Detection Of Cardiac Abnormalities Research Articles

Routine pre-employment echocardiography assessment in young adults: cost and benefits

BackgroundConventional echocardiography is a safe, available, and accurate tool for cardiac structural and functional evaluation, but it should not cancel clinical assessment and history tacking, and indeed both are complementary. A pre-employment assessment is important for employees and community safety and suitability for a specific work requirement.ResultsAiming to assess the value of routine pre-employment echocardiography for the detection of cardiac abnormalities, we examined seven hundred ninety-five persons who were routinely referred to us for pre-employment conventional echocardiography. Only 9 persons had structural cardiac abnormalities (1.3%) and distributed as follows: two had bicuspid aortic valve with isolated aortic regurgitation, one of them had mild AR, and the other had moderate AR. Two cases had mitral valve prolapse, one of them had trivial MR, while the other had a flail anterior leaflet with severe MR. One patient had atrial septal defect 1.5 cm with mild pulmonary hypertension and right-sided chambers dilatation. One patient had dextrocardia (situs inversus totalis) without other cardiac problems. One had moderate pulmonary hypertension and modest right-sided chambers dilation. Two patients had left ventricular hypertrophy. Surprisingly, we did not detect rheumatic valvular heart disease. The money cost of echocardiography tests for those 795 persons was 198,750 Egyptian pounds (LE); their transportation cost was about 19.800LE. The total group time cost of the tests was 265 h, total time lost at the waiting room was 1590 h, total transportation time lose was 2385 h, so the total time cost was about 4000 h. Using psychological stress questionnaire, 33 participants (4.2%) had results suggestive of a low sense of psychological pressure due to echocardiography examination, 221 participants (27.8%) had results suggestive of a moderate feeling of stress, while 541 participants (68%) had results suggestive of a high sense of stress.ConclusionWe recommend against routine echocardiography for cardiac assessment in pre-employment assessment and to do it only for persons with abnormal clinical or ECG findings.

Detection of Cardiac Structural Abnormalities in Fetal Ultrasound Videos Using Deep Learning

Artificial Intelligence (AI) technologies have recently been applied to medical imaging for diagnostic support. With respect to fetal ultrasound screening of congenital heart disease (CHD), it is still challenging to achieve consistently accurate diagnoses owing to its manual operation and the technical differences among examiners. Hence, we proposed an architecture of Supervised Object detection with Normal data Only (SONO), based on a convolutional neural network (CNN), to detect cardiac substructures and structural abnormalities in fetal ultrasound videos. We used a barcode-like timeline to visualize the probability of detection and calculated an abnormality score of each video. Performance evaluations of detecting cardiac structural abnormalities utilized videos of sequential cross-sections around a four-chamber view (Heart) and three-vessel trachea view (Vessels). The mean value of abnormality scores in CHD cases was significantly higher than normal cases (p < 0.001). The areas under the receiver operating characteristic curve in Heart and Vessels produced by SONO were 0.787 and 0.891, respectively, higher than the other conventional algorithms. SONO achieves an automatic detection of each cardiac substructure in fetal ultrasound videos, and shows an applicability to detect cardiac structural abnormalities. The barcode-like timeline is informative for examiners to capture the clinical characteristic of each case, and it is also expected to acquire one of the important features in the field of medical AI: the development of “explainable AI.”

Speeding up an Adaptive Filter based ECG Signal Pre-processing on Embedded Architectures

Medical applications increasingly require complex calculations with constraints of accelerated processing time. These applications are therefore oriented towards the integration of high-performance embedded architectures. In this context, the detection of cardiac abnormalities is a task that remains a high priority in emergency medicine. ECG analysis is a complex task that requires significant computing time since a large amount of information must be analyzed in parallel with high frequencies. Real-time processing is the biggest challenge for researchers, when talking about applications that require time constraints like that of cardiac activity monitoring. This work evaluates the Adaptive Dual Threshold Filter (ADTF) algorithm dedicated to ECG signal filtering using various embedded architectures: A Raspberry 3B+ and Odroid XU4. The implementation has been based on C/C++ and OpenMP to exploit the parallelism in the used architectures. The evaluation was validated using several ECG signals proposed in MIT-BIH Arrhythmia database with a sampling frequency of 360 Hz. Based on an algorithmic complexity study and a parallelization of the functional blocks which present significant workloads, the evaluation results show a mean execution time of 7.5 ms on the Raspberry 3B+ and 0.34 ms on the Odroid XU4. With an efficient parallelization on the Odroid XU4 architecture, real-time performance can be achieved.

