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Pediatric Cardiology Jun 2022We aimed to examine the relationship between epicardial fat thickness (EFT) measured by echocardiography and cardiovascular functional parameters in children with type 1...
We aimed to examine the relationship between epicardial fat thickness (EFT) measured by echocardiography and cardiovascular functional parameters in children with type 1 diabetes mellitus (T1DM). The study included 50 type 1 diabetic children and 50 healthy subjects matched by sex, age, and body mass index. In addition to laboratory tests, all participants underwent transthoracic echocardiography for EFT, cardiac dimensions and left ventricular functions, and ultrasonographic examination for brachial artery flow-mediated dilation (FMD) response and carotid intima-media thickness (CIMT). Multivariate linear regression was used to analyze the relationship between EFT and CIMT, FMD, lateral mitral E' velocity, and mitral E/E' ratio. EFT was significantly increased in diabetic children compared with controls (P < 0.001). In comparison with controls diabetic children had significantly increased mitral A, decreased lateral mitral E', decreased mitral E/A ratio, decreased lateral mitral E'/A' ratio, and increased mitral E/E' ratio (P < 0.001). FMD response was significantly lower in diabetic group versus controls (P < 0.001) and CIMT was significantly increased in diabetics versus controls (P = 0.03). EFT was negatively correlated with lateral mitral E' velocity (r = - 0.613, P < 0.001), positively correlated with mitral E/E' ratio (r = 0.60, P < 0.001), positively correlated with CIMT (r = 0.881, P < 0.001), and negatively correlated with FMD (r = - 0.533, P < 0.001). By multivariate regression analysis, the EFT was independently and positively associated with CIMT mean and E/E' mean and negatively associated with FMD mean and E' mean. The cut-off point for EFT as predictor of endothelial dysfunction was 6.95 mm. Our findings suggest that children with T1DM have subclinical LV diastolic and vascular endothelial dysfunctions associated with increased EFT.
Topics: Adipose Tissue; Carotid Intima-Media Thickness; Child; Diabetes Mellitus, Type 1; Diastole; Heart Murmurs; Humans; Pericardium
PubMed: 35088126
DOI: 10.1007/s00246-021-02811-x -
Recenti Progressi in Medicina Dec 2014Cardiac auscultation permits to distinguish between the innocent heart murmurs and pathologic murmurs; characteristics of pathologic murmurs include a holosystolic or... (Review)
Review
Cardiac auscultation permits to distinguish between the innocent heart murmurs and pathologic murmurs; characteristics of pathologic murmurs include a holosystolic or diastolic murmur, maximal murmur intensity at the upper left sternal border and increased intensity when the patient stands. Murmurs should be described by their timing in the cardiac cycle, intensity, shape, pitch, location, radiation, and response to dynamic maneuvers. When the medical history and physical examination support the diagnosis of innocent heart murmur, neither further investigation nor referal is indicated. On the contrary, echocardiography is recommended for patients with any other abnormal physical examination findings that increase the likelihood of structural heart disease. In this review we discuss the definition and classification of murmurs, how to evaluate it.
Topics: Child; Echocardiography; Heart Auscultation; Heart Murmurs; Humans; Systolic Murmurs
PubMed: 25533235
DOI: 10.1701/1706.18620 -
Sensors (Basel, Switzerland) Jun 2023(1) Background: Mastery of auscultation can be challenging for many healthcare providers. Artificial intelligence (AI)-powered digital support is emerging as an aid to...
(1) Background: Mastery of auscultation can be challenging for many healthcare providers. Artificial intelligence (AI)-powered digital support is emerging as an aid to assist with the interpretation of auscultated sounds. A few AI-augmented digital stethoscopes exist but none are dedicated to pediatrics. Our goal was to develop a digital auscultation platform for pediatric medicine. (2) Methods: We developed StethAid-a digital platform for artificial intelligence-assisted auscultation and telehealth in pediatrics-that consists of a wireless digital stethoscope, mobile applications, customized patient-provider portals, and deep learning algorithms. To validate the StethAid platform, we characterized our stethoscope and used the platform in two clinical applications: (1) Still's murmur identification and (2) wheeze detection. The platform has been deployed in four children's medical centers to build the first and largest pediatric cardiopulmonary datasets, to our knowledge. We have trained and tested deep-learning models using these datasets. (3) Results: The frequency response of the StethAid stethoscope was comparable to those of the commercially available Eko Core, Thinklabs One, and Littman 3200 stethoscopes. The labels provided by our expert physician offline were in concordance with the labels of providers at the bedside using their acoustic stethoscopes for 79.3% of lungs cases and 98.3% of heart cases. Our deep learning algorithms achieved high sensitivity and specificity for both Still's murmur identification (sensitivity of 91.9% and specificity of 92.6%) and wheeze detection (sensitivity of 83.7% and specificity of 84.4%). (4) Conclusions: Our team has created a technically and clinically validated pediatric digital AI-enabled auscultation platform. Use of our platform could improve efficacy and efficiency of clinical care for pediatric patients, reduce parental anxiety, and result in cost savings.
