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Frontiers in Cardiovascular Medicine 2023This study aims to assess the ability of state-of-the-art machine learning algorithms to detect valvular heart disease (VHD) from digital heart sound recordings in a...
OBJECTIVE
This study aims to assess the ability of state-of-the-art machine learning algorithms to detect valvular heart disease (VHD) from digital heart sound recordings in a general population that includes asymptomatic cases and intermediate stages of disease progression.
METHODS
We trained a recurrent neural network to predict murmurs from heart sound audio using annotated recordings collected with digital stethoscopes from four auscultation positions in 2,124 participants from the Tromsø7 study. The predicted murmurs were used to predict VHD as determined by echocardiography.
RESULTS
The presence of aortic stenosis (AS) was detected with a sensitivity of 90.9%, a specificity of 94.5%, and an area under the curve (AUC) of 0.979 (CI: 0.963-0.995). At least moderate AS was detected with an AUC of 0.993 (CI: 0.989-0.997). Moderate or greater aortic and mitral regurgitation (AR and MR) were predicted with AUC values of 0.634 (CI: 0.565-703) and 0.549 (CI: 0.506-0.593), respectively, which increased to 0.766 and 0.677 when clinical variables were added as predictors. The AUC for predicting symptomatic cases was higher for AR and MR, 0.756 and 0.711, respectively. Screening jointly for symptomatic regurgitation or presence of stenosis resulted in an AUC of 0.86, with 97.7% of AS cases ( = 44) and all 12 MS cases detected.
CONCLUSIONS
The algorithm demonstrated excellent performance in detecting AS in a general cohort, surpassing observations from similar studies on selected cohorts. The detection of AR and MR based on HS audio was poor, but accuracy was considerably higher for symptomatic cases, and the inclusion of clinical variables improved the performance of the model significantly.
PubMed: 38328674
DOI: 10.3389/fcvm.2023.1170804 -
Chest Sep 2023
Topics: Humans; Fatigue; Heart Murmurs
PubMed: 37689478
DOI: 10.1016/j.chest.2022.09.050 -
Medical & Biological Engineering &... Apr 2024Obtaining accurate cardiac auscultation signals, including basic heart sounds (S1 and S2) and subtle signs of disease, is crucial for improving cardiac diagnoses and...
Obtaining accurate cardiac auscultation signals, including basic heart sounds (S1 and S2) and subtle signs of disease, is crucial for improving cardiac diagnoses and making the most of telehealth. This research paper introduces an innovative approach that utilizes a modified cosine transform (MCT) and a masking strategy based on long short-term memory (LSTM) to effectively distinguish heart sounds and murmurs from background noise and interfering sounds. The MCT is used to capture the repeated pattern of the heart sounds, while the LSTMs are trained to construct masking based on the repeated MCT spectrum. The proposed strategy's performance in maintaining the clinical relevance of heart sounds continues to demonstrate effectiveness, even in environments marked by increased noise and complex disruptions. The present work highlights the clinical significance and reliability of the suggested methodology through in-depth signal visualization and rigorous statistical performance evaluations. In comparative assessments, the proposed approach has demonstrated superior performance compared to recent algorithms, such as LU-Net and PC-DAE. Furthermore, the system's adaptability to various datasets enhances its reliability and practicality. The suggested method is a potential way to improve the accuracy of cardiovascular diagnostics in an era of rapid advancement in medical signal processing. The proposed approach showed an enhancement in the average signal-to-noise ratio (SNR) by 9.6 dB at an input SNR of - 6 dB and by 3.3 dB at an input SNR of 10 dB. The average signal distortion ratio (SDR) achieved across a variety of input SNR values was 8.56 dB.
PubMed: 38627355
DOI: 10.1007/s11517-024-03088-x -
Echocardiography (Mount Kisco, N.Y.) Aug 2023Adequate grading of mitral regurgitation (MR) in patients with mitral valve prolapse (MVP) in the presence of mid-late systolic jets can represent a major challenge. In...
