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Tandon A, Avari Silva JN, Bhatt AB, Drummond CK, Hill AC, Paluch AE, Waits S, Zablah JE, Harris KC. Advancing Wearable Biosensors for Congenital Heart Disease: Patient and Clinician Perspectives: A Science Advisory From the American Heart Association. Circulation 2024; 149:e1134-e1142. [PMID: 38545775 DOI: 10.1161/cir.0000000000001225] [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] [Indexed: 05/08/2024]
Abstract
Wearable biosensors (wearables) enable continual, noninvasive physiologic and behavioral monitoring at home for those with pediatric or congenital heart disease. Wearables allow patients to access their personal data and monitor their health. Despite substantial technologic advances in recent years, issues with hardware design, data analysis, and integration into the clinical workflow prevent wearables from reaching their potential in high-risk congenital heart disease populations. This science advisory reviews the use of wearables in patients with congenital heart disease, how to improve these technologies for clinicians and patients, and ethical and regulatory considerations. Challenges related to the use of wearables are common to every clinical setting, but specific topics for consideration in congenital heart disease are highlighted.
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Bhaltadak V, Ghewade B, Yelne S. A Comprehensive Review on Advancements in Wearable Technologies: Revolutionizing Cardiovascular Medicine. Cureus 2024; 16:e61312. [PMID: 38947726 PMCID: PMC11212841 DOI: 10.7759/cureus.61312] [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: 03/26/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Wearable technologies have emerged as powerful tools in healthcare, offering continuous monitoring and personalized insights outside traditional clinical settings. These devices have garnered significant attention in cardiovascular medicine for their potential to transform patient care and improve outcomes. This comprehensive review provides an overview of wearable technologies' evolution, advancements, and applications in cardiovascular medicine. We examine the miniaturization of sensors, integration of artificial intelligence (AI), and proliferation of remote patient monitoring solutions. Key findings include the role of wearables in the early detection of cardiovascular conditions, personalized health tracking, and remote patient management. Challenges such as data privacy concerns and regulatory hurdles are also addressed. The adoption of wearable technologies holds promise for shifting healthcare from reactive to proactive, enabling precision diagnostics, treatment optimization, and preventive strategies. Collaboration among healthcare stakeholders is essential to harnessing the full potential of wearables in cardiovascular medicine and ushering in a new era of personalized, proactive healthcare.
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Affiliation(s)
- Vaishnavi Bhaltadak
- Respiratory Medicine, School of Allied Health Science, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Babaji Ghewade
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Bruce C, Gatzoulis MA, Brida M. Digital technology and artificial intelligence for improving congenital heart disease care: alea iacta est. Eur Heart J 2024; 45:1386-1389. [PMID: 38327005 DOI: 10.1093/eurheartj/ehad898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Affiliation(s)
- Charo Bruce
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guys & St Thomas's NHS Trust, Sydney Street, London SW3 6NP, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guys & St Thomas's NHS Trust, Sydney Street, London SW3 6NP, UK
- National Heart & Lung Institute, Imperial College, South Kensington Campus, London SW7 2AZ, UK
| | - Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guys & St Thomas's NHS Trust, Sydney Street, London SW3 6NP, UK
- National Heart & Lung Institute, Imperial College, South Kensington Campus, London SW7 2AZ, UK
- Medical Faculty University of Rijeka, Ul. Braće Branchetta 20/1, 51000 Rijeka, Croatia
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Mayourian J, La Cava WG, Vaid A, Nadkarni GN, Ghelani SJ, Mannix R, Geva T, Dionne A, Alexander ME, Duong SQ, Triedman JK. Pediatric ECG-Based Deep Learning to Predict Left Ventricular Dysfunction and Remodeling. Circulation 2024; 149:917-931. [PMID: 38314583 PMCID: PMC10948312 DOI: 10.1161/circulationaha.123.067750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Artificial intelligence-enhanced ECG analysis shows promise to detect ventricular dysfunction and remodeling in adult populations. However, its application to pediatric populations remains underexplored. METHODS A convolutional neural network was trained on paired ECG-echocardiograms (≤2 days apart) from patients ≤18 years of age without major congenital heart disease to detect human