Cardiac functions in children with steroid-sensitive nephrotic syndrome.

The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid-sensitive nephrotic syndrome (NS). The study population consisted of 19 patients with debut-relapse of NS aged 1-18years and 30 sex and age-matched healthy controls. Blood and urine samples, two M-mode conventional echocardiograms and tissue Doppler velocity imaging were evaluated in both attack and remission periods. With regard to conventional pulse wave Doppler (cPWD), steroid-sensitive NS patients (both in debut / relapse and in remission periods) had a higher peak of late diastolic flow velocities (A peak), and patients in debut / relapse had a lower E/A ratio than the control group, indicating diastolic dysfunction (overall P = 0.003 and P = 0.006, respectively). Based on tissue Doppler velocity imaging echocardiography results, patients in debut/relapse had a higher A' and a lower E'/A' ratio (overall P < 0.001 and P = 0.001, respectively). There was also a significant difference in the cPWD E/TDI E' ratio between the patients showing an increased cPWD E/TDI E' ratio in remission periods compared to in debut/relapse periods (P = 0.09). The albumin levels were positively correlated with E'/A' and E/ E' ratio (r = 0.609; P = 0.007, r = 0.472; P = 0.041 respectively). Systolic cardiac functions are preserved but diastolic functions are affected in steroid-sensitive NS patients both in debut/relapse and in remission periods in a relatively short time. The persistence of left ventricular (LV) dysfunction during the remission period requires special attention during the follow up for early detection of cardiac abnormalities.

Fetal Echocardiography as a Screening Method for Detection of Congenital Heart Disease

Background: Congenital heart diseases (CHDs) are among the most common congenital abnormalities. They are frequently missed on routine obstetric ultrasound (US) examination. Although fetal echocardiography is reserved only for high-risk cases, many cases with cardiac abnormalities are born to mothers with no identifiable risk factors. Aim of work: is to assess fetal echocardiography as a screening method for prenatal detection of cardiac abnormalities in an un-selected group of pregnant females. Patients and Methods: During the period of March 2108 to March 2019, 150 fetuses for 149 un-selected pregnant female (there was a set of twin pregnancy) underwent a detailed fetal echocardiographic examination; cases that had maternal, fetal or familial risk factors for CHD were categorized as high risk, others with no known risk factors were low risk. Results: Structural heart defects were found in 6 (4%) fetuses in both high and low risk groups. The prevalence of prenatally detected cardiac abnormalities was 3.5% in the low-risk group and 5.5 % % in the high-risk group. The difference in the incidence of CHD between the two groups was not statistically significant (P=0.4). Conclusion: Our study shows no difference in the incidence of CHDs between pregnancies associated with high risk factors compared to those with no risk factors, so we advocate fetal echocardiography to be included in any fetal anomaly scanning for every pregnant woman regardless the presence of risk factors

Feature Extraction and Classification of ECG Signal Based on The Standard Extended Wavelet Transform Technique: Cardiology Based Telemedicine

For early detection of cardiac abnormalities, an ECGs cardiac signal is relied upon due to it includes a lot of information that can be utilized for heart disease classification. The ECG signal is too sensitive to various types of noise since it is low frequency and has a small amplitude, these noises decrease the diagnostic accuracy and may outcome in a wrong decision by the clinician. Therefore, rejecting the ECG signal is a necessary condition for successful diagnosis of heart attacks. In this manuscript, the standard extended of Discrete Wavelet Transformc called Dual-Tree Complex Wavelet Transform (Dual-Tree (CWT)) method is utilized to denoise the noisy ECG signal and extract the key features followed by the implementation of the peak detection algorithm. The quality is measured based on performance metrics, and an increase in Signal to Noise Ratio ( SNR) is achieved utilizing the technique. The heart rate (HR) calculation is in line with the gold standard of the various benchmark databases utilized for the proposed procedure and precise heart failure has been calculated.

