Abstract
BackgroundNew sensors for intelligent remote monitoring of the heart should be developed. Recently, a cutaneous force-frequency relation recording system has been validated based on heart sound amplitude and timing variations at increasing heart rates.AimTo assess sensor-based post-exercise contractility, diastolic function and pressure in normal and diseased hearts as a model of a wireless telemedicine system.MethodsWe enrolled 150 patients and 22 controls referred for exercise-stress echocardiography, age 55 ± 18 years. The sensor was attached in the precordial region by an ECG electrode. Stress and recovery contractility were derived by first heart sound amplitude vibration changes; diastolic times were acquired continuously. Systemic pressure changes were quantitatively documented by second heart sound recording.ResultsInterpretable sensor recordings were obtained in all patients (feasibility = 100%). Post-exercise contractility overshoot (defined as increase > 10% of recovery contractility vs exercise value) was more frequent in patients than controls (27% vs 8%, p < 0.05). At 100 bpm stress heart rate, systolic/diastolic time ratio (normal, < 1) was > 1 in 20 patients and in none of the controls (p < 0.01); at recovery systolic/diastolic ratio was > 1 in only 3 patients (p < 0.01 vs stress). Post-exercise reduced arterial pressure was sensed.ConclusionPost-exercise contractility, diastolic time and pressure changes can be continuously measured by a cutaneous sensor. Heart disease affects not only exercise systolic performance, but also post-exercise recovery, diastolic time intervals and blood pressure changes – in our study, all of these were monitored by a non-invasive wearable sensor.
Highlights
Telemonitoring heart failure patients is a very promising way of managing several complex and costly healthcare issues [1]
Heart rate dropped rapidly at recovery, but at each recovery step contractility was higher than exercise values in 42 subjects with echo and in 40 with sensor (Chi-square p < 0.01)
Since systemic pressure changes are measured by protocol and derivable by the sensor (S2 vibrations amplitude), comparisons were made (Fig. 4, lower panels); 41 (80%) of the subjects had post-exercise hypotension, and 36 (69%) second heart sound undershoot (Chi square p < 0.01)
Summary
Telemonitoring heart failure patients is a very promising way of managing several complex and costly healthcare issues [1]. Recent European Society of Cardiology (ESC) guidelines on heart failure do recommend developing management programs for recently hospitalized patients with HF [2]. Noninvasive new sensors for intelligent remote cardiac monitoring should be developed and integrated with other standard physiological sensor and biomarkers. A new cutaneous force-frequency relation recording system has recently been validated in the stress echo lab, based on heart sound amplitude and timing variations at increasing heart rates. New sensors for intelligent remote monitoring of the heart should be developed. A cutaneous force-frequency relation recording system has been validated based on heart sound amplitude and timing variations at increasing heart rates
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