expert-classified greater than mild left ventricular (LV) dysfunction, hypertrophy, and dilation (individually and as a composite outcome). Model performance was evaluated on single ECG-echocardiogram pairs per patient at Boston Children's Hospital and externally at Mount Sinai Hospital using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC). RESULTS The training cohort comprised 92 377 ECG-echocardiogram pairs (46 261 patients; median age, 8.2 years). Test groups included internal testing (12 631 patients; median age, 8.8 years; 4.6% composite outcomes), emergency department (2830 patients; median age, 7.7 years; 10.0% composite outcomes), and external validation (5088 patients; median age, 4.3 years; 6.1% composite outcomes) cohorts. Model performance was similar on internal test and emergency department cohorts, with model predictions of LV hypertrophy outperforming the pediatric cardiologist expert benchmark. Adding age and sex to the model added no benefit to model performance. When using quantitative outcome cutoffs, model performance was similar between internal testing (composite outcome: AUROC, 0.88, AUPRC, 0.43; LV dysfunction: AUROC, 0.92, AUPRC, 0.23; LV hypertrophy: AUROC, 0.88, AUPRC, 0.28; LV dilation: AUROC, 0.91, AUPRC, 0.47) and external validation (composite outcome: AUROC, 0.86, AUPRC, 0.39; LV dysfunction: AUROC, 0.94, AUPRC, 0.32; LV hypertrophy: AUROC, 0.84, AUPRC, 0.25; LV dilation: AUROC, 0.87, AUPRC, 0.33), with composite outcome negative predictive values of 99.0% and 99.2%, respectively. Saliency mapping highlighted ECG components that influenced model predictions (precordial QRS complexes for all outcomes; T waves for LV dysfunction). High-risk ECG features include lateral T-wave inversion (LV dysfunction), deep S waves in V1 and V2 and tall R waves in V6 (LV hypertrophy), and tall R waves in V4 through V6 (LV dilation). CONCLUSIONS This externally validated algorithm shows promise to inexpensively screen for LV dysfunction and remodeling in children, which may facilitate improved access to care by democratizing the expertise of pediatric cardiologists.
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Affiliation(s)
- Joshua Mayourian
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - William G. La Cava
- Computational Health Informatics Program, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Akhil Vaid
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Girish N. Nadkarni
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sunil J. Ghelani
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Rebekah Mannix
- Department of Medicine, Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark E. Alexander
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Son Q. Duong
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Pediatric Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John K. Triedman
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Tran T, Steiner JM, Venkateswaran A, Buber J. Peak oxygen consumption by smartwatches compared with cardiopulmonary exercise test in complex congenital heart disease. Heart 2024; 110:353-358. [PMID: 37827554 DOI: 10.1136/heartjnl-2023-322989] [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: 05/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE To evaluate for correlation between exercise capacity as assessed by peak oxygen consumption (pVO2) measurement during a cardiopulmonary exercise test (CPET) and smartwatches reporting this parameter in patients with adult congenital heart disease (ACHD) complex lesions. METHODS A prospective study that included patients with ACHD either a Fontan circulation or a right ventricle supporting the systemic circulation who underwent two separate CPETs at least 1 year apart. Generalised estimating equations linear regression was performed to identify factors associated with correlation between smartwatch and CPET-derived pVO2. RESULTS 48 patients (71% with a Fontan circulation, 42% females, mean age 33±9 years) underwent two CPETs between May 2018 and May 2022 with echocardiograms performed within 6 months of each CPET. Apple Watch was the predominant smartwatch used (79%). Smartwatch and CPET measured peak heart rate (Pearson correlation=0.932, 95% CI (0.899, 0.954)) and pVO2 (0.8627, 95% CI (0.8007, 0.9064) and 0.8634, 95% CI (0.7676, 0.9215) in the first and second CPET, respectively) correlated well, with smartwatch-measured pVO2 values measuring higher by a mean of 3.146 mL/kg/min (95% CI (2.559, 3.732)). Changes in pVO2 between the first and the second CPET also correlated well (Pearson correlation=0.9165, 95% CI (0.8549, 0.9525)), indicating that for every 1 mL/(min kg) change in CPET-measured pVO2, there was a corresponding 0.896 mL/(min kg) change in the smartwatch-measured pVO2. CONCLUSION Both absolute values and changes over time in pVO2 as measured by smartwatches and CPETs correlate well in patients with complex ACHD.
