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Biosensors Jul 2022The biomedical acoustic signal plays an important role in clinical non-invasive diagnosis. In view of the deficiencies in early diagnosis of cardiovascular diseases,...
The biomedical acoustic signal plays an important role in clinical non-invasive diagnosis. In view of the deficiencies in early diagnosis of cardiovascular diseases, acoustic properties of and heart sounds are utilized. In this paper, we propose an integrated concave cilium MEMS heart sound sensor. The concave structure enlarges the area for receiving sound waves to improve the low-frequency sensitivity, and realizes the low-frequency and high-sensitivity characteristics of an MEMS heart sound sensor by adopting a reasonable acoustic package design, reducing the loss of heart sound distortion and faint heart murmurs, and improving the auscultation effect. Finally, experimental results show that the integrated concave ciliated MEMS heart sound sensor's sensitivity reaches -180.6 dB@500 Hz, as compared with the traditional bionic ciliated MEMS heart sound sensor; the sensitivity is 8.9 dB higher. The sensor has a signal-to-noise ratio of 27.05 dB, and has good heart sound detection ability, improving the accuracy of clinical detection methods.
Topics: Cilia; Heart; Heart Sounds; Micro-Electrical-Mechanical Systems; Signal-To-Noise Ratio
PubMed: 35884337
DOI: 10.3390/bios12070534 -
Journal of the American Heart... Oct 2023Background The success of cardiac auscultation varies widely among medical professionals, which can lead to missed treatments for structural heart disease. Applying...
Background The success of cardiac auscultation varies widely among medical professionals, which can lead to missed treatments for structural heart disease. Applying machine learning to cardiac auscultation could address this problem, but despite recent interest, few algorithms have been brought to clinical practice. We evaluated a novel suite of Food and Drug Administration-cleared algorithms trained via deep learning on >15 000 heart sound recordings. Methods and Results We validated the algorithms on a data set of 2375 recordings from 615 unique subjects. This data set was collected in real clinical environments using commercially available digital stethoscopes, annotated by board-certified cardiologists, and paired with echocardiograms as the gold standard. To model the algorithm in clinical practice, we compared its performance against 10 clinicians on a subset of the validation database. Our algorithm reliably detected structural murmurs with a sensitivity of 85.6% and specificity of 84.4%. When limiting the analysis to clearly audible murmurs in adults, performance improved to a sensitivity of 97.9% and specificity of 90.6%. The algorithm also reported timing within the cardiac cycle, differentiating between systolic and diastolic murmurs. Despite optimizing acoustics for the clinicians, the algorithm substantially outperformed the clinicians (average clinician accuracy, 77.9%; algorithm accuracy, 84.7%.) Conclusions The algorithms accurately identified murmurs associated with structural heart disease. Our results illustrate a marked contrast between the consistency of the algorithm and the substantial interobserver variability of clinicians. Our results suggest that adopting machine learning algorithms into clinical practice could improve the detection of structural heart disease to facilitate patient care.
Topics: Adult; Humans; Deep Learning; Heart Murmurs; Heart Diseases; Heart Auscultation; Algorithms
PubMed: 37830333
DOI: 10.1161/JAHA.123.030377 -
Circulation Journal : Official Journal... Feb 2022Coexistent pulmonary hypertension with severe aortic stenosis confers a greater risk of mortality for patients undergoing transcatheter aortic valve replacement (TAVR)....
BACKGROUND
Coexistent pulmonary hypertension with severe aortic stenosis confers a greater risk of mortality for patients undergoing transcatheter aortic valve replacement (TAVR). In this patient population, the impact of significant decoupling between pulmonary artery diastolic and pulmonary capillary wedge, as it relates to clinical risk, remained uncertain.Methods and Results:Patients with severe aortic stenosis who underwent TAVR and completed pre-procedural and post-procedural invasive hemodynamic assessments with right heart catheterization were retrospectively assessed. The impact of post-TAVR decoupling, defined as a pressure difference ≥3 mmHg, on 2-year all-cause mortality or risk of heart failure admission was analyzed. Among 77 included patients (median age 86 years, 23 men), 16 had post-TAVR decoupling. The existence of post-TAVR decoupling was associated with a higher cumulative incidence of the primary endpoint (44% vs. 7%, P=0.001), with an adjusted hazard ratio of 5.87 (95% confidence interval 1.58-21.9, P=0.008).
