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Kardiologiia Feb 2020This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the... (Review)
Review
This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.
Topics: Cardiologists; Echocardiography; Humans; Lung; Pulmonary Edema; Ultrasonography
PubMed: 32245358
DOI: 10.18087/cardio.2020.1.n617 -
Biomedical Engineering Online Sep 2022With the spread of COVID-19, telemedicine has played an important role, but tele-auscultation is still unavailable in most countries. This study introduces and tests a...
BACKGROUND
With the spread of COVID-19, telemedicine has played an important role, but tele-auscultation is still unavailable in most countries. This study introduces and tests a tele-auscultation system (Stemoscope) and compares the concordance of the Stemoscope with the traditional stethoscope in the evaluation of heart murmurs.
METHODS
A total of 57 patients with murmurs were recruited, and echocardiographs were performed. Three cardiologists were asked to correctly categorize heart sounds (both systolic murmur and diastolic murmur) as normal vs. abnormal with both the Stemoscope and a traditional acoustic stethoscope under different conditions. Firstly, we compared the in-person auscultation agreement between Stemoscope and the conventional acoustic stethoscope. Secondly, we compared tele-auscultation (recorded heart sounds) agreement between Stemoscope and acoustic results. Thirdly, we compared both the Stemoscope tele-auscultation results and traditional acoustic stethoscope in-person auscultation results with echocardiography. Finally, ten other cardiologists were asked to complete a qualitative questionnaire to assess their experience using the Stemoscope.
RESULTS
For murmurs detection, the in-person auscultation agreement between Stemoscope and the acoustic stethoscope was 91% (p = 0.67). The agreement between Stemoscope tele-auscultation and the acoustic stethoscope in-person auscultation was 90% (p = 0.32). When using the echocardiographic findings as the reference, the agreement between Stemoscope (tele-auscultation) and the acoustic stethoscope (in-person auscultation) was 89% vs. 86% (p = 1.00). The system evaluated by ten cardiologists is considered easy to use, and most of them would consider using it in a telemedical setting.
CONCLUSION
In-person auscultation and tele-auscultation by the Stemoscope are in good agreement with manual acoustic auscultation. The Stemoscope is a helpful heart murmur screening tool at a distance and can be used in telemedicine.
Topics: Auscultation; COVID-19; Electronics; Heart Auscultation; Heart Murmurs; Humans; Stethoscopes
PubMed: 36068509
DOI: 10.1186/s12938-022-01032-4 -
BMC Pulmonary Medicine Mar 2022Auscultation with stethoscope has been an essential tool for diagnosing the patients with respiratory disease. Although auscultation is non-invasive, rapid, and... (Review)
Review
Auscultation with stethoscope has been an essential tool for diagnosing the patients with respiratory disease. Although auscultation is non-invasive, rapid, and inexpensive, it has intrinsic limitations such as inter-listener variability and subjectivity, and the examination must be performed face-to-face. Conventional stethoscope could not record the respiratory sounds, so it was impossible to share the sounds. Recent innovative digital stethoscopes have overcome the limitations and enabled clinicians to store and share the sounds for education and discussion. In particular, the recordable stethoscope made it possible to analyze breathing sounds using artificial intelligence, especially based on neural network. Deep learning-based analysis with an automatic feature extractor and convoluted neural network classifier has been applied for the accurate analysis of respiratory sounds. In addition, the current advances in battery technology, embedded processors with low power consumption, and integrated sensors make possible the development of wearable and wireless stethoscopes, which can help to examine patients living in areas of a shortage of doctors or those who need isolation. There are still challenges to overcome, such as the analysis of complex and mixed respiratory sounds and noise filtering, but continuous research and technological development will facilitate the transition to a new era of a wearable and smart stethoscope.
Topics: Artificial Intelligence; Auscultation; Humans; Respiratory Sounds; Stethoscopes; Technology
PubMed: 35361176
DOI: 10.1186/s12890-022-01896-1 -
BMJ Open Mar 2023The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.
OBJECTIVE
The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.
DESIGN/METHODS
A systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiography, to evaluate VHD in adults, was performed in MEDLINE (1947-November 2021) and EMBASE (1947-November 2021). Two reviewers screened all references by title and abstract, to select studies to be included. Disagreements were resolved by consensus meetings. Reference lists of included studies were also screened. The results are presented as a narrative synthesis, and risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2.
MAIN OUTCOME MEASURES
Sensitivity, specificity and likelihood ratios (LRs).
