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Ogawa S, Namino F, Mori T, Sato G, Yamakawa T, Saito S. AI diagnosis of heart sounds differentiated with super StethoScope. J Cardiol 2024; 83:265-271. [PMID: 37734656 DOI: 10.1016/j.jjcc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
In the aging global society, heart failure and valvular heart diseases, including aortic stenosis, are affecting millions of people and healthcare systems worldwide. Although the number of effective treatment options has increased in recent years, the lack of effective screening methods is provoking continued high mortality and rehospitalization rates. Appropriately, auscultation has been the primary option for screening such patients, however, challenges arise due to the variability in auscultation skills, the objectivity of the clinical method, and the presence of sounds inaudible to the human ear. To address challenges associated with the current approach towards auscultation, the hardware of Super StethoScope was developed. This paper is composed of (1) a background literature review of bioacoustic research regarding heart disease detection, (2) an introduction of our approach to heart sound research and development of Super StethoScope, (3) a discussion of the application of remote auscultation to telemedicine, and (4) results of a market needs survey on traditional and remote auscultation. Heart sounds and murmurs, if collected properly, have been shown to closely represent heart disease characteristics. Correspondingly, the main characteristics of Super StethoScope include: (1) simultaneous collection of electrocardiographic and heart sound for the detection of heart rate variability, (2) optimized signal-to-noise ratio in the audible frequency bands, and (3) acquisition of heart sounds including the inaudible frequency ranges. Due to the ability to visualize the data, the device is able to provide quantitative results without disturbance by sound quality alterations during remote auscultations. An online survey of 3648 doctors confirmed that auscultation is the common examination method used in today's clinical practice and revealed that artificial intelligence-based heart sound analysis systems are expected to be integrated into clinicians' practices. Super StethoScope would open new horizons for heart sound research and telemedicine.
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Huang J, Zhang W, Fu W, Le J, Qi Y, Hou X, Pan X, Li R, He B. Noninvasive evaluation of pulmonary hypertension using the second heart sound parameters collected by a mobile cardiac acoustic monitoring system. Front Cardiovasc Med 2023; 10:1292647. [PMID: 38193021 PMCID: PMC10773866 DOI: 10.3389/fcvm.2023.1292647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Background Pulmonary hypertension (PH) is linked to higher rates of morbidity and mortality worldwide. Early diagnosis of PH is important for clinical treatment. The estimated pulmonary artery systolic pressure (ePASP ≥ 35 mmHg) measured by echocardiography helps screen PH patients. In this paper, we report a novel PH screening method through a mobile cardiac acoustic monitoring system. Methods In the retrospective study, patients admitted to our hospital between January 2022 and April 2023 were classified into PH and control groups using ePASP and compared with acoustic cardiographic parameters. According to ePASP, PH severity was classified as mild, moderate, and severe. We analyzed the first and second heart sound (S1, S2) characteristics, including amplitude (S1A, S2A), energy (S1E, S2E), and frequency (S1F, S2F). Results The study included 209 subjects, divided into PH (n = 121) and control (n = 88) groups. Pearson correlation analysis confirmed the positive correlation between S2F and ePASP. The diagnostic performance of S2F as assessed by the area under the ROC curve was 0.775 for PH. The sensitivity and specificity of diagnosing ePASP ≥ 35 mmHg when S2F ≥ 36 Hz were found to be 79.34% and 67.05%, respectively, according to ROC analysis. Severity classification was performed using S2F, the area under the ROC curve was 0.712-0.838 for mild PH, 0.774-0.888 for moderate PH, and 0.826-0.940 for severe PH. Conclusions S2F collected by the mobile cardiac acoustic monitoring system offers a convenient method for remote PH screening, potentially improving PH management and outcomes.