CONCLUSIONS
A greater risk of worse outcomes in those with post-TAVR decoupling was observed. A therapeutic strategy for post-TAVR decoupling and its clinical implication need to be created and investigated in the future.
Topics: Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Heart Murmurs; Humans; Male; Pulmonary Artery; Pulmonary Wedge Pressure; Retrospective Studies; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34602582
DOI: 10.1253/circj.CJ-21-0573 -
Turkish Journal of Urology Jul 2019The aim of this study was to evaluate the prevalence of innocent heart murmurs in children affected by nocturnal enuresis (NE).
OBJECTIVE
The aim of this study was to evaluate the prevalence of innocent heart murmurs in children affected by nocturnal enuresis (NE).
RESULTS
The prevalence of innocent heart murmurs in G2 was 6.34%. This condition was significantly more frequent in children who suffered from NE. Indeed, in G1, the prevalence of innocent heart murmurs was 21.45%, although there were few differences between the children with monosymptomatic NE and non-monosymptomatic NE; moreover, this prevalence was higher in males.
MATERIAL AND METHODS
We enrolled a total of 401 children (G1), 300 males and 101 females, aged 5-15 years, affected by NE and referred to the Service of Pediatrics, "Campus Bio-Medico" University Hospital of Rome, from September 2013 to September 2018, into the study. The control group was composed of 394 children without NE (G2). The study was carried out in compliance with the Helsinki Declaration.
CONCLUSION
These findings made us aware of the presence of possible underlying mechanisms, which explain the association between a higher prevalence of innocent heart murmurs and enuresis, and further studies are required to explore this issue.
PubMed: 30817273
DOI: 10.5152/tud.2019.16363 -
Journal of Veterinary Cardiology : the... Aug 2017To assess the prevalence of functional ejection murmurs and murmurs of mitral regurgitation (MR) due to myxomatous mitral valve disease in healthy whippets; to assess...
OBJECTIVES
To assess the prevalence of functional ejection murmurs and murmurs of mitral regurgitation (MR) due to myxomatous mitral valve disease in healthy whippets; to assess the diagnostic value of auscultation to detect MR; and investigate the relationship between age and presence of echocardiographically documented MR (MR).
ANIMALS
A total of 200 healthy client-owned Whippets, recruited at national shows between 2005 and 2009 were involved in this study.
METHODS
Cross-sectional study. Dogs were examined by auscultation by one examiner and Doppler echocardiography by another, and results were compared. Prevalence of types of murmurs and MR were calculated and correlated to age. Accuracy of auscultation to predict MR was calculated.
RESULTS
Left-sided systolic heart murmurs were detected in 185/200 (93%) of dogs. Left apical systolic murmurs (L) were detected in 57/200 (29%) and left basilar systolic murmurs (L) in 128/200 of the dogs (64%). MR was present in 76/200 (38%) dogs. Prevalence MR was correlated with age (r = 0.96, p=0.0028). Mitral regurgitation detected by echocardiography was present in 12/78 (15%) of the dogs ≤ 2 years of age and in 59% of the dogs at 7-8 years old. Detection of L predicted MR with sensitivity 65%, specificity 94%, positive predictive value 86%, and negative predictive value 81%; and accuracy improved when only dogs with more intense L (grade ≥ 3/6) were considered.
CONCLUSIONS
Systolic murmurs are common in North American Whippets and this breed exhibits a high prevalence of MR, which may be documented at a relatively early age. Whippets with non-clinical MR may not be identifiable by auscultation alone; echocardiographic examination may be required to exclude a diagnosis of MR. Louder heart murmurs allow more accurate localization in this population.
Topics: Animals; Cross-Sectional Studies; Dog Diseases; Dogs; Echocardiography; Female; Heart Murmurs; Male; Mitral Valve; Mitral Valve Insufficiency; Prevalence; United States
PubMed: 28666945
DOI: 10.1016/j.jvc.2017.04.004 -
Biomedical Engineering Online Aug 2018There are two major challenges in automated heart sound analysis: segmentation and classification. An efficient segmentation is capable of providing valuable diagnostic...
BACKGROUND
There are two major challenges in automated heart sound analysis: segmentation and classification. An efficient segmentation is capable of providing valuable diagnostic information of patients. In addition, it is crucial for some feature-extraction based classification methods. Therefore, the segmentation of heart sound is of significant value.
