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Journal of Cardiovascular... Jan 2016Atrial fibrillation (AF) is a common and dangerous rhythm abnormality. Smartphones are increasingly used for mobile health applications by older patients at risk for AF...
BACKGROUND
Atrial fibrillation (AF) is a common and dangerous rhythm abnormality. Smartphones are increasingly used for mobile health applications by older patients at risk for AF and may be useful for AF screening.
OBJECTIVES
To test whether an enhanced smartphone app for AF detection can discriminate between sinus rhythm (SR), AF, premature atrial contractions (PACs), and premature ventricular contractions (PVCs).
METHODS
We analyzed two hundred and nineteen 2-minute pulse recordings from 121 participants with AF (n = 98), PACs (n = 15), or PVCs (n = 15) using an iPhone 4S. We obtained pulsatile time series recordings in 91 participants after successful cardioversion to sinus rhythm from preexisting AF. The PULSE-SMART app conducted pulse analysis using 3 methods (Root Mean Square of Successive RR Differences; Shannon Entropy; Poincare plot). We examined the sensitivity, specificity, and predictive accuracy of the app for AF, PAC, and PVC discrimination from sinus rhythm using the 12-lead EKG or 3-lead telemetry as the gold standard. We also administered a brief usability questionnaire to a subgroup (n = 65) of app users.
RESULTS
The smartphone-based app demonstrated excellent sensitivity (0.970), specificity (0.935), and accuracy (0.951) for real-time identification of an irregular pulse during AF. The app also showed good accuracy for PAC (0.955) and PVC discrimination (0.960). The vast majority of surveyed app users (83%) reported that it was "useful" and "not complex" to use.
CONCLUSION
A smartphone app can accurately discriminate pulse recordings during AF from sinus rhythm, PACs, and PVCs.
Topics: Aged; Algorithms; Atrial Fibrillation; Atrial Premature Complexes; Attitude to Computers; Diagnosis, Differential; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Mobile Applications; Patient Satisfaction; Photoplethysmography; Predictive Value of Tests; Prospective Studies; Pulse; Reproducibility of Results; Signal Processing, Computer-Assisted; Smartphone; Surveys and Questionnaires; Telemetry; Ventricular Premature Complexes
PubMed: 26391728
DOI: 10.1111/jce.12842 -
Veterinary Journal (London, England :... Feb 2021Atrial fibrillation (AF) is suspected by an irregularly irregular rhythm during auscultation at rest and should be confirmed by electrocardiography. Heart rate... (Review)
Review
Atrial fibrillation (AF) is suspected by an irregularly irregular rhythm during auscultation at rest and should be confirmed by electrocardiography. Heart rate monitoring is potentially interesting for AF detection by horse owners, based on the disproportionally high heart rate during exercise or increased heart rate variability. Echocardiography and laboratory analysis are useful to identify underlying cardiac disease. Horses with severe cardiac disease should not undergo cardioversion due to the risk of recurrence. Cardioversion is recommended especially in horses performing high intensity exercise or showing average maximal heart rates higher than 220 beats per min or abnormal ventricular complexes during exercise or stress. Pharmacological cardioversion can be performed using quinidine sulphate administered orally, with an overall mean reported success rate around 80%. Other therapeutic drugs have been described such as flecainide, amiodarone or novel atrial specific compounds. Transvenous electrical cardioversion (TVEC) is performed by delivering a shock between two cardioversion catheters positioned in the left pulmonary artery and right atrium, with a success rate of >95%. After cardioversion, most horses return to their previous level of performance. However, the recurrence rate after pharmacological or electrical cardioversion is up to 39%. Recurrence has been related to previous unsuccessful treatment attempts, valvular regurgitation and the presence of atrial premature depolarisations or low atrial contractile function after cardioversion. Large atrial size and long AF duration have also been suggested as risk factors. Different approaches for preventing recurrence have been described such as the administration of sotalol, however, large clinical studies have not been published.
Topics: Animals; Atrial Fibrillation; Horse Diseases; Horses; Prognosis
PubMed: 33468306
DOI: 10.1016/j.tvjl.2020.105594 -
Heart (British Cardiac Society) Apr 2021The diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the...
BACKGROUND AND PURPOSE
The diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.
METHODS
Patients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.
RESULTS
7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14-37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).
CONCLUSIONS
A relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.
Topics: Aged; Atrial Fibrillation; Brain Ischemia; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Rate; Humans; Male; Mass Screening; Primary Health Care; Prospective Studies; Time Factors
PubMed: 32620555
DOI: 10.1136/heartjnl-2020-316904 -
Revista Paulista de Pediatria : Orgao... 2019To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between...
OBJECTIVE
To evaluate the physical activity level and functional capacity of children and adolescents with congenital heart disease and to describe correlations between functionality, surgical and echocardiographic findings, metabolic and inflammatory profile and differences between acyanotic and cyanotic heart defects.
