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Sensors (Basel, Switzerland) Jun 2024The phonocardiogram (PCG) can be used as an affordable way to monitor heart conditions. This study proposes the training and testing of several classifiers based on SVMs...
The phonocardiogram (PCG) can be used as an affordable way to monitor heart conditions. This study proposes the training and testing of several classifiers based on SVMs (support vector machines), k-NN (k-Nearest Neighbor), and NNs (neural networks) to perform binary ("Normal"/"Pathologic") and multiclass ("Normal", "CAD" (coronary artery disease), "MVP" (mitral valve prolapse), and "Benign" (benign murmurs)) classification of PCG signals, without heart sound segmentation algorithms. Two datasets of 482 and 826 PCG signals from the Physionet/CinC 2016 dataset are used to train the binary and multiclass classifiers, respectively. Each PCG signal is pre-processed, with spike removal, denoising, filtering, and normalization; afterward, it is divided into 5 s frames with a 1 s shift. Subsequently, a feature set is extracted from each frame to train and test the binary and multiclass classifiers. Concerning the binary classification, the trained classifiers yielded accuracies ranging from 92.4 to 98.7% on the test set, with memory occupations from 92.7 kB to 11.1 MB. Regarding the multiclass classification, the trained classifiers achieved accuracies spanning from 95.3 to 98.6% on the test set, occupying a memory portion from 233 kB to 14.1 MB. The NNs trained and tested in this work offer the best trade-off between performance and memory occupation, whereas the trained k-NN models obtained the best performance at the cost of large memory occupation (up to 14.1 MB). The classifiers' performance slightly depends on the signal quality, since a denoising step is performed during pre-processing. To this end, the signal-to-noise ratio (SNR) was acquired before and after the denoising, indicating an improvement between 15 and 30 dB. The trained and tested models occupy relatively little memory, enabling their implementation in resource-limited systems.
Topics: Humans; Phonocardiography; Machine Learning; Signal Processing, Computer-Assisted; Algorithms; Neural Networks, Computer; Wearable Electronic Devices; Support Vector Machine
PubMed: 38931636
DOI: 10.3390/s24123853 -
Journal of the American Heart... Sep 2023Background Short-term effects on mitral valve (MV) anatomy after transcatheter edge-to-edge repair using the PASCAL system remain unknown. Precise quantification might...
Background Short-term effects on mitral valve (MV) anatomy after transcatheter edge-to-edge repair using the PASCAL system remain unknown. Precise quantification might allow for an advanced analysis of predictors for mean transmitral gradients. Methods and Results Consecutive patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation using PASCAL or MitraClip systems were included. Quantification of short-term MV changes throughout the cardiac cycle was performed using peri-interventional 3-dimensional MV images. Predictors for mean transmitral gradients were identified in univariable and multivariable regression analysis. Long-term results were described during 1-year follow-up. A total of 100 patients undergoing transcatheter edge-to-edge repair using PASCAL (n=50) or MitraClip systems (n=50) were included. Significant reductions of anterior-posterior diameter, annular circumference, and area throughout the cardiac cycle were found in both cohorts (<0.05 for all). Anatomic MV orifice area remained larger in the PASCAL cohort in mid (2.8±1.0 versus 2.4±0.9 cm; =0.049) and late diastole (2.7±1.1 versus 2.2±0.8 cm; =0.036) compared with the MitraClip cohort. Besides a device-specific profile of independent predictor of mean transmitral gradients, reduction of middiastolic anatomic MV orifice area was identified as an independent predictor in both the PASCAL (=-0.410; =0.001) and MitraClip cohorts (=-0.318; =0.028). At follow-up, reduction of mitral regurgitation grade to mild or less was more durable in the PASCAL cohort (90% versus 72%; =0.035). Conclusions PASCAL and MitraClip showed comparable short-term effects on MV geometry. However, PASCAL might better preserve MV function and demonstrated more durable mitral regurgitation reduction during follow-up. Identification of independent predictors for mean transmitral gradients might potentially help to guide device selection in the future.
