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Electric Imaging of Myocardial Ischemia

Electric Imaging of Myocardial Ischemia. Rob MacLeod, Bonnie Punske, Shibaji Shome, Bulent Yilmaz, and Bruno Taccardi. Cardiovascular Research and Training Institute Bioenginering Department University of Utah. Origins. Occlusion. Pre-PTCA. Peak-PTCA. 0. mV. -80.

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Electric Imaging of Myocardial Ischemia

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  1. Electric Imaging of Myocardial Ischemia Rob MacLeod, Bonnie Punske, Shibaji Shome, Bulent Yilmaz, and Bruno Taccardi Cardiovascular Research and Training InstituteBioenginering DepartmentUniversity of Utah

  2. Origins Occlusion Pre-PTCA Peak-PTCA

  3. 0 mV -80 Biophysics of Acute Ischemia

  4. Imaging Approach

  5. Cardiac Mapping of Ischemia LAD LCx Epicardium Endocardium Source of Electrocardiographic ST Changes in Subendocardial Ischemia Li et al. Circ. Res. 82:957-970, 1998

  6. Research Questions • ST elevation or (transient) depression? • Acute occlusion versus graded flow? • How do ST changes image on the body surface?

  7. Technical Apparatus • “Andy III” • 370 electrodes • R = 500 W cm • Homogeneous • 1024 channel acquisition

  8. Isolated Heart Preparation Electrolytic Torso Tank Flow Regulators Heat Exchange C J Support Dog Epicardial Sock Electrodes TorsoTank Electrodes

  9. Flow Control

  10. Epicardial Electrode Sock • Nylon stocking material • 490 recording wires • 24 pacing wires • Reference markers for geometry

  11. Protocols • Acute, complete occlusion • 3-minute duration • measurements each 30 s • Graded flow • 2-minute intervals at each flow rate • measurement at end of each interval • Graded heart rate • constant flow rate • increase rate in 2-minute intervals • measurement at end of each interval

  12. Signal Processing 3/8 5/8 80ms Qon Soff SToff Toff ST80

  13. Tank/Heart Geometry

  14. Acute OcclusionST Flow Time 30 300 270 24 240 210 18 180 150 12 120 90 6 60 30 0 s ml/min 4Jan01-ocl1

  15. Graded FlowST 30 ml/m 24 ml/m 18 ml/m 12 ml/m 6 ml/m 0 ml/m 10Jan01-ocl1

  16. Graded Pacing ST80 (reduced flow) 34 ml/m 215 24 ml/m 190 165 18 ml/m 12 ml/m 150 6 ml/m 130 0 ml/m Flow Heart Rate 10Jan01-ocl4

  17. Fixed Rate, Decreased Flow • Start flow at 35 • Reduce to 0 • Increase back to 35 • 3 minutes at each flow rate

  18. 33 30 27 24 21 18 15 12 9 6 3 ReducedFlow:ST-80 Flow Time 35 28 21 14 7 0 ml/min min 19Jan01-ocl1

  19. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  20. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  21. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  22. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  23. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  24. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  25. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  26. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  27. ReducedFlow:ST-80 Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min 19Jan01-ocl1

  28. Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min ReducedFlow:ST-80 19Jan01-ocl1

  29. Flow Time 33 35 30 27 28 24 21 21 18 15 14 12 9 7 6 3 0 ml/min min ReducedFlow:ST-80 19Jan01-ocl1

  30. Fixed Flow, Increased Rate • Start flow at 35 • Reduce to 21 • Increase rate

  31. Increased Rate:ST-80 Flow Time Rate 35 18 231 15 214 28 12 200 21 9 188 14 6 176 7 3 167 0 158 ml/min min BPM 19Jan01-ocl1

  32. Increased Rate:ST-80 Flow Time Rate 35 18 231 15 214 28 12 200 21 9 188 14 6 176 7 3 167 0 158 ml/min min BPM 19Jan01-ocl1

  33. Increased Rate:ST-80 Flow Time Rate 35 18 231 15 214 28 12 200 21 9 188 14 6 176 7 3 167 0 158 ml/min min BPM 19Jan01-ocl1

  34. Increased Rate:ST-80 Flow Time Rate 35 18 231 15 214 28 12 200 21 9 188 14 6 176 7 3 167 0 158 ml/min min BPM 19Jan01-ocl1

  35. Increased Rate:ST-80 Flow Time Rate 35 18 231 15 214 28 12 200 21 9 188 14 6 176 7 3 167 0 158 ml/min min BPM 19Jan01-ocl1

  36. Increased Rate:ST-80 Flow Time Rate 35 18 231 15 214 28 12 200 21 9 188 14 6 176 7 3 167 0 158 ml/min min BPM 19Jan01-ocl1

  37. Increased Rate:ST-80 Flow Time Rate 35 18 231 15 214 28 12 200 21 9 188 14 6 176 7 3 167 0 158 ml/min min BPM 19Jan01-ocl1

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