Umesh Pai

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.

Pericardial cyst: a benign anomaly

A 54-year-old asymptomatic man was detected to have a prominent left heart border on a routine chest x-ray done during his annual health check (figure 1, arrows). Echocardiogram revealed a cystic lesion occupying the space antero-lateral to the right ventricular outflow tract (RVOT; figure 2). The cystic cavity did not produce any compression of the RVOT. CT of the chest showed a 6×4 cm homogeneous smooth-walled cyst with …

Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

Central venous stenosis is an important hindrance to long-term maintenance of arteriovenous access in the upper extremities in dialysis patients. Aim The present study was done to determine feasibility and clinical success of endovascular approach for the treatment of symptomatic central venous stenosis associated with significant ipsilateral limb edema in dialysis patients with vascular access in the upper limb. Methods A database of hemodialysis patients who underwent endovascular treatment for central venous stenosis from January 2014 to January 2017 at our institute was retrospectively reviewed. Follow-up was variable. Results The study included ten patients (6 men and 4 women) with a mean age of 45.2 years, who underwent thirteen interventions during a period of 3 years. The technical success rate for endovascular treatment was 100%. One patient underwent primary PTA (percutaneous transluminal angioplasty). Seven patients underwent primary PTA and stenting. Three patients underwent secondary PTA. One among these patients underwent secondary PTA twice along with fistuloplasty. One patient underwent secondary PTA with stenting. No immediate complications were encountered during the procedure. Our study shows a primary patency rate of 67% and 33% at 6 months and 12 months for PTA with stenting. Our study also shows secondary or assisted primary patency of 75% at 6 months of follow-up. Conclusions Endovascular therapy (PTA) with or without stenting for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule and long-term patency rate is not very good.

Sinus rhythm in rheumatic mitral stenosis after balloon mitral valvotomy: Is it feasible?

INTRODUCTION Atrial Fibrillation (AF) is largely present in patients with rheumatic valvular disease, leading to hospitalizations. AIM We aimed to study the restoration and maintenance of Sinus Rhythm (SR) in rheumatic patients with Mitral Stenosis (MS) and AF after Balloon Mitral Valvotomy (BMV) and evaluated the factors which affect the maintenance of SR. MATERIALS AND METHODS A total of 50 patients who underwent BMV at U. N. Mehta Institute of Cardiology and Research Centre from 2010 November to 2013 January were included in the study. Subsequently, all patients were treated with amiodarone and electrical cardioversion was applied in patients in whom it was necessary. The patients were followed for six months for conversion and maintenance of SR. RESULTS Total 34 (68%) patients reverted to SR. Twelve patients reverted to SR with amiodarone and 22 patients with electrical cardioversion and amiodarone. Out of the total, 29 patients and 26 patients remained in SR at the end of follow up at 3 months and 6 months respectively. CONCLUSION Smaller Left Atrial (LA) size and greater Mitral Valve Area (MVA) are the chief predictors of restoration and maintenance of SR. Combining BMV with an aggressive anti-arrhythmic strategy offers the best prospect of rhythm control.

Preliminary Evaluation of Clinical and Angiographic Outcomes with Biodegradable Polymer Coated Sirolimus-Eluting Stent in De Novo Coronary Artery Disease: Results of the MANIPAL-FLEX Study.

Objective. The objective of the MANIPAL-FLEX study was to evaluate the feasibility, preliminary safety, and efficacy of the Supraflex sirolimus-eluting stent (SES) implantation, in de novo coronary artery disease, using clinical and quantitative coronary angiography (QCA) follow-ups. Methods. This was a prospective, nonrandomized, multicenter, single-arm study that enrolled 189 patients with de novo coronary artery disease who were treated with the Supraflex SES. Of 189 patients enrolled, the first 61 consecutive patients who consented to a 9-month follow-up evaluation by QCA, irrespective of presence of symptoms, were to be followed up with angiography at 9 months. The primary endpoint of the study was target lesion failure (TLF), including cardiac death, myocardial infarction, and target lesion revascularization during 12-month follow-up after the index procedure. Results. The mean age of the study population was 58 ± 11 years, with 51.3% (97/189) of hypertensive patients. Total of 66 lesions, analyzed by offline QCA, showed good scaffolding of the target vessel with in-stent late lumen loss at 9 months of 0.18 ± 0.23 mm. The observed TLF at 30-day, 6-month, and 12-month follow-up were 2 (1.1%), 6 (3.2%), and 10 (5.3%), respectively. Conclusion. This study provides preliminary evidence for the feasibility, safety, and efficacy of the Supraflex sirolimus-eluting stent.