METHODS
A cross-sectional study including children and adolescents with congenital heart disease between six and 18 years old that were evaluated with the 6-minute walk test (6MWT) to assess functional capacity. The short version form of the International Physical Activity Questionnaire (IPAQ) was performed to evaluate physical activity levels. Also, echocardiography and blood collection, to evaluate the metabolic (blood glucose, lipids, insulin) and inflammatory markers (C-reactive protein), were assessed.
RESULTS
Twenty-five individuals were evaluated. Of them, 14 had acyanotic heart defects and 11 cyanotic heart defects. Mean age was 12.0±3.7 years, and 20 (80%) were male. IPAQ showed that six (24%) individuals were very active, eight (32%) were active, nine (36%) had irregular physical activity, and two (8%) were sedentary. The mean distance walked in the 6MWT, considering all studied individuals, was 464.7±100.4 m, which was 181.4±42.0 m less than the predicted (p=0.005). There was a positive correlation between Z score 6MWT and the number of surgical procedures (r=-0.455; p=0.022).
CONCLUSIONS
Children and adolescents with congenital heart disease have low functional capacity, but they are not completely sedentary.
Topics: Adolescent; Blood Pressure Determination; Body Mass Index; Brazil; Child; Cross-Sectional Studies; Exercise; Exercise Tolerance; Female; Heart Defects, Congenital; Heart Rate; Humans; Male; Physical Functional Performance; Sedentary Behavior; Walk Test
PubMed: 30624535
DOI: 10.1590/1984-0462/;2019;37;1;00016 -
PLOS Digital Health Dec 2022Our current understanding of human physiology and activities is largely derived from sparse and discrete individual clinical measurements. To achieve precise, proactive,...
Our current understanding of human physiology and activities is largely derived from sparse and discrete individual clinical measurements. To achieve precise, proactive, and effective health management of an individual, longitudinal, and dense tracking of personal physiomes and activities is required, which is only feasible by utilizing wearable biosensors. As a pilot study, we implemented a cloud computing infrastructure to integrate wearable sensors, mobile computing, digital signal processing, and machine learning to improve early detection of seizure onsets in children. We recruited 99 children diagnosed with epilepsy and longitudinally tracked them at single-second resolution using a wearable wristband, and prospectively acquired more than one billion data points. This unique dataset offered us an opportunity to quantify physiological dynamics (e.g., heart rate, stress response) across age groups and to identify physiological irregularities upon epilepsy onset. The high-dimensional personal physiome and activity profiles displayed a clustering pattern anchored by patient age groups. These signatory patterns included strong age and sex-specific effects on varying circadian rhythms and stress responses across major childhood developmental stages. For each patient, we further compared the physiological and activity profiles associated with seizure onsets with the personal baseline and developed a machine learning framework to accurately capture these onset moments. The performance of this framework was further replicated in another independent patient cohort. We next referenced our predictions with the electroencephalogram (EEG) signals on selected patients and demonstrated that our approach could detect subtle seizures not recognized by humans and could detect seizures prior to clinical onset. Our work demonstrated the feasibility of a real-time mobile infrastructure in a clinical setting, which has the potential to be valuable in caring for epileptic patients. Extension of such a system has the potential to be leveraged as a health management device or longitudinal phenotyping tool in clinical cohort studies.
PubMed: 36812648
DOI: 10.1371/journal.pdig.0000161 -
Work (Reading, Mass.) 2017Cynicism, as a personality trait, has adverse effects on health. The question was asked whether cynical attitudes that develop due to work-related stress correlate with...
BACKGROUND
Cynicism, as a personality trait, has adverse effects on health. The question was asked whether cynical attitudes that develop due to work-related stress correlate with stress levels and whether it has a negative influence on health.
OBJECTIVES
To investigate associations of the cynicism subscale scores of the Maslach Burnout Inventory-General Survey (MBI-GS) with levels of stress, anxiety, questionnaire-based physical health and with a number of physiological health risk indicators.
METHODS
Cynicism, anxiety, questionnaire-based physical health scores, as well as allostatic load, heart rate variability and C-reactive protein, were assessed in 27 males working between 40 and 80 irregular hours per week.
RESULTS
Cynicism scores related to stress levels (r = 0.411, p = 0.030). Effects of work-related cynicism on physical health were suggested by negative associations with questionnaire-based scores on physical health (r = -0.383, p = 0.044) and heart rate variability indicators (r = -0.379, p = 0.047 to r = -0.496, p = 0.007), and by positive associations with anxiety levels (r = 0.408, p = 0.031), heart rate (r = 0.449, p = 0.017), BMI (r = 0.426, p = 0.024) allostatic load (r = 0.360, p = 0.065) and levels of the inflammatory marker C-reactive protein (r = 0.407, p = 0.035).
CONCLUSIONS
Cynicism, as reflected by the MBI-GS, increases with increased stress levels and could contribute to the decline in the health reported for burnout.
