1
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Turnbull S, Garikapati K, Bennett RG, Campbell TG, Kotake Y, De Silva K, Mahajan R, Wong MS, Kazi S, Marschner S, Byth K, Thomas SP, Chow CK, Kumar S. Accuracy of a Single-Lead ECG Device for Diagnosis of Cardiac Arrhythmias Compared Against Cardiac Electrophysiology Study. Heart Lung Circ 2024; 33:1465-1474. [PMID: 38971645 DOI: 10.1016/j.hlc.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/25/2024] [Accepted: 05/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Single-lead electrocardiogram (ECG) devices may allow detection and diagnosis of cardiac rhythms. However, data on their accuracy for detecting cardiac arrhythmias beyond atrial fibrillation are limited. We aimed to determine the accuracy of the AliveCor KardiaMobile (AC) (AliveCor Inc, Mountain View, CA, USA) for the diagnosis of arrhythmias against gold standard cardiac electrophysiology study (EPS). METHOD Patients undergoing clinically indicated EPS underwent simultaneous rhythm recording with an AC, standard 12-lead ECG, and EP catheters for intracardiac electrograms. Rhythms recorded during EPS were classified based on electrogram, 12-lead ECG, and clinical findings. Blinded reviewers provided differential diagnoses for the single-lead AC tracings; a separate reviewer compared diagnoses made between the AC tracings and EPS findings. RESULTS In 49 patients, 843 cardiac rhythms were captured during 502 AC recordings. Analysis of tracings containing sinus rhythm (n=273) returned an overall accuracy of 92%, with sensitivity and specificity values of 93% and 92%, respectively. Accuracy for tracings per rhythm was atrial fibrillation 91% (n=51); supraventricular tachycardia accuracy was 89% (n=191), ventricular tachycardia 91% (n=198), ventricular fibrillation 98% (n=11), and asystole 100% (n=5). Accuracy for supraventricular ectopy was 93% (n=28) and for premature ventricular complexes was 91% (n=86). Overall accuracy was 94% for solitary rhythms and 93% in tracings from patients with baseline bundle branch block. CONCLUSIONS When compared against the gold standard EPS diagnosis, the interpretation of arrhythmias recorded by an AliveCor single-lead ECG device had reasonable diagnostic accuracy.
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Affiliation(s)
- Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Kartheek Garikapati
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy G Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Rajiv Mahajan
- Department of Cardiology, Lyell McEwin Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Mary S Wong
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Samia Kazi
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Karen Byth
- Westmead Research and Education Network, Westmead Hospital, Sydney, NSW, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
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Schipper F, Grassi A, Ross M, Cerny A, Anderer P, Hermans L, van Meulen F, Leentjens M, Schoustra E, Bosschieter P, van Sloun RJG, Overeem S, Fonseca P. Overnight Sleep Staging Using Chest-Worn Accelerometry. SENSORS (BASEL, SWITZERLAND) 2024; 24:5717. [PMID: 39275628 PMCID: PMC11398147 DOI: 10.3390/s24175717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/14/2024] [Accepted: 08/28/2024] [Indexed: 09/16/2024]
Abstract
Overnight sleep staging is an important part of the diagnosis of various sleep disorders. Polysomnography is the gold standard for sleep staging, but less-obtrusive sensing modalities are of emerging interest. Here, we developed and validated an algorithm to perform "proxy" sleep staging using cardiac and respiratory signals derived from a chest-worn accelerometer. We collected data in two sleep centers, using a chest-worn accelerometer in combination with full PSG. A total of 323 participants were analyzed, aged 13-83 years, with BMI 18-47 kg/m2. We derived cardiac and respiratory features from the accelerometer and then applied a previously developed method for automatic cardio-respiratory sleep staging. We compared the estimated sleep stages against those derived from PSG and determined performance. Epoch-by-epoch agreement with four-class scoring (Wake, REM, N1+N2, N3) reached a Cohen's kappa coefficient of agreement of 0.68 and an accuracy of 80.8%. For Wake vs. Sleep classification, an accuracy of 93.3% was obtained, with a sensitivity of 78.7% and a specificity of 96.6%. We showed that cardiorespiratory signals obtained from a chest-worn accelerometer can be used to estimate sleep stages among a population that is diverse in age, BMI, and prevalence of sleep disorders. This opens up the path towards various clinical applications in sleep medicine.
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Affiliation(s)
- Fons Schipper
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
- Philips Sleep and Respiratory Care, 5656 AE Eindhoven, The Netherlands
| | - Angela Grassi
- Philips Sleep and Respiratory Care, 5656 AE Eindhoven, The Netherlands
| | - Marco Ross
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
- The Siesta Group, 1210 Vienna, Austria
| | | | | | - Lieke Hermans
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Fokke van Meulen
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands
| | - Mickey Leentjens
- Department of Otorhinolaryngology, Head and Neck Surgery OLVG West, 1061 AE Amsterdam, The Netherlands
| | - Emily Schoustra
- Department of Otorhinolaryngology, Head and Neck Surgery OLVG West, 1061 AE Amsterdam, The Netherlands
| | - Pien Bosschieter
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands
| | - Pedro Fonseca
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
- Philips Sleep and Respiratory Care, 5656 AE Eindhoven, The Netherlands
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3
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Bahrami Rad A, Kirsch M, Li Q, Xue J, Sameni R, Albert D, Clifford GD. A Crowdsourced AI Framework for Atrial Fibrillation Detection in Apple Watch and Kardia Mobile ECGs. SENSORS (BASEL, SWITZERLAND) 2024; 24:5708. [PMID: 39275619 PMCID: PMC11398038 DOI: 10.3390/s24175708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024]
Abstract
Background: Atrial fibrillation (AFib) detection via mobile ECG devices is promising, but algorithms often struggle to generalize across diverse datasets and platforms, limiting their real-world applicability. Objective: This study aims to develop a robust, generalizable AFib detection approach for mobile ECG devices using crowdsourced algorithms. Methods: We developed a voting algorithm using random forest, integrating six open-source AFib detection algorithms from the PhysioNet Challenge. The algorithm was trained on an AliveCor dataset and tested on two disjoint AliveCor datasets and one Apple Watch dataset. Results: The voting algorithm outperformed the base algorithms across all metrics: the average of sensitivity (0.884), specificity (0.988), PPV (0.917), NPV (0.985), and F1-score (0.943) on all datasets. It also demonstrated the least variability among datasets, signifying its highest robustness and effectiveness in diverse data environments. Moreover, it surpassed Apple's algorithm on all metrics and showed higher specificity but lower sensitivity than AliveCor's Kardia algorithm. Conclusions: This study demonstrates the potential of crowdsourced, multi-algorithmic strategies in enhancing AFib detection. Our approach shows robust cross-platform performance, addressing key generalization challenges in AI-enabled cardiac monitoring and underlining the potential for collaborative algorithms in wearable monitoring devices.
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Affiliation(s)
- Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
| | | | - Qiao Li
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
| | - Joel Xue
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
- AliveCor Inc., Mountain View, CA 94043, USA
| | - Reza Sameni
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | | | - Gari D Clifford
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
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4
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Celeski M, Di Gioia G, Nusca A, Segreti A, Squeo MR, Lemme E, Mango F, Ferrera A, Ussia GP, Grigioni F. The Spectrum of Coronary Artery Disease in Elite Endurance Athletes-A Long-Standing Debate: State-of-the-Art Review. J Clin Med 2024; 13:5144. [PMID: 39274357 PMCID: PMC11395881 DOI: 10.3390/jcm13175144] [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: 07/30/2024] [Revised: 08/27/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024] Open
Abstract
Physical activity is recommended for the prevention of primary and secondary cardiovascular (CV) disease as it is linked to a number of health benefits, especially CV. However, recent research suggests that high-volume, long-term endurance exercise may hasten rather than slow the coronary atherosclerosis progression. This contentious theory has generated a great discussion and is still a major source of doubt when it comes to the clinical treatment of coronary artery disease (CAD) in athletes. CAD is the primary cause of sudden cardiac death in athletes over 35 years. Thus, recent studies evaluated the prevalence of CAD in athletes and its clinical and prognostic implications. Indeed, many studies have shown a relationship between endurance sports and higher volumes of coronary calcified plaque as determined by computed tomography. However, the precise pathogenetic substrate for the existence of an increased coronary calcification burden among endurance athletes remains unclear. Moreover, the idea that coronary plaques in elite athletes present a benign morphology has been cast into doubt by some recent studies showing potential association with adverse cardiovascular events. This review aims to analyze the association between physical activity and CAD, explaining possible underlying mechanisms of atherosclerotic progression and non-ischemic coronary lesions, focusing primarily on clinical and prognostic implications, multimodal evaluation, and management of CAD in endurance athletes.
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Affiliation(s)
- Mihail Celeski
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 6, 00135 Roma, Italy
| | - Annunziata Nusca
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Andrea Segreti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 6, 00135 Roma, Italy
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Roma, Italy
| | - Erika Lemme
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Roma, Italy
| | - Federica Mango
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Roma, Italy
| | - Armando Ferrera
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Roma, Italy
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00198 Roma, Italy
| | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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5
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Saggu DK, Udigala MN, Sarkar S, Sathiyamoorthy A, Dash S, P VRM, Rajan V, Calambur N. Feasibility of a using chest strap and dry electrode system for longer term cardiac arrhythmia monitoring: Results from a pilot observational study. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00113-X. [PMID: 39181329 DOI: 10.1016/j.ipej.2024.08.003] [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: 12/20/2023] [Revised: 03/26/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND AND AIM Cardiac arrhythmia diagnostic yield improves with increased duration of monitoring. We investigated patient comfort, diagnostic quality of ECG, and arrhythmia diagnostic yield using a single lead longer term external cardiac monitor (ECM). METHODS The observational ECM feasibility study enrolled patients with increased risk of cardiac arrhythmia. The ECM investigational prototype was designed using a chest strap with dry electrodes connected to module capable of triggered loop recording of ECG, and automatic detection of arrhythmia. In group-A of study (24-h inpatient), patients wore ECM and Holter that recorded ECG from the ECM and adhesive electrodes. In group-B of study (12-weeks ambulatory), at monthly follow-ups patients filled out a comfort survey and device stored arrhythmia episodes were reviewed. RESULTS The study enrolled 34 patients (38 % females, average age 57.5 years, 65 % had palpitations, 12 % had syncope). Diagnostic quality ECG was recorded on 76.5 % of the monitoring duration in 12 of 20 patients with reviewable data in group-A, with motion artifacts causing loss in ECG signal for 18.7 % of the time. In 14 patients in group-B, 94.9 % of the survey responses indicated that ECM was comfortable to wear. Cardiac arrhythmia was observed in 4 of 17 patients (24 %) in group-A and 9 of 14 patients (64 %) in group-B in device recorded episodes. All ECM detected pause and tachycardia were inappropriate detections due to motion artifacts and temporary device removal. CONCLUSION The chest strap-based ECM device was mostly comfortable to wear and recorded diagnostic quality ECG in three-fourth of monitoring period. Cardiac arrhythmia was observed in 64 % of patients over 3-month monitoring along with large number of motion artifact induced inappropriate detections.