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Affiliation(s)
- Tomio Tran
- Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jill Marie Steiner
- Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Jonathan Buber
- Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
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Baroutidou A, Otountzidis N, Papazoglou AS, Moysidis DV, Kartas A, Mantziari L, Kamperidis V, Ziakas A, Giannakoulas G. Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives. J Am Heart Assoc 2024; 13:e032102. [PMID: 38193287 PMCID: PMC10926799 DOI: 10.1161/jaha.123.032102] [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: 08/05/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024]
Abstract
The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique underlying anatomic and physiological background further adds to the difficulty in eliminating the AF burden in these patients. Herein, we provide an overview of the current knowledge on the pathophysiology and risk factors for AF in adult congenital heart disease, with a special focus on the existing challenges in AF ablation. Emerging imaging modalities and ablation techniques might have a role to play. Evidence regarding the safety and efficacy of AF ablation in adult congenital heart disease is summarized, especially for patients with an atrial septal defect, Ebstein anomaly of the tricuspid valve, tetralogy of Fallot, and Fontan circulation. Finally, any remaining gaps in knowledge and potential areas of future research are highlighted.
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Affiliation(s)
- Amalia Baroutidou
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Nikolaos Otountzidis
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | | | - Anastasios Kartas
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Vasileios Kamperidis
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Antonios Ziakas
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - George Giannakoulas
- First Department of CardiologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
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Habib E, Srivasthan K, El Masry H. Evaluation and Management of Sudden Death Risk in Repaired Tetralogy of Fallot. J Pers Med 2023; 13:1715. [PMID: 38138942 PMCID: PMC10744881 DOI: 10.3390/jpm13121715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Although substantial progress has been made to prevent sudden cardiac death in repaired tetralogy of Fallot patients, ventricular arrhythmia and sudden death continue to be major causes of morbidity and mortality in these patients. Greater survival in contemporary cohorts has been attributed to enhanced surgical techniques, more effective management of heart failure, and increased efforts in risk stratification and management of ventricular arrhythmias. More recently, our understanding of predictive risk factors has evolved into personalized risk prediction tools that rely on comprehensive demographic, imaging, functional, and electrophysiological data. However, the universal applicability of these different scoring systems is limited due to differences between study cohorts, types of anatomic repair, imaging modalities, and disease complexity. Noninvasive risk stratification is critical to identify those who may derive benefit from catheter ablation or cardioverter defibrillator implantation for primary prevention. Ultimately, assessment and risk stratification by a multidisciplinary team is crucial to analyze the various complex factors for every individual patient and discuss further options with patients and their families.
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Affiliation(s)
- Eiad Habib
- Division of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA;
| | | | - Hicham El Masry
- Division of Cardiology, Mayo Clinic, Scottsdale, AZ 85259, USA;
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Zahedivash A, Chubb H, Giacone H, Boramanand NK, Dubin AM, Trela A, Lencioni E, Motonaga KS, Goodyer W, Navarre B, Ravi V, Schmiedmayer P, Bikia V, Aalami O, Ling XB, Perez M, Ceresnak SR. Utility of smart watches for identifying arrhythmias in children. COMMUNICATIONS MEDICINE 2023; 3:167. [PMID: 38092993 PMCID: PMC10719318 DOI: 10.1038/s43856-023-00392-9] [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: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Arrhythmia symptoms are frequent complaints in children and often require a pediatric cardiology evaluation. Data regarding the clinical utility of wearable technologies are limited in children. We hypothesize that an Apple Watch can capture arrhythmias in children. METHODS We present an analysis of patients ≤18 years-of-age who had signs of an arrhythmia documented by an Apple Watch. We include patients evaluated at our center over a 4-year-period and highlight those receiving a formal arrhythmia diagnosis. We evaluate the role of the Apple Watch in arrhythmia diagnosis, the results of other ambulatory cardiac monitoring studies, and findings of any EP studies. RESULTS We identify 145 electronic-medical-record identifications of Apple Watch, and find arrhythmias confirmed in 41 patients (28%) [mean age 13.8 ± 3.2 years]. The arrythmias include: 36 SVT (88%), 3 VT (7%), 1 heart block (2.5%) and wide 1 complex tachycardia (2.5%). We show that invasive EP study confirmed diagnosis in 34 of the 36 patients (94%) with SVT (2 non-inducible). We find that the Apple Watch helped prompt a workup resulting in a new arrhythmia diagnosis for 29 patients (71%). We note traditional ambulatory cardiac monitors were worn by 35 patients (85%), which did not detect arrhythmias in 10 patients (29%). In 73 patients who used an Apple Watch for recreational or self-directed heart rate monitoring, 18 (25%) sought care due to device findings without any arrhythmias identified. CONCLUSION We demonstrate that the Apple Watch can record arrhythmia events in children, including events not identified on traditionally used ambulatory monitors.