Non-invasive detection of exercise-induced cardiac conduction abnormalities in sudden cardiac death survivors in the inherited cardiac conditions.

Rate adaptation of the action potential ensures spatial heterogeneities in conduction across the myocardium are minimized at different heart rates providing a protective mechanism against ventricular fibrillation (VF) and sudden cardiac death (SCD), which can be quantified by the ventricular conduction stability (V-CoS) test previously described. We tested the hypothesis that patients with a history of aborted SCD due to an underlying channelopathy or cardiomyopathy have a reduced capacity to maintain uniform activation following exercise. Sixty individuals, with (n = 28) and without (n = 32) previous aborted-SCD event underwent electro-cardiographic imaging recordings following exercise treadmill test. These included 25 Brugada syndrome, 13 hypertrophic cardiomyopathy, 12 idiopathic VF, and 10 healthy controls. Data were inputted into the V-CoS programme to calculate a V-CoS score that indicate the percentage of ventricle that showed no significant change in ventricular activation, with a lower score indicating the development of greater conduction heterogeneity. The SCD group, compared to those without, had a lower median (interquartile range) V-CoS score at peak exertion [92.8% (89.8-96.3%) vs. 97.3% (94.9-99.1%); P < 0.01] and 2 min into recovery [95.2% (91.1-97.2%) vs. 98.9% (96.9-99.5%); P < 0.01]. No significant difference was observable later into recovery at 5 or 10 min. Using the lowest median V-CoS scores obtained during the entire recovery period post-exertion, SCD survivors had a significantly lower score than those without for each of the different underlying aetiologies. Data from this pilot study demonstrate the potential use of this technique in risk stratification for the inherited cardiac conditions.

Superiority of cardiac magnetic resonance imaging over echocardiography in early detection of subclinical cardiac abnormalities in systemic lupus erythematosus patients

BackgroundCardiovascular disease (CVD) has become increasingly recognized as a cause of mortality, especially in patients with long-standing systemic lupus erythematosus (SLE). Aim of the workTo detect subclinical cardiac involvement and its relation to clinical characteristics, disease activity and damage. Patients and methodsTransthoracic echocardiography (TTE) was performed in 36 SLE patients. Cardiac magnetic resonance (CMR) sections were obtained. T1-weighted inversion recovery scout images were obtained after injection of gadolinium. ResultsThirty-six patients were included with a mean age of 32.4 ± 8.5 years; 35 females and 1 male; with disease duration of 7.9 ± 5 years. The frequent cardiac presentations on TTE were tricuspid regurgitation (TR) (41.6%), mitral regurgitation (MR) (36.1%), mitral thickening (25%), early diastolic mitral flow/mitral flow during atrial contraction (E/A) < 1 (19.4%). The most frequent cardiac presentations by CMR were MR (25%), pericarditis (25%), mitral thickening (13.9%), TR (13.9%), myocarditis (8.3). Neither SLE Disease Activity Index (SLEDAI) nor Systemic Lupus International Collaborating Clinics (SLICC) damage index, high- sensitivity-C reactive protein (hsCRP), C3 and C4 levels were significantly correlated with the ejection fraction (EF) by CMR. There was significant negative correlation between disease duration and EF by CMR (r = −0.36, p = 0.03). Using multiple regression, EF by CMR was strongly predicted by disease duration (p = 0.025). The analysis of EF and MR fraction by CMR and TTE showed acceptable moderate agreement. CMR and TTE showed 83.3% agreement in the detection of pericarditis. ConclusionCMR is superior to echocardiography in detection of subclinical abnormalities in SLE.