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6
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Gambril JA, Ghazi SM, Sansoterra S, Ferdousi M, Kola-Kehinde O, Ruz P, Kittai AS, Rogers K, Grever M, Bhat S, Wiczer T, Byrd JC, Woyach J, Addison D. Atrial fibrillation burden and clinical outcomes following BTK inhibitor initiation. Leukemia 2024:10.1038/s41375-024-02334-3. [PMID: 39154059 DOI: 10.1038/s41375-024-02334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 06/21/2024] [Accepted: 07/01/2024] [Indexed: 08/19/2024]
Abstract
Bruton's tyrosine kinase inhibitors (BTKi) have dramatic efficacy against B-cell malignancies, but link with cardiotoxicity, including atrial fibrillation (AF). Burden, severity, and implications of BTKi-related AF are unknown. Leveraging a large-cohort of consecutive B-cell malignancy patients initiated on BTKi from 2009-2020, we identified patients with extended ambulatory rhythm monitoring. The primary outcome was AF burden after BTKi-initiation. Secondary outcomes included ventricular arrhythmia burden and other arrhythmias. Observed incident-AF rates and burden with next-generation BTKi's were compared to ibrutinib. Multivariable regression defined association between rhythm measures and major adverse cardiac events (MACE), and mortality. There were 98 BTKi-treated patients [38.8% next-generation BTKi's, 14.3% prior-AF], with 28,224 h of monitoring. Median duration BTKi-use was 34 months. Over mean duration 12 days monitoring, 72.4% developed arrhythmias (16.3% incident-AF, 31.6% other SVTs, 14.3% ventricular tachycardia). 14.3% had high AF-burden. AF-burden was similar between ibrutinib and next-generation BTKi's. No single antiarrhythmic-therapy prevented BTKi-related AF. However, antiarrhythmic initiation associated with reduction in arrhythmic burden (P = 0.009). In a multivariable model accounting for traditional cardiovascular risk factors, prior-AF associated with increased post-BTKi AF-burden. In follow-up, high AF burden associated with MACE (HR 3.12, P = 0.005) and mortality (HR 2.97, P = 0.007). Among BTKi-treated patients, high AF burden prognosticates future MACE and mortality risk.
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Grants
- CDP 2331-20 Leukemia and Lymphoma Society (Leukemia & Lymphoma Society)
- CDP 2331-20 Leukemia and Lymphoma Society (Leukemia & Lymphoma Society)
- R01-CA197870 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- R35-CA197734 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- K12-CA133250 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- R01HL170038 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- K23-CA178183 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- R01-CA197870 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- R01HL170038 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- K23-HL155890 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- R01HL170038 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
- R01HL1168045 U.S. Department of Health & Human Services | NIH | NCI | Division of Cancer Epidemiology and Genetics, National Cancer Institute (National Cancer Institute Division of Cancer Epidemiology and Genetics)
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Affiliation(s)
- John Alan Gambril
- Department of Internal Medicine, Ohio State University Medical Center, Columbus, OH, USA.
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA.
| | - Sanam M Ghazi
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Stephen Sansoterra
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Mussammat Ferdousi
- Department of Internal Medicine, Ohio State University Medical Center, Columbus, OH, USA
| | - Onaopepo Kola-Kehinde
- Department of Internal Medicine, Ohio State University Medical Center, Columbus, OH, USA
| | - Patrick Ruz
- Department of Internal Medicine, Ohio State University Medical Center, Columbus, OH, USA
| | - Adam S Kittai
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Kerry Rogers
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Michael Grever
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Seema Bhat
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Tracy Wiczer
- Department of Pharmacy, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - John C Byrd
- Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Woyach
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Zepeda-Echavarria A, Ratering Arntz NCM, Westra AH, van Schelven LJ, Euwe FE, Noordmans HJ, Vessies M, van de Leur RR, Hassink RJ, Wildbergh TX, van der Zee R, Doevendans PA, van Es R, Jaspers JEN. On the design and development of a handheld electrocardiogram device in a clinical setting. Front Digit Health 2024; 6:1403457. [PMID: 39184339 PMCID: PMC11341539 DOI: 10.3389/fdgth.2024.1403457] [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: 03/19/2024] [Accepted: 07/17/2024] [Indexed: 08/27/2024] Open
Abstract
Cardiovascular diseases (CVDs) are a global burden that requires attention. For the detection and diagnosis of CVDs, the 12-lead ECG is a key tool. With technological advancements, ECG devices are becoming smaller and available for home use. Most of these devices contain a limited number of leads and are aimed to detect atrial fibrillation (AF). To investigate whether a four-electrode arrangement could provide enough information to diagnose other CVDs, further research is necessary. At the University Medical Center Utrecht in a multidisciplinary team, we developed the miniECG, a four-electrode ECG handheld system for scientific research in clinical environments (TRL6). This paper describes the process followed during the development of the miniECG. From assembling a multidisciplinary team, which includes engineers, cardiologists, and clinical physicians to the contribution of team members in the design input, design, and testing for safety and functionality of the device. Finally, we detail how the development process was composed by iterative design steps based on user input and intended use evolution. The miniECG is a device compliant for scientific research with patients within Dutch Medical Centers. We believe that hospital-based development led to a streamlined process, which could be applied for the design and development of other technologies used for scientific research in clinical environments.
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Affiliation(s)
- Alejandra Zepeda-Echavarria
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Niek C. M. Ratering Arntz
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Albert H. Westra
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Leonard J. van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Froukje E. Euwe
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Melle Vessies
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rutger R. van de Leur
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rutger J. Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | | | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
- Department of Cardiology, Central Military Hospital, Utrecht, Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joris E. N. Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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8
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Bohn L, Rial-Vázquez J, Nine I, Rúa-Alonso M, Fariñas J, Giráldez-García MA, Mota J, Iglesias-Soler E. Arterial stiffness assessment by pulse wave velocity in postmenopausal women: comparison between noninvasive devices. Menopause 2024; 31:709-715. [PMID: 38916283 DOI: 10.1097/gme.0000000000002383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVE This study aimed to ascertain the accuracy of measure arterial stiffness using the HUAWEI GT 3 Pro smartwatch and pOpmètre device against the SphygmoCor (algorithms: intersect tangent and maximum of the second derivate). METHODS Twenty-three physically active postmenopausal women (age: 58.9 ± 3.2 years; body mass index: 26.3 ± 4.8 kg/m 2 ) were recruited. Carotid-femoral pulse wave velocity, finger-toe pulse wave velocity, and wrist-finger pulse wave velocity were obtained using SphygmoCor, pOpmètre and HUAWEI GT 3 Pro devices in a randomized order. Additionally, the pulse mean carotid-femoral and finger-toe pulse transit time was registered for SphygmoCor and pOpmètre, respectively. RESULTS Lower values of pulse wave velocity were recorded by HUAWEI in comparison with SphygmoCor with both algorithms, whereas no significant differences were detected between SphygmoCor and pOpmètre results. Pulse wave velocity values from SphygmoCor were positively correlated with pOpmètre results ( r = 0.464 and r = 0.451 using intersect tangent and second derivative algorithms), whereas this was not the case with those obtained from HUAWEI. Coefficients of bias of Lin's concordance coefficients close to 1 (0.832 and 0.831 for intersect tangent and second derivative algorithm, respectively) and mean bias close to 0 from Bland-Altman analysis suggested an acceptable agreement between pulse wave velocity obtained from SphygmoCor and pOpmètre. CONCLUSIONS Our results suggest an acceptable concordance of pulse wave velocity values recoded by SphygmoCor and pOpmètre, whereas this was not the case for data obtained from HUAWEI GT 3 Pro smartwatch. Therefore, the pOpmètre may be a viable alternative for assessing arterial stiffness, but measurement via the smartwatch device cannot be recommended.
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Affiliation(s)
| | | | - Iván Nine
- University of A Coruna, Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, A Coruña
| | | | - Juan Fariñas
- University of A Coruna, Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, A Coruña
| | - Manuel Avelino Giráldez-García
- University of A Coruna, Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, A Coruña
| | - Jorge Mota
- Research Center in Physical Activity, health and Leisure (CIAFEL)-Faculty of Sports-University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR); University of Porto, Porto, Portugal
| | - Eliseo Iglesias-Soler
- University of A Coruna, Performance and Health Group, Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, A Coruña
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9
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Ghazizadeh E, Naseri Z, Deigner HP, Rahimi H, Altintas Z. Approaches of wearable and implantable biosensor towards of developing in precision medicine. Front Med (Lausanne) 2024; 11:1390634. [PMID: 39091290 PMCID: PMC11293309 DOI: 10.3389/fmed.2024.1390634] [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: 02/23/2024] [Accepted: 04/30/2024] [Indexed: 08/04/2024] Open
Abstract
In the relentless pursuit of precision medicine, the intersection of cutting-edge technology and healthcare has given rise to a transformative era. At the forefront of this revolution stands the burgeoning field of wearable and implantable biosensors, promising a paradigm shift in how we monitor, analyze, and tailor medical interventions. As these miniature marvels seamlessly integrate with the human body, they weave a tapestry of real-time health data, offering unprecedented insights into individual physiological landscapes. This log embarks on a journey into the realm of wearable and implantable biosensors, where the convergence of biology and technology heralds a new dawn in personalized healthcare. Here, we explore the intricate web of innovations, challenges, and the immense potential these bioelectronics sentinels hold in sculpting the future of precision medicine.
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Affiliation(s)
- Elham Ghazizadeh
- Department of Bioinspired Materials and Biosensor Technologies, Faculty of Engineering, Institute of Materials Science, Kiel University, Kiel, Germany
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Naseri
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hans-Peter Deigner
- Institute of Precision Medicine, Furtwangen University, Villingen-Schwenningen, Germany
- Fraunhofer Institute IZI (Leipzig), Rostock, Germany
- Faculty of Science, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Hossein Rahimi
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zeynep Altintas
- Department of Bioinspired Materials and Biosensor Technologies, Faculty of Engineering, Institute of Materials Science, Kiel University, Kiel, Germany
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10
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Zhao F, Balthazaar S, Hiremath SV, Nightingale TE, Panza GS. Enhancing Spinal Cord Injury Care: Using Wearable Technologies for Physical Activity, Sleep, and Cardiovascular Health. Arch Phys Med Rehabil 2024:S0003-9993(24)01076-1. [PMID: 38972475 DOI: 10.1016/j.apmr.2024.06.014] [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: 02/16/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
Wearable devices have the potential to advance health care by enabling real-time monitoring of biobehavioral data and facilitating the management of an individual's health conditions. Individuals living with spinal cord injury (SCI) have impaired motor function, which results in deconditioning and worsening cardiovascular health outcomes. Wearable devices may promote physical activity and allow the monitoring of secondary complications associated with SCI, potentially improving motor function, sleep, and cardiovascular health. However, several challenges remain to optimize the application of wearable technologies within this population. One is striking a balance between research-grade and consumer-grade devices in terms of cost, accessibility, and validity. Additionally, limited literature supports the validity and use of wearable technology in monitoring cardio-autonomic and sleep outcomes for individuals with SCI. Future directions include conducting performance evaluations of wearable devices to precisely capture the additional variation in movement and physiological parameters seen in those with SCI. Moreover, efforts to make the devices small, lightweight, and inexpensive for consumer ease of use may affect those with severe motor impairments. Overcoming these challenges holds the potential for wearable devices to help individuals living with SCI receive timely feedback to manage their health conditions and help clinicians gather comprehensive patient health information to aid in diagnosis and treatment.
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Affiliation(s)
- Fei Zhao
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI
| | - Shane Balthazaar
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada; Department of Cardiology, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Shivayogi V Hiremath
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| | - Gino S Panza
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI.
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11
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Gill SK, Barsky A, Guan X, Bunting KV, Karwath A, Tica O, Stanbury M, Haynes S, Folarin A, Dobson R, Kurps J, Asselbergs FW, Grobbee DE, Camm AJ, Eijkemans MJC, Gkoutos GV, Kotecha D. Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial. Nat Med 2024; 30:2030-2036. [PMID: 39009776 PMCID: PMC11271403 DOI: 10.1038/s41591-024-03094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/24/2024] [Indexed: 07/17/2024]
Abstract
Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n = 143,379,796) and physical activity (n = 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) -2.82 to 5.27; P = 0.55); adjusted 0.66 (95% CI -3.45 to 4.77; P = 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P = 0.74) or patients with high activity levels (≥30,000 steps per week; P = 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P = 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337 .