METHODS
This paper presents an automatic heart sound segmentation method that combines the time-domain analysis, frequency-domain analysis and time-frequency-domain analysis. Employing this method, the boundaries of heart sound components are first located, and the components are then recognized. Finally, the heart sounds are divided into several segments on the basis of the results of boundary localization and component identification.
RESULTS
In order to evaluate the performance of the proposed method, quantitative experiments are performed on an authoritative heart sound database. The experimental results show that the boundary localization has a sensitivity (Se) of 100%, a positive predictive value (PPV) of 99.3% and an accuracy (Acc) of 99.93%. Moreover, the Se, PPV and Acc of component identification reach 98.63, 99.86 and 98.49%, respectively.
CONCLUSION
The proposed method shows reliable performance on the segmentation of heart sounds. Compared with previous works, this method can be applied to not only normal heart sounds, but also the sounds with S3, S4 and murmurs, thus greatly increasing the applied range.
Topics: Automation; Heart Murmurs; Heart Sounds; Signal Processing, Computer-Assisted
PubMed: 30081909
DOI: 10.1186/s12938-018-0538-9 -
Journal of Thoracic Disease Jan 2021Valvular heart disease (VHD) is a chronic progressive condition with an increasing prevalence in the Western world due to aging populations. VHD is often diagnosed at a... (Review)
Review
Valvular heart disease (VHD) is a chronic progressive condition with an increasing prevalence in the Western world due to aging populations. VHD is often diagnosed at a late stage when patients are symptomatic and the outcomes of therapy, including valve replacement, may be sub-optimal due the development of secondary complications, including left ventricular (LV) dysfunction. The clinical application of artificial intelligence (AI), including machine learning (ML), has promise in supporting not only early and more timely diagnosis, but also hastening patient referral and ensuring optimal treatment of VHD. As physician auscultation lacks accuracy in diagnosis of significant VHD, computer-aided auscultation (CAA) with the help of a commercially available digital stethoscopes improves the detection and classification of heart murmurs. Although used little in current clinical practice, CAA can screen large populations at low cost with high accuracy for VHD and faciliate appropriate patient referral. Echocardiography remains the next step in assessment and planning management and AI is delivering major changes in speeding training, improving image quality by pattern recognition and image sorting, as well as automated measurement of multiple variables, thereby improving accuracy. Furthermore, AI then has the potential to hasten patient disposal, by automated alerts for red-flag findings, as well as decision support in dealing with results. In management, there is great potential in ML-enabled tools to support comprehensive disease monitoring and individualized treatment decisions. Using data from multiple sources, including demographic and clinical risk data to image variables and electronic reports from electronic medical records, specific patient phenotypes may be identified that are associated with greater risk or modeled to the estimate trajectory of VHD progression. Finally, AI algorithms are of proven value in planning intervention, facilitating transcatheter valve replacement by automated measurements of anatomical dimensions derived from imaging data to improve valve selection, valve size and method of delivery.
PubMed: 33569220
DOI: 10.21037/jtd-20-1837 -
Journal of Healthcare Engineering 2020Heart auscultation is a convenient tool for early diagnosis of heart diseases and is being developed to be an intelligent tool used in online medicine. Currently, there...
Heart auscultation is a convenient tool for early diagnosis of heart diseases and is being developed to be an intelligent tool used in online medicine. Currently, there are few studies on intelligent diagnosis of pediatric murmurs due to congenital heart disease (CHD). The purpose of the study was to develop a method of intelligent diagnosis of pediatric CHD murmurs. Phonocardiogram (PCG) signals of 86 children were recorded with 24 children having normal heart sounds and 62 children having CHD murmurs. A segmentation method based on the discrete wavelet transform combined with Hadamard product was implemented to locate the first and the second heart sounds from the PCG signal. Ten features specific to CHD murmurs were extracted as the input of classifier after segmentation. Eighty-six artificial neural network classifiers were composed into a classification system to identify CHD murmurs. The accuracy, sensitivity, and specificity of diagnosis for heart murmurs were 93%, 93.5%, and 91.7%, respectively. In conclusion, a method of intelligent diagnosis of pediatric CHD murmurs is developed successfully and can be used for online screening of CHD in children.