Topics: Humans; Heart Murmurs; Mitral Valve; Mitral Valve Insufficiency
PubMed: 37646220
DOI: 10.1161/JAHA.123.030333 -
Cureus Jan 2024One of the many physical exam skills introduced to medical students during their pre-clerkship education is cardiac auscultation, one purpose of which is to teach the... (Review)
Review
One of the many physical exam skills introduced to medical students during their pre-clerkship education is cardiac auscultation, one purpose of which is to teach the detection and identification of heart murmurs. Cardiac auscultation with a stethoscope has been the standard method of teaching. Another method, point-of-care ultrasound (POCUS), has been recently introduced as another modality by which students learn to detect and identify murmurs. The emerging popularity of POCUS in undergraduate medical curricula has led many institutions to include it in their curricula; however, doing so is challenging. Not only is cost a major factor, but reorganizing curricula to allow sufficient time for POCUS training has proven to be difficult. Additionally, the presence of notable gaps in the literature regarding the efficacy of POCUS for teaching the detection and identification of heart murmur has increased scrutiny of its value. Studies that assessed teaching cardiac auscultation to medical students in their pre-clinical years via stethoscope have used different teaching methods. However, evaluation of these studies identified numerous limitations, one being little long-term retention of cardiac auscultation knowledge. Furthermore, several barriers to integration of POCUS in undergraduate medical education were identified. The purpose of this review is to synthesize the literature comparing the effectiveness of these different tools of a cardiac exam for detection of heart murmurs in undergraduate medical education and identify gaps in literature requiring future exploration.
PubMed: 38410315
DOI: 10.7759/cureus.53013 -
American Family Physician Mar 2022
Topics: Child; Heart Auscultation; Heart Murmurs; Humans; Parents
PubMed: 35289586
DOI: No ID Found -
International Journal of Environmental... Jul 2020Primary heart tumors (PHTs) in the pediatric population are very rare and do not manifest any characteristic symptoms.
BACKGROUND
Primary heart tumors (PHTs) in the pediatric population are very rare and do not manifest any characteristic symptoms.
METHODS
A retrospective analysis of 61 cases was undertaken. Data from three centers for the years 2003-2018 were gathered. The tumors' clinical course, location, number, hemodynamic, treatment, and follow-up were evaluated. Echocardiography was complemented with magnetic resonance imaging, computer tomography, and histopathological examination.
RESULTS
Out of 61 PHT diagnoses, 56 (91.8%) were circumstantial including all 16 (26.2%) prenatal tumors. The reasons for cardiological consultations were arrhythmia, syncopes, lowered physical performance, and murmurs. Only five patients (8.2%) were suspected of tumors based on previous symptoms of sclerosis tuberosa. Rhabdomyoma was the most frequently found PHT (60.7%). The tumors were predominantly located in the ventricles (49.1%) and intraventricular septum (14.9%) and tended to be single (70.5%). About 37.7% of patients suffered from coexistent multi-organ problems, two (3.28%) from congenital heart defects and one (1.64%) from Carney's syndrome. Tumor resection was performed on 26 (42.7%) patients, of which 16 (61.5%) underwent total and 10 (38.5%) partial tumor resection. During the follow-up (mean 4.3 years), 54 patients (88.5%) have improved or were stable, while seven (11.5%) died.
CONCLUSIONS
Primary pediatric heart tumors are diagnosed completely circumstantially, and the most common is rhabdomyoma, although arrhythmia may suggest fibroma. Diagnosis of a heart tumor in children is not synonymous with fatal prognosis, and most of them require only constant observation. Life-saving operation allows improvement, while the prognosis for malignant tumors in children is definitely unfavorable.
Topics: Adolescent; Child; Echocardiography; Female; Follow-Up Studies; Heart Neoplasms; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Vena Cava, Superior
PubMed: 32751243
DOI: 10.3390/ijerph17155471 -
PloS One 2022Restrictive cardiomyopathy (RCM) is a rare disease characterized by increased ventricular stiffness and preserved ventricular contraction. Various sarcomere gene...
Restrictive cardiomyopathy (RCM) is a rare disease characterized by increased ventricular stiffness and preserved ventricular contraction. Various sarcomere gene variants are known to cause RCM; however, more than a half of patients do not harbor such pathogenic variants. We recently demonstrated that cardiac fibroblasts (CFs) play important roles in inhibiting the diastolic function of cardiomyocytes via humoral factors and direct cell-cell contact regardless of sarcomere gene mutations. However, the mechanical properties of CFs that are crucial for intercellular communication and the cardiomyocyte microenvironment remain less understood. In this study, we evaluated the rheological properties of CFs derived from pediatric patients with RCM and healthy control CFs via atomic force microscopy. Then, we estimated the cellular modulus scale factor related to the cell stiffness, fluidity, and Newtonian viscosity of single cells based on the single power-law rheology model and analyzed the comprehensive gene expression profiles via RNA-sequencing. RCM-derived CFs showed significantly higher stiffness and viscosity and lower fluidity compared to healthy control CFs. Furthermore, RNA-sequencing revealed that the signaling pathways associated with cytoskeleton elements were affected in RCM CFs; specifically, cytoskeletal actin-associated genes (ACTN1, ACTA2, and PALLD) were highly expressed in RCM CFs, whereas several tubulin genes (TUBB3, TUBB, TUBA1C, and TUBA1B) were down-regulated. These results implies that the signaling pathways associated with cytoskeletal elements alter the rheological properties of RCM CFs, particularly those related to CF-cardiomyocyte interactions, thereby leading to diastolic cardiac dysfunction in RCM.