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Affiliation(s)
- Simrat K Gill
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Andrey Barsky
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Xin Guan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Karina V Bunting
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andreas Karwath
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Otilia Tica
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Amos Folarin
- Department of Biostatistics & Health Informatics, King's College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Richard Dobson
- Department of Biostatistics & Health Informatics, King's College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Julia Kurps
- Real World Data team, The Hyve, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Amsterdam University Medical Center, Department of Cardiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - A John Camm
- Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Marinus J C Eijkemans
- Amsterdam University Medical Center, Department of Cardiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
- West Midlands NHS Secure Data Environment, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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12
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Francisco-Pascual J, Mallofré Vila N, Santos-Ortega A, Rivas-Gándara N. Tachyarrhythmias in congenital heart disease. Front Cardiovasc Med 2024; 11:1395210. [PMID: 38887448 PMCID: PMC11180807 DOI: 10.3389/fcvm.2024.1395210] [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: 03/03/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
The prevalence of congenital heart disease (CHD) in adult patients has risen with advances in diagnostic and surgical techniques. Surgical modifications and hemodynamic changes increase the susceptibility to arrhythmias, impacting morbidity and mortality rates, with arrhythmias being the leading cause of hospitalizations and sudden deaths. Patients with CHD commonly experience both supraventricular and ventricular arrhythmias, with each CHD type associated with different arrhythmia patterns. Macroreentrant atrial tachycardias, particularly cavotricuspid isthmus-dependent flutter, are frequently reported. Ventricular arrhythmias, including monomorphic ventricular tachycardia, are prevalent, especially in patients with surgical scars. Pharmacological therapy involves antiarrhythmic and anticoagulant drugs, though data are limited with potential adverse effects. Catheter ablation is preferred, demanding meticulous procedural planning due to anatomical complexity and vascular access challenges. Combining imaging techniques with electroanatomic navigation enhances outcomes. However, risk stratification for sudden death remains challenging due to anatomical variability. This article practically reviews the most common tachyarrhythmias, treatment options, and clinical management strategies for these patients.
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Affiliation(s)
- Jaume Francisco-Pascual
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Mallofré Vila
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alba Santos-Ortega
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Rivas-Gándara
- Unitat D'Arritmies, Servei de Cardiologia, Hospital Universitari Vall D'Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
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13
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Armoundas AA, Ahmad FS, Bennett DA, Chung MK, Davis LL, Dunn J, Narayan SM, Slotwiner DJ, Wiley KK, Khera R. Data Interoperability for Ambulatory Monitoring of Cardiovascular Disease: A Scientific Statement From the American Heart Association. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e000095. [PMID: 38779844 DOI: 10.1161/hcg.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Wearable devices are increasingly used by a growing portion of the population to track health and illnesses. The data emerging from these devices can potentially transform health care. This requires an interoperability framework that enables the deployment of platforms, sensors, devices, and software applications within diverse health systems, aiming to facilitate innovation in preventing and treating cardiovascular disease. However, the current data ecosystem includes several noninteroperable systems that inhibit such objectives. The design of clinically meaningful systems for accessing and incorporating these data into clinical workflows requires strategies to ensure the quality of data and clinical content and patient and caregiver accessibility. This scientific statement aims to address the best practices, gaps, and challenges pertaining to data interoperability in this area, with considerations for (1) data integration and the scope of measures, (2) application of these data into clinical approaches/strategies, and (3) regulatory/ethical/legal issues.
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14
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Di Mambro C, Yammine ML, Tamborrino PP, Giordano U, Righi D, Unolt M, Cantarutti N, Maiolo S, Albanese S, Carotti A, Amodeo A, Galletti L, Drago F. Long-term incidence of arrhythmias in extracardiac conduit Fontan and comparison between systemic left and right ventricle. Europace 2024; 26:euae097. [PMID: 38650062 PMCID: PMC11089577 DOI: 10.1093/europace/euae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/16/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS The extracardiac conduit-Fontan (ECC) has become the preferred technique for univentricular heart palliation, but there are currently no data on the incidence of long-term arrhythmias. This study investigated the incidence of arrhythmias and relation to single ventricle morphology in the long-term follow-up (FU) in ECC. METHODS AND RESULTS All patients with ECC performed in our Centre between 1987 and 2017 were included (minimum FU 5 years). Of 353 consecutive patients, 303 [57.8% males, aging 8-50 (median 20) years at last FU] were considered and divided into two groups depending on left (194 in Group 1) or right (109 in Group 2) ventricular morphology. Eighty-five (28%) experienced ≥1 arrhythmic complications, with early and late arrhythmias in 17 (5.6%) and 73 (24.1%) patients, respectively. Notably, late bradyarrhythmias occurred after 6 years in 21 (11%) patients in Group 1, and in 15 (13.8%) in Group 2 [P = 0.48]. Late tachyarrhythmias occurred in 55 (18.2%) patients after 12 years: 33 (17%) in Group 1 and 22 (20.2%) patients in Group 2 [P = 0.5]. Ventricular tachycardias (VT) were documented after 12.5 years in 14 (7.2%) patients of Group 1 and 15 (13.8%) of Group 2 [P = 0.06] with a higher incidence in Group 2 during the FU [P = 0.005]. CONCLUSION Extracardiac conduit is related to a significant arrhythmic risk in the long-term FU, higher than previously reported. Bradyarrhythmias occur earlier but are less frequent than tachyarrhythmias. Interestingly, patients with systemic right ventricle have a significantly higher incidence of VT, especially in a very long FU.
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Affiliation(s)
- Corrado Di Mambro
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
| | - Marie Laure Yammine
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
| | - Pietro Paolo Tamborrino
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
| | - Ugo Giordano
- Sports Medicine Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Daniela Righi
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
| | - Marta Unolt
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
| | - Stella Maiolo
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
| | - Sonia Albanese
- Cardiac Surgery Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Adriano Carotti
- Cardiac Surgery Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplant and Mechanical Assist Device, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Lorenzo Galletti
- Cardiac Surgery Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Neonatal and Cardiological Area, Bambino Gesù Children’s Hospital IRCCS (European Reference Network for Rare and Low Prevalence Complex Disease of the Heart-ERN GUARD-Heart), Via Torre di Palidoro, 00050 Rome, Italy
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15
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Lingawi S, Hutton J, Khalili M, Shadgan B, Christenson J, Grunau B, Kuo C. Cardiorespiratory Sensors and Their Implications for Out-of-Hospital Cardiac Arrest Detection: A Systematic Review. Ann Biomed Eng 2024; 52:1136-1158. [PMID: 38358559 DOI: 10.1007/s10439-024-03442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major health problem, with a poor survival rate of 2-11%. For the roughly 75% of OHCAs that are unwitnessed, survival is approximately 2-4.4%, as there are no bystanders present to provide life-saving interventions and alert Emergency Medical Services. Sensor technologies may reduce the number of unwitnessed OHCAs through automated detection of OHCA-associated physiological changes. However, no technologies are widely available for OHCA detection. This review identifies research and commercial technologies developed for cardiopulmonary monitoring that may be best suited for use in the context of OHCA, and provides recommendations for technology development, testing, and implementation. We conducted a systematic review of published studies along with a search of grey literature to identify technologies that were able to provide cardiopulmonary monitoring, and could be used to detect OHCA. We searched MEDLINE, EMBASE, Web of Science, and Engineering Village using MeSH keywords. Following inclusion, we summarized trends and findings from included studies. Our searches retrieved 6945 unique publications between January, 1950 and May, 2023. 90 studies met the inclusion criteria. In addition, our grey literature search identified 26 commercial technologies. Among included technologies, 52% utilized electrocardiography (ECG) and 40% utilized photoplethysmography (PPG) sensors. Most wearable devices were multi-modal (59%), utilizing more than one sensor simultaneously. Most included devices were wearable technologies (84%), with chest patches (22%), wrist-worn devices (18%), and garments (14%) being the most prevalent. ECG and PPG sensors are heavily utilized in devices for cardiopulmonary monitoring that could be adapted to OHCA detection. Developers seeking to rapidly develop methods for OHCA detection should focus on using ECG- and/or PPG-based multimodal systems as these are most prevalent in existing devices. However, novel sensor technology development could overcome limitations in existing sensors and could serve as potential additions to or replacements for ECG- and PPG-based devices.
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Affiliation(s)
- Saud Lingawi
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada.
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
- Centre for Aging SMART, University of British Columbia, 2635 Laurel St., Vancouver, BC, V5Z 1M9, Canada.
| | - Jacob Hutton
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, Canada
- Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada
| | - Mahsa Khalili
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada
- Centre for Aging SMART, University of British Columbia, 2635 Laurel St., Vancouver, BC, V5Z 1M9, Canada
- Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada
| | - Babak Shadgan
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopedic Surgery, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Jim Christenson
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, Canada
- Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada
| | - Brian Grunau
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, Canada
- Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada
| | - Calvin Kuo
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART, University of British Columbia, 2635 Laurel St., Vancouver, BC, V5Z 1M9, Canada
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16
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Armoundas AA, Narayan SM, Arnett DK, Spector-Bagdady K, Bennett DA, Celi LA, Friedman PA, Gollob MH, Hall JL, Kwitek AE, Lett E, Menon BK, Sheehan KA, Al-Zaiti SS. Use of Artificial Intelligence in Improving Outcomes in Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1028-e1050. [PMID: 38415358 PMCID: PMC11042786 DOI: 10.1161/cir.0000000000001201] [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] [Indexed: 02/29/2024]
Abstract
A major focus of academia, industry, and global governmental agencies is to develop and apply artificial intelligence and other advanced analytical tools to transform health care delivery. The American Heart Association supports the creation of tools and services that would further the science and practice of precision medicine by enabling more precise approaches to cardiovascular and stroke research, prevention, and care of individuals and populations. Nevertheless, several challenges exist, and few artificial intelligence tools have been shown to improve cardiovascular and stroke care sufficiently to be widely adopted. This scientific statement outlines the current state of the art on the use of artificial intelligence algorithms and data science in the diagnosis, classification, and treatment of cardiovascular disease. It also sets out to advance this mission, focusing on how digital tools and, in particular, artificial intelligence may provide clinical and mechanistic insights, address bias in clinical studies, and facilitate education and implementation science to improve cardiovascular and stroke outcomes. Last, a key objective of this scientific statement is to further the field by identifying best practices, gaps, and challenges for interested stakeholders.
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17
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Liu LR, Huang MY, Huang ST, Kung LC, Lee CH, Yao WT, Tsai MF, Hsu CH, Chu YC, Hung FH, Chiu HW. An Arrhythmia classification approach via deep learning using single-lead ECG without QRS wave detection. Heliyon 2024; 10:e27200. [PMID: 38486759 PMCID: PMC10937691 DOI: 10.1016/j.heliyon.2024.e27200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
Arrhythmia, a frequently encountered and life-threatening cardiac disorder, can manifest as a transient or isolated event. Traditional automatic arrhythmia detection methods have predominantly relied on QRS-wave signal detection. Contemporary research has focused on the utilization of wearable devices for continuous monitoring of heart rates and rhythms through single-lead electrocardiogram (ECG), which holds the potential to promptly detect arrhythmias. However, in this study, we employed a convolutional neural network (CNN) to classify distinct arrhythmias without QRS wave detection step. The ECG data utilized in this study were sourced from the publicly accessible PhysioNet databases. Taking into account the impact of the duration of ECG signal on accuracy, this study trained one-dimensional CNN models with 5-s and 10-s segments, respectively, and compared their results. In the results, the CNN model exhibited the capability to differentiate between Normal Sinus Rhythm (NSR) and various arrhythmias, including Atrial Fibrillation (AFIB), Atrial Flutter (AFL), Wolff-Parkinson-White syndrome (WPW), Ventricular Fibrillation (VF), Ventricular Tachycardia (VT), Ventricular Flutter (VFL), Mobitz II AV Block (MII), and Sinus Bradycardia (SB). Both 10-s and 5-s ECG segments exhibited comparable results, with an average classification accuracy of 97.31%. It reveals the feasibility of utilizing even shorter 5-s recordings for detecting arrhythmias in everyday scenarios. Detecting arrhythmias with a single lead aligns well with the practicality of wearable devices for daily use, and shorter detection times also align with their clinical utility in emergency situations.