Topics: Anxiety Disorders; Burnout, Professional; C-Reactive Protein; Heart Rate; Humans; Male; Personality; Risk Factors; Stress, Psychological; Surveys and Questionnaires
PubMed: 28339417
DOI: 10.3233/WOR-172518 -
Scientific Reports Nov 2023A medical check-up during driving enables the early detection of diseases. Heartbeat irregularities indicate possible cardiovascular diseases, which can be determined...
A medical check-up during driving enables the early detection of diseases. Heartbeat irregularities indicate possible cardiovascular diseases, which can be determined with continuous health monitoring. Therefore, we develop a redundant sensor system based on electrocardiography (ECG) and photoplethysmography (PPG) sensors attached to the steering wheel, a red, green, and blue (RGB) camera behind the steering wheel. For the video, we integrate the face recognition engine SeetaFace to detect landmarks of face segments continuously. Based on the green channel, we derive colour changes and, subsequently, the heartbeat. We record the ECG, PPG, video, and reference ECG with body electrodes of 19 volunteers during different driving scenarios, each lasting 15 min: city, highway, and countryside. We combine early, signal-based late, and sensor-based late fusion with a hybrid convolutional neural network (CNN) and integrated majority voting to deliver the final heartbeats that we compare to the reference ECG. Based on the measured and the reference heartbeat positions, the usable time was 51.75%, 58.62%, and 55.96% for the driving scenarios city, highway, and countryside, respectively, with the hybrid algorithm and combination of ECG and PPG. In conclusion, the findings suggest that approximately half the driving time can be utilised for in-vehicle heartbeat monitoring.
Topics: Humans; Heart Rate; Signal Processing, Computer-Assisted; Electrocardiography; Algorithms; Neural Networks, Computer; Photoplethysmography
PubMed: 38012195
DOI: 10.1038/s41598-023-47484-z -
Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients.Sensors (Basel, Switzerland) May 2023(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce....
(1) Background: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin's concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients-age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2-30.5), and NIHSS score 8 (IQR 1.5-20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.
Topics: Aged; Female; Humans; Male; Atrial Fibrillation; Breast Neoplasms; Heart Rate Determination; Pilot Projects; Stroke; Aged, 80 and over; Randomized Controlled Trials as Topic
PubMed: 37430546
DOI: 10.3390/s23104632 -
Hypertension Research : Official... Sep 2022
Topics: Atrial Fibrillation; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Humans; Pulse
PubMed: 35768726
DOI: 10.1038/s41440-022-00971-8 -
Biomedical Signal Processing and Control Apr 2019The description of production kinematics of dysphonic voices plays an important role in the clinical care of voice disorders. However, high-speed videolaryngoscopy is...
BACKGROUND AND OBJECTIVES
The description of production kinematics of dysphonic voices plays an important role in the clinical care of voice disorders. However, high-speed videolaryngoscopy is not routinely used in clinical practice, partly because there is a lack of diagnostic markers that may be obtained from high-speed videos automatically. Aim of the study is to propose and test a procedure that automatically detects extra pulses, which may occur in voiced source signals of pathological voices in addition to cyclic pulses.
MATERIAL AND METHODS
Glottal area waveforms (GAW) are synthesized and used to test a detector for extra pulses. Regarding synthesis, for each GAW a cyclic pulse train is mixed with an extra pulse train, and additive noise. The cyclic pulse trains are varied across GAWs in terms of fundamental frequency, pulse shape, and modulation noise, i.e., jitter and shimmer. The extra pulse trains are varied across GAWs in terms of the height of the extra pulses, and their rates of occurrence. The energy level of the additive noise is also varied. Regarding detection, first, the fundamental frequency is estimated jointly with the cyclic pulse train waveform, second, the modulation noise is estimated, and finally the extra pulse train waveform is estimated. Two versions of the detector are compared, i.e., one that parameterizes the shapes of the cyclic pulses, and one that uses unparameterized pulse shape estimates. Two corpora are used for testing, i.e., one with 100 GAWs containing random extra pulses, and one with 25 GAWs containing extra pulses in the closed phases of each glottal phase representing subharmonic voices.
RESULTS AND DISCUSSION
With pulse shape parameterization (PSP) a maximum mean accuracy of 88.3% is achieved when detecting random extra pulses. Without PSP, the maximum mean accuracy reduces to 82.9%. Detection performance decreases if the energy level of additive noise is higher than -25 dB with respect to the energy of the cyclic pulse train, and if the irregularity strength exceeds 0.1. For bicyclic, i.e., subharmonic voices, the approach fails without PSP, whereas with PSP, a mean sensitivity of 87.4% is achieved for subharmonic voices.
CONCLUSION
A synthesizer for GAWs containing extra pulses, and a detector for extra pulses are proposed. With PSP, favorable detector performance is observed for not too high levels of additive noise and irregularity strengths. In signals with high noise levels, the detector without PSP outperforms the other one. Detection of extra pulses fails if irregularity strength is large. For subharmonic voices PSP must be used.
PubMed: 30996730
DOI: 10.1016/j.bspc.2019.01.007