Adequate grading of mitral regurgitation (MR) in patients with mitral valve prolapse (MVP) in the presence of mid-late systolic jets can represent a major challenge. In this entity, jets are commonly overestimated by echocardiography. Correct quantification is crucial and highly relevant for the further management and prognosis of these oftentimes young patients. This case points out potential pitfalls and underlines the importance to systematically include qualitative, quantitative, and semi-quantitative parameters into the echocardiographic assessment.
Topics: Humans; Mitral Valve Prolapse; Mitral Valve Insufficiency; Echocardiography; Prognosis; Heart Murmurs
PubMed: 37138500
DOI: 10.1111/echo.15583 -
Cureus Dec 2023Morgagni hernia is a rare congenital defect of the diaphragm, especially seen in children but rarely observed in adults. It occurs due to a congenital defect during the...
Morgagni hernia is a rare congenital defect of the diaphragm, especially seen in children but rarely observed in adults. It occurs due to a congenital defect during the development of the diaphragm. Bochdalek hernia is a common congenital form of diaphragmatic hernia. Morgagni hernia is usually rare with a prevalence of approximately 2-3%. Beaver tail liver, which is also called sliver of liver, is a rare variant of liver morphology. Sometimes elongated left lobe of the liver can extend laterally across the midline to contact and often surround the spleen. A 46-year-old female from Karnataka complained of fever with chills and lower back aches for seven days with no history of chest pain, vomiting, or diarrhea. There have been no similar complaints in the past. She had no other comorbidities. She was a non-smoker and non-alcoholic. Biomass gas exposure for 20 years was noted as she cooked food with firewood. She was a housewife by occupation with no history of trauma or surgeries in the past. The general physical exam was unremarkable. The respiratory system was normal. Auscultation showed decreased breath sounds in the mammary area of the right side of the chest with normal vesicular breath sounds in all other areas. Per abdominal exam showed a flat abdomen. Umbilicus was central in position. There was tenderness in the right hypochondriac and epigastric regions with no guarding or rigidity. On examining the cardiovascular system, apical impulses could not be palpated and normal heart sounds were heard with no cardiac murmurs. Other systems examination was normal. Routine blood investigations were done, revealing hemoglobin of 11.6%, total WBC of 6270 cells, and hematocrit of 33.1%. The renal function test was within normal limits (creatinine = 0.7 mg/dl). A chest X-ray revealed a right lower zone, para cardiac well-circumscribed structure suggestive of a cyst with an air-fluid level inside. Chest CT was suggestive of a hernia in the anterior aspect of the diaphragm measuring 3.5 x 3.3 cm at the level of D9 vertebral body with transverse colon and omentum as its contents, ascending upwards into anterior and superior mediastinum for a length of 13 cm causing shift of cardia posteriorly and to the left (anterior midline diaphragmatic hernia - Morgagni hernia). A hyperdense lesion (Hounsfield unit = 64) measuring 1.3 x 1.8 cm was noted in segment seven of the right lobe of the liver, suggestive of a complex cyst. Beaver tail was noted in the liver. Morgagni hernia usually presents in younger age groups with respiratory symptoms. Its incidental detection in adults is very rare. In this case, the patient was having lower backache and no other gastrointestinal symptoms. The respiratory and cardiothoracic systems get affected because the intestinal contents herniating through the diaphragm shift the position of the cardia and the lower lobes of the lungs, which may have implications such as repeated cough and infections. Symptomatic hernias are usually detected in an early age group. It can present with symptoms of gastrointestinal obstruction or acute chest symptoms or can even be asymptomatic. Treatment is primarily surgical repair of the hernia. This can be done either transthoracically or transabdominally. It is usually advised that surgical repair should be done even in asymptomatic cases as in this case, to avoid obstruction of the intestine or worsening of the hernia that is pulling the abdominal contents into the thorax.
PubMed: 38161555
DOI: 10.7759/cureus.49769 -
Scientific Reports Mar 2024Traditionally, heart murmurs are diagnosed through cardiac auscultation, which requires specialized training and experience. The purpose of this study is to predict...