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Affiliation(s)
- Liong-Rung Liu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Ming-Yuan Huang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Shu-Tien Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Lu-Chih Kung
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Chao-hsiung Lee
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Ming-Feng Tsai
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Cheng-Hung Hsu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chang Chu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Fei-Hung Hung
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Hung-Wen Chiu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Bioinformatics Data Science Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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18
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Kim J, Lee SJ, Ko B, Lee M, Lee YS, Lee KH. Identification of Atrial Fibrillation With Single-Lead Mobile ECG During Normal Sinus Rhythm Using Deep Learning. J Korean Med Sci 2024; 39:e56. [PMID: 38317452 PMCID: PMC10843976 DOI: 10.3346/jkms.2024.39.e56] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The acquisition of single-lead electrocardiogram (ECG) from mobile devices offers a more practical approach to arrhythmia detection. Using artificial intelligence for atrial fibrillation (AF) identification enhances screening efficiency. However, the potential of single-lead ECG for AF identification during normal sinus rhythm (NSR) remains under-explored. This study introduces a method to identify AF using single-lead mobile ECG during NSR. METHODS We employed three deep learning models: recurrent neural network (RNN), long short-term memory (LSTM), and residual neural networks (ResNet50). From a dataset comprising 13,509 ECGs from 6,719 patients, 10,287 NSR ECGs from 5,170 patients were selected. Single-lead mobile ECGs underwent noise filtering and segmentation into 10-second intervals. A random under-sampling was applied to reduce bias from data imbalance. The final analysis involved 31,767 ECG segments, including 15,157 labeled as masked AF and 16,610 as Healthy. RESULTS ResNet50 outperformed the other models, achieving a recall of 79.3%, precision of 65.8%, F1-score of 71.9%, accuracy of 70.5%, and an area under the receiver operating characteristic curve (AUC) of 0.79 in identifying AF from NSR ECGs. Comparative performance scores for RNN and LSTM were 0.75 and 0.74, respectively. In an external validation set, ResNet50 attained an F1-score of 64.1%, recall of 68.9%, precision of 60.0%, accuracy of 63.4%, and AUC of 0.68. CONCLUSION The deep learning model using single-lead mobile ECG during NSR effectively identified AF at risk in future. However, further research is needed to enhance the performance of deep learning models for clinical application.
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Affiliation(s)
- Jiwoong Kim
- Department of Mathematics and Statistics, Chonnam National University, Gwangju, Korea
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | | | - Bonggyun Ko
- Department of Mathematics and Statistics, Chonnam National University, Gwangju, Korea
- XRAI, Gwangju, Korea
| | - Myungeun Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | | | - Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
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19
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Liang J, Lv R, Li M, Chai J, Wang S, Yan W, Zheng Z, Li P. Hydrogels for the Treatment of Myocardial Infarction: Design and Therapeutic Strategies. Macromol Biosci 2024; 24:e2300302. [PMID: 37815522 DOI: 10.1002/mabi.202300302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/02/2023] [Indexed: 10/11/2023]
Abstract
Cardiovascular diseases (CVDs) have become the leading global burden of diseases in recent years and are the primary cause of human mortality and loss of healthy life expectancy. Myocardial infarction (MI) is the top cause of CVDs-related deaths, and its incidence is increasing worldwide every year. Recently, hydrogels have garnered great interest from researchers as a promising therapeutic option for cardiac tissue repair after MI. This is due to their excellent properties, including biocompatibility, mechanical properties, injectable properties, anti-inflammatory properties, antioxidant properties, angiogenic properties, and conductive properties. This review discusses the advantages of hydrogels as a novel treatment for cardiac tissue repair after MI. The design strategies of various hydrogels in MI treatment are then summarized, and the latest research progress in the field is classified. Finally, the future perspectives of this booming field are also discussed at the end of this review.
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Affiliation(s)
- Jiaheng Liang
- Frontiers Science Center for Flexible Electronics (FSCFE), Institute of Flexible Electronics (IFE), Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), Xi'an, 710072, China
- Laboratory for Advanced Interfacial Materials and Devices, Department of Applied Biology and Chemical Technology (ABCT), Research Institute for Intelligent Wearable Systems (RI-IWEAR), The Hong Kong Polytechnic University, Hong Kong, SAR, 999077, China
| | - Ronghao Lv
- Frontiers Science Center for Flexible Electronics (FSCFE), Institute of Flexible Electronics (IFE), Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), Xi'an, 710072, China
| | - Maorui Li
- Frontiers Science Center for Flexible Electronics (FSCFE), Institute of Flexible Electronics (IFE), Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), Xi'an, 710072, China
| | - Jin Chai
- Frontiers Science Center for Flexible Electronics (FSCFE), Institute of Flexible Electronics (IFE), Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), Xi'an, 710072, China
| | - Shuo Wang
- Frontiers Science Center for Flexible Electronics (FSCFE), Institute of Flexible Electronics (IFE), Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), Xi'an, 710072, China
| | - Wenjun Yan
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710072, China
| | - Zijian Zheng
- Laboratory for Advanced Interfacial Materials and Devices, Department of Applied Biology and Chemical Technology (ABCT), Research Institute for Intelligent Wearable Systems (RI-IWEAR), The Hong Kong Polytechnic University, Hong Kong, SAR, 999077, China
| | - Peng Li
- Frontiers Science Center for Flexible Electronics (FSCFE), Institute of Flexible Electronics (IFE), Institute of Biomedical Materials and Engineering (IBME), Northwestern Polytechnical University (NPU), Xi'an, 710072, China
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20
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Alibrandi L, Tognetti R, Domenech O, Croce M, Giuntoli M, Grosso G, Vezzosi T. Smartphone-based six-lead ECG: A new device for electrocardiographic recording in dogs. Vet J 2024; 303:106043. [PMID: 37992801 DOI: 10.1016/j.tvjl.2023.106043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
Smartphone-based technology for electrocardiographic recording is now part of the new concept of mobile health in both human and veterinary medicine. Although smartphone-based ECG for electrocardiographic screening in dogs is reliable, one-lead ECG devices have mainly been evaluated. This prospective study assessed the feasibility and the diagnostic reliability of a new smartphone-based six-lead electrocardiograph (smECG) in dogs, in comparison to a standard six-lead electrocardiograph (stECG). All ECG tracings were blindly reviewed by an expert operator, who judged whether tracings were acceptable for interpretation, performed the electrocardiographic measurements, and assigned a diagnosis. The agreement in the electrocardiographic interpretation and diagnosis between smECG and stECG was assessed using the Bland-Altman test and Cohen's k test. The study included 108 client-owned dogs. The tracings obtained by the smECG were interpretable in 100 % of cases. No clinically relevant differences between smECG and stECG were found in the assessment of heart rate, interval duration, and QRS mean electrical axis. The smECG tended to underestimate the amplitude of the P and R waves. Perfect agreement was found in the detection of sinus rhythm, atrial fibrillation, ventricular arrhythmias, atrioventricular blocks, and bundle branch blocks. Our study suggests that the tested smartphone-based six-lead ECG is a clinically reliable device for the assessment of heart rate and heart rhythm in dogs, and thus could be used in a clinical setting in dogs and for telemedicine.
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Affiliation(s)
- L Alibrandi
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, Pisa, San Piero a Grado 56122, Italy; Unit of Translational Critical Care Medicine, Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa, Italy
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, Pisa, San Piero a Grado 56122, Italy.
| | - O Domenech
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
| | - M Croce
- Department of Cardiology, Anicura Istituto Veterinario Novara, Granozzo con Monticello, Italy
| | - M Giuntoli
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, Pisa, San Piero a Grado 56122, Italy
| | - G Grosso
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, Pisa, San Piero a Grado 56122, Italy
| | - T Vezzosi
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, Pisa, San Piero a Grado 56122, Italy
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21
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Spatz ES, Ginsburg GS, Rumsfeld JS, Turakhia MP. Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine. N Engl J Med 2024; 390:346-356. [PMID: 38265646 DOI: 10.1056/nejmra2301903] [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: 01/25/2024]
Affiliation(s)
- Erica S Spatz
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - Geoffrey S Ginsburg
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - John S Rumsfeld
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - Mintu P Turakhia
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
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22
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Xu B, Jiang F, Zhu Z, Meng H, Xu L. Adaptive convolutional dictionary learning for denoising seismocardiogram to enhance the classification performance of aortic stenosis. Comput Biol Med 2024; 168:107763. [PMID: 38056208 DOI: 10.1016/j.compbiomed.2023.107763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Aortic stenosis (AS) is the most prevalent type of valvular heart disease (VHD), traditionally diagnosed using echocardiogram or phonocardiogram. Seismocardiogram (SCG), an emerging wearable cardiac monitoring modality, is proved to be feasible in non-invasive and cost-effective AS diagnosis. However, SCG waveforms acquired from patients with heart diseases are typically weak, making them more susceptible to noise contamination. While most related researches focus on motion artifacts, sensor noise and quantization noise have been mostly overlooked. These noises pose additional challenges for extracting features from the SCG, especially impeding accurate AS classification. METHOD To address this challenge, we present a convolutional dictionary learning-based method. Based on sparse modeling of SCG, the proposed method generates a personalized adaptive-size dictionary from noisy measurements. The dictionary is used for sparse coding of the noisy SCG into a transform domain. Reconstruction from the domain removes the noise while preserving the individual waveform pattern of SCG. RESULTS Using two self-collected SCG datasets, we established optimal dictionary learning parameters and validated the denoising performance. Subsequently, the proposed method denoised SCG from 50 subjects (25 AS and 25 non-AS). Leave-one-subject-out cross-validation (LOOCV) was applied to 5 machine learning classifiers. Among the classifiers, a bi-layer neural network achieved a moderate accuracy of 90.2%, with an improvement of 13.8% from the denoising. CONCLUSIONS The proposed sparsity-based denoising technique effectively removes stochastic sensor noise and quantization noise from SCG, consequently improving AS classification performance. This approach shows promise for overcoming instrumentation constraints of SCG-based diagnosis.