RESULTS
We found 23 articles meeting the inclusion criteria. Auscultation was compared with full echocardiography in 15 of the articles; pulsed Doppler was used as reference standard in 2 articles, while aortography and ventriculography was used in 5 articles. One article used point-of-care ultrasound. The articles were published from year 1967 to 2021. Sensitivity of auscultation ranged from 30% to 100%, and specificity ranged from 28% to 100%. LRs ranged from 1.35 to 26. Most of the included studies used cardiologists or internal medicine residents or specialists as auscultators, whereas two used general practitioners and two studied several different auscultators.
CONCLUSION
Sensitivity, specificity and LRs of auscultation varied considerably across the different studies. There is a sparsity of data from general practice, where auscultation of the heart is usually one of the main methods for detecting VHD. Based on this review, the diagnostic utility of auscultation is unclear and medical doctors should not rely too much on auscultation alone. More research is needed on how auscultation, together with other clinical findings and history, can be used to distinguish patients with VHD.
PROSPERO REGISTRATION NUMBER
CRD42018091675.
Topics: Adult; Humans; Heart Auscultation; Ultrasonography; Auscultation; Echocardiography; Heart Valve Diseases
PubMed: 36963797
DOI: 10.1136/bmjopen-2022-068121 -
Women and Birth : Journal of the... Sep 2020Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring. (Meta-Analysis)
Meta-Analysis Review
PROBLEM
Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring.
BACKGROUND
Intrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome.
AIM
This systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women.
METHODS
A systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken.
FINDINGS
Nine randomised controlled trials and 26 non-experimental studies were included. Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy.
DISCUSSION
Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome.
CONCLUSION
There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.
Topics: Auscultation; Cardiotocography; Cerebral Palsy; Cesarean Section; Female; Fetal Monitoring; Humans; Infant, Newborn; Labor, Obstetric; Parturition; Perinatal Mortality; Pregnancy; Stillbirth
PubMed: 31668871
DOI: 10.1016/j.wombi.2019.10.002 -
Neurology India 2020The actual investigation of the body of a patient by the clinician in search for the signs of the disease beginning with the primary vital signs and continues with the... (Review)
Review
The actual investigation of the body of a patient by the clinician in search for the signs of the disease beginning with the primary vital signs and continues with the careful and attentive observation of the patient. This article reviews the key findings in the physical examination of patients with ischemic stroke that have the potential to indicate the etiology of the infarct and to help to choose the use of ancillary tests. Through a systematic search of articles published in English related to the physical examination of patients with stroke, we identified key findings in the vital signs and classic components of the physical exam (appearance of the patient, auscultation, and eye examination) that have shown clinical significance when determining ischemic stroke etiology. We further suggest that the prompt identification of such findings can translate into better use of diagnostic tools and selection of ancillary confirmatory tests, thus, reducing the time to etiology based treatment and secondary prevention of ischemic stroke. in this manuscript, we aim to show that even though nowadays the clinical skills tend to be overlooked due to the overreliance on technology, the physical exam continues to be a valuable tool in the clinician armamentarium when facing the challenge of a patient with ischemic stroke.
Topics: Auscultation; Heart Auscultation; Humans; Ischemic Stroke; Neck; Ophthalmoscopy; Physical Examination; Secondary Prevention; Vital Signs
PubMed: 32415006
DOI: 10.4103/0028-3886.284386 -
Annual International Conference of the... Nov 2021This work addresses the automatic segmentation of neonatal phonocardiogram (PCG) to be used in the artificial intelligence-assisted diagnosis of abnormal heart sounds....
This work addresses the automatic segmentation of neonatal phonocardiogram (PCG) to be used in the artificial intelligence-assisted diagnosis of abnormal heart sounds. The proposed novel algorithm has a single free parameter - the maximum heart rate. The algorithm is compared with the baseline algorithm, which was developed for adult PCG segmentation. When evaluated on a large clinical dataset of neonatal PCG with a total duration of over 7h, an F1 score of 0.94 is achieved. The main features relevant for the segmentation of neonatal PCG are identified and discussed. The algorithm is able to increase the number of cardiac cycles by a factor of 5 compared to manual segmentation, potentially allowing to improve the performance of heart abnormality detection algorithms.
Topics: Artificial Intelligence; Heart Auscultation; Heart Sounds; Phonocardiography; Signal Processing, Computer-Assisted
PubMed: 34891256
DOI: 10.1109/EMBC46164.2021.9630574 -
IEEE Journal of Biomedical and Health... Mar 2022Aspiration is a serious complication of swallowing disorders. Adequate detection of aspiration is essential in dysphagia management and treatment. High-resolution...