Traditionally, heart murmurs are diagnosed through cardiac auscultation, which requires specialized training and experience. The purpose of this study is to predict patients' clinical outcomes (normal or abnormal) and identify the presence or absence of heart murmurs using phonocardiograms (PCGs) obtained at different auscultation points. A semi-supervised model tailored to PCG classification is introduced in this study, with the goal of improving performance using time-frequency deep features. The study begins by investigating the behavior of PCGs in the time-frequency domain, utilizing the Stockwell transform to convert the PCG signal into two-dimensional time-frequency maps (TFMs). A deep network named AlexNet is then used to derive deep feature sets from these TFMs. In feature reduction, redundancy is eliminated and the number of deep features is reduced to streamline the feature set. The effectiveness of the extracted features is evaluated using three different classifiers using the CinC/Physionet challenge 2022 dataset. For Task I, which focuses on heart murmur detection, the proposed approach achieved an average accuracy of 93%, sensitivity of 91%, and F1-score of 91%. According to Task II of the CinC/Physionet challenge 2022, the approach showed a clinical outcome cost of 5290, exceeding the benchmark set by leading methods in the challenge.
Topics: Humans; Phonocardiography; Algorithms; Signal Processing, Computer-Assisted; Heart Murmurs; Heart Auscultation
PubMed: 38555390
DOI: 10.1038/s41598-024-58274-6 -
Animals : An Open Access Journal From... Jan 2024Mitral and aortic valve insufficiencies have been commonly reported in horses. The objective of this study was to establish the use of acoustic cardiography (Audicor) in...
Mitral and aortic valve insufficiencies have been commonly reported in horses. The objective of this study was to establish the use of acoustic cardiography (Audicor) in horses with aortic (AI) or mitral valve insufficiency (MI). A total of 17 healthy horses, 18 horses with AI, and 28 horses with MI were prospectively included. None of the horses was in heart failure. Echocardiography and Audicor analyses were conducted. Electromechanical activating time (EMAT), rate-corrected EMATc, left ventricular systolic time (LVST), rate-corrected LVSTc, and intensity and persistence of the third and fourth heart sound (S3, S4) were reported by Audicor. Graphical analysis of the three-dimensional (3D) phonocardiogram served to visually detect murmurs. Audicor snapshot variables were compared between groups using one-way ANOVA followed by Tukey's multiple-comparisons test. The association between Audicor snapshot variables and the corresponding echocardiographic variables was investigated by linear regression and Bland-Altman analyses. Heart murmurs were not displayed on Audicor phonocardiograms. No significant differences were found between Audicor variables obtained in clinically healthy horses and horses with valvular insufficiency. The Audicor device is unable to detect heart murmurs in horses. Audicor variables representing cardiac function are not markedly altered, and their association with corresponding echocardiographic variables is poor in horses with valvular insufficiency that are not in heart failure.
PubMed: 38275790
DOI: 10.3390/ani14020331 -
Journal of Zoo and Wildlife Medicine :... Jan 2024The asymptomatic and slow progressive nature of cardiopathies represents a risk to the welfare of avian species in human care. Diagnosis and treatment of cardiac disease...
The asymptomatic and slow progressive nature of cardiopathies represents a risk to the welfare of avian species in human care. Diagnosis and treatment of cardiac disease in birds pose a challenge due to unique anatomic and physiologic characteristics. Comprehensive cardiac assessments with diagnostic tools such as echocardiography, color-Doppler, the biomarker cardiac troponin I (cTn1), and cholesterol serum concentrations have been utilized in different bird species with varying success. Saddle-billed storks () have been maintained in human care for over 80 yrs and several institutions have noted heart murmurs and cardiomegaly. Despite these findings, peer-reviewed literature describing cardiopathies is lacking for this species. This case series documents the identification of mitral valve regurgitation in saddle-billed storks in a breeding center. Transcoelomic echocardiography using a ventromedial approach with a two-chambered view and color Doppler was utilized. Echocardiographic measurements were taken and compared 1 yr later in most of the birds. There was left atrial enlargement and worsened mitral regurgitation in one geriatric patient, and no progression of the disease in two young birds. Serum samples showed that cTn1 had different concentrations depending on the severity of the disease, whereas cholesterol was within reference range for all birds. Treatment with digoxin and pimobendan was recommended in one bird, serum concentrations of digoxin were tested in a 6-mon span, results were within therapeutic range, and there were no overt adverse effects. There was a suspected genetic component in this population, as four of the five birds with confirmed mitral regurgitation were related.