Possible new options and benefits to detect myocarditis, right ventricular remodeling and coronary anomalies by echocardiography in systematic preparticipation screening of athletes

Exclusion of cardiac abnormalities should be performed at the beginning of the athlete’s career. Myocarditis, right ventricular remodeling and coronary anomalies are well-known causes of life-threatening events of athletes, major cardiovascular events and sudden cardiac death. The feasibility of an extended comprehensive echocardiographic protocol for the detection of structural cardiac abnormalities in athletes should be tested. This standardized protocol of transthoracic echocardiography includes two- and three-dimensional imaging, tissue Doppler imaging, and coronary artery scanning. Post processing was performed for deformation analysis of all compounds including layer strain. During 2017 and 2018, the feasibility of successful image acquisition and post processing analysis was retrospectively analyzed in 54 male elite athletes. In addition, noticeable findings inside the analyzed cohort are described. The extended image acquisition and data analyzing was feasible from 74 to 100%, depending on the used modalities. One case of myocarditis was detected in the present cohort. Coronary anomalies were not found. Right ventricular size and function were within normal ranges. Isovolumetric right ventricular relaxation time showed significant regional differences. One case of hypertrophic cardiomyopathy and two subjects with bicuspid aortic valves were found. Due to the excessive cardiac stress in highly competitive sports, high-quality and precise screening modalities are necessary, especially with respect to acquired cardiac diseases like acute myocarditis and pathological changes of left ventricular and RV geometry. The documented feasibility of the proposed extended protocol underlines the suitability to detect distinct morphological and functional cardiac alterations and documents the potential added value of a comprehensive echocardiography.

Left ventricular myocardial deformation: a study on diastolic function in the Chinese male population and its relationship with fat distribution.

Obesity has become an epidemic in China with its increased prevalence, especially in the male population. Disparities in fat distribution rather than increasing body mass index (BMI) confer the risk of different diseases, including cardiac abnormalities. Therefore, early detection of cardiac abnormalities is important for treatment to reverse the progression to heart failure. Nowadays, strain analysis based on cardiac magnetic resonance (CMR) imaging has been established to assess myocardial function in diverse cardiac diseases. We aimed to assess the relationship between fat distribution and subclinical diastolic dysfunction in obese Chinese men assessed by deformation registration algorithm (DRA)-based myocardial strain rate (SR) analysis. A total of 115 male participants with different BMI underwent CMR scanning using a 1.5T MAGNETOM Aera (Siemens Healthcare, Erlangen, Germany) and computed tomography (CT) scan. All the participants were enrolled from September 2017 to April 2018. They were classified into 3 groups according to their BMIs with 23 and 27.5 kg/m2 being the cutoff values. A Trufi-Strain prototype software (version 2.0, Siemens Healthcare, Erlangen, Germany) was used to quantify SR in both early and late diastole from CMR cine images. Ratios of early and late SRs were calculated. Areas of epicardial and pericardial adipose tissue (EAT and PAT) were measured on a single 4-chamber-view slice of cine images. Volumes of visceral and subcutaneous adipose tissue (VAT and SAT) were acquired semi-automatically from CT images using the dedicated software Cardiac Risk2.0 (Siemens Healthcare). Waist and hip circumferences were manually measured (WC and HC). Analysis of variance or nonparametric tests, along with correlation and stepwise multivariate regression analysis models, was applied for statistical analysis. Peak late diastolic SRs were higher in obese men compared with their lean counterparts [-36.25±10.46 vs. -29.46±8.17, 66.97±18.58 vs. 45.62 (42.44, 55.96), and 56.81±15.07 vs. 41.40±6.41 for radial, circumferential, and longitudinal SRs, respectively; P<0.05]. All SR ratios in the obese subgroups were lower than those of lean men (3.12±1.14 vs. 4.63±1.24, 2.12±0.58 vs. 2.96±0.62 and 1.63±0.50 vs. 2.20±0.63 for radial, circumferential, and longitudinal directions, respectively; P<0.05). EAT was a significant predictor of diastolic function assessed by radial and circumferential SR ratios (β=-0.439 and -0.337 respectively; all P<0.001), while VAT was a significant predictor of circumferential and longitudinal SR ratios (β=-0.216 and -0.355, respectively, P<0.05). Decreased LV diastolic function assessed by DRA-based SR analysis in obesity is associated with fat distribution. Furthermore, EAT and VAT might be better predictors of a decrease of diastolic function in obese Chinese men than BMI.

Cardiac axis evaluation as a screening method for detecting cardiac abnormalities in the first trimester of pregnancy.