Topics: Actins; Cardiomyopathy, Restrictive; Child; Fibroblasts; Heart Murmurs; Humans; Microscopy, Atomic Force; Myocytes, Cardiac; RNA; Rheology; Tubulin
PubMed: 36174041
DOI: 10.1371/journal.pone.0275296 -
Journal of Cardiology Dec 2020The widespread use of cardiac computed tomography (CT) has increased the incidental discovery of fistulas of the coronary artery (CAF). This condition is rare and can...
Coronary artery fistula in adults: Incidence and appearance on cardiac computed tomography and comparison of detectability and hemodynamic effects with those on transthoracic echocardiography.
BACKGROUND
The widespread use of cardiac computed tomography (CT) has increased the incidental discovery of fistulas of the coronary artery (CAF). This condition is rare and can affect hemodynamic parameters, but few reports focus on its hemodynamic effects. We investigated the frequency and types of CAF on CT and compared them with those of transthoracic echocardiography (TTE) to evaluate the detectability of CAF and its hemodynamic effects.
MATERIALS AND METHODS
We retrospectively evaluated cardiac CT images of 6789 adult patients who underwent imaging from January 1, 2013 through September 30, 2019 at our institution. We assessed the CT images for the presence of CAF and compared our findings with those obtained by TTE in control cases without CAF.
RESULTS
The prevalence of CAF determined with cardiac CT was 0.91%, with the left anterior descending artery (67.7%) as the most common site of origin and the main pulmonary artery (82.3%) as the most common origin of drainage. The incidence of aneurysm accompanying CAF was 48.4%. Color Doppler in TTE demonstrated abnormal flow that would suggest the presence of CAF of only 23.1%. Echocardiographic findings of hemodynamics did not differ significantly between patients with and without CAF nor between elderly and non-elderly patients with CAF.
CONCLUSIONS
Our study revealed differing prevalence and types of CAF from those reported using coronary angiography and little impact of CAF on hemodynamics. Color Doppler in TTE did not readily depict abnormal flow that might suggest the presence of a fistula, but cardiac CT allowed noninvasive and comprehensive assessment of CAF. Thus, we believe the acquisition of cardiac CT is necessary to establish the cause of continuous murmur that is not identified with TTE.
Topics: Adult; Aged; Aged, 80 and over; Arterio-Arterial Fistula; Coronary Artery Disease; Echocardiography; Female; Heart Murmurs; Hemodynamics; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 32636129
DOI: 10.1016/j.jjcc.2020.06.005 -
Acta Veterinaria Scandinavica Sep 2021Cardiac auscultation is an important screening test at the first health examination of puppies because most clinically relevant congenital cardiac anomalies cause a loud...
BACKGROUND
Cardiac auscultation is an important screening test at the first health examination of puppies because most clinically relevant congenital cardiac anomalies cause a loud murmur from birth. This retrospective study aimed to investigate the age at which dogs with suspected congenital cardiac anomalies were referred to a veterinary cardiology specialist for murmur investigation. A secondary aim was to establish the time interval between the visit to the cardiologist and the first available murmur documentation. The digital archive of a veterinary teaching hospital was searched for dogs with congenital cardiac anomalies and puppies with innocent murmurs during a 5-year period. Dogs had to be referred because of a murmur, and they had to undergo physical examination and echocardiography by a veterinary cardiology specialist. The health certificate section of the pet passport, and the medical records from the referring veterinarian, were reviewed to identify the date when the murmur was first documented.
RESULTS
Of the 271 included dogs, 94% had a congenital cardiac anomaly and 6% had an innocent murmur. The dogs' median age was 190 days when they were examined by the cardiologist. Only 10% of the dogs were referred by the breeder's veterinarian, while 90% of the dogs were referred by the new owner's veterinarian. The median age of the first available murmur documentation by a first opinion veterinary practitioner was 95 days.
