Search

Background The objective of this international multicenter study was to investigate both early and late outcomes of cardiac resynchronization therapy (CRT) in patients with a systemic right ventricle (SRV) and to identify predictors for congestive heart failure readmissions and mortality. Methods and Results This retrospective international multicenter study included 13 centers. The study population comprised 80 adult patients with SRV (48.9% women) with a mean age of 45±14 (range, 18-77) years at initiation of CRT. Median follow-up time was 4.1 (25th-75th percentile, 1.3-8.3) years. Underlying congenital heart disease consisted of congenitally corrected transposition of the great arteries and dextro-transposition of the great arteries in 63 (78.8%) and 17 (21.3%) patients, respectively. CRT resulted in significant improvement in functional class (before CRT: III, 25th-75th percentile, II-III; after CRT: II, 25th-75th percentile, II-III; P=0.005) and QRS duration (before CRT: 176±27; after CRT: 150±24 milliseconds; P=0.003) in patients with pre-CRT ventricular pacing who underwent an upgrade to a CRT device (n=49). These improvements persisted during long-term follow-up with a marginal but significant increase in SRV function (before CRT; 30%, 25th-75th percentile, 25-35; after CRT: 31%, 25th-75th percentile, 21-38; P=0.049). In contrast, no beneficial change in the above-mentioned variables was observed in patients who underwent de novo CRT (n=31). A quarter of all patients were readmitted for heart failure during follow-up, and mortality at latest follow-up was 21.3%. Conclusions This international experience with CRT in patients with an SRV demonstrated that CRT in selected patients with SRV dysfunction and pacing-induced dyssynchrony yielded consistent improvement in QRS duration and New York Heart Association functional status, with a marginal increase in SRV function.

A three-dimensional (3D) finite element model of a railway crossing panel for use in multibody simulation (MBS) of dynamic vehicle–track interaction is presented. It is a two-layer track model with stock rails and sleepers represented by beam elements and a crossing rail represented by 3D solid elements. The track model uses linear bushings for the rail fastenings and bi-linear bushings for the ballast to allow for potentially voided sleepers. Based on the output from the MBS, the structural loading of the crossing in terms of strains, stresses and sleeper-ballast contact pressures is extracted in a post-processing step. The model is calibrated and validated to measurement data from a comprehensively instrumented switch & crossing (S&C) demonstrator installed in the Austrian railway network as a part of the European research programme Shift2Rail. The applied procedure for the calibration and critical assessment of the crossing model is described in detail. It is based on a model parameterisation with eight parameters relating to the rail fastening and foundation stiffnesses and to a distribution of the ballast voids. The calibration method uses Latin hypercube samples to explore the parameter space in a sensitivity analysis before a parameter optimisation is performed using a gradient-based method on a response surface built from a polyharmonic spline. In a comparative study it is shown that the 3D model and a more conventional beam model of the crossing rail show similar calibration results and good agreement with the measured data. The 3D model allows for the extraction of stress concentrations in the crossing rail but has an increased computational time of about 30% compared to the beam model. [ABSTRACT FROM AUTHOR]

This paper presents a finite element model of a railway crossing panel for use in multibody simulations (MBS). It is a two-layer track model with rails and sleepers represented by beam elements that use linear bushings for rail fastenings and non-linear bushings for ballast. The model is calibrated and validated to measurement data from a comprehensively instrumented switch and crossing demonstrator installed in the Austrian railway network as a part of the European research programme Shift2Rail. The validation concerns the capability of the model to capture the structural response of the crossing panel under traffic loading after calibration of physical track parameters to realistic values. The structural response is measured in the form of displacements, strains, and sleeper-ballast contact forces. It is shown that the developed model can represent the measured track responses well and that it was necessary to account for a varying sleeper-ballast gap distribution along the crossing transition sleeper to obtain good agreement. The calibration uses Latin hypercube samples to explore the parameter space in a sensitivity analysis before a parameter optimisation is performed using a gradient-based method on a response surface built from a polyharmonic spline. [ABSTRACT FROM AUTHOR]

With increasing train speeds and reduced time windows for maintenance work, the interest in the application of slab track technology to increase the capacity of high-speed railways has grown. Slab track may still be considered a relatively young technology, but with several different designs available on the market. Current research on slab tracks commonly focuses on improved methods. In contrast, the formulation of requirements, and evaluation towards these, are seldom investigated. In this paper, state-of-the-art simulation models are employed to illustrate and address the needs for innovative requirements in terms of structural integrity and robustness, life cycle cost (LCC) and environmental footprint of new and existing slab track designs. Based on demonstration examples, it is argued that current standards may lead to overly conservative designs inducing higher LCC and environmental footprint than necessary. Extensions of the standards in terms of LCC and environmental footprint are suggested. The conflict of interest between structural integrity and robustness, LCC and environmental footprint is discussed, and suggestions for how to optimise slab track structures are proposed. [ABSTRACT FROM AUTHOR]