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Affiliation(s)
- Bowen Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China; Key Laboratory of Medical Image Computing, Ministry of Education, Shenyang, 110169, China
| | - Fangfang Jiang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China; Key Laboratory of Medical Image Computing, Ministry of Education, Shenyang, 110169, China.
| | - Ziyu Zhu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China; Key Laboratory of Medical Image Computing, Ministry of Education, Shenyang, 110169, China
| | - Haobo Meng
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China; Key Laboratory of Medical Image Computing, Ministry of Education, Shenyang, 110169, China
| | - Lisheng Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, 110169, China; Key Laboratory of Medical Image Computing, Ministry of Education, Shenyang, 110169, China
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23
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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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24
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Tran HHV, Urgessa NA, Geethakumari P, Kampa P, Parchuri R, Bhandari R, Alnasser AR, Akram A, Kar S, Osman F, Mashat GD, Mohammed L. Detection and Diagnostic Accuracy of Cardiac Arrhythmias Using Wearable Health Devices: A Systematic Review. Cureus 2023; 15:e50952. [PMID: 38249280 PMCID: PMC10800119 DOI: 10.7759/cureus.50952] [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: 08/28/2022] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Photoplethysmography (PPG) is the wearable devices' most widely used technology for monitoring heart rate. The systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. This systematic review seeks to establish the effects of wearable health devices on cardiac arrhythmias concerning their impact on the personalization of cardiac management, their refining effect on stroke prevention strategies, and their influence on research and preventive care of cardiac arrhythmias and their re-evaluation of the patient-physician relationship. The population, exposure, control, outcomes, and studies (PECOS) criteria were used in the systematic review. This review considered studies that covered the tests conducted on individuals who presented with cardiovascular diseases (CVD) and also healthy people. The intervention for studies included wearable health devices that could detect and diagnose cardiac arrhythmias. The study considered articles that reported on the personalization of cardiac management, stroke prevention strategies, influence in research and preventive care of cardiac arrhythmias, and the re-evaluation of the patient-physician relationship. Two independent researchers were used in the extraction of the data. In case of dispute, the issue was resolved using a third party. The study's quality analysis was conducted using AXIS. The management of atrial fibrillation (AF) lies heavily in the prevention of stroke. The accuracy being reported in the prediction of arrhythmias and the monitoring of heart rates makes wearable devices an efficient means to personalize health care. Personalization of health and treatment in preventing and managing arrhythmias becomes possible due to the portability of smart wearable devices. However, limitations may be observed due to the high costs incurred in their purchase and use. Using smart wearable devices for the detection of cardiac arrhythmias was very significant.
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Affiliation(s)
- Hadrian Hoang-Vu Tran
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Neway A Urgessa
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prabhitha Geethakumari
- Internal Medicine, California Institute of Behavioural Neurosciences & Psycholgy, Fairfield, USA
| | - Prathima Kampa
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rakesh Parchuri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Renu Bhandari
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ali R Alnasser
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aqsa Akram
- Internal Medicine, Dallah Hospital, Riyadh, SAU
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Saikat Kar
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fatema Osman
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ghadi D Mashat
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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25
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Jung YM, Kang S, Son JM, Lee HS, Han GI, Yoo AH, Kwon JM, Park CW, Park JS, Jun JK, Lee MS, Lee SM. Electrocardiogram-based deep learning model to screen peripartum cardiomyopathy. Am J Obstet Gynecol MFM 2023; 5:101184. [PMID: 37863197 DOI: 10.1016/j.ajogmf.2023.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy, one of the most fatal conditions during delivery, results in heart failure secondary to left ventricular systolic dysfunction. Left ventricular dysfunction can result in abnormalities in electrocardiography. However, the usefulness of electrocardiography in the identification of peripartum cardiomyopathy in pregnant women remains unclear. OBJECTIVE This study aimed to evaluate the effectiveness of a 12-lead electrocardiography-based artificial intelligence/machine learning-based software as a medical device for screening peripartum cardiomyopathy. STUDY DESIGN This retrospective cohort study included pregnant women who underwent transthoracic echocardiography between a month before and 5 months after delivery and underwent 12-lead electrocardiography within 30 days of echocardiography between December 2011 and May 2022 at Seoul National University Hospital. The performance of 12-lead electrocardiography-based artificial intelligence/machine learning analysis (AiTiALVSD software; version 1.00.00, which was developed to screen for left ventricular systolic dysfunction in the general population) was evaluated for the identification of peripartum cardiomyopathy. In addition, the performance of another artificial intelligence/machine learning algorithm using only 1-lead electrocardiography to detect left ventricular systolic dysfunction was evaluated in identifying peripartum cardiomyopathy. The results were obtained under a 95% confidence interval and considered significant when P<.05. RESULTS Among the 14,557 women who delivered during the study period, 204 (1.4%) underwent transthoracic echocardiography a month before and 5 months after delivery. Among them, 12 (5.8%) were diagnosed with peripartum cardiomyopathy. The results showed that AiTiALVSD for 12-lead electrocardiography was highly effective in detecting peripartum cardiomyopathy, with an area under the receiver operating characteristic of 0.979 (95% confidence interval, 0.953-1.000), an area under the precision-recall curve of 0.715 (95% confidence interval, 0.499-0.951), a sensitivity of 0.917 (95% confidence interval, 0.760-1.000), a specificity of 0.927 (95% confidence interval, 0.890-0.964), a positive predictive value of 0.440 (95% confidence interval, 0.245-0.635), and a negative predictive value of 0.994 (95% confidence interval, 0.983-1.000). In addition, a 1-lead (lead I) artificial intelligence/machine learning algorithm showed excellent performance; the area under the receiver operating characteristic, area under the precision-recall curve, sensitivity, specificity, positive predictive value, and negative predictive value were 0.944 (95% confidence interval, 0.895-0.993), 0.520 (95% confidence interval, 0.319-0.801), 0.833 (95% confidence interval, 0.622-1.000), 0.880 (95% confidence interval, 0.834-0.926), 0.303 (95% confidence interval, 0.146-0.460), and 0.988 (95% confidence interval, 0.972-1.000), respectively. CONCLUSION The 12-lead electrocardiography-based artificial intelligence/machine learning-based software as a medical device (AiTiALVSD) and 1-lead algorithm are noninvasive and effective ways of identifying cardiomyopathies occurring during the peripartum period, and they could potentially be used as highly sensitive screening tools for peripartum cardiomyopathy.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea Drs Jung, C Park, J Park, Jun, and S Lee); Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (Drs Jung and S Lee); Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee)
| | - Sora Kang
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee)
| | - Jeong Min Son
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee)
| | - Hak Seung Lee
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee)
| | - Ga In Han
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee)
| | - Ah-Hyun Yoo
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee)
| | - Joon-Myoung Kwon
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee)
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea Drs Jung, C Park, J Park, Jun, and S Lee)
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea Drs Jung, C Park, J Park, Jun, and S Lee)
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea Drs Jung, C Park, J Park, Jun, and S Lee)
| | - Min Sung Lee
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee).
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea Drs Jung, C Park, J Park, Jun, and S Lee); Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (Drs Jung and S Lee); Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea (Drs Jung, Ms Kang, Drs Son and H Lee, Ms Han, Ms Yoo, Drs Kwon, M Lee, and S Lee); Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea (Dr S Lee).
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Liu Z, Li H, Li W, Zhuang D, Zhang F, Ouyang W, Wang S, Bertolaccini L, Alskaf E, Pan X. Noncontact remote sensing of abnormal blood pressure using a deep neural network: a novel approach for hypertension screening. Quant Imaging Med Surg 2023; 13:8657-8668. [PMID: 38106309 PMCID: PMC10722034 DOI: 10.21037/qims-23-970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 12/19/2023]
Abstract
Background As the global burden of hypertension continues to increase, early diagnosis and treatment play an increasingly important role in improving the prognosis of patients. In this study, we developed and evaluated a method for predicting abnormally high blood pressure (HBP) from infrared (upper body) remote thermograms using a deep learning (DL) model. Methods The data used in this cross-sectional study were drawn from a coronavirus disease 2019 (COVID-19) pilot cohort study comprising data from 252 volunteers recruited from 22 July to 4 September 2020. Original video files were cropped at 5 frame intervals to 3,800 frames per slice. Blood pressure (BP) information was measured using a Welch Allyn 71WT monitor prior to infrared imaging, and an abnormal increase in BP was defined as a systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg. The PanycNet DL model was developed using a deep neural network to predict abnormal BP based on infrared thermograms. Results A total of 252 participants were included, of which 62.70% were male and 37.30% were female. The rate of abnormally high HBP was 29.20% of the total number. In the validation group (upper body), precision, recall, and area under the receiver operating characteristic curve (AUC) values were 0.930, 0.930, and 0.983 [95% confidence interval (CI): 0.904-1.000], respectively, and the head showed the strongest predictive ability with an AUC of 0.868 (95% CI: 0.603-0.994). Conclusions This is the first technique that can perform screening for hypertension without contact using existing equipment and data. It is anticipated that this technique will be suitable for mass screening of the population for abnormal BP in public places and home BP monitoring.
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Affiliation(s)
- Zeye Liu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hang Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenchao Li
- Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Huazhong Fuwai Hospital, Pediatric Cardiac Surgery, Zhengzhou, China
| | - Donglin Zhuang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbin Ouyang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shouzheng Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ebraham Alskaf
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, UK
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Che Z, O'Donovan S, Xiao X, Wan X, Chen G, Zhao X, Zhou Y, Yin J, Chen J. Implantable Triboelectric Nanogenerators for Self-Powered Cardiovascular Healthcare. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2207600. [PMID: 36759957 DOI: 10.1002/smll.202207600] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Triboelectric nanogenerators (TENGs) have gained significant traction in recent years in the bioengineering community. With the potential for expansive applications for biomedical use, many individuals and research groups have furthered their studies on the topic, in order to gain an understanding of how TENGs can contribute to healthcare. More specifically, there have been a number of recent studies focusing on implantable triboelectric nanogenerators (I-TENGs) toward self-powered cardiac systems healthcare. In this review, the progression of implantable TENGs for self-powered cardiovascular healthcare, including self-powered cardiac monitoring devices, self-powered therapeutic devices, and power sources for cardiac pacemakers, will be systematically reviewed. Long-term expectations of these implantable TENG devices through their biocompatibility and other utilization strategies will also be discussed.
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Affiliation(s)
- Ziyuan Che
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Sarah O'Donovan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Xiao Xiao
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Xiao Wan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Guorui Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Xun Zhao
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Yihao Zhou
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Junyi Yin
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
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Ullah M, Hamayun S, Wahab A, Khan SU, Rehman MU, Haq ZU, Rehman KU, Ullah A, Mehreen A, Awan UA, Qayum M, Naeem M. Smart Technologies used as Smart Tools in the Management of Cardiovascular Disease and their Future Perspective. Curr Probl Cardiol 2023; 48:101922. [PMID: 37437703 DOI: 10.1016/j.cpcardiol.2023.101922] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. The advent of smart technologies has significantly impacted the management of CVD, offering innovative tools and solutions to improve patient outcomes. Smart technologies have revolutionized and transformed the management of CVD, providing innovative tools to improve patient care, enhance diagnostics, and enable more personalized treatment approaches. These smart tools encompass a wide range of technologies, including wearable devices, mobile applications,3D printing technologies, artificial intelligence (AI), remote monitoring systems, and electronic health records (EHR). They offer numerous advantages, such as real-time monitoring, early detection of abnormalities, remote patient management, and data-driven decision-making. However, they also come with certain limitations and challenges, including data privacy concerns, technical issues, and the need for regulatory frameworks. In this review, despite these challenges, the future of smart technologies in CVD management looks promising, with advancements in AI algorithms, telemedicine platforms, and bio fabrication techniques opening new possibilities for personalized and efficient care. In this article, we also explore the role of smart technologies in CVD management, their advantages and disadvantages, limitations, current applications, and their smart future.
