1. CVRTI 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

2. CVRTI Origins Occlusion Pre-PTCAPeak-PTCA

3. CVRTI Biophysics of Acute Ischemia 0 -80 mV

4. CVRTI Imaging Approach

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

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

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

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

9. CVRTI Flow Control

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

11. CVRTI 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. CVRTI Data Processing Signals (Everett) –gain correction, windowing, baseline correction –global fiducials (Q on, S off, T off ) Geometry –location of sock in tank –coronaries Maps (Matlab, Map3d) –integrals: QRS, QRST, ST, STT, ST80

13. CVRTI Signal Processing T off Q on S off 3/85/8 ST off 80ms ST 80

14. CVRTI Tank/Heart Geometry

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

16. CVRTI Graded Flow  QRS 30 ml/m 24 ml/m 18 ml/m 12 ml/m 6 ml/m 0 ml/m 10Jan01-ocl1

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

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

19. CVRTI Graded Pacing  ST80 34 ml/m 24 ml/m 18 ml/m 12 ml/m 6 ml/m 0 ml/m 215 190 165 150 130 FlowHeart Rate 10Jan01-ocl5 (full flow)

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

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

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

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

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

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

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

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

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

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

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

31. CVRTI Reduced Flow:  ST-80 19Jan01-ocl1 35 28 21 14 7 0 ml/minmin FlowTime 30 27 24 21 18 15 12 9 6 3 33

32. CVRTI Reduced Flow:  ST-80 19Jan01-ocl1 35 28 21 14 7 0 ml/minmin FlowTime 30 27 24 21 18 15 12 9 6 3 33

33. CVRTI Fixed Flow, Increased Rate Start flow at 35 Reduce to 21 Increase rate

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

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

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

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

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

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

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