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Affiliation(s)
- Jingjuan Huang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxia Fu
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiawei Le
- Department of Cardiac Function, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiding Qi
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xumin Hou
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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Mi J, Zhao Z, Wang H, Tang H. Study of the Relationship between Pulmonary Artery Pressure and Heart Valve Vibration Sound Based on Mock Loop. Bioengineering (Basel) 2023; 10:985. [PMID: 37627870 PMCID: PMC10451642 DOI: 10.3390/bioengineering10080985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The vibration of the heart valves' closure is an important component of the heart sound and contains important information about the mechanical activity of a heart. Stenosis of the distal pulmonary artery can lead to pulmonary hypertension (PH). Therefore, in this paper, the relationship between the vibration sound of heart valves and the pulmonary artery blood pressure was investigated to contribute to the noninvasive detection of PH. In this paper, a lumped parameter circuit platform of pulmonary circulation was first set to guide the establishment of a mock loop of circulation. By adjusting the distal vascular resistance of the pulmonary artery, six different pulmonary arterial pressure states were achieved. In the experiment, pulmonary artery blood pressure, right ventricular blood pressure, and the vibration sound of the pulmonary valve and tricuspid valve were measured synchronously. Features of the time domain and frequency domain of two valves' vibration sound were extracted. By conducting a significance analysis of the inter-group features, it was found that the amplitude, energy and frequency features of vibration sounds changed significantly. Finally, the continuously varied pulmonary arterial blood pressure and valves' vibration sound were obtained by continuously adjusting the resistance of the distal pulmonary artery. A backward propagation neural network and deep learning model were used, respectively, to estimate the features of pulmonary arterial blood pressure, pulmonary artery systolic blood pressure, the maximum rising rate of pulmonary artery blood pressure and the maximum falling rate of pulmonary artery blood pressure by the vibration sound of the pulmonary and tricuspid valves. The results showed that the pulmonary artery pressure parameters can be well estimated by valve vibration sounds.
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Affiliation(s)
- Jiachen Mi
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China; (J.M.); (Z.Z.); (H.W.)
- INTESIM (Dalian) Co., Ltd., Dalian 116024, China
| | - Zehang Zhao
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China; (J.M.); (Z.Z.); (H.W.)
| | - Hongkai Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China; (J.M.); (Z.Z.); (H.W.)
| | - Hong Tang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China; (J.M.); (Z.Z.); (H.W.)
- Liaoning Key Lab of Integrated Circuit and Biomedical Electronic System, Dalian University of Technology, Dalian 116024, China
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4
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Ge B, Yang H, Ma P, Guo T, Pan J, Wang W. Detection of pulmonary hypertension associated with congenital heart disease based on time-frequency domain and deep learning features. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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5
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Ge B, Yang H, Ma P, Guo T, Pan J, Wang W. Detection of pulmonary arterial hypertension associated with congenital heart disease based on time–frequency domain and deep learning features. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Relationship between Cardiac Acoustic Biomarkers and Pulmonary Artery Pressure in Patients with Heart Failure. J Clin Med 2022; 11:jcm11216373. [DOI: 10.3390/jcm11216373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Since an elevation of pulmonary artery pressure (PAP) often precedes clinical worsening of heart failure (HF), early and non-invasive detection of this sign is useful in HF care. This study aimed to assess whether cardiac acoustic biomarkers (CABs) are associated with the elevation of PAP in patients with HF. Patients with HF scheduled to undergo right heart catheterization were prospectively enrolled. CABs were concurrently recorded during catheterization at rest (baseline) and while applying a handgrip (exercise). Forty-nine patients were included in the analysis, and their mean PAP significantly increased after exercise compared to baseline. Several CABs correlated significantly with mean PAP by absolute values, among which S2 Width (r = 0.354; p = 0.014 and r = 0.363; p = 0.010) and S3 Strength (r = 0.375; p = 0.009 and r = 0.386; p = 0.007) were consistent throughout baseline and exercise. The response of CABs to exercise-induced PAP elevation was divided into two patterns: increasing and decreasing. The frequency of cardiac index below 2.2 mL/m2 was significantly higher in the decreasing pattern. CABs related to S2 and S3 showed significant correlations with absolute PAP values both at baseline and after exercise in patients with HF, but no significant correlations between their changes from baseline to post-exercise were observed in this study population. Further research is therefore needed to assess whether CABs can sensitively reflect changes in PAP according to HF status and underlying phenotypes.