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Affiliation(s)
- Muneeb Ullah
- Department of Pharmacy, Kohat University of Science and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Shah Hamayun
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Abdul Wahab
- Department of Pharmacy, Kohat University of Science and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Shahid Ullah Khan
- Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, 22080, Khyber Pakhtunkhwa, Pakistan
| | - Mahboob Ur Rehman
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Zia Ul Haq
- Department of Public Health, Institute of Public Health Sciences, Khyber Medical University, Peshawar 25120, Pakistan
| | - Khalil Ur Rehman
- Department of Chemistry, Institute of chemical Sciences, Gomel University, Dera Ismail Khan, KPK, Pakistan
| | - Aziz Ullah
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea
| | - Aqsa Mehreen
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Punjab, Pakistan
| | - Uzma A Awan
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Punjab, Pakistan
| | - Mughal Qayum
- Department of Pharmacy, Kohat University of Science and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Naeem
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi, Punjab, Pakistan.
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Chandrasekaran R, Sharma P, Moustakas E. Exploring Disparities in Healthcare Wearable Use among Cardiovascular Patients: Findings from a National Survey. Rev Cardiovasc Med 2023; 24:307. [PMID: 39076432 PMCID: PMC11272832 DOI: 10.31083/j.rcm2411307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2024] Open
Abstract
Background Use of healthcare wearable devices holds significant potential for improving the prevention and management of cardiovascular diseases (CVD). However, we have limited knowledge on the actual use of wearable devices by CVD patients and the key factors associated with their use. This study aims to assess wearable device use and willingness to share health data among CVD patients, while identifying socio-demographic, health, and technology-related factors associated with wearable technology use. Methods Using a national survey of 933 CVD patients, we assess use of wearable healthcare devices (use, frequency of use and willingness to share health data from wearable with a provider), and a set of socio-demographic factors (age, gender, race, education and household income), health-related variables (general health, presence of comorbid conditions: diabetes and high blood pressure, attitude towards exercise) and technology self-efficacy using logistic regression. Results Of the 933 CVD patients, 18.34% reported using a healthcare wearable device in the prior 12 months. Of those, 41.92% indicated using it every day and another 19.76% indicated using it 'almost every day'. 83.54% of wearable users indicated their willingness to share health data with their healthcare providers. Female CVD patients are more likely to use wearables compared to men (odds ratio (OR) = 1.65, 95% confidence interval (CI) = 1.04-2.63). The odds decrease with age, and are significantly high in patients with higher income levels. In comparison with non-Hispanic White, Hispanic (OR = 0.14, 95% CI = 0.03-0.70) and African Americans (OR = 0.17, 95% CI = 0.04-0.86) are less likely to use healthcare wearables. CVD patients who perceive their general health to be better (OR = 1.45, 95% CI = 1.11-1.89) and those who enjoy exercising (OR = 1.76, 95% CI = 1.22-2.55) are more likely to use wearables. CVD patients who use the internet for searching for medical information (OR = 2.10, 95% CI = 1.17-3.77) and those who use electronic means to make appointments with their providers (OR = 2.35, 95% CI = 1.48-3.74) are more inclined to use wearables. Conclusions Addressing low wearable device usage among CVD patients requires targeted policy interventions to ensure equitable access. Variations in gender, age, race/ethnicity, and income levels emphasize the need for tailored strategies. Technological self-efficacy, positive health perceptions, and exercise enjoyment play significant roles in promoting wearable use. These insights should guide healthcare leaders in designing effective strategies for integrating wearables into cardiovascular care.
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Affiliation(s)
| | - Pratik Sharma
- Department of Information & Decision Sciences, University of Illinois at
Chicago, IL 60607, USA
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30
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Clark AM, Sousa BJ, Ski CF, Redfern J, Neubeck L, Allana S, Peart A, MacDougall D, Thompson DR. Main Mechanisms of Remote Monitoring Programs for Cardiac Rehabilitation and Secondary Prevention: A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2023; 43:412-418. [PMID: 37890176 DOI: 10.1097/hcr.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
PURPOSE The objective of this report was to identify the main mechanisms of home-based remote monitoring programs for cardiac rehabilitation (RM CR) and examine how these mechanisms vary by context. METHODS This was a systematic review using realist synthesis. To be included, articles had to be published in English between 2010 and November 2020 and contain specific data related to mechanisms of effect of programs. MEDLINE All (1946-) via Ovid, Embase (1974-) via Ovid, APA PsycINFO (1806-), CINAHL via EBSCO, Scopus databases, and gray literature were searched. RESULTS From 13 747 citations, 91 focused on cardiac conditions, with 23 reports including patients in CR. Effective RM CR programs more successfully adapted to different patient home settings and broader lives, incorporated individualized patient health data, and had content designed specifically for patients in cardiac rehabilitation. Relatively minor but common technical issues could significantly reduce perceived benefits. Patients and families were highly receptive to the programs and viewed themselves as fortunate to receive such services. The RM CR programs could be improved via incorporating more connectivity to other patients. No clear negative effects on perceived utility or outcomes occurred by patient age, ethnicity, or sex. Overall, the programs were seen to best suit highly motivated patients and consolidated rather than harmed existing relationships with health care professionals and teams. CONCLUSIONS Remote monitoring CR programs are perceived by patients to be beneficial and attractive. Future RM CR programs should consider adaptability to different home settings, incorporate individualized health data, and contain content specific to patient needs.
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Affiliation(s)
- Alexander M Clark
- Faculty of Health Disciplines, Athabasca University, Edmonton, Canada (Dr Clark); Office of the Provost and VP Academic, University of Alberta, Edmonton, Canada (Ms Sousa); Integrated Care Academy, University of Suffolk, Ipswich, England (Dr Ski); Faculty of Medicine and Health, The University of Sydney, Sydney, Australia (Dr Redfern); School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland (Dr Neubeck); School of Nursing, Western University, London, Ontario, Canada (Dr Allana), Eastern Health Clinical School, Monash University, Melbourne, Australia (Ms Peart); Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada (Ms MacDougall); and School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland (Dr Thompson)
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31
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White M, Pizzetta C, Davidson E, Hines A, Azevedo M, Ikem F, Jones LM, Malone S, Berhie G. Mississippi church leaders' perceptions of challenges and barriers to the use of consumer wearables among community members. AIMS Public Health 2023; 10:775-790. [PMID: 38187904 PMCID: PMC10764966 DOI: 10.3934/publichealth.2023052] [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: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 01/09/2024] Open
Abstract
Background Wearables have begun to play a transformative role in health management and disease prevention. Objective This study examined the use of wearable devices in African American communities in Mississippi, USA, through the lens of church leaders. Methods We conducted focus groups with church leaders to record their perceptions about the use of wearables of their community members. We conducted six focus groups with a total of 89 church leaders from across the state of Mississippi. The focus groups were designed to contextualize and explain the socio-cognitive processes that provided an understanding of wearable device adoption practices among community members. Participants were male and female church leaders who were recruited from the three Mississippi Districts. The church leaders' perceptions of barriers and challenges to the adoption of consumer wearables in their communities were thoroughly analyzed using thematic analysis. Results There was great apprehension on the part of community members about the security of the information they entered into the wearable devices and about how that information could be used by other parties. Many community members who understood the value of proactive health behaviors could not afford the high cost of purchasing wearable devices, while others displayed a low level of comfort with technology, believing that wearable use was for younger people. Conclusion More expansive adoption of wearable devices in Mississippi will depend on the ability of the public health professionals, policy-makers and manufacturers to address the barriers that were identified by this study, thereby enabling the community to have full access to the potential benefits of these technologies.
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Affiliation(s)
- Monique White
- Public Health, Informatics, and Technology, College of Health Sciences, Jackson State University, Jackson, MS, USA
| | - Candis Pizzetta
- Department of English, Foreign Languages, and Speech Communication, College of Liberal Arts, Jackson State University, Jackson, MS, USA
| | - Edith Davidson
- Department of Business Administration, College of Business Administration, Jackson State University, Jackson, MS, USA
| | - Andre Hines
- Department of Public Policy & Administration, College of Liberal Arts, Jackson State University, Jackson, MS, USA
| | - Mario Azevedo
- Department of History and Philosophy, College of Liberal Arts, Jackson State University, Jackson, MS, USA
| | - Fidelis Ikem
- Department of Business Administration, College of Business Administration, Jackson State University, Jackson, MS, USA
| | - Lena M. Jones
- Department of Public Policy & Administration, College of Liberal Arts, Jackson State University, Jackson, MS, USA
| | - Shelia Malone
- Department of Epidemiology and Biostatistics, College of Health Sciences, Jackson State University, Jackson, MS, USA
| | - Girmay Berhie
- Public Health, Informatics, and Technology, College of Health Sciences, Jackson State University, Jackson, MS, USA
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Chia PL, Tan K, Ng S, Foo D. Contemporary wearable and handheld technology for the diagnosis of cardiac arrhythmias in Singapore. Singapore Med J 2023:386397. [PMID: 37870042 DOI: 10.4103/singaporemedj.smj-2023-048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Twelve-lead electrocardiography (ECG) remains the gold standard for the diagnosis of cardiac arrhythmias. It provides a snapshot of the cardiac electrical activity while the leads are attached to the patient. As medical training is required to use the ECG machine, its use remains restricted to the clinic and hospital settings. These aspects limit the usefulness of 12-lead ECG in the diagnosis of cardiac arrhythmias, especially in individuals with short-lasting and infrequent paroxysmal symptoms. The introduction of ECG recording features in wearable and handheld smart devices has changed the paradigm of cardiac arrhythmia diagnosis, empowering patients to record their ECG as and when symptoms occur. This review describes contemporary ambulatory heart rhythm monitors commonly available in Singapore and their expanding role in the diagnosis of cardiac rhythm abnormalities.
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Affiliation(s)
- Pow-Li Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Kenny Tan
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Shonda Ng
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - David Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
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Barrigon ML, Romero-Medrano L, Moreno-Muñoz P, Porras-Segovia A, Lopez-Castroman J, Courtet P, Artés-Rodríguez A, Baca-Garcia E. One-Week Suicide Risk Prediction Using Real-Time Smartphone Monitoring: Prospective Cohort Study. J Med Internet Res 2023; 25:e43719. [PMID: 37656498 PMCID: PMC10504627 DOI: 10.2196/43719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/03/2023] [Accepted: 06/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Suicide is a major global public health issue that is becoming increasingly common despite preventive efforts. Though current methods for predicting suicide risk are not sufficiently accurate, technological advances provide invaluable tools with which we may evolve toward a personalized, predictive approach. OBJECTIVE We aim to predict the short-term (1-week) risk of suicide by identifying changes in behavioral patterns characterized through real-time smartphone monitoring in a cohort of patients with suicidal ideation. METHODS We recruited 225 patients between February 2018 and March 2020 with a history of suicidal thoughts and behavior as part of the multicenter SmartCrisis study. Throughout 6 months of follow-up, we collected information on the risk of suicide or mental health crises. All participants underwent voluntary passive monitoring using data generated by their own smartphones, including distance walked and steps taken, time spent at home, and app usage. The algorithm constructs daily activity profiles for each patient according to these data and detects changes in the distribution of these profiles over time. Such changes are considered critical periods, and their relationship with suicide-risk events was tested. RESULTS During follow-up, 18 (8%) participants attempted suicide, and 14 (6.2%) presented to the emergency department for psychiatric care. The behavioral changes identified by the algorithm predicted suicide risk in a time frame of 1 week with an area under the curve of 0.78, indicating good accuracy. CONCLUSIONS We describe an innovative method to identify mental health crises based on passively collected information from patients' smartphones. This technology could be applied to homogeneous groups of patients to identify different types of crises.