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Affiliation(s)
- Aydin Zahedivash
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Henry Chubb
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Heather Giacone
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Nicole K Boramanand
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Anne M Dubin
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Anthony Trela
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Erin Lencioni
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Kara S Motonaga
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - William Goodyer
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Brittany Navarre
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA
| | - Vishnu Ravi
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Paul Schmiedmayer
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Vasiliki Bikia
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Oliver Aalami
- Stanford University, Stanford Byers Center for Biodesign, Palo Alto, CA, USA
| | - Xuefeng B Ling
- Stanford University, Department of Surgery, Palo Alto, CA, USA
| | - Marco Perez
- Stanford University, Cardiovascular Medicine - Electrophysiology, Department of Medicine, Palo Alto, CA, USA
| | - Scott R Ceresnak
- Stanford University, Lucile Packard Children's Hospital, Department of Pediatrics, Pediatric Cardiology, Palo Alto, CA, USA.
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Kakarla J, Denham NC, Ishikita A, Oechslin E, Alonso-Gonzalez R, Nair K. Risk Stratification for Sudden Cardiac Death in Repaired Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:414-425. [PMID: 38161672 PMCID: PMC10755789 DOI: 10.1016/j.cjcpc.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 01/03/2024]
Abstract
There has been significant progress in the prevention of sudden cardiac death in repaired tetralogy of Fallot. Contemporary cohorts report greater survival attributable to improved surgical techniques, heart failure management, and proactive strategies for risk stratification and management of ventricular arrhythmias including defibrillator implantation and ablation technology. Over the last 25 years, our understanding of predictive risk factors has also improved from invasive and more limited measures to individualized risk prediction scores based on extensive demographic, imaging, electrophysiological, and functional data. Although each of these contemporary scoring systems improves prediction, there are important differences between the study cohorts, included risk factors, and imaging modalities that can significantly affect interpretation and implementation for the individual patient. In addition, accurate phenotyping of disease complexity and anatomic repair substantially modulates this risk and the mechanism of sudden death. Routine implementation of risk stratification within repaired tetralogy of Fallot management is important and directly informs primary prevention defibrillator implantation as well as consideration for proactive invasive strategies including ventricular tachycardia ablation and pulmonary valve replacement. Assessment and risk stratification by a multidisciplinary team of experts in adult congenital heart disease are crucial and critical. Although we have increased understanding, reconciliation of these complex factors for the individual patient remains challenging and often requires careful consideration and discussion with multidisciplinary teams, patients, and their families.
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Affiliation(s)
- Jayant Kakarla
- University Health Network Toronto, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Nathan C. Denham
- University Health Network Toronto, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Ayako Ishikita
- University Health Network Toronto, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Erwin Oechslin
- University Health Network Toronto, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- University Health Network Toronto, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
| | - Krishnakumar Nair
- University Health Network Toronto, Peter Munk Cardiac Centre, Toronto Adult Congenital Heart Disease Program, and University of Toronto, Toronto, Ontario, Canada
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Leone D, Buber J, Shafer K. Exercise as Medicine: Evaluation and Prescription for Adults with Congenital Heart Disease. Curr Cardiol Rep 2023; 25:1909-1919. [PMID: 38117446 DOI: 10.1007/s11886-023-02006-1] [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] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Understanding exercise physiology as it relates to adult congenital heart disease (ACHD) can be complex. Here we review fundamental physiologic principles and provide a framework for application to the unique ACHD patient population. RECENT FINDINGS ACHD exercise participation has changed dramatically in the last 50 years. A modern approach focuses on exercise principles and individual anatomic and physiologic considerations. With an evolving better understanding of ACHD exercise physiology, we can strategize plans for patients to participate in dynamic and static exercises. Newly developed technologies including wearable devices provide additive information for ACHD providers for further assessment and monitoring. Preparation and assessment for ACHD patients prior to exercise require a thoughtful, personalized approach. Exercise prescriptions can be formulated to adequately meet the needs of our patients.
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Affiliation(s)
- David Leone
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Jonathan Buber
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Keri Shafer
- Boston Children's Hospital, Boston, MA, USA.
