-
IEEE Journal of Biomedical and Health... Sep 2023Cardiac auscultation, exhibited by phonocardiogram (PCG), is a non-invasive and low-cost diagnostic method for cardiovascular diseases (CVDs). However, deploying it in...
Cardiac auscultation, exhibited by phonocardiogram (PCG), is a non-invasive and low-cost diagnostic method for cardiovascular diseases (CVDs). However, deploying it in practice is quite challenging, due to the inherent murmurs and a limited number of supervised samples in heart sound data. To solve these problems, not only heart sound analysis based on handcrafted features, but also computer-aided heart sound analysis based on deep learning have been extensively studied in recent years. Though with elaborate design, most of these methods still use additional pre-processing to improve classification performance, which heavily relies on time-consuming experienced engineering. In this article, we propose a parameter-efficient densely connected dual attention network (DDA) for heart sound classification. It combines two advantages simultaneously of the purely end-to-end architecture and enriched contextual representations of the self-attention mechanism. Specifically, the densely connected structure can automatically extract the information flow of heart sound features hierarchically. Alongside, improving contextual modeling capabilities, the dual attention mechanism adaptively aggregates local features with global dependencies via a self-attention mechanism, which captures the semantic interdependencies across position and channel axes respectively. Extensive experiments across stratified 10-fold cross-validation strongly evidence that our proposed DDA model surpasses current 1D deep models on the challenging Cinc2016 benchmark with significant computational efficiency.
Topics: Humans; Heart Murmurs; Heart Sounds; Heart Auscultation; Cardiovascular Diseases
PubMed: 37318972
DOI: 10.1109/JBHI.2023.3286585 -
Pediatric Cardiology Dec 2023Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. Interstage telecardiology visits (TCV) have...
Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. Interstage telecardiology visits (TCV) have been effective in identifying clinical concerns and preventing unnecessary emergency department visits in this high-risk population. We aimed to assess the feasibility of implementing auscultation with digital stethoscopes (DSs) during TCV and the potential impact on interstage care in our Infant Single Ventricle Monitoring & Management Program. In addition to standard home-monitoring practice for TCV, caregivers received training on use of a DS (Eko CORE attachment assembled with Classic II Infant Littman stethoscope). Sound quality of the DS and comparability to in-person auscultation were evaluated based on two providers' subjective assessment. We also evaluated provider and caregiver acceptability of the DS. From 7/2021 to 6/2022, the DS was used during 52 TCVs in 16 patients (median TCVs/patient: 3; range: 1-8), including 7 with hypoplastic left heart syndrome. Quality of heart sounds and murmur auscultation were subjectively equivalent to in-person findings with excellent inter-rater agreement (98%). All providers and caregivers reported ease of use and confidence in evaluation with the DS. In 12% (6/52) of TCVs, the DS provided additional significant information compared to a routine TCV; this expedited life-saving care in two patients. There were no missed events or deaths. Use of a DS during TCV was feasible in this fragile cohort and effective in identifying clinical concerns with no missed events. Longer term use of this technology will further establish its role in telecardiology.
Topics: Infant; Humans; Stethoscopes; Feasibility Studies; Heart Defects, Congenital; Hypoplastic Left Heart Syndrome; Heart Murmurs
PubMed: 37285041
DOI: 10.1007/s00246-023-03198-7 -
The Journal of Tehran Heart Center Jul 2022Keutel syndrome (KS) as a scarce autosomal recessive disorder is characterized by hearing loss, multiple peripheral pulmonary stenoses, abnormal cartilage calcification,...
