIPE, Amlodipine Treated Non-Oedema (ATNE) in Phase I, and AIPE and Cilnidipine Treated (CT) Groups in Phase II. RESULTS The clinical and demographic parameters were matched. PR was significantly high in AIPE group than the ATNE, and it was significantly reduced after one month follow up with the substitution of cilnidipine. The median (IQR) value of PR was 4.87 (3.58, 6.63), 3.50 (1.44, 5.47) and 2.66 (1.02, 5.66) ng/ml in AIPE, ATNE, CT group respectively. VAS was significantly high in AIPE group than ATNE, and it significantly reduced after one month follow up with CT group. The median (IQR) value of vasopressin was 6.78 (2.55, 9.16), 2.58 (1.61, 5.73) and 2.50 (1.23, 5.00) ng/ml in AIPE, ATNE and CT groups respectively. There was no significant difference seen in plasma ANP levels between the groups. The p-value was <0.05 which is statistically significant. CONCLUSION The AIPE may not be volume overload or fluid retention; it may be due to persistent raise in adrenergic activity followed chronic amlodipine therapy. Cilnidipine relatively suppresses the sympathetic activity, and completely resolves the AIPE by significantly reducing PR and VAS levels. ANP did not show a difference between groups. Cilnidipine is the suitable alternative antihypertensive drug for AIPE patients.

Echocardiographic abnormalities in cirrhosis & their correlation with severity of cirrhosis using Child-Pugh score among patients in a tertiary care hospital

Background & objectives: Child-Pugh score (CPS) is a widely used prognostic marker in cases of cirrhosis and pulmonary arterial hypertension (PAH). However, the role of this score in the quantification of severity of PAH is not well studied. In mild cases, echocardiography is more sensitive. This study was done to assess the association between echocardiography and severity of cirrhosis using CPS. Methods: A cross-sectional study was done from April to June 2014 in 42 patients with cirrhosis using a pre-tested semi-structured interview schedule. Results: There was no significant association between echocardiographic changes and CPS in patients with liver cirrhosis. Interpretation & conclusions: Advising an echocardiographic evaluation may prove beneficial in patients of Child-Pugh Grades B and C. However, more extensive studies are required to confirm the same.

Large clot splitting the left atrium into two distinct cavities: a report through mitral stenosis transoesophageal echocardiography

A 53-year-old woman diagnosed with rheumatic mitral stenosis (at the age of 40 years) presented with worsening dyspnoea New York Heart Association class III of 1 month duration. She was on regular treatment with diuretics, β-blockers and warfarin (in view of valvular atrial fibrillation). However, 1 month prior to presentation, she was off all medications except warfarin, which she was compliant on. Blood investigations revealed the presence of subclinical hypothyroidism with an optimal international normalised ratio of 2.64. ECG …