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Wang M, Hu Y, Guo B, Tang H. Simulation of Acute Pulmonary Hypertension in Beagle Dogs. Int Heart J 2022; 63:612-622. [PMID: 35650161 DOI: 10.1536/ihj.21-676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acoustic cardiography (AC) combined with heart sound (HS) recording and electrocardiogram (ECG) provides a noninvasive and inexpensive way to understand the electrical mechanical activity of the heart. Pulmonary artery stenosis can cause hemodynamic abnormalities that might lead to pulmonary hypertension (PH). In this paper, we examined the relationships between the acoustic characteristics of the AC and hemodynamic changes in a beagle dog model of PH.Four healthy beagle dogs were injected with the prostaglandin endoperoxide receptor agonist U-44069 to induce acute PH states. AC was employed to analyze the process of pre-PH, intra-PH, and post-PH. Right ventricular blood pressure (RVBP) was measured via right cardiac catheterization, an invasive method performed in parallel for comparative hemodynamic evaluation. As RVBP increased or decreased, the HS features changed accordingly during acute PH occurrence and development. Right ventricular systolic blood pressure (RVSBP) significantly correlated with the minimum of the first HS (S1) amplitude (correlation coefficient (CC) = -0.82), energy of the S1 (CC = 0.86), energy of the second HS (S2) (CC = 0.67), entropy of the S1 (CC = -0.94), and ratio of electromechanical systolic time (EMST) to the cardiac cycle time (CC = 0.81). The two techniques (AC [HSs and ECG] versus right cardiac catheterization [RVBP]) were significantly correlated. Especially, the diastolic filling time (DFT) had a significant relationship with the right ventricular diastolic time (RVDT) (CC = 0.97), perfusion time (PT) (CC = 0.96), and cardiac cycle time (RR) (CC = 0.96). The CCs between the RVDT and the max dp/dt to min dp/dt, the EMST and the Q to min dp/dt, and the electromechanical activation time and the Q to max dp/dt were 0.95, 0.99, and 0.86, respectively. Furthermore, the logistic regression model with different combinations was used to identify the effective features for monitoring hemodynamic and pathophysiologic conditions.AC provided significant insight into mechanical dysfunction in a rapid and noninvasive way that could be used for early screening of PH.
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Affiliation(s)
- Miao Wang
- School of Biomedical Engineering, Dalian University of Technology
| | - YaTing Hu
- School of Biomedical Engineering, Dalian University of Technology
| | - BinBin Guo
- School of Biomedical Engineering, Dalian University of Technology
| | - Hong Tang
- School of Biomedical Engineering, Dalian University of Technology
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Cardiac acoustic biomarkers as surrogate markers to diagnose the phenotypes of pulmonary hypertension: an exploratory study. Heart Vessels 2021; 37:593-600. [PMID: 34599380 PMCID: PMC8917031 DOI: 10.1007/s00380-021-01943-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
Pulmonary hypertension (PH) is commonly associated with left heart disease. In this retrospective study, using the database of a clinical study conducted between January 2008 and July 2008, the phenotypes of PH were classified using non-invasive cardiac acoustic biomarkers (CABs) and compared with classification by echocardiography. Records with same-day measurement of acoustic cardiography and right heart catheterization (RHC) parameters were included; cases with congenital heart disease were excluded. Using the RHC measurements, PH was classified as pre-capillary PH (Prec-PH), isolated post-capillary PH (Ipc-PH), and combined pre-capillary and post-capillary PH (Cpc-PH). The first, second, third, and fourth heart sounds (S1, S2, S3, and S4) were quantified as CABs (intensity, complexity, and strength). Forty subjects were selected: 5 had Prec-PH, 5 had Ipc-PH, 8 had Cpc-PH, and 22 had No-PH. CABs were significantly correlated with RHC measurements, with significant differences among phenotypes. Phenotype classification was performed using various CABs, and the diagnostic performance as assessed by the area under the receiver operating characteristic curve was 0.674–0.720 for Prec-PH, 0.657–0.807 for Ipc-PH, and 0.742 for Cpc-PH. High negative and low positive predictive values for phenotype identification were observed. CABs may provide an ambulatory measurement method with home-monitoring friendliness which is more convenient than standard examinations to identify presence of PH and its phenotypes.