Keutel syndrome (KS) as a scarce autosomal recessive disorder is characterized by hearing loss, multiple peripheral pulmonary stenoses, abnormal cartilage calcification, and morphological defects including midface hypoplasia and brachytelephalangism. We herein describe a 5-year-old boy who was referred for the evaluation of incidentally auscultated heart murmurs. He had no obvious abnormalities at birth but suffered from recurrent episodes of infectious otitis media during infancy. Physical examination revealed facial abnormalities, such as a broad nasal bridge, a sloping forehead, maxillary hypoplasia, and brachytelephalangism. Chest radiography showed tracheobronchial tree calcification. Transthoracic echocardiography illustrated peripheral pulmonary artery stenosis, moderate tricuspid regurgitation, and pulmonary hypertension. Computed tomography angiography confirmed calcification and segmental stenosis in the peripheral pulmonary arteries. The patient was diagnosed with KS. Most of these patients have a good prognosis. During the follow-up of these patients and examinations, we should pay attention to their symptoms related to upper respiratory tract infections, the extent of hearing, and the possibility of tracheal and pulmonary artery stenosis development. KS is a disease with a good prognosis, and a careful initial examination of babies, including facial appearance and heart auscultation, may lead to the early diagnosis of this disease.
PubMed: 37252084
DOI: 10.18502/jthc.v17i3.10849 -
IEEE Journal of Biomedical and Health... Aug 2023Murmurs are abnormal heart sounds, identified by experts through cardiac auscultation. The murmur grade, a quantitative measure of the murmur intensity, is strongly...
OBJECTIVE
Murmurs are abnormal heart sounds, identified by experts through cardiac auscultation. The murmur grade, a quantitative measure of the murmur intensity, is strongly correlated with the patient's clinical condition. This work aims to estimate each patient's murmur grade (i.e., absent, soft, loud) from multiple auscultation location phonocardiograms (PCGs) of a large population of pediatric patients from a low-resource rural area.
METHODS
The Mel spectrogram representation of each PCG recording is given to an ensemble of 15 convolutional residual neural networks with channel-wise attention mechanisms to classify each PCG recording. The final murmur grade for each patient is derived based on the proposed decision rule and considering all estimated labels for available recordings. The proposed method is cross-validated on a dataset consisting of 3456 PCG recordings from 1007 patients using a stratified ten-fold cross-validation. Additionally, the method was tested on a hidden test set comprised of 1538 PCG recordings from 442 patients.
RESULTS
The overall cross-validation performances for patient-level murmur gradings are 86.3% and 81.6% in terms of the unweighted average of sensitivities and F1-scores, respectively. The sensitivities (and F1-scores) for absent, soft, and loud murmurs are 90.7% (93.6%), 75.8% (66.8%), and 92.3% (84.2%), respectively. On the test set, the algorithm achieves an unweighted average of sensitivities of 80.4% and an F1-score of 75.8%.
CONCLUSIONS
This study provides a potential approach for algorithmic pre-screening in low-resource settings with relatively high expert screening costs.
SIGNIFICANCE
The proposed method represents a significant step beyond detection of murmurs, providing characterization of intensity, which may provide an enhanced classification of clinical outcomes.
Topics: Humans; Child; Phonocardiography; Heart Murmurs; Heart Auscultation; Algorithms; Auscultation; Heart Sounds
PubMed: 37163396
DOI: 10.1109/JBHI.2023.3275039 -
BMC Infectious Diseases May 2023As a member of the HACEK group, Aggregatibacter segnis (A. segnis) is a fastidious Gram-negative coccobacillus that resides in the human oropharyngeal flora. Infective...
BACKGROUND
As a member of the HACEK group, Aggregatibacter segnis (A. segnis) is a fastidious Gram-negative coccobacillus that resides in the human oropharyngeal flora. Infective endocarditis caused by A. segnis is rarely reported.