CONCLUSIONS
Only 10% of the puppies in the present study were referred to a veterinary cardiology specialist for murmur investigation before they were sold to a new owner. Referral prior to re-homing would have been feasible if the murmur had been detected and documented by the breeder's veterinarian, if referral was offered by the breeder's veterinarian and the referral was accepted by the breeder.
Topics: Animals; Cardiology; Dogs; Heart Murmurs; Hospitals, Animal; Hospitals, Teaching; Referral and Consultation; Retrospective Studies
PubMed: 34556139
DOI: 10.1186/s13028-021-00603-0 -
The Egyptian Heart Journal : (EHJ) :... Jan 2021Congenital heart disease (CHD) is a multifactorial birth defect which has variable demographic characteristics among children in different geographical areas. This study...
BACKGROUND
Congenital heart disease (CHD) is a multifactorial birth defect which has variable demographic characteristics among children in different geographical areas. This study aimed to detect the distribution of demographic data, perinatal risk factors, types, age, and mode of presentation of CHD among Egyptian children.
RESULTS
The medical records of 1005 patients were included. They were 545 males (54%) and 462 females (46%) with a ratio of 1.2:1. Acyanotic CHD was encountered in 79.2%. Isolated ventricular septal defect and tetralogy of Fallot were the most common acyanotic and cyanotic lesions, respectively. The majority was diagnosed within the first year of life (86.7%) and was born to young mothers (91.3%). The accidental discovery of a murmur was the most frequent presentation (35%). Heart failure was detected in 44%, audible murmurs in 74.4%, maternal illnesses in 54%, consanguinity in 44.6%, prematurity in 19.3%, assisted reproduction in 11.7%, family history of CHD in 9.2%, abortions in 7.1%, and extracardiac anomalies in 3.6% of the studied population. Down syndrome (DS) was the most commonly occurring chromosomal anomaly, and the atrioventricular septal defect was the most characteristic cardiac lesion found among them.
CONCLUSIONS
There is no sex predilection among Egyptian children with CHD. Most of the cases are diagnosed in early infancy. Accidental discovery of a murmur is the most common mode of presentation. A variety of predisposing risk factors are abundant in the Egyptian population. DS is the most common chromosomal anomaly linked to CHD. Establishment of a national medical birth registry containing all information about all births in Egypt is needed for adequate surveillance and monitoring of perinatal health problems and congenital birth defects so that preventive measures can be early implemented. Proper and detailed data collection should be fulfilled in the medical records of every single patient.
PubMed: 33512632
DOI: 10.1186/s43044-021-00133-0 -
Annals of Medicine and Surgery (2012) Oct 2023Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the...
INTRODUCTION
Although clinical guidelines suggest echocardiography before surgery in patients with hip fracture, no prospective studies exist in the literature. The aim of the present investigation was to assess whether preoperative echocardiography affects time to surgery, length of hospital stay (LOS), and in hospital mortality in high-risk patients who need surgery for a hip fracture.
MATERIAL AND METHODS
In the study entered 255 consecutive patients with hip fracture referred to a multidisciplinary hip fracture unit. Seven hundred seventeen patients referred before the implementation of routine echocardiographic examination were considered as control group. Echocardiography was performed in patients with systolic murmurs, unstable clinical conditions, recent decompensation of heart failure or hospital admission for coronary disease. Time to surgery, LOS, and in hospital mortality in patients who underwent preoperative echocardiography (high-risk group) were compared with patients who did not undergo echo (low-risk group) and with the control group.
RESULTS
122/255 patients underwent echocardiography. The two groups did not differ for age, sex, type or fracture, and notably time to surgery and LOS. Coronary heart disease, atrial fibrillation, and two or more comorbidities were more frequent in the echo group. Overall clinical characteristics were not different from group of patients referred before the implementation of the echocardiographic protocol but in these last patients time to surgery and LOS were significantly longer. As well in hospital mortality was not significantly different in the two groups (1.9 in echo vs. 1.7% in nonecho) but lower than in the control group (4.1% ).
CONCLUSIONS
An echocardiographic guide may be useful in a high-risk group with a hip fracture to choose the proper anesthetic setting, referral for intensive care observation after surgery and, optimal medical treatment, including fluid management without delay in time to surgery.
PubMed: 37811064
DOI: 10.1097/MS9.0000000000001151