Congenital cardiac abnormalities refer to especially anatomic malformations of the heart that normally occur during fetal heart development, before eight weeks after conception. Aim: The aim is to investigate the association between cardiac axis and congenital heart abnormalities for a potential underline clinical application of cardiac axis evaluation during detection by abnormalities at the time of first trimester ultrasound. It is known that aneuploids can be associated in almost half of cases with cardiac abnormalities, so the angle of the cardiac axis could be a potential indirect marker for the detection of aneuploids in the first trimester of pregnancy. Being easy to obtain, from the cross-section at the chest level with the visualization of the four chambers, does not require additional sections to those provided in the current guides, we aim to prove its usefulness in diagnosing aneuploids and congenital cardiac abnormalities along with the translucent nuchal flow, at the level of the venous duct and the presence of tricuspid regurgitation. Conclusions: Cardiac axis has a higher value for the detection of congenital cardiac abnormalities with respect to the nuchal translucency, tricuspid regurgitation and inverted A wave at the level of the venous duct.

Subclinical Left Ventricular Dysfunction in Severe Obesity and Reverse Cardiac Remodeling after Bariatric Surgery.

Aim:Obesity is associated with an increased cardiovascular risk. This study aimed to assess the role of echocardiography in the early detection of subclinical cardiac abnormalities in a cohort of obese patients with a preserved ejection fraction (EF) undergoing bariatric surgery.Methods and Results:Forty consecutive severely obese patients (body mass index≥35 kg/m2) referring to our center for bariatric surgery were enrolled in this prospective cohort study. Despite a baseline EF of 61% ± 3%, almost half patients (43%) had a systolic dysfunction (SD) defined as global longitudinal strain (GLS)>−18%, and most of them (60%) had left ventricular hypertrophy (LVH) or concentric remodeling (CR). At 10-months after surgery, body weight decreased from 120 ± 15 kg to 83 ± 12 kg, body mass index from 44 ± 5 kg/m2 to 31 ± 5 kg/m2 (both P < 0.001). Septal and left ventricular posterior wall thickness decreased respectively from 10 ± 1 mm to 9 ± 1 mm (P = 0.004) and from 10 ± 1 mm to 9 ± 1 mm (P = 0.007). All systolic parameters improved: EF from 61% ± 3% to 64% ± 3% (P = 0.002) and GLS from −17% ± 2% to −20% ± 1% (P < 0.001). Epicardial fat thickness reduction (from 4.7 ± 1 mm to 3.5 ± 0.7 mm, P < 0.001) correlated with the reduction of left atrial area (P < 0.001 R = 0.35) and volume (P = 0.02 R = 0.25). Following bariatric surgery, we observed a reduced prevalence of LVH/CR (before 60%, after 22%, P = 0.001) and a complete resolution of preclinical SD (before 43%, after 0%, P < 0.001). Moreover, a postoperative reduction of at least 30 kg correlated with regression of septal hypertrophy (P < 0.001).Conclusions:Obese patients candidate to bariatric surgery have an high prevalence of preclinical SD and LVH/CR, early detectable with echocardiography. Bariatric surgery is associated with reverse cardiac remodeling; it might also have a preventive effect on atrial fibrillation occurrence by reducing its substrate.

Improvements in Accurate Detection of Cardiac Abnormalities and Prognostic Health Diagnosis Using Artificial Intelligence in Medical Systems

This paper presents an approach of apt prognostic diagnostics of cardiac health by using Artificial Intelligence (AI) in safety-related based non-invasive bio-medical systems. This approach addresses the existing challenge in identification of the actual abnormality of the vital cardiac signal from the various interrupting factors like bio-signal faulted due to high noise signal interference, electronic and software fault, mechanical fault like sensor contacts failures, wear and tear of equipment. Presently, most of the medical systems use a 1oo1(one-out-of-one) system architectures, and there exists a safety procedure to raise a particular defined type of standard alarm for a specific failure to detect an abnormality. These existing approaches may incur high maintenance costs and subject to random failures with long downtimes of the system and where it affects operational safety to a certain extent. However, there is a scope to improve in the segregation of the actual fault-free signal and extract the abnormality of the vital feature for prognostic diagnostics. With advancements in systems engineering and usage of safety-related design architectures in medical systems, we used an Artificial Intelligence (AI) based approach in performing the data analytics on the selected correct vital signal for prognostic analysis. As a case study, we evaluated by configuring the system with the 2oo2 fault-tolerant safety-related design architecture and implemented the diagnostic function using the AI-based method on the apt logged data during system operation. The results show a substantial improvement in the accuracy of the cardiac health findings.