Topics: Adolescent; Algorithms; Child; Child, Preschool; Heart Auscultation; Heart Defects, Congenital; Heart Murmurs; Humans; Infant; Neural Networks, Computer; Signal Processing, Computer-Assisted; Wavelet Analysis
PubMed: 32454963
DOI: 10.1155/2020/9640821 -
Plants (Basel, Switzerland) Jun 2022is an endemic tree of Brazil, occurring mainly in the northeast region in the Cerrado environment. The species, popularly known as "pequi", produces fruits that are... (Review)
Review
is an endemic tree of Brazil, occurring mainly in the northeast region in the Cerrado environment. The species, popularly known as "pequi", produces fruits that are used in the manufacture of oil for food and medicinal purposes. This work reviewed studies conducted with the species, highlighting its ethnomedicinal use, its pharmacological potential, including its chemical constituents, and its cultural and socioeconomic importance. Information was obtained through the main scientific research platforms. The keyword "" was used as the main index for searching the following platforms: PubMed, PubMed Central, SciElo, Scopus and Web of Science. The compiled papers demonstrate that has great medicinal, economic and cultural importance for northeastern Brazil. Popularly, the fruits of are used to treat broncho-pulmonary diseases (bronchitis, colds and flu). The fixed oil is widely used to relieve pain from various causes in the treatment of inflammation, flu, eczema, burns, fever, rickets, indigestion, heart murmurs, fatigue and erectile dysfunction. Some of these uses are corroborated by pharmacological trials, which have demonstrated the antioxidant, healing, anti-inflammatory, gastroprotective, antinociceptive and antimicrobial properties of the species. Chemically, fatty acids and phenolic compounds are the main constituents recorded for the species. Due to its medicinal properties, the fruits and oil of have a high commercial demand and are one of the main forms of subsistence activities for local populations. On the other hand, the extractive practice of the fruits, associated with anthropic factors and its physiological nature, makes the species threatened with extinction. Thus, public management policies are highly necessary in order to avoid its extinction.
PubMed: 35807637
DOI: 10.3390/plants11131685 -
Chest Apr 2022Multiparametric risk assessment is used in pulmonary arterial hypertension (PAH) to target therapy. However, this strategy is imperfect because most patients remain at...
BACKGROUND
Multiparametric risk assessment is used in pulmonary arterial hypertension (PAH) to target therapy. However, this strategy is imperfect because most patients remain at intermediate or high risk after initial treatment, with low risk being the goal. Metrics of right ventricular (RV) adaptation are promising tools that may help refine our therapeutic strategy.
RESEARCH QUESTION
Does RV adaptation predict therapeutic response over time?
STUDY DESIGN AND METHODS
We evaluated 52 incident treatment-naive patients with advanced PAH by catheterization and cardiac imaging longitudinally at baseline, follow-up 1 (∼3 months), and follow-up 2 (∼18 months). All patients received goal-directed therapy with parenteral treprostinil and/or combination therapy with treatment escalation if functional class I or II was not achieved. On the basis of their therapeutic response, patients were evaluated at follow-up 1 as nonresponders (died) or as responders, and again at follow-up 2 as super-responders (low risk) or partial responders (high/intermediate risk). Multiparametric risk was based on a simplified European Respiratory Society/European Society of Cardiology guideline score. RV adaptation was evaluated with the single-beat coupling ratio (Ees/Ea) and diastolic function with diastolic elastance (Eed). Data are expressed as mean ± SD or as OR (95% CI).
RESULTS
Nine patients (17%) were nonresponders. PAH-directed therapy improved the European Respiratory Society low-risk score from 1 (2%) at baseline to 23 (55%) at follow-up 2. Ees/Ea at presentation was nonsignificantly higher in responders (0.9 ± 0.4) vs nonresponders (0.6 ± 0.4; P = .09) but could not be used to predict super-responder status at follow-up 2 (OR, 1.40 [95% CI, 0.28-7.0]; P = .84). Baseline RV ejection fraction and change in Eed were successfully used to predict super-responder status at follow-up 2 (OR, 1.15 [95% CI, 1.0-1.27]; P = .009 and OR, 0.29 [95% CI, 0.86-0.96]; P = .04, respectively).
INTERPRETATION
In patients with advanced PAH, RV-pulmonary arterial coupling could not discriminate irreversible RV failure (nonresponders) at presentation but showed a late trend to improvement by follow-up 2. Early change in Eed and baseline RV ejection fraction were the best predictors of therapeutic response.
Topics: Familial Primary Pulmonary Hypertension; Heart Murmurs; Humans; Hypertension, Pulmonary; Prospective Studies; Pulmonary Arterial Hypertension; Pulmonary Artery; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 34637777
DOI: 10.1016/j.chest.2021.09.040