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Affiliation(s)
- Maria Luisa Barrigon
- Department of Psychiatry, Jimenez Diaz Foundation University Hospital, Madrid, Spain
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lorena Romero-Medrano
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Madrid, Spain
- Evidence-Based Behavior (eB2), Madrid, Spain
| | - Pablo Moreno-Muñoz
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Madrid, Spain
- Cognitive Systems Section, Technical University of Denmark, Lyngby, Denmark
| | | | - Jorge Lopez-Castroman
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Madrid, Spain
- Department of Psychiatry, Centre Hospitalier Universitaire Nîmes, Nîmes, France
- Institut de Génomique Fonctionnelle, CNRS-INSERM, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Institut de Génomique Fonctionnelle, CNRS-INSERM, University of Montpellier, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, Centre Hospitalier Universitaire, Montpellier, France
| | - Antonio Artés-Rodríguez
- Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Madrid, Spain
- Evidence-Based Behavior (eB2), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
- Instituto de Investigacion Sanitaria Gregorio Marañón, Madrid, Spain
| | - Enrique Baca-Garcia
- Department of Psychiatry, Jimenez Diaz Foundation University Hospital, Madrid, Spain
- Evidence-Based Behavior (eB2), Madrid, Spain
- Department of Psychiatry, Centre Hospitalier Universitaire Nîmes, Nîmes, France
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Institute of Health, Madrid, Spain
- Department of Psychiatry, Autonomous University of Madrid, Madrid, Spain
- Department of Psychiatry, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain
- Department of Psychiatry, General Hospital of Villalba, Madrid, Spain
- Department of Psychiatry, Infanta Elena University Hospital, Valdemoro, Madrid, Spain
- Department of Psychology, Universidad Catolica del Maule, Talca, Chile
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Naydenov S, Jekova I, Krasteva V. Recognition of Supraventricular Arrhythmias in Holter ECG Recordings by ECHOView Color Map: A Case Series Study. J Cardiovasc Dev Dis 2023; 10:360. [PMID: 37754789 PMCID: PMC10532174 DOI: 10.3390/jcdd10090360] [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: 07/28/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Ambulatory 24-72 h Holter ECG monitoring is recommended for patients with suspected arrhythmias, which are often transitory and might remain unseen in resting standard 12-lead ECG. Holter manufacturers provide software diagnostic tools to assist clinicians in evaluating these large amounts of data. Nevertheless, the identification of short arrhythmia events and differentiation of the arrhythmia type might be a problem in limited Holter ECG leads. This observational clinical study aims to explore a novel and weakly investigated ECG modality integrated into a commercial diagnostic tool ECHOView (medilog DARWIN 2, Schiller AG, Switzerland), while used for the interpretation of long-term Holter-ECG records by a cardiologist. The ECHOView transformation maps the beat waveform amplitude to a color-coded bar. One ECHOView page integrates stacked color bars of about 1740 sequential beats aligned by R-peak in a window (R ± 750 ms). The collected 3-lead Holter ECG recordings from 86 patients had a valid duration of 21 h 20 min (19 h 30 min-22 h 45 min), median (quartile range). The ECG rhythm was reviewed with 3491 (3192-3723) standard-grid ECG pages and a substantially few number of 51 (44-59) ECHOView pages that validated the ECHOView compression ratio of 67 (59-74) times. Comments on the ECG rhythm and ECHOView characteristic patterns are provided for 14 examples representative of the most common rhythm disorders seen in our population, including supraventricular arrhythmias (supraventricular extrasystoles, paroxysmal supraventricular arrhythmia, sinus tachycardia, supraventricular tachycardia, atrial fibrillation, and flutter) and ventricular arrhythmias (ventricular extrasystoles, non-sustained ventricular tachycardia). In summary, the ECHOView color map transforms the ECG modality into a novel diagnostic image of the patient's rhythm that is comprehensively interpreted by a cardiologist. ECHOView has the potential to facilitate the manual overview of Holter ECG recordings, to visually identify short-term arrhythmia episodes, and to refine the diagnosis, especially in high-rate arrhythmias.
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Affiliation(s)
- Stefan Naydenov
- Department of Internal Diseases “Prof. St. Kirkovich”, Medical University of Sofia, 1431 Sofia, Bulgaria;
| | - Irena Jekova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl. 105, 1113 Sofia, Bulgaria;
| | - Vessela Krasteva
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str. Bl. 105, 1113 Sofia, Bulgaria;
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Zepeda-Echavarria A, van de Leur RR, van Sleuwen M, Hassink RJ, Wildbergh TX, Doevendans PA, Jaspers J, van Es R. Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review. JMIR Cardio 2023; 7:e44003. [PMID: 37418308 PMCID: PMC10362423 DOI: 10.2196/44003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments. OBJECTIVE This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence. METHODS We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices' technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases. RESULTS From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation. CONCLUSIONS ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities.
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Affiliation(s)
- Alejandra Zepeda-Echavarria
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Meike van Sleuwen
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
- HeartEye BV, Delft, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Joris Jaspers
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - René van Es
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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Bazoukis G, Bollepalli SC, Chung CT, Li X, Tse G, Bartley BL, Batool-Anwar S, Quan SF, Armoundas AA. Application of artificial intelligence in the diagnosis of sleep apnea. J Clin Sleep Med 2023; 19:1337-1363. [PMID: 36856067 PMCID: PMC10315608 DOI: 10.5664/jcsm.10532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023]
Abstract
STUDY OBJECTIVES Machine learning (ML) models have been employed in the setting of sleep disorders. This review aims to summarize the existing data about the role of ML techniques in the diagnosis, classification, and treatment of sleep-related breathing disorders. METHODS A systematic search in Medline, EMBASE, and Cochrane databases through January 2022 was performed. RESULTS Our search strategy revealed 132 studies that were included in the systematic review. Existing data show that ML models have been successfully used for diagnostic purposes. Specifically, ML models showed good performance in diagnosing sleep apnea using easily obtained features from the electrocardiogram, pulse oximetry, and sound signals. Similarly, ML showed good performance for the classification of sleep apnea into obstructive and central categories, as well as predicting apnea severity. Existing data show promising results for the ML-based guided treatment of sleep apnea. Specifically, the prediction of outcomes following surgical treatment and optimization of continuous positive airway pressure therapy can be guided by ML models. CONCLUSIONS The adoption and implementation of ML in the field of sleep-related breathing disorders is promising. Advancements in wearable sensor technology and ML models can help clinicians predict, diagnose, and classify sleep apnea more accurately and efficiently. CITATION Bazoukis G, Bollepalli SC, Chung CT, et al. Application of artificial intelligence in the diagnosis of sleep apnea. J Clin Sleep Med. 2023;19(7):1337-1363.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Cheuk To Chung
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
| | - Xinmu Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong
- Kent and Medway Medical School, Canterbury, Kent, United Kingdom
| | - Bethany L. Bartley
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Salma Batool-Anwar
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Asthma and Airway Disease Research Center, University of Arizona College of Medicine, Tucson, Arizona
| | - Antonis A. Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
- Broad Institute, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Gagnon-Turcotte G, Cote-Allard U, Mascret Q, Torresen J, Gosselin B. Photoplethysmography-based derivation of physiological information using the BioPoint. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083646 DOI: 10.1109/embc40787.2023.10340642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The BioPoint is a new wireless and wearable device, targeting both the ambulatory and on-site monitoring of biosignals. It is described as being capable of streaming and recording the i) electromyography, ii) electrocardiography, iii) electrodermal activity, iv) photoplethysmography, v) skin temperature and vi) actigraphy simultaneously, while making the raw signals recorded by the sensors readily available. However, an in-depth assessment of the biophysical signals recorded by this device, as well as its ability to derive vital signs and other health metrics, remains to be carried out. Consequently, this work proposes a preliminary study to evaluate the quality of the signals that can be acquired by this wearable with a focus on the derivation of heart rate and peripheral blood oxygenation via photoplethysmography. The device is quantitatively compared to the medical-grade pulse oximeter NoninConnect 3245, by Nonin inc. This study was performed with participants wearing the BioPoint at different positions on the body (finger, wrist, forearm, biceps and plantar arch), while the NoninConnect was worn on the fingertip and used as the ground truth. The results show that the BioPoint can accurately determine both heart rate and oxygen saturation from various locations on the body. However, as the BioPoint's photoplethysmograph is not calibrated it cannot be used for medical purposes (non-medical-grade).
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Zaman S, Padayachee Y, Shah M, Samways J, Auton A, Quaife NM, Sweeney M, Howard JP, Tenorio I, Bachtiger P, Kamalati T, Pabari PA, Linton NWF, Mayet J, Peters NS, Barton C, Cole GD, Plymen CM. Smartphone-Based Remote Monitoring in Heart Failure With Reduced Ejection Fraction: Retrospective Cohort Study of Secondary Care Use and Costs. JMIR Cardio 2023; 7:e45611. [PMID: 37351921 PMCID: PMC10334716 DOI: 10.2196/45611] [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: 01/12/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Despite effective therapies, the economic burden of heart failure with reduced ejection fraction (HFrEF) is driven by frequent hospitalizations. Treatment optimization and admission avoidance rely on frequent symptom reviews and monitoring of vital signs. Remote monitoring (RM) aims to prevent admissions by facilitating early intervention, but the impact of noninvasive, smartphone-based RM of vital signs on secondary health care use and costs in the months after a new diagnosis of HFrEF is unknown. OBJECTIVE The purpose of this study is to conduct a secondary care health use and health-economic evaluation for patients with HFrEF using smartphone-based noninvasive RM and compare it with matched controls receiving usual care without RM. METHODS We conducted a retrospective study of 2 cohorts of newly diagnosed HFrEF patients, matched 1:1 for demographics, socioeconomic status, comorbidities, and HFrEF severity. They are (1) the RM group, with patients using the RM platform for >3 months and (2) the control group, with patients referred before RM was available who received usual heart failure care without RM. Emergency department (ED) attendance, hospital admissions, outpatient use, and the associated costs of this secondary care activity were extracted from the Discover data set for a 3-month period after diagnosis. Platform costs were added for the RM group. Secondary health care use and costs were analyzed using Kaplan-Meier event analysis and Cox proportional hazards modeling. RESULTS A total of 146 patients (mean age 63 years; 42/146, 29% female) were included (73 in each group). The groups were well-matched for all baseline characteristics except hypertension (P=.03). RM was associated with a lower hazard of ED attendance (hazard ratio [HR] 0.43; P=.02) and unplanned admissions (HR 0.26; P=.02). There were no differences in elective admissions (HR 1.03, P=.96) or outpatient use (HR 1.40; P=.18) between the 2 groups. These differences were sustained by a univariate model controlling for hypertension. Over a 3-month period, secondary health care costs were approximately 4-fold lower in the RM group than the control group, despite the additional cost of RM itself (mean cost per patient GBP £465, US $581 vs GBP £1850, US $2313, respectively; P=.04). CONCLUSIONS This retrospective cohort study shows that smartphone-based RM of vital signs is feasible for HFrEF. This type of RM was associated with an approximately 2-fold reduction in ED attendance and a 4-fold reduction in emergency admissions over just 3 months after a new diagnosis with HFrEF. Costs were significantly lower in the RM group without increasing outpatient demand. This type of RM could be adjunctive to standard care to reduce admissions, enabling other resources to help patients unable to use RM.
