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Heart Failure Clinics Apr 2020Heart failure (HF) is a leading cause of hospitalization. Suitable pharmacologic management is critical. Distinct physical findings such as congestion and peripheral... (Review)
Review
Heart failure (HF) is a leading cause of hospitalization. Suitable pharmacologic management is critical. Distinct physical findings such as congestion and peripheral hypoperfusion need to be considered in selecting pharmacologic therapy. By applying the pretest probability and likelihood ratios of unique physical findings of HF to a Markov model, a definite posttest probability can be obtained. This article focuses on the findings of S3, jugular venous pressure, proportional pulse pressure, bendopnea, trepopnea, and various heart murmurs. Incorporating statistical precision in physical assessments, diagnoses of HF can be further refined, providing a sophisticated approach to evaluate patients hemodynamics status noninvasively.
Topics: Heart Failure; Hemodynamics; Humans; Markov Chains; Patient Selection; Physical Examination
PubMed: 32143759
DOI: 10.1016/j.hfc.2019.12.001 -
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 -
Heart (British Cardiac Society) Sep 2020
Topics: Adult; Heart Atria; Heart Murmurs; Heart Neoplasms; Hemangiosarcoma; Humans; Magnetic Resonance Imaging; Male; Multimodal Imaging; Positron-Emission Tomography; Predictive Value of Tests
PubMed: 32788289
DOI: 10.1136/heartjnl-2020-316736 -
Journal of Feline Medicine and Surgery Aug 2021The aim of this study was to define the clinical characteristics of cats referred for evaluation of subclinical cardiac murmurs, and, secondarily, to identify predictors...
OBJECTIVES
The aim of this study was to define the clinical characteristics of cats referred for evaluation of subclinical cardiac murmurs, and, secondarily, to identify predictors of echocardiographic identification of cardiac disease.
METHODS
One hundred and sixty-three apparently healthy cats with subclinical murmurs were retrospectively enrolled. Medical records of cats older than 1 year of age referred for the evaluation of subclinical murmurs were reviewed. Cats were considered healthy if clinical signs of systemic disease or cardiac disease were not reported and cats were not receiving cardiac medications. Logistic regression was used to identify clinical variables that predict echocardiographic identification of cardiac disease.
RESULTS
One hundred and eight cats (66.3%) had echocardiographic evidence of cardiac disease with hypertrophic cardiomyopathy being the most common (80.5%). Left atrial enlargement was uncommon; in 90% of cats with echocardiographically identified cardiac disease, the left atrial aortic ratio from two-dimensional echocardiography was <1.51. Cats with cardiac disease were more likely to be male ( = 0.016), weigh more ( <0.01) and have a murmur of intensity ⩾3/6 ( = 0.019) than cats without cardiac disease. Murmur intensity ⩾grade 3/6 ( = 0.01) and male sex ( = 0.01) were independent predictors of echocardiographic evidence of cardiac disease in multivariable analysis.
CONCLUSIONS AND RELEVANCE
The majority of cats referred for evaluation of subclinical cardiac murmurs have cardiac disease. Based on left atrial dimensions, cardiac disease is generally mild. Male sex and a loud cardiac murmur are associated with the identification of cardiac disease.
Topics: Animals; Cardiomyopathy, Hypertrophic; Echocardiography; Female; Heart Diseases; Heart Murmurs; Male; Retrospective Studies
PubMed: 33215949
DOI: 10.1177/1098612X20972058 -
Nature Reviews. Cardiology Jul 2021
Topics: Artificial Intelligence; Heart Murmurs; Humans
PubMed: 33976396
DOI: 10.1038/s41569-021-00567-8 -
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 -
Journal of Biological Regulators and... 2020Congenital hypothyroidism (CH) is the most common endocrine disease in children, according to literature, infants with CH have an increased risk of associated congenital...
Congenital hypothyroidism (CH) is the most common endocrine disease in children, according to literature, infants with CH have an increased risk of associated congenital malformations (CM), especially cardiac defects (CD), compared to the general population. We retrospectively analyzed medical records of 255 patients with a positive screening result for CH in the period 1991-2016 followed at our Center. At the time of enrollment, the clinical examination included looking for the presence of heart murmurs and dysmorphic features. In all patients an echocardiography with cardiological evaluation were performed. Of all patients, 191 were included in the final analysis. Of these, 51.3% (98/191) presented an eutopic normally sized thyroid gland while 48.7% (93/191) showed a thyroid dysgenesis. Among the studied infants, 13.6% (26/191) presented CD. The most frequent cardiac anomaly was atrial septal defect (ASD) which was found in 65.4% (17/26) of patients with CD. Other defects were ventricular septal defect (VSD), patent ductus arteriosus (PDA), pulmonary valve stenosis (PvS), transposition of the great vessels (TGV), aortic valve stenosis (AvS). Six patients had multiple defects. In the analysed group, there was no significant relation with sex, type of CH, median blood-TSH (b-TSH) and serum-TSH (s-TSH) values and frequency of CD. There is a high prevalence of CD in CH, indicating the need of routine echocardiography in these patients to achieve an early diagnosis and management of CD.
Topics: Child; Congenital Hypothyroidism; Echocardiography; Heart Defects, Congenital; Humans; Retrospective Studies
PubMed: 33000607
DOI: No ID Found -
European Heart Journal. Cardiovascular... Sep 2022The left atrium (LA) has a pivotal role in cardiac performance and LA deformation is a well-known prognostic predictor in several clinical conditions including heart...
AIMS
The left atrium (LA) has a pivotal role in cardiac performance and LA deformation is a well-known prognostic predictor in several clinical conditions including heart failure with reduced ejection fraction. The aim of this study is to investigate the effect of cardiac resynchronization therapy (CRT) on both LA morphology and function and to assess the impact of LA reservoir strain (LARS) on left ventricular (LV) systolic and diastolic remodelling after CRT.
METHODS AND RESULTS
Two hundred and twenty-one CRT-candidates were prospectively included in the study in four tertiary centres and underwent echocardiography before CRT-implantation and at 6-month follow-up (FU). CRT-response was defined by a 15% reduction in LV end-systolic volume. LV systolic and diastolic remodelling were defined as the percent reduction in LV end-systolic and end-diastolic volume at FU. Indexed LA volume (LAVI) and LV-global longitudinal (GLS) strain were the main parameters correlated with LARS, with LV-GLS being the strongest determinant of LARS (r = -0.59, P < 0.0001). CRT induced a significant improvement in LAVI and LARS in responders (both P < 0.0001). LARS was an independent predictor of both LV systolic and diastolic remodelling at follow-up (r = -0.14, P = 0.049 and r = -0.17, P = 0.002, respectively).
CONCLUSION
CRT induces a significant improvement in LAVI and LARS in responders. In CRT candidates, the evaluation of LARS before CRT delivery is an independent predictor of LV systolic and diastolic remodelling at FU.
Topics: Cardiac Resynchronization Therapy; Diastole; Echocardiography; Heart Atria; Heart Failure; Heart Murmurs; Heart Ventricles; Humans; Treatment Outcome; Ventricular Dysfunction, Left
PubMed: 34432006
DOI: 10.1093/ehjci/jeab163