Carotid stenting in a nonagenarian patient with symptomatic carotid stenosis.

Carotid artery stenosis is a disabling disease in all age groups. Elderly people are more prone to recurrent strokes due to advancing age and multiple co-morbidities. Treatment options for symptomatic carotid stenosis in the very elderly are the same as in younger patients although with a higher operative risk. We describe a successful case of carotid artery stenting in a nonagenarian with symptomatic carotid artery stenosis, a subgroup for whom treatment options are rarely discussed in guidelines.

A Comparative Evaluation of Stress Distribution with Two Attachment Systems of Varying Heights in a Mandibular Implant-Supported Overdenture: A Three-Dimensional Finite Element Analysis: Stress Distribution in a Mandibular IOD

PURPOSE To analyze and compare the stress distribution in an implant-retained overdenture complex using ball and Locator attachments of three heights by means of a 3D finite element analysis (FEA). MATERIALS AND METHODS Six finite element models comprising an edentulous mandible with two interforaminal bone-level implants and ball attachments of heights 1 mm (A1), 3 mm (A3), and 5 mm (A5), and Locator attachments of heights 1 mm (B1), 3 mm (B3), and 5 mm (B5), were designed using ANSYS Workbench Software. Unilateral vertical (100 N) and oblique loads (100 N at 30° to the longitudinal axis of the implant in buccolingual direction) were applied. Average von Mises stress values were evaluated quantitatively and qualitatively. RESULTS Locator attachments showed lower stress values as compared to the ball attachments in all examined areas. The increase in the height of both resulted in increased stress values. Higher values were observed at the implant neck in all models, as compared to the body and the apex. The recorded stress was higher in the cortical bone as compared to the cancellous bone. CONCLUSIONS Within the limitations of the study, Locator attachments demonstrated lesser and more homogenous stress distribution in the implant-overdenture complex in comparison to ball attachments. The stresses generated within the tissues increase with an increase in collar height of the attachment system and therefore, attachments should be as short as possible for more favorable stress transmission.

Evaluation of the Effect of Different Finish Lines and Luting Agents on Marginal Fit and Microleakage in Direct Metal Laser Sintered Copings-An in Vitro Study

Background & Objectives:. The present study aimed to study the effect of finish line and luting cements on marginal gap and micro leakage in copings fabricated by Direct Metal Laser Sintering (DMLS) Methods: 28 maxillary premolars were divided

A study of right ventricular function in pre- and post-valvular surgeries

Aims The aim of this study is to compare tricuspid annular plane systolic excursion (TAPSE) in pre- and postoperative valvular heart surgery patients using M-mode imaging, to determine changes in tissue Doppler parameters among patients undergoing valvular heart surgery, and to analyze tissue deformation parameters of right ventricle (RV) and RV strain in pre- and postoperative patients. Materials and methods This was an observational, cross-sectional, single-center study that included 24 patients who underwent echocardiographic assessment prior to surgery, after surgery, and at 1-month follow-up. Assessment of left and right ventricles by M-mode echocardiography, evaluation of RV by 2D Doppler echocardiography, tissue Doppler imaging, and strain imaging were performed. Results The TAPSE was significantly reduced immediately after surgery (14.8 ± 0.37 vs. 10.9 ± 0.26 mm), which was then improved on follow-up assessment (17.8 ± 34 mm) (p = 0.001). Tricuspid valve diastolic velocity was increased after surgery and then gradually declined at 1-month follow-up (p = 0.003). Presurgery RV free wall strain was found to be reduced, which was then improved during post-procedure analysis as well as on follow-up (p = 0.001). Conclusions After cardiac valvular surgery, RV myocardial deformation showed a gradual improvement after 1 month, although there was an immediate decline in RV function postsurgery. The pattern of RV contraction, as showed by RV strain, varied postsurgery, which was remarkably increased in postoperative patients at the time of follow-up. Tissue deformation imaging being an emerging technique helps in the assessment of minute, subtle changes that occur in the RV myocardial function in cardiac patients undergoing valve surgery.