CASE PRESENTATION
A 31-year-old male was admitted to our hospital for a 3-month history of intermittent high fever, chills, and chest distress. On presentation, he was febrile and tachycardic but otherwise with stable vital signs. Physical examination revealed systolic murmurs in the aortic and mitral valve areas. Pitting edema was evident in the lower extremities. Transthoracic echocardiography demonstrated multiple vegetations in the mitral and aortic valves. Severe regurgitation of the aortic valve and left heart dysfunction were also detected. With the suspicion of infective endocarditis and heart failure, we immediately performed microbiological tests and arranged the cardiac replacement surgery. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and metagenomic next-generation sequencing (mNGS) identified A. segnis from the bloodstream. While the surgical specimen culture was negative, the mNGS was positive for A. segnis. The patient was treated with ceftriaxone for four weeks and discharged. He remained clinically well, with laboratory results restored.
CONCLUSION
This is the first report of A. segnis infective endocarditis that combined MALDI-TOF and metagenomic next-generation sequencing in the diagnosis. The hypothesis-independent molecular techniques can outperform conventional tools to prevent diagnostic delay.
Topics: Male; Humans; Adult; Aggregatibacter segnis; Delayed Diagnosis; Endocarditis; Endocarditis, Bacterial; Heart Failure; Fever
PubMed: 37158846
DOI: 10.1186/s12879-023-08231-x -
Veterinary Journal (London, England :... May 2023This study assessed a new smartphone-based digital stethoscope (DS) featuring simultaneous phonocardiographic and one-lead electrocardiogram (ECG) recording in dogs and...
This study assessed a new smartphone-based digital stethoscope (DS) featuring simultaneous phonocardiographic and one-lead electrocardiogram (ECG) recording in dogs and cats. The audio files and ECG traces obtained by the device were compared with conventional auscultation and standard ECG. A total of 99 dogs and nine cats were prospectively included. All cases underwent conventional auscultation using an acoustic stethoscope, standard six-lead ECG, standard echocardiography and recordings with the DS. All the audio recordings, phonocardiographic files and ECG traces were then blind reviewed by an expert operator. The agreement between methods was assessed using Cohen's kappa and the Bland-Altman test. Audio recordings were considered interpretable in 90% animals. Substantial agreement was found in the diagnosis of heart murmur (κ = 0.691) and gallop sound (k = 0.740). In nine animals with an echocardiographic diagnosis of heart disease, only the DS detected a heart murmur or gallop sound. ECG traces recorded with the new device were deemed interpretable in 88 % animals. Diagnosis of heart rhythm showed moderate agreement in the identification of atrial fibrillation (k = 0.596). The detection of ventricular premature complexes and bundle branch blocks revealed an almost perfect agreement (k = 1). Overall, the DS showed a good diagnostic accuracy in detecting heart murmurs, gallop sounds, ventricular premature complexes and bundle branch blocks. A clinically relevant overdiagnosis of atrial fibrillation was found but without evidence of false negatives. The DS could represent a useful screening tool for heart sound abnormalities and cardiac arrhythmias..
Topics: Cats; Dogs; Animals; Phonocardiography; Atrial Fibrillation; Stethoscopes; Ventricular Premature Complexes; Smartphone; Bundle-Branch Block; Cat Diseases; Dog Diseases; Heart Murmurs; Electrocardiography
PubMed: 37141934
DOI: 10.1016/j.tvjl.2023.105987 -
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 -
Echocardiography (Mount Kisco, N.Y.) Aug 2023There are relatively few studies investigating cardiac structural and functional abnormalities associated with systemic lupus erythematous (SLE). The long-term prognosis... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
There are relatively few studies investigating cardiac structural and functional abnormalities associated with systemic lupus erythematous (SLE). The long-term prognosis of SLE patients is closely related to the cardiovascular events caused by SLE. Accordingly, it is necessary to assess early myocardial systolic function and synchrony.
METHODS
Overall, 90 patients with SLE were randomly selected from our outpatient and inpatient clinics and divided according to SLE Disease Activity Index (SLE-DAI-2000) scores: group A, stable (scores 0-4); group B, mildly active stage (scores 5-9); and group C, moderately active stage (scores ≥10). Each group included 30 patients. Further, 30 sex- and age-matched healthy individuals who were referred for check-ups at the same period were selected as controls (group D). The minimum age for entry into the group was 17 years old. Autostrain LV and three-dimensional quantitative analysis (3DQA) were applied to obtain left ventricular systolic function parameters, information on strain parameters, and correlations between parameters. Simultaneity parameters measured by Autostrain LV and 3DQA were tested for reproducibility.