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Luciani M, Saccocci M, Kuwata S, Cesarovic N, Lipiski M, Arand P, Bauer P, Guidotti A, Regar E, Erne P, Zuber M, Maisano F. Reintroducing Heart Sounds for Early Detection of Acute Myocardial Ischemia in a Porcine Model - Correlation of Acoustic Cardiography With Gold Standard of Pressure-Volume Analysis. Front Physiol 2019; 10:1090. [PMID: 31507452 PMCID: PMC6713932 DOI: 10.3389/fphys.2019.01090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background Acoustic cardiography is a hybrid technique that couples heart sounds recording with ECG providing insights into electrical-mechanical activity of the heart in an unsupervised, non-invasive and inexpensive manner. During myocardial ischemia hemodynamic abnormalities appear in the first minutes and we hypothesize a putative diagnostic role of acoustic cardiography for prompt detection of cardiac dysfunction for future patient management improvement. Methods and Results Ten female Swiss large white pigs underwent permanent distal coronary occlusion as a model of acute myocardial ischemia. Acoustic cardiography analyses were performed prior, during and after coronary occlusion. Pressure-volume analysis was conducted in parallel as an invasive method of hemodynamic assessment for comparison. Similar systolic and diastolic intervals obtained with the two techniques were significantly correlated [Q to min dP/dt vs. Q to second heart sound (r2 = 0.9583, p < 0.0001), PV diastolic filling time vs. AC perfusion time (r2 = 0.9686, p < 0.0001)]. Indexes of systolic and diastolic impairment correlated with quantifiable features of heart sounds [Tau vs. fourth heart sound Display Value (r2 = 0.2721, p < 0.0001) cardiac output vs. third heart sound Display Value (r2 = 0.0791 p = 0.0023)]. Additionally, acoustic cardiography diastolic time (AUC 0.675, p = 0.008), perfusion time (AUC 0.649, p = 0.024) and third heart sound Display Value (AUC 0.654, p = 0.019) emerged as possible indicators of coronary occlusion. Finally, these three parameters, when joined with heart rate into a composite joint-index, represent the best model in our experience for ischemia detection (AUC 0.770, p < 0.001). Conclusion In the rapidly evolving setting of acute myocardial ischemia, acoustic cardiography provided meaningful insights of mechanical dysfunction in a prompt and non-invasive manner. These findings should propel interest in resurrecting this technique for future translational studies as well as reconsidering its reintroduction in the clinical setting.
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Affiliation(s)
- Marco Luciani
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Saccocci
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Shingo Kuwata
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Miriam Lipiski
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | | | - Peter Bauer
- VisCardia, Inc., Portland, OR, United States
| | - Andrea Guidotti
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Evelyn Regar
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Erne
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Michel Zuber
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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10
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Elgendi M, Bobhate P, Jain S, Guo L, Rutledge J, Coe Y, Zemp R, Schuurmans D, Adatia I. The Voice of the Heart: Vowel-Like Sound in Pulmonary Artery Hypertension. Diseases 2018; 6:E26. [PMID: 29652794 PMCID: PMC6023489 DOI: 10.3390/diseases6020026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022] Open
Abstract
Increased blood pressure in the pulmonary artery is referred to as pulmonary hypertension and often is linked to loud pulmonic valve closures. For the purpose of this paper, it was hypothesized that pulmonary circulation vibrations will create sounds similar to sounds created by vocal cords during speech and that subjects with pulmonary artery hypertension (PAH) could have unique sound signatures across four auscultatory sites. Using a digital stethoscope, heart sounds were recorded at the cardiac apex, 2nd left intercostal space (2LICS), 2nd right intercostal space (2RICS), and 4th left intercostal space (4LICS) undergoing simultaneous cardiac catheterization. From the collected heart sounds, relative power of the frequency band, energy of the sinusoid formants, and entropy were extracted. PAH subjects were differentiated by applying the linear discriminant analysis with leave-one-out cross-validation. The entropy of the first sinusoid formant decreased significantly in subjects with a mean pulmonary artery pressure (mPAp) ≥ 25 mmHg versus subjects with a mPAp < 25 mmHg with a sensitivity of 84% and specificity of 88.57%, within a 10-s optimized window length for heart sounds recorded at the 2LICS. First sinusoid formant entropy reduction of heart sounds in PAH subjects suggests the existence of a vowel-like pattern. Pattern analysis revealed a unique sound signature, which could be used in non-invasive screening tools.
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Affiliation(s)
- Mohamed Elgendi
- Department of Obstetrics & Gynecology, University of British Columbia and BC Children's & Women's Hospital, Vancouver, BC V6H 3N1, Canada.
- School of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Prashant Bobhate
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Shreepal Jain
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Long Guo
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Jennifer Rutledge
- Division of Cardiology at Alberta Children's Hospital, Calgary, AB T3B 6A8, Canada.
| | - Yashu Coe
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
- Mazankowski Alberta Heart Institute, Edmonton, AB T6G 2B7, Canada.
| | - Roger Zemp
- School of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 2V2, Canada.
| | - Dale Schuurmans
- Department of Computing Science, University of Alberta, Edmonton, AB T6G 2E8, Canada.
| | - Ian Adatia
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2B7, Canada.
- Mazankowski Alberta Heart Institute, Edmonton, AB T6G 2B7, Canada.