Left ventricular functions in patients with beta-thalassemia major: a speckle tracking imaging study

Objectives To assess left ventricular (LV) functions in patients with beta-thalassemia major (β-TM) on regular blood transfusion (without cardiac manifestations) by speckle tracking echocardiography and correlate the findings with serum ferritin levels of these patients. Background Patients with β-TM have extravasal hemolysis and ineffective erythropoiesis, resulting in severe anemia. Thus, they require regular blood transfusions, which results in iron overload. Patients with thalassemia absorb more iron than normal individuals. Iron overload results in iron deposition in a variety of parenchymal tissues including the heart leading to ventricular systolic and diastolic dysfunctions. Iron-mediated cardiomyopathy is the main cause of death in patients with thalassemia. Early detection of cardiac abnormalities is important as aggressive chelation therapy may improve prognosis in these patients. Patients and methods A total of 50 patients with β-TM on regular blood transfusion for more than or equal to 4 years and 25 sex-matched and age-matched controls were included. The laboratory parameters measured were blood hemoglobin and ferritin, which were measured 2 h before doing echocardiography with Doppler imaging and speckle tracking analysis. Results There were no significant differences in LV ejection fraction and fractional shortening between the groups by conventional echocardiography. However, by using speckle tracking echocardiography, systolic strain and strain rate of the LV walls were significantly lower in patients with thalassemia. Conclusion Patients with thalassemia have regional systolic dysfunction in the LV walls, even if they do not have overt heart failure. Strain imaging is more helpful than conventional echocardiography in early detection of LV systolic dysfunction in patients with thalassemia.

Systematic echo-doppler screening identifies subtle structural and functional cardiac abnormalities in type 2 diabetes mellitus without documented cardio vascular disease: DIACAR a prospective study

Type 2 diabetes mellitus (DM2) is associated with a high prevalence of cardio vascular (CV) disorders including heart failure. The prevalence of asymptomatic cardiac dysfunction in DM2 remains poorly documented in patients without a history of cardio vascular disease. The purpose of DIACAR is to characterize cardiac function by doppler-echocardiography in a population of DM2 without documented CV disease. One hundred and sixteen consecutive outpatients (63 males, 53 females) with DM2 were evaluated prospectively in a single center: 2D (Simpson biplane) & 3D (Heart Model Philips) left ventricular (LV) ejection fraction (EF), LV and left atrial (LA) volumes, 2D global longitudinal strain, diastolic function and LV mass index were measured. All patients with a documented history of CV disease or presenting with symptoms suggestive of any cardiac disorder were excluded. Patients were 57.8 ± 10.9 years old and had a history of DM2 of 12.7 ± 8.7 years. Fifty-two patients (45%) were treated with insulin. Body mass index was 29 ± 4.9 kg/m 2 . Mean values of the echo Doppler parameters were in the normal range ( Table 1 ). 2D Simpson EF and E/e’ were normal in all except one and two patients respectively. However, LV mass index was increased in 8/63 men and 10/53 women and LA volume index was increased in 14/116 patients whereas 2D Simpson LV volumes were all in the normal range. Finally, 2D global longitudinal strain was reduced in 44/105 patients. In a selected population of DM2 without documented CV disease, cardiac function assessed by EF and E/e’ was in the normal range in nearly all patients. By contrast, subtle abnormalities of LV and LA morphology as well as 2D global longitudinal strain were found in a significant proportion of these asymptomatic patients. These results suggest that a systematic screening of DM2 patients by doppler- echocardiography with 2D global longitudinal strain is useful for the early detection of cardiac abnormalities.