RESULTS
A two-by-two comparison of groups A-C showed that as the disease activity score increased, AP4LS%, AP2LS%, AP3LS%, and the LV mean overall longitudinal strain all gradually decreased, while LV longitudinal strain peak time standard deviation (Tls-SD) gradually increased, with all differences being statistically significant (p < .05). In groups A-C compared with controls, Tmsv-17-SD, Tmsv-17-Dif, Tmsv-17-SD%, and Tmsv-17-Dif% were all significantly prolonged (p < .05). Further, Tls-SD was positively correlated with Tmsv-17-SD and Tmsv-17-Dif, and there was good agreement between Autostrain and 3DQA for the measurement of left ventricular synchrony indexes, with Tmsv-17-Dif having the best repeatability (intraobserver interclass correlation coefficient (ICC) = .979; interobserver ICC = .848, p < .01).
CONCLUSION
Autostrain LV can accurately detect changes in left ventricular myocardial strain in patients with SLE early in the disease, with simple operation. The 3DQA technique can quantitatively evaluate left ventricular systolic synchronization in patients with SLE, and Autostrain LV synchronization index measurements correlate significantly with 3DQA. Both methods are reproducible, but 3DQA is more sensitive to left ventricular synchronous motion changes.
Topics: Humans; Adolescent; Ventricular Dysfunction, Left; Reproducibility of Results; Ventricular Function, Left; Heart; Lupus Erythematosus, Systemic; Heart Murmurs
PubMed: 37126423
DOI: 10.1111/echo.15562 -
Journal of Veterinary Cardiology : the... Apr 2023Systolic murmurs in the absence of cardiac structural abnormalities are common in cats. Narrow aorto-septal angle (AoSA) and septal remodeling can be a cause of a...
INTRODUCTION/OBJECTIVES
Systolic murmurs in the absence of cardiac structural abnormalities are common in cats. Narrow aorto-septal angle (AoSA) and septal remodeling can be a cause of a systolic murmur in elderly human beings. The aim of this study was to measure the AoSA in cats and to investigate the association between the AoSA and the presence of a murmur and isolated basal septal hypertrophy (IBSH).
ANIMALS
The study population comprised 122 cats.
MATERIALS AND METHODS
A physical exam, blood pressure measurement, chest radiographs, and echocardiography were performed.
RESULTS
A systolic murmur was audible in 39/122 cats. A difference between cats with and without a murmur was found for age (P=0.0001), interventricular basal septal thickness (BIVSd) (P=0.004), AoSA (P=0.003), aortic (P<0.0001), and pulmonic (P=0.021) flow velocity, the presence of IBSH (P<0.0001), and systolic anterior motion of the mitral valve (P=0.0002). More than 50% of cats with a murmur had an AoSA ≤122°. Less than 25% of the cats with an AoSA ≥137° had a murmur. The AoSA narrowed 0.55°/year of age (P<0.001), whereas the BIVSd increased 0.11 mm/year of age (P<0.0001); the BIVSd increased as the AoSA narrowed. In all cats with AoSA < 120°, IBSH was present.
CONCLUSIONS
This study demonstrates that the probability of having a systolic murmur in cats is increased by the presence of a narrow AoSA. Aging was associated with a narrower AoSA and a thicker basal septum; these findings might represent an age-related heart remodeling.
Topics: Humans; Cats; Animals; Systolic Murmurs; Echocardiography; Heart Murmurs; Ventricular Septum; Hypertrophy; Cat Diseases
PubMed: 37037177
DOI: 10.1016/j.jvc.2023.03.002