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11
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Lin CY, Chang SL, Lin YJ, Lo LW, Hu YF, Chao TF, Chung FP, Tuan TC, Liao JN, Chang YT, Te ALD, Yamada S, Cheng HM, Sung SH, Kuo L, Li HY, Chang TY, Minh HQ, Salim S, Huang TC, Chen SA. Predicting the Origin of Ventricular Arrhythmia Using Acoustic Cardiography. Sci Rep 2017; 7:15490. [PMID: 29138409 PMCID: PMC5686143 DOI: 10.1038/s41598-017-15573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/30/2017] [Indexed: 11/10/2022] Open
Abstract
This study aimed to examine the relationship between measurements related to heart sounds and the origin of ventricular arrhythmia. We retrospectively evaluated 45 patients undergoing catheter ablation with contemporaneous digital acoustic cardiography of the first heart sound (S1) and the second heart sound (S2). The patients with baseline wide QRS morphology (>120 ms or aberrant conduction), heart failure, valvular heart disease, chronic pulmonary disease, and obesity were excluded. Ventricular arrhythmias from the left ventricle had an increased S1 complexity score and S1 duration in comparison to adjacent sinus beats. On the other hand, ventricular arrhythmia from right ventricle had decreased S1 complexity score and S1 duration in comparison to adjacent sinus beats. The difference of S1 (ΔS1) parameters between premature ventricular complex and sinus beat was significantly smaller in right ventricular arrhythmia group compared with and left ventricular arrhythmia group. For predicting the origin of ventricular arrhythmia, the ΔS1 duration provide better predictive accuracy (sensitivity: 100%, specificity: 100%, cutoff value: −1.28 ms) in comparison to ΔS1 complexity score (sensitivity 71.4%, specificity 75.0%, cutoff value: −0.13). The change of S1 complexity and duration determined from acoustic cardiography could accurately predict the ventricular arrhythmia origin.
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Affiliation(s)
- Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Abigail Louise D Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ling Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hsing-Yuan Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hoang Quang Minh
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Simon Salim
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Institude of Clinical Medicine, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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12
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Elgendi M, Bobhate P, Jain S, Guo L, Kumar S, Rutledge J, Coe Y, Zemp R, Schuurmans D, Adatia I. The unique heart sound signature of children with pulmonary artery hypertension. Pulm Circ 2015; 5:631-9. [PMID: 26697170 DOI: 10.1086/683694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
We hypothesized that vibrations created by the pulmonary circulation would create sound like the vocal cords during speech and that subjects with pulmonary artery hypertension (PAH) might have a unique sound signature. We recorded heart sounds at the cardiac apex and the second left intercostal space (2LICS), using a digital stethoscope, from 27 subjects (12 males) with a median age of 7 years (range: 3 months-19 years) undergoing simultaneous cardiac catheterization. Thirteen subjects had mean pulmonary artery pressure (mPAp) < 25 mmHg (range: 8-24 mmHg). Fourteen subjects had mPAp ≥ 25 mmHg (range: 25-97 mmHg). We extracted the relative power of the frequency band, the entropy, and the energy of the sinusoid formants from the heart sounds. We applied linear discriminant analysis with leave-one-out cross validation to differentiate children with and without PAH. The significance of the results was determined with a t test and a rank-sum test. The entropy of the first sinusoid formant contained within an optimized window length of 2 seconds of the heart sounds recorded at the 2LICS was significantly lower in subjects with mPAp ≥ 25 mmHg relative to subjects with mPAp < 25 mmHg, with a sensitivity of 93% and specificity of 92%. The reduced entropy of the first sinusoid formant of the heart sounds in children with PAH suggests the existence of an organized pattern. The analysis of this pattern revealed a unique sound signature, which could be applied to a noninvasive method to diagnose PAH.