Aspiration is a serious complication of swallowing disorders. Adequate detection of aspiration is essential in dysphagia management and treatment. High-resolution cervical auscultation has been increasingly considered as a promising noninvasive swallowing screening tool and has inspired automatic diagnosis with advanced algorithms. The performance of such algorithms relies heavily on the amount of training data. However, the practical collection of cervical auscultation signal is an expensive and time-consuming process because of the clinical settings and trained experts needed for acquisition and interpretations. Furthermore, the relatively infrequent incidence of severe airway invasion during swallowing studies constrains the performance of machine learning models. Here, we produced supplementary training exemplars for desired class by capturing the underlying distribution of original cervical auscultation signal features using auxiliary classifier Wasserstein generative adversarial networks. A 10-fold subject cross-validation was conducted on 2079 sets of 36-dimensional signal features collected from 189 patients undergoing swallowing examinations. The proposed data augmentation outperforms basic data sampling, cost-sensitive learning and other generative models with significant enhancement. This demonstrates the remarkable potential of proposed network in improving classification performance using cervical auscultation signals and paves the way of developing accurate noninvasive swallowing evaluation in dysphagia care.
Topics: Algorithms; Auscultation; Deglutition; Deglutition Disorders; Humans; Machine Learning
PubMed: 34415842
DOI: 10.1109/JBHI.2021.3106565 -
Computers in Biology and Medicine Jun 2022The paper proposes a graph-theoretical approach to auscultation, bringing out the potential of graph features in classifying the bioacoustics signals. The complex...
The paper proposes a graph-theoretical approach to auscultation, bringing out the potential of graph features in classifying the bioacoustics signals. The complex network analysis of the bioacoustics signals - vesicular (VE) and bronchial (BR) breath sound - of 48 healthy persons are carried out for understanding the airflow dynamics during respiration. The VE and BR are classified by the machine learning techniques extracting the graph features - the number of edges (E), graph density (D), transitivity (T), degree centrality (D) and eigenvector centrality (E). The higher value of E, D, and T in BR indicates the temporally correlated airflow through the wider tracheobronchial tract resulting in sustained high-intense low-frequencies. The frequency spread and high-frequencies in VE, arising due to the less correlated airflow through the narrow segmental bronchi and lobar, appears as a lower value for E, D, and T. The lower values of D and E justify the inferences from the spectral and other graph parameters. The study proposes a methodology in remote auscultation that can be employed in the current scenario of COVID-19.
Topics: Auscultation; COVID-19; Humans; Lung; Machine Learning; Signal Processing, Computer-Assisted
PubMed: 35405403
DOI: 10.1016/j.compbiomed.2022.105491 -
Hospital Practice (1995) Aug 2022COVID-19 has had a great impact on the elderly population. All admitted patients underwent cardiac auscultation at the Emergency Department. However, to our knowledge,...
INTRODUCTION
COVID-19 has had a great impact on the elderly population. All admitted patients underwent cardiac auscultation at the Emergency Department. However, to our knowledge, there is no literature that explains the implications of cardiac auscultation at the Emergency Department.
MATERIAL AND METHODS
Data collection from our hospital records. Our cohort consists of 300 admissions with a mean age of 81.6 years and 50.7% men.
RESULTS
Pathological cardiac auscultation at the Emergency Department was a risk factor for in-hospital mortality (RR = 1.9; 95% CI 1.3-2.8), heart failure (RR = 3.2; 95% CI = 1.8-5.6), respiratory failure (RR = 1.8; 95% CI = 1.3-2.5), acute kidney injury (RR = 2.6; 95% CI = 2-3.2), and ICU admission (RR = 3.3; 95% CI = 1.3-8.2). The findings in patients with pathological cardiac auscultation were that oxygen saturation in the Emergency Department, arterial pH, and HCO3 were significantly lower, and the ALT/GPT, LDH, and lactate determinations were significantly higher, which is compatible and correlates with the fact that the main variable is indeed a risk factor for a more severe clinical course. Among the findings from pathological auscultation, arrhythmic tone/arrhythmia was the most frequent (50%) and a risk factor for in-hospital mortality (RR = 2.3; 95% CI = 1.6-3.4). Logistic regression was performed from a multivariate analysis that showed that the initial arrhythmia correlated with pathological cardiac auscultation is an independent risk factor for in-hospital mortality.
CONCLUSION
Continuous rhythm monitoring makes it possible to detect arrhythmias and act proactively, and to offer greater care and attention to these patients who have a higher risk of in-hospital mortality and a worse prognosis. Cardiac auscultation can alert us in order to perform more electrocardiograms in these patients and thus have better monitoring.
Topics: Aged; Aged, 80 and over; Arrhythmias, Cardiac; COVID-19; Female; Heart Auscultation; Hospital Mortality; Hospitalization; Humans; Male
PubMed: 35468303
DOI: 10.1080/21548331.2022.2069772