P2437Screening for cardiac relaxation abnormalities using surface ECG wavelets for identifying high-risk cardiac phenotypic abnormalities

Abstract Background The impairment of myocardial relaxation is a strong predictor of all-cause mortality and has been proposed to be a potential tool for cardiovascular (CV) risk stratification. We investigated a novel signal-processed electrocardiography (spECG) technique to extract the features of abnormal myocardial relaxation as a screening tool to identify high-risk CV patients. Methods Time–frequency-energy features extracted from continuous wavelet-transformed spECG (Fig. A) were obtained in 1,006 cases. A machine learning model was trained for predicting abnormal myocardial relaxation as a screening tool for detecting high-risk CV patients. High-risk CV phenotype was defined as presence of LV hypertrophy, advanced LV diastolic dysfunction (grade 2 or 3), LV ejection fraction &lt;50%, and/or significant valvular heart disease. Results After training with 5-fold cross validation using data from 810 patients, the machine learning model when tested in an independent hold-out validation set of 180 cases, showed an area under receiver-operating characteristic curve (AUC) of 0.83 (p&lt;0.001) for prediction of myocardial relaxation impairment (Fig. B). A prediction of abnormal relaxation was associated with older patients (64±11 vs. 45±16 years old, p&lt;0.001) with a higher prevalence of coronary artery disease (23% vs. 7%, p=0.004), hypertension (70% vs. 40%, p&lt;0.001), and diabetes (30% vs. 9%, p=0.001). Furthermore, a prediction of abnormal myocardial relaxation was associated with increased likelihood of high-risk CV phenotypes (Odds ratio: 3.93, p&lt;0.001) including LV hypertrophy (Odds ratio: 2.62, p=0.028), advanced LV diastolic dysfunction (Odds ratio: 11.4, p=0.020), and LV ejection fraction &lt;50% (Odds ratio 10.5, p=0.025). Age and gender modified the prediction of abnormal relaxation with higher diagnostic value seen for patients under 60 years (Fig C, AUC: 0.88, p&lt;0.001) and in male patients (Fig D, AUC: 0.87, p&lt;0.001). The algorithm for abnormal relaxation also showed robust prediction of LV ejection fraction &lt;50% (Fig E, AUC: 0.91, p&lt;0.001) in male patients. spECG showed significant net reclassification improvement (0.47, p&lt;0.001) and integrated discrimination improvement (0.16, p&lt;0.001) over traditional surface ECG interpretation using Glasgow score for predicting abnormal relaxation and other high-risk phenotypic presentations. ROC curves Conclusion The spECG provided a robust prediction of abnormal myocardial relaxation and may be a valuable screening strategy for early detection of high-risk cardiac structural and functional abnormalities.

The electrocardiogram endeavour: from the Holter single-lead recordings to multilead wearable devices supported by computational machine learning algorithms.

This review aims to provide a comprehensive recapitulation of the evolution in the field of cardiac rhythm monitoring, shedding light in recent progress made in multilead ECG systems and wearable devices, with emphasis on the promising role of the artificial intelligence and computational techniques in the detection of cardiac abnormalities.

Wireless Stretchable Hybrid Electronics for Smart, Connected, and Ambulatory Monitoring of Human Health

Continuous ambulatory cardiac monitoring using electrocardiogram (ECG) can reveal a range of essential health conditions. However, commercially available devices rely on bulky wires, rigid sensors/electronics and cause great discomfort that disrupts one’s lifestyle and prevents long-term use. Moreover, standard gel-based electrodes are prone to degradation over long-term use and can causing allergic skin reactions. Also, research-level skin-wearable devices, while excelling in few aspects, fall short as concept-only presentations, due to the fundamental challenges in active wireless communication and integration as a single device platform. Here, we introduce a fully wireless, low-profile, multifunctional stretchable hybrid electronic (SHE) device that offers smart, connected, and ambulatory health monitoring. As shown in Figure 1, the low-modulus, elastomeric system construction provides the gentle, yet sufficient, device adhesion to skin, obviating the need for straps, tapes, or adhesives, and demonstrates a type of monitoring scheme inconspicuous not only to the observer, but also to the user. Integration of a set of stretchable nanomembrane sensors with a highly flexible, membrane-based wireless circuit enables the continuous, long-range (up to 15 m) monitoring of ECG, heart rate, respiratory rate, and physical activities. Implementation of convolutional neural networks and algorithms for real-time classifications of multi-modal physiological signals demonstrates the device feasibility for multi-faceted clinically relevant analysis. In vivo demonstrations involving human subjects both with and without cardiac conditions reveal the feasibility of the device as a continuous, ambulatory, and multifunctional health monitor with emphasis on real-time detection of cardiac abnormalities. Further in vivo demonstration of SHE applied on athletes during treadmill exercises validate the versatility of SHE in both clinical and research environments. Figure 1: Overview of SHE. (A) Photograph showing the stretchable hybrid electronics applied on human chest. (B) Blow-up render detailing the structural components of SHE including the thin-film stretchable skin electrodes, hyperelastic membranes, mechanical decoupling chamber, stretchable connector, and flexible data acquisition unit. Figure 1

