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  • Noninvasive Cardiovascular and Hemodynamic Core Lab

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  • The Ultrasound Core Laboratory (UCL) has been reorganized and is now the Noninvasive Cardiovascular Ultrasound and Hemodynamic Laboratory. This reorganization consolidates all cardiovascular studies, pulmonary function studies and noninvasive hemodynamics under the same core lab.

    Hypertension and heart failure are the research areas of focus of the Cardiovascular Group at MSM. The cardiovascular ultrasound-imaging core is a key component of the cardiovascular research infrastructure in evaluating the mechanisms of heart muscle and blood vessels changes in hypertension and its complications.

    The lab also serves as the coordinating center for studies and data collected at certain designated clinical sites.

    Director: Rigobert Lapu-Bula, MD, PhD is an Assistant Professor in the Department of Medicine, Section of Cardiology. By virtue of his doctoral training in cardiology, he has a long-standing interest and extensive experience in the use of echocardiographic techniques in evaluating the mechanisms and outcomes of congestive heart failure (CHF). His experience in cardiovascular-hemodynamics and exercise physiology has helped establish the Ultrasound Core.

    Dr Lapu Bula has been looking at the relationship between eNOS polymorphisms, endothelial derived flow mediated dilation, left ventricular hypertrophy and myocardial blood flow in hypertensive subjects. He is also continuing his pilot work on myocardial blood flow abnormalities using a new model of salt-sensitivity and pre-hypertension.

    As the lead investigator in the ongoing NASA human studies on blood pressure regulation under controlled conditions of simulated microgravity and salt manipulations as countermeasures, he has also established relationships with other investigators through Space Medicine and Life Sciences Research Center (SMLSRC) and the National Space Biomedical Research Institute (NSBRI). Such a multidisciplinary interaction has been very helpful to bridge the gap between animal models and human subjects in our understanding of post-flight and bed rest-induced orthostasis.

    Cardiologists: Elizabeth Ofili , MD, MPH (Chief, Section of Cardiology and Director, CRC), Adefisayo Oduwole, MD ( Associate Professor of Medicine ), Anekwe Onwuanyi MD(Associate Professors of Medicine ). These cardiologists are board-certified with advanced training and experience in interpreting echocardiograms and conducting hemodynamic/echo stress testing.

    Manager: Jan Morgan, BS has over 14-years experience in laboratory investigation and 5-years in clinical research. She currently coordinates patient recruitment and scheduling for the CCRE clinical research studies and responsible for the day-to-day operation of the CRC Core lab. She will provide technical support for laboratory assays, order and maintain project related research supplies and serve as liaison between Cores/Departments. She also assists in data preparation for scientific and seminar presentations.

    Personnel: Vonsina Clark (CVT), has over 5 years experience in various cardiac and vascular ultrasound modalities and exercise stress testing techniques performed at the CRC as well as at our remote clinical site (Morehouse Medical Associates).

    Goals and Objectives: The purpose of the Noninvasive Cardiovascular Ultrasound and Hemodynamic Laboratory is to provide the technical and analytical support for various research projects in which the modality of cardiovascular ultrasound imaging is employed in humans. Specific objectives are:

    • To provide high quality cardiovascular ultrasound procedures, which adhere to the established protocols of the given clinical research project.
    • T o expand the capabilities of the Ultrasound Core Lab to be able to analyze and manage cardiovascular ultrasound studies and data from designated remote clinical sites, with the Core Lab serving as the coordinating center.
    • To integrate other CRC physiological resources into the “Non-invasive Cardiovascular Ultrasound and Hemodynamic Laboratory” thereby supporting a broader base of investigators.

    Facilities and Equipment: The CRC Ultrasound Core Laboratory is a Digital Echo Lab. The digital image acquisition unit performs full digital recording from any echo system from designated remote sites to acquire full study data (including stress echo studies) with audio as well as single-frame capture for Doppler, M-mode and text screens. Dedicated core lab echocardiographic equipment consists of cutting-edge ultrasound imaging instruments, super- VHS video player/recorders, industrial grade color video monitors, digital frame grabbers, digital image archiving (storage/retrieval), digital imaging network, and high quality grade color page printers.

    An ATL HDI 5000-ultrasound system was recently installed for all cardiac and vascular reactivity ultrasound studies. This ATL upgrade allows output of digitally acquired images from the echo-system to a customized networked cardiovascular workstation (ProSolv) for off-line review/analysis.

    Additional equipment for various vascular and hemodynamic testing/monitoring modalities expand the Ultrasound Core capability to a comprehensive performance Core Lab.

    Training: The Core Director supervises the training of the technical staff. Training is conducted primarily at the Core Laboratory, and includes didactic and supervised “hands-on” learning, individually or in small groups. Training provides the study site ultrasonographer with the rationale, significance and technique of the ultrasound procedure.

    Specific objectives include but not limited to: a) to correctly perform the sequence of tasks for the brachial artery ultrasound procedure; b) to acquire high-quality images for analysis by the Core Laboratory Directors; c) to avoid sources of variability in image acquisition, measurement error, and artifacts; d) to properly collect and record the study data; e) to properly label and ship video cassette tapes, CDs, images, and forms to the Core Laboratory; f) to maintain communication with the Core Laboratory regarding the technique and/or brachial ultrasound procedure.

    Image acquisition is standardized. Operators (including sonographer/CVT, cardiologist or staff fellow) perform the same procedures using the same approach, patient position, machine setting and recording criteria in accordance with existing recommendations, mainly those of the American Society of Echocardiography. During ultrasound examination, the operator performs direct measurements of structure/diameters (M-mode or two-dimensional modalities) as well as of the Doppler signals, using on-line electronic calipers and tape-recording the whole procedure in addition to the digital clips.

    The Images are stored then reviewed on video or digital format by one of the cardiologists in the presence of the operator/CVT or staff member participating in the acquisition sessions. In our lab, off-line revisions of clinical echo examinations are routinely performed for both teaching purposes and quality improvement. Total quality management of the Core Lab services has been connected with our comprehensive system of quality assurance, which integrates quality development, quality maintenance, and quality improvement.

    Each study is completed with a formal written report and interpretation. This report is kept on file with copies of image documentation (paper and/or tape or optical disk or server) for review or offline analysis.

    List of Tests and Services:

    Cardiac and Vascular Imaging

    • Transthoracic Echocardiography
    • Quantitative Analysis of Echocardiograms
    • Doppler Tissue Imaging (DTI)
    • Myocardial Contrast Echocardiography (MCE)
    • Dobutamine Stress Echocardiography
    • Exercise Stress Echocardiography
    • Brachial Artery Ultrasound Imaging
    • Finger Plethysmography
    • Carotid Ultrasound Imaging
    • Vascular Compliance/Stiffness Pulse-Wave Analysis

    Stress Testing and Cardiovascular Hemodynamics

    • Exercise ECG Stress Testing
    • Maximal O 2 Uptake Testing
    • Respiratory Energy Expenditure
    • Twelve-Lead Electrocardiography (ECG)
    • Tilt-Testing
    • T-Wave Alternans
    • Ambulatory Blood Pressure Monitoring
    • Holter Monitoring

    Cardiovascular Hemodynamics Phenotype Assessment