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Nogimori Y, Sato K, Takamizawa K, Ogawa Y, Tanaka Y, Shiraga K, Masuda H, Matsui H, Kato M, Daimon M, Fujiu K, Inuzuka R. Prediction of adverse cardiovascular events in children using artificial intelligence-based electrocardiogram. Int J Cardiol 2024:132019. [PMID: 38579941 DOI: 10.1016/j.ijcard.2024.132019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Convolutional neural networks (CNNs) have emerged as a novel method for evaluating heart failure (HF) in adult electrocardiograms (ECGs). However, such CNNs are not applicable to pediatric HF, where abnormal anatomy of congenital heart defects plays an important role. ECG-based CNNs reflecting neurohormonal activation (NHA) may be a useful marker of pediatric HF. This study aimed to develop and validate an ECG-derived marker of pediatric HF that reflects the risk of future cardiovascular events. METHODS Based on 21,378 ECGs from 8324 children, a CNN was trained using B-type natriuretic peptide (BNP) and the occurrence of major adverse cardiovascular events (MACEs). The output of the model, or the electrical heart failure indicator (EHFI), was compared with the BNP regarding its ability to predict MACEs in 813 ECGs from 295 children. RESULTS EHFI achieved a better area under the curve than BNP in predicting MACEs within 180 days (0.826 versus 0.691, p = 0.03). On Cox univariable analyses, both EHFI and BNP were significantly associated with MACE (log10 EHFI: hazard ratio [HR] = 16.5, p < 0.005 and log10 BNP: HR = 4.4, p < 0.005). The time-dependent average precisions of EHFI in predicting MACEs were 32.4%-67.9% and 1.6-7.5-fold higher than those of BNP in the early period. Additionally, the MACE rate increased monotonically with EHFI, whereas the rate peaked at approximately 100 pg/mL of BNP and decreased in the higher range. CONCLUSIONS ECG-derived CNN is a novel marker of HF with different prognostic potential from BNP. CNN-based ECG analysis may provide a new guide for assessing pediatric HF.
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Affiliation(s)
| | - Kaname Sato
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | | | - Yosuke Ogawa
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | - Yu Tanaka
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | - Kazuhiro Shiraga
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | - Hitomi Masuda
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | - Hikoro Matsui
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Japan
| | - Masao Daimon
- Department of Clinical Laboratory, The University of Tokyo Hospital, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital, Japan.
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Nogimori Y, Seo H, Ueda H. A three-dimensional computer graphics tool for congenital heart diseases. Pediatr Int 2020; 62:738-740. [PMID: 32472612 DOI: 10.1111/ped.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 12/15/2019] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshitsugu Nogimori
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Hirofumi Seo
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.,SCIEMENT, Inc., Tokyo, Japan
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
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Miura K, Harita Y, Takahashi N, Tsurumi H, Yasudo H, Isojima T, Hirata Y, Inuzuka R, Takizawa K, Toyofuku E, Nishimoto H, Takamizawa M, Ando T, Sugawa M, Yanagisawa A, Inatomi J, Nogimori Y, Kinumaki A, Namai Y, Hattori M, Oka A. Nonosmotic secretion of arginine vasopressin and salt loss in hyponatremia in Kawasaki disease. Pediatr Int 2020; 62:363-370. [PMID: 31657491 DOI: 10.1111/ped.14036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/30/2019] [Accepted: 09/25/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The precise mechanism of hyponatremia in Kawasaki disease (KD) remains elusive because assessment of volume status based on serial changes in body weight is lacking in previous reports. METHODS Seventeen patients who were diagnosed with KD and hyponatremia (serum sodium levels <135 mmol/L) were analyzed. Volume status was assessed based on serial changes in body weight. Plasma arginine vasopressin (ADH), urine electrolytes, and serum cytokine levels were measured on diagnosis of hyponatremia. An increase in body weight by >3% was defined as hypervolemia and a decrease in body weight by >3% was defined as hypovolemia. RESULTS The volume status was hypervolemic in three patients (18%), euvolemic in 14 (82%), and hypovolemic in none (0%). Five (29%) patients were diagnosed with "syndrome of inappropriate secretion of antidiuretic hormone" (SIADH) and no patients were diagnosed with hypotonic dehydration. The contribution of decreased total exchangeable cations (salt loss) to hyponatremia (5.9% [interquartile range, 4.3%, 6.7%]) was significantly larger than that of increased total body water (-0.7% [-1.8%, 3.1%]) (P = 0.004). Serum interleukin-6 levels were elevated in all of the nine patients who were evaluated. Among the 12 (71%) patients who did not meet the criteria of SIADH and hypotonic dehydration, plasma ADH levels were inappropriately high in ten patients. These patients were also characterized by euvolemic or hypervolemic hyponatremia and salt loss, which might be compatible with a diagnosis of SIADH. CONCLUSIONS Our study shows that hyponatremia in KD is euvolemic or hypervolemic and is associated with nonosmotic secretion of ADH and salt loss in the majority of patients.
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Affiliation(s)
- Kenichiro Miura
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan.,Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yutaka Harita
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Haruko Tsurumi
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Hiroki Yasudo
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | | | - Yoichiro Hirata
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Keiichi Takizawa
- Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan
| | - Etsushi Toyofuku
- Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan
| | - Hajime Nishimoto
- Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan
| | - Masaru Takamizawa
- Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan
| | - Taro Ando
- Department of Pediatrics, Yaizu City Hospital, Yaizu, Shizuoka, Japan
| | - Masahiro Sugawa
- Department of Pediatrics, Yaizu City Hospital, Yaizu, Shizuoka, Japan
| | | | - Jun Inatomi
- Department of Pediatrics, Yaizu City Hospital, Yaizu, Shizuoka, Japan
| | | | - Akiko Kinumaki
- Department of Pediatrics, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Yoshiyuki Namai
- Department of Pediatrics, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akira Oka
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
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Takano T, Akagi M, Takaki H, Inuzuka R, Nogimori Y, Ono H, Kaneko M, Hagiwara N. Sex differences in congenital heart disease in Down syndrome: study data from medical records and questionnaires in a region of Japan. BMJ Paediatr Open 2019; 3:e000414. [PMID: 31321317 PMCID: PMC6598551 DOI: 10.1136/bmjpo-2018-000414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/01/2019] [Indexed: 11/09/2022] Open
Abstract
Reports indicate lower Down syndrome (DS) survival among females than among males in Australia, contrasting with female longevity in the general population. Using data on 1310 people with DS (626 females and 684 males) in Japan from five hospitals' medical records and questionnaires completed by parents of people with DS, we investigated sex differences in congenital heart disease (CHD), which may be related to mortality. The CHD rate was significantly higher for females (354, 57%) than for males (338, 49%; p=0.010). Significantly more females (199, 32%) than males (175, 26%) underwent surgery for CHD (p=0.018).
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Affiliation(s)
- Takako Takano
- Department of Child Health, Tokyo Kasei University, Itabashi-ku, Japan
| | - Michio Akagi
- Department of Medical Education, Kyorin University, Mitaka, Japan
| | - Haruyoshi Takaki
- Department of Nursing, Tokyo Healthcare University, Meguro-ku, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, University of Tokyo, Bunkyo-ku, Japan
| | - Yoshitsugu Nogimori
- Department of Cardiovascular Medicine, Kanagawa Childrens Medical Center, Yokohama, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Masahide Kaneko
- Department of Pediatrics, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Japan
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