Noise-tolerant modular neural network system for classifying ECG signal

Millions of electrocardiograms (ECG) are interpreted every year, requiring specialized training for accurate interpretation. Because automated and accurate classification ECG signals will improve early diagnosis of heart condition, several neural network (NN) approaches have been proposed for classifying ECG signals. Current strategies for a critical step, the preprocessing for noise removal, still are unsatisfactory. We propose a modular NN approach based on artificial noise injection, to improve the generalization capability of the resulting model. The NN classifier initially performed a fairly accurate recognition of four types of cardiac anomalies in simulated ECG signals with minor, moderate, severe, and extreme noise, with an average accuracy of 99.2%, 95.1%, 91.4%, and 85.2% respectively. Ultimately we discriminated normal and abnormal heartbeat patterns for single lead of raw ECG signals, obtained 95.7% of overall accuracy and 99.5% of Precision. Therefore, is a useful tool for the detection and diagnosis of cardiac abnormalities.

Dose Optimization in Computer Tomography Pediatric Cranial Scans

Background and Objective: Nowadays, Computer Tomography is one of the best radiological imaging technics which can give right diagnostic information, among the detection of multiphasic adenomas, the detection of cardiac, cerebral and vascular abnormalities. Although these good qualities, this technic is too radiant for the patient. In this paper, we based on the irradiation doses delivered from the current protocols to find a practical method of their optimization during the pediatric cranial scan. Materials and Methods: This work relies on a collection of data from patients in the hospitals, so that analyze them, give the conclusions and, propose an optimal practical method to decrease the irradiation doses. To collect data, we performed a prospective study of seventeen months (from December 2017 to May 2019) carried out simultaneously in three hospitals of the city: The Centre Medical la Cathedrale (H1), the Yaounde Central Hospital (H2) and the Yaounde Gyneaco-Obstetric and pediatric hospital (H3). This study included a total of 192 cases of cerebral trauma, of which 11 cases excluded for incomplete information. The dosimetry quality control (CTDIvol) using the PMMA phantoms of 16 cm and 32 cm fulfilled. The scanographic parameters of the patient acquisition protocol were recorded and analyzed. Some of those parameters were modified and entered the CT with the help of a biomedical engineer to reduce the delivered dose. The relationship between CTDIvol and kV is statistically significant (p < 0.05) to identify significant differences in obtained results before and after the optimization of protocols. Results: Among patients, 172 are boys, and the remaining 9 are girls all were in the 0 to 15 age group. CTDIvol values varied from 34.2 mGy to 107.8 mGy and PDLs from 107.8 mGy.cm to 2214.5 mGy.cm in H1. In H2, CTDIvol varied from 5.8 mGy to 44 mGy and PDLs from 91.4 mGy.cm to 665.5 mGy.cm. CTDIvol varied between 9.34 mGy to 92.81 mGy and PDLs from 162.38 mGy.cm to 2713.67 mGy.cm in H3. All values are taken at 75th percentile, with or without contrast injection. Conclusion: The implementation of the optimization of protocols requires the display of the CT parameters to use and to respect during the traumatic brain tests. With displaying and respecting protocol, the CTDIvol decreased by almost 50 per cent.