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11
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Padovani P, Singh Y, Pass RH, Vasile CM, Nield LE, Baruteau AE. E-Health: A Game Changer in Fetal and Neonatal Cardiology? J Clin Med 2023; 12:6865. [PMID: 37959330 PMCID: PMC10650296 DOI: 10.3390/jcm12216865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements have greatly impacted the healthcare industry, including the integration of e-health in pediatric cardiology. The use of telemedicine, mobile health applications, and electronic health records have demonstrated a significant potential to improve patient outcomes, reduce healthcare costs, and enhance the quality of care. Telemedicine provides a useful tool for remote clinics, follow-up visits, and monitoring for infants with congenital heart disease, while mobile health applications enhance patient and parents' education, medication compliance, and in some instances, remote monitoring of vital signs. Despite the benefits of e-health, there are potential limitations and challenges, such as issues related to availability, cost-effectiveness, data privacy and security, and the potential ethical, legal, and social implications of e-health interventions. In this review, we aim to highlight the current application and perspectives of e-health in the field of fetal and neonatal cardiology, including expert parents' opinions.
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Affiliation(s)
- Paul Padovani
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
| | - Yogen Singh
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert H. Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children’s Hospital, New York, NY 10029, USA;
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France;
| | - Lynne E. Nield
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A1, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alban-Elouen Baruteau
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
- CHU Nantes, CNRS, INSERM, L’Institut du Thorax, Nantes Université, 44000 Nantes, France
- INRAE, UMR 1280, PhAN, Nantes Université, 44000 Nantes, France
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12
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Drummond CK, Tandon A. Advancing Wearable Technology for Monitoring Heart Activity in Paediatric Populations. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:196-197. [PMID: 37969856 PMCID: PMC10642130 DOI: 10.1016/j.cjcpc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Colin K. Drummond
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Animesh Tandon
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pediatric Cardiology, Children’s Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pediatrics, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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13
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Montazeri Ghahjaverstan N, Balmer-Minnes D, Taghibeyglou B, Moineau B, Chaves G, Alizadeh-Meghrazi M, Cifra B, Jeewa A, Yadollahi A. Textile-based Wearable to Monitor Heart Activity in Paediatric Population: A Pilot Study. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:187-195. [PMID: 37969855 PMCID: PMC10642137 DOI: 10.1016/j.cjcpc.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/25/2023] [Indexed: 11/17/2023]
Abstract
Background Cardiac monitoring for children with heart disease still employs common clinical techniques that require visits to hospital either in an ambulatory or inpatient setting. Frequent cardiac monitoring, such as heart rate monitoring, can limit children's physical activity and quality of life. The main objective of this study is to evaluate the performance of a textile-based device (SKIIN) in measuring heart rate (HR) in different tasks: lying down, sitting, standing, exercising, and cooling down. Methods Twenty participants including healthy children and children with heart disease were included in this study. The difference between the HRs recorded by the SKIIN was compared with a reference electrocardiogram collection by normalized root mean squared error. Participants completed a questionnaire on their experience wearing the textile device with additional parental feedback on the textile device collected. Results Participants had the median age of 14 years (range: 10-17 years), with body mass index 23.1 ± 3.8 kg/m2 and body surface area 1.70 ± 0.25 m2. The HR recorded by SKIIN and reference system significantly changes between tasks (P < 0.001), while not significantly different from each other (P > 0.05). The normalized root mean squared error was 3.8% ± 3.0% and 3.6% ± 3.7% for healthy and the heart disease groups, respectively. All participants found the textile device non-irritating and easy to wear. Conclusions This study provides proof of concept that HR can be robustly and conveniently monitored by smart textiles, with similar accuracy to standard-of-care devices.
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Affiliation(s)
- Nasim Montazeri Ghahjaverstan
- Sleep Research Laboratory, KITE—Toronto Rehabilitation Institute, University Health Network Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Diana Balmer-Minnes
- Division of Cardiology, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Behrad Taghibeyglou
- Sleep Research Laboratory, KITE—Toronto Rehabilitation Institute, University Health Network Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Bastien Moineau
- Research and Development, Myant Inc, Toronto, Ontario, Canada
| | - Gabriela Chaves
- Research and Development, Myant Inc, Toronto, Ontario, Canada
| | | | - Barbara Cifra
- Division of Cardiology, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Division of Cardiology, Department of Paediatrics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Azadeh Yadollahi
- Sleep Research Laboratory, KITE—Toronto Rehabilitation Institute, University Health Network Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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