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Affiliation(s)
- Mohamed Elgendi
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada ; Current address: Electrical and Computer Engineering in Medicine Group, University of British Columbia, and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Prashant Bobhate
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Shreepal Jain
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Long Guo
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Shine Kumar
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Rutledge
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Yashu Coe
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Roger Zemp
- School of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Dale Schuurmans
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Adatia
- Department of Pediatrics and Pediatric Pulmonary Hypertension Service, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
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Elgendi M, Bobhate P, Jain S, Rutledge J, Coe JY, Zemp R, Schuurmans D, Adatia I. Time-domain analysis of heart sound intensity in children with and without pulmonary artery hypertension: a pilot study using a digital stethoscope. Pulm Circ 2015; 4:685-95. [PMID: 25610604 DOI: 10.1086/678513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/13/2014] [Indexed: 01/30/2023] Open
Abstract
We studied digital stethoscope recordings in children undergoing simultaneous catheterization of the pulmonary artery (PA) to determine whether time-domain analysis of heart sound intensity would aid in the diagnosis of PA hypertension (PAH). Heart sounds were recorded and stored in .wav mono audio format. We performed recordings for 20 seconds with sampling frequencies of 4,000 Hz at the second left intercostal space and the cardiac apex. We used programs written in the MATLAB 2010b environment to analyze signals. We annotated events representing the first (S1) and second (S2) heart sounds and the aortic (A2) and pulmonary (P2) components of S2. We calculated the intensity (I) of the extracted event area (x) as [Formula: see text], where n is the total number of heart sound samples in the extracted event and k is A2, P2, S1, or S2. We defined PAH as mean PA pressure (mPAp) of at least 25 mmHg with PA wedge pressure of less than 15 mmHg. We studied 22 subjects (median age: 6 years [range: 0.25-19 years], 13 female), 11 with PAH (median mPAp: 55 mmHg [range: 25-97 mmHg]) and 11 without PAH (median mPAp: 15 mmHg [range: 8-24 mmHg]). The P2∶A2 (P = .0001) and P2∶S2 (P = .0001) intensity ratios were significantly different between subjects with and those without PAH. There was a linear correlation (r > 0.7) between the P2∶S2 and P2∶A2 intensity ratios and mPAp. We found that the P2∶A2 and P2∶S2 intensity ratios discriminated between children with and those without PAH. These findings may be useful for developing an acoustic device to diagnose PAH.
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Affiliation(s)
- Mohamed Elgendi
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Prashant Bobhate
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Shreepal Jain
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Rutledge
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - James Y Coe
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Roger Zemp
- School of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Dale Schuurmans
- Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Adatia
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada ; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
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14
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Colman R, Whittingham H, Tomlinson G, Granton J. Utility of the physical examination in detecting pulmonary hypertension. A mixed methods study. PLoS One 2014; 9:e108499. [PMID: 25343585 PMCID: PMC4208756 DOI: 10.1371/journal.pone.0108499] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/25/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients with pulmonary hypertension (PH) often present with a variety of physical findings reflecting a volume or pressure overloaded right ventricle (RV). However, there is no consensus regarding the diagnostic utility of the physical examination in PH. METHODS We conducted a systematic review of publications that evaluated the clinical examination and diagnosis of PH using MEDLINE (1946-2013) and EMBASE (1947-2013). We also prospectively evaluated the diagnostic utility of the physical examination findings. Patients who underwent right cardiac catheterization for any reason were recruited. After informed consent, participants were examined by 6 physicians (3 "specialists" and 3 "generalists") who were unaware of the results of the patient's hemodynamics. Each examiner independently assessed patients for the presence of a RV lift, loud P2, jugular venous distension (JVD), tricuspid insufficiency murmur and right-sided 4th heart sound at rest and during a slow inspiration. A global rating (scale of 1-5) of the likelihood that the patient had pulmonary hypertension was provided by each examiner. RESULTS 31 articles that assessed the physical examination in PH were included in the final analysis. There was heterogeneity amongst the studies and many did not include control data. The sign most associated with PH in the literature was a loud pulmonic component of the second heart sound (P2). In our prospective study physical examination was performed on 52 subjects (25 met criteria for PH; mPAP ≥ 25 mmHg). The physical sign with the highest likelihood ratio (LR) was a loud P2 on inspiration with a LR +ve 1.9, 95% CrI [1.2, 3.1] when data from all examiners was analyzed together. Results from the specialist examiners had higher diagnostic utility; a loud P2 on inspiration was associated with a positive LR of 3.2, 95% CrI [1.5, 6.2] and a right sided S4 on inspiration had a LR +ve 4.7, 95% CI [1.0, 15.6]. No aspect of the physical exam, could consistently rule out PH (negative LRs 0.7-1.3). CONCLUSIONS The presence of a loud P2 or audible right-sided 4th heart sound are associated with PH. However the physical examination is unreliable for determining the presence of PH.
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Affiliation(s)
- Rebecca Colman
- Pulmonary hypertension program, Toronto General Hospital, Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Whittingham
- Department of Critical Care Medicine, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, Mount Sinai Hospital and University Health Network, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Granton
- Pulmonary hypertension program, Toronto General Hospital, Division of Respirology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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