Topics: Animals; Humans; Mitral Valve Insufficiency; Birds; Echocardiography; Digoxin; Cholesterol
PubMed: 38252011
DOI: 10.1638/2023-0039 -
Annales de Cardiologie Et D'angeiologie Feb 2024Acute rheumatic fever (ARF) is a multi-systemic disease, in which cardiac involvement is the most serious major manifestation of disease. The aim of this study was to...
INTRODUCTION
Acute rheumatic fever (ARF) is a multi-systemic disease, in which cardiac involvement is the most serious major manifestation of disease. The aim of this study was to analyse cardiac involvement in children with ARF and his risk factors.
MATERIALS AND METHODS
It were a retrospective study including all children under the age of 14 years who were hospitalized for ARF in the pediatric department of the CHU Hédi Chaker of Sfax, during a period of twelve years (2010-2022).
RESULTS
We collected 50 cases (31 boys and 19 girls). Twenty-two patients (44%) developed cardiac lesions. The mean age at diagnosis was 9.6 years [5-14 years]. A pathological heart murmur was detected in 14 cases (n = 14/22) was classified as mild carditis in 15 cases, moderate carditis in 5 cases and severe in 2 cases. The median follow-up time was 3,3 years. Nineteen patients developed valvular sequelae Risk factors of cardiac lesions was: age more than 8 years, heart murmur, allonged PR, CRP > 100 mg/l and VS > 100 mm.
CONCLUSION
CR is still a public health problem in Tunisia. It is a serious pathology that can cause serious increases in morbidity rates. Thus, we must strengthen preventive strategies.
Topics: Child; Male; Female; Humans; Adolescent; Retrospective Studies; Myocarditis; Rheumatic Heart Disease; Rheumatic Fever; Heart Murmurs
PubMed: 37988890
DOI: 10.1016/j.ancard.2023.101676 -
European Heart Journal. Case Reports Aug 2023Pericarditis is a common pericardial disorder that is frequently accompanied by a pericardial friction rub, which can be detected during a physical examination. Although...
BACKGROUND
Pericarditis is a common pericardial disorder that is frequently accompanied by a pericardial friction rub, which can be detected during a physical examination. Although patients' awareness of cardiac murmurs and vascular bruits has been extensively reported, there are no reports on patients' self-awareness of a pericardial friction rub.
CASE SUMMARY
We present the first case of a patient with acute pericarditis associated with objective self-awareness of a pericardial friction rub, which we recorded with an electronic stethoscope and confirmed the sound with the patient. The patient had a recent history of three-vessel coronary artery bypass grafting and presented with a progressively worsening, rhythmic, and 'sandpaper-scratching' sound in both ears. The sound was more pronounced in the left lateral decubitus position. The symptom resolved with colchicine therapy and was associated with concomitant resolution of the pericardial friction rub.
DISCUSSION
This is the first documented case of a patient demonstrating objective self-awareness of a pericardial rub resulting from acute pericarditis associated with post-pericardiotomy syndrome. Tinnitus refers to the perception of an auditory sensation that can be subjective or objective, depending on whether it is heard only by the individual or can also be heard by an observer. While objective tinnitus caused by cardiovascular conditions has been previously reported, no cases have attributed the pericardial friction rub as the underlying cause. Therefore, we suggest using the term pericardial rub tinnitus to describe this unique phenomenon.
PubMed: 37547373
DOI: 10.1093/ehjcr/ytad333