Topics: Humans; Child; Artificial Intelligence; Auscultation; Stethoscopes; Heart Murmurs; Algorithms; Respiratory Sounds
PubMed: 37420914
DOI: 10.3390/s23125750 -
European Heart Journal Jun 2021
Topics: Blood Pressure; Cardiovascular Diseases; Diastole; Heart Murmurs; Humans; Hypertension
PubMed: 33677481
DOI: 10.1093/eurheartj/ehab109 -
Circulation Journal : Official Journal... May 2019
Topics: Aged; Aortic Valve Insufficiency; Aortic Valve Stenosis; Heart Murmurs; Humans; Male
PubMed: 30282849
DOI: 10.1253/circj.CJ-18-0697 -
The International Journal of... Apr 2015
Topics: Diastole; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Female; Heart Murmurs; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Phonocardiography; Predictive Value of Tests; Signal Processing, Computer-Assisted; Young Adult
PubMed: 25712167
DOI: 10.1007/s10554-015-0609-y -
Cardiology in the Young Apr 2024Left ventricular tumour is a rare condition in children. The causes include vegetations, thrombus, and fibroma. 2-year-old asymptomatic female presented with an innocent...
Left ventricular tumour is a rare condition in children. The causes include vegetations, thrombus, and fibroma. 2-year-old asymptomatic female presented with an innocent heart murmur at 6 months of age. Subsequent follow-ups at 18 months of age showed left ventricular mass. Surgical pathology revealed "nodular fasciitis." This type of tumour has never been described in the heart before.
Topics: Child; Humans; Female; Child, Preschool; Fasciitis; Heart Neoplasms; Fibroma; Heart Ventricles; Heart Murmurs
PubMed: 38282536
DOI: 10.1017/S1047951124000052 -
JAMA May 2019
Topics: Aneurysm, False; Cardiobacterium; Diagnostic Errors; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Heart Auscultation; Heart Murmurs; Humans; Ischemic Attack, Transient; Male; Middle Aged; Mitral Valve Prolapse
PubMed: 31087026
DOI: 10.1001/jama.2019.5165 -
The Journal of Pediatrics Jun 2022To assess the influence of diastolic dysfunction on the evolution of pulmonary hypertension in neonates with Down Syndrome over the early newborn period. (Observational Study)
Observational Study
OBJECTIVE
To assess the influence of diastolic dysfunction on the evolution of pulmonary hypertension in neonates with Down Syndrome over the early newborn period.
STUDY DESIGN
This was a prospective observational cohort study. Echocardiography was performed three times over the first week of life in both Down syndrome and control cohorts. Measurements of pulmonary arterial pressure in addition to left ventricular (LV) and right ventricular systolic and diastolic function were collected.
RESULTS
Seventy babies with Down syndrome and 60 control infants were enrolled. Forty-eight of the infants with Down syndrome (69%) were born with congenital heart disease (CHD). Echocardiography surrogates of pulmonary hypertension and myocardial function remained significantly impaired in the Down syndrome group in comparison with control infants (all P < .01). In the Down syndrome group, LV early diastolic strain rate was independently associated with measures of pulmonary hypertension while controlling for gestational age, cesarean delivery, and the presence of CHD (P < .01).
CONCLUSIONS
Intrinsic LV diastolic impairment is directly associated with higher indices of pulmonary hypertension in infants with Down syndrome and may be a contributing factor to its evolution.
Topics: Arterial Pressure; Diastole; Down Syndrome; Heart Murmurs; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Prospective Studies; Ventricular Dysfunction, Left
PubMed: 35176311
DOI: 10.1016/j.jpeds.2022.02.014 -
Circulation. Cardiovascular... Nov 2015
Topics: Aged; Cardiomyopathies; Coronary Angiography; Coronary Vessels; Dyspnea; Echocardiography; Female; Heart Murmurs; Humans; Hypertrophy, Left Ventricular; Male; Vascular Fistula
PubMed: 26510560
DOI: 10.1161/CIRCINTERVENTIONS.115.003062