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Affiliation(s)
| | - Yorissa Padayachee
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Moulesh Shah
- Imperial College Health Partners, London, United Kingdom
| | - Jack Samways
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Alice Auton
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Nicholas M Quaife
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | | | - Indira Tenorio
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | | | - Punam A Pabari
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | - Jamil Mayet
- Imperial College London, London, United Kingdom
| | | | - Carys Barton
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | | | - Carla M Plymen
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
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Turnbull S, Garikapati K, Bennett RG, Campbell TG, Kotake Y, Mahajan R, Marschner S, Byth K, Chow CK, Kumar S. Utility of a Handheld, Single-Lead ECG Device for Diagnosis of Cardiac Arrhythmias. J Am Coll Cardiol 2023; 81:2292-2294. [PMID: 37286259 DOI: 10.1016/j.jacc.2023.03.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/02/2023] [Accepted: 03/31/2023] [Indexed: 06/09/2023]
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Jones AK, Yan CL, Rivera Rodriquez BP, Kaur S, Andrade-Bucknor S. Role of wearable devices in cardiac telerehabilitation: A scoping review. PLoS One 2023; 18:e0285801. [PMID: 37256878 DOI: 10.1371/journal.pone.0285801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based comprehensive program that includes exercise training, health education, physical activity promotion, and extensive counseling for the management of cardiovascular risk factors. Wearable devices monitor certain physiological functions, providing biometric data such as heart rate, movement, sleep, ECG analysis, blood pressure, energy expenditure, and numerous other parameters. Recent evidence supports wearable devices as a likely relevant component in cardiovascular risk assessment and disease prevention. The purpose of this scoping review is to better understand the role of wearable devices in home-based CR (HBCR) and to characterize the evidence regarding the incorporation of wearable devices in HBCR programs and cardiovascular outcomes. METHODS & FINDINGS We created a search strategy for multiple databases, including PubMed, Embase (Elsevier), CINAHL (Ebsco), Cochrane CENTRAL (Wiley), and Scopus (Elsevier). Studies were included if the patients were eligible for CR per Medicare guidelines and >18 years of age and if some type of wearable device was utilized during HBCR. Our search yielded 57 studies meeting all criteria. The studies were classified into 4 groups: patients with coronary heart disease (CHD) without heart failure (HF); patients with HF; patients with heart valve repair or replacement; and patients with exposure to center-based CR. In three groups, there was an upward trend toward improvement in quality of life (QOL) and peak VO2, less sedentary time, and an increase in daily step count in the intervention groups compared to control groups. CONCLUSIONS HBCR using wearable devices can be a comparable alternative or adjunct to center-based CR for patients with CHD and HF. More studies are needed to draw conclusions about the comparability of HBCR to center-based CR in patients with heart valve repair or replacement.
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Affiliation(s)
- Alexis K Jones
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Crystal Lihong Yan
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | - Beatriz P Rivera Rodriquez
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | - Sukhpreet Kaur
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | - Sharon Andrade-Bucknor
- Department of Medicine, Division of Cardiovascular Disease, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
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Wang Q, Cui J, Tang Y, Pang L, Chen K, Zhang B. Research on a Precision Calibration Model of a Flexible Strain Sensor Based on a Variable Section Cantilever Beam. SENSORS (BASEL, SWITZERLAND) 2023; 23:4778. [PMID: 37430692 DOI: 10.3390/s23104778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 07/12/2023]
Abstract
The flexible strain sensor's measuring range is usually over 5000 με, while the conventional variable section cantilever calibration model has a measuring range within 1000 με. In order to satisfy the calibration requirements of flexible strain sensors, a new measurement model was proposed to solve the inaccurate calculation problem of the theoretical strain value when the linear model of a variable section cantilever beam was applied to a large range. The nonlinear relationship between deflection and strain was established. The finite element analysis of a variable section cantilever beam with ANSYS shows that the linear model's relative deviation is as high as 6% at 5000 με, while the relative deviation of the nonlinear model is only 0.2%. The relative expansion uncertainty of the flexible resistance strain sensor is 0.365% (k = 2). Simulation and experimental results show that this method solves the imprecision of the theoretical model effectively and realizes the accurate calibration of a large range of strain sensors. The research results enrich the measurement models and calibration models for flexible strain sensors and contribute to the development of strain metering.
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Affiliation(s)
- Qi Wang
- School of Information Science and Engineering, Zhejiang Sci-Tech University, Hangzhou 310018, China
- National Institute of Metrology, Beijing 100029, China
| | - Jianjun Cui
- National Institute of Metrology, Beijing 100029, China
| | - Yanhong Tang
- Metrology and Testing Institute of Tibet Autonomous Region, Lhasa 850000, China
| | - Liang Pang
- Metrology and Testing Institute of Tibet Autonomous Region, Lhasa 850000, China
| | - Kai Chen
- National Institute of Metrology, Beijing 100029, China
| | - Baowu Zhang
- College of Metrology and Measurement Engineering, China Jiliang University, Hangzhou 310018, China
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Shurlock J, Brown S, Dayer M, Furniss G. Rapid Roll Out of a Pacemaker Home Monitoring Programme: A Patient Perspective. Heart Lung Circ 2023:S1443-9506(23)00151-8. [PMID: 37150706 DOI: 10.1016/j.hlc.2023.03.015] [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: 09/27/2022] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess the safety, efficacy, and patient acceptability of a pacemaker home monitoring (HM) service. METHODS All patients receiving a new Biotronik (Biotronik, Berlin, Germany) pacemaker between March 2020 and February 2021 were contacted for participation. Participants were surveyed on their experience of pacemaker HM. HM alerts and remote wound monitoring rates were also assessed. RESULTS Of the patients contacted, 77% responded, with a mean age of 80.6±9.9 years. Of these, 95.8% agreed that the home monitoring (HM) has been beneficial. Two thirds preferred HM to face-to-face follow-up and two thirds felt safe with HM. Three themes were identified from the comments: reassurance, technology and data security. Forty-one percent (41%) of respondents would like more reassurance that their HM is working, 18% mentioned technology with mixed responses, and 4.7% cited cybersecurity or the use of their personal data as a concern. The average one-way patient journey saved was 24.3±16.7 km (15.1±10.4 miles). One in three HM alerts required action but only 3.4% were urgent. Remote wound review was successful in 59%. CONCLUSIONS The majority of patients prefer HM and almost all think it has been beneficial. It saves significant travel time and provides actionable alerts. The patient experience could be improved by reassuring patients that their device is being monitored.
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Affiliation(s)
| | - Stewart Brown
- Cardiology department, Musgrove Park Hospital, Taunton, UK
| | - Mark Dayer
- Cardiology department, Musgrove Park Hospital, Taunton, UK
| | - Guy Furniss
- Cardiology department, Musgrove Park Hospital, Taunton, UK
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Hearn J, Van den Eynde J, Chinni B, Cedars A, Gottlieb Sen D, Kutty S, Manlhiot C. Data Quality Degradation on Prediction Models Generated From Continuous Activity and Heart Rate Monitoring: Exploratory Analysis Using Simulation. JMIR Cardio 2023; 7:e40524. [PMID: 37133921 DOI: 10.2196/40524] [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: 06/24/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Limited data accuracy is often cited as a reason for caution in the integration of physiological data obtained from consumer-oriented wearable devices in care management pathways. The effect of decreasing accuracy on predictive models generated from these data has not been previously investigated. OBJECTIVE The aim of this study is to simulate the effect of data degradation on the reliability of prediction models generated from those data and thus determine the extent to which lower device accuracy might or might not limit their use in clinical settings. METHODS Using the Multilevel Monitoring of Activity and Sleep in Healthy People data set, which includes continuous free-living step count and heart rate data from 21 healthy volunteers, we trained a random forest model to predict cardiac competence. Model performance in 75 perturbed data sets with increasing missingness, noisiness, bias, and a combination of all 3 perturbations was compared to model performance for the unperturbed data set. RESULTS The unperturbed data set achieved a mean root mean square error (RMSE) of 0.079 (SD 0.001) in predicting cardiac competence index. For all types of perturbations, RMSE remained stable up to 20%-30% perturbation. Above this level, RMSE started increasing and reached the point at which the model was no longer predictive at 80% for noise, 50% for missingness, and 35% for the combination of all perturbations. Introducing systematic bias in the underlying data had no effect on RMSE. CONCLUSIONS In this proof-of-concept study, the performance of predictive models for cardiac competence generated from continuously acquired physiological data was relatively stable with declining quality of the source data. As such, lower accuracy of consumer-oriented wearable devices might not be an absolute contraindication for their use in clinical prediction models.
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Affiliation(s)
- Jason Hearn
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Jef Van den Eynde
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Bhargava Chinni
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Ari Cedars
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Danielle Gottlieb Sen
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Shelby Kutty
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Heart Center, Johns Hopkins University, Baltimore, MD, United States
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Garg L, Moss J, Hyman MC, Arkles J, Callans DJ, Dixit S, Epstein AE, Frankel DS, Garcia FC, Kumareswaran R, Sharkoski T, Markman TM, Nazarian S, Riley MP, Santangeli P, Schaller RD, Supple GE, Marchlinski F, Deo R. Simultaneous comparison of patch versus multi-electrode cardiac monitoring for the detection of arrhythmias: The COMPARE study. Heart Rhythm 2023:S1547-5271(23)02118-5. [PMID: 37085025 DOI: 10.1016/j.hrthm.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Lohit Garg
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado, Denver, Colorado
| | - Juwann Moss
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew E Epstein
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tiffany Sharkoski
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy M Markman
- Division of Cardiovascular Medicine, Electrophysiology Section, University of Colorado, Denver, Colorado
| | - Saman Nazarian
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Riley
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Robert D Schaller
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis Marchlinski
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Division of Cardiovascular Medicine, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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McLean MK, Weaver RG, Lane A, Smith MT, Parker H, Stone B, McAninch J, Matolak DW, Burkart S, Chandrashekhar MVS, Armstrong B. A Sliding Scale Signal Quality Metric of Photoplethysmography Applicable to Measuring Heart Rate across Clinical Contexts with Chest Mounting as a Case Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:3429. [PMID: 37050488 PMCID: PMC10098585 DOI: 10.3390/s23073429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
UNLABELLED Photoplethysmography (PPG) signal quality as a proxy for accuracy in heart rate (HR) measurement is useful in various public health contexts, ranging from short-term clinical diagnostics to free-living health behavior surveillance studies that inform public health policy. Each context has a different tolerance for acceptable signal quality, and it is reductive to expect a single threshold to meet the needs across all contexts. In this study, we propose two different metrics as sliding scales of PPG signal quality and assess their association with accuracy of HR measures compared to a ground truth electrocardiogram (ECG) measurement. METHODS We used two publicly available PPG datasets (BUT PPG and Troika) to test if our signal quality metrics could identify poor signal quality compared to gold standard visual inspection. To aid interpretation of the sliding scale metrics, we used ROC curves and Kappa values to calculate guideline cut points and evaluate agreement, respectively. We then used the Troika dataset and an original dataset of PPG data collected from the chest to examine the association between continuous metrics of signal quality and HR accuracy. PPG-based HR estimates were compared with reference HR estimates using the mean absolute error (MAE) and the root-mean-square error (RMSE). Point biserial correlations were used to examine the association between binary signal quality and HR error metrics (MAE and RMSE). RESULTS ROC analysis from the BUT PPG data revealed that the AUC was 0.758 (95% CI 0.624 to 0.892) for signal quality metrics of STD-width and 0.741 (95% CI 0.589 to 0.883) for self-consistency. There was a significant correlation between criterion poor signal quality and signal quality metrics in both Troika and originally collected data. Signal quality was highly correlated with HR accuracy (MAE and RMSE, respectively) between PPG and ground truth ECG. CONCLUSION This proof-of-concept work demonstrates an effective approach for assessing signal quality and demonstrates the effect of poor signal quality on HR measurement. Our continuous signal quality metrics allow estimations of uncertainties in other emergent metrics, such as energy expenditure that relies on multiple independent biometrics. This open-source approach increases the availability and applicability of our work in public health settings.
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Affiliation(s)
- Marnie K. McLean
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - R. Glenn Weaver
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Abbi Lane
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Michal T. Smith
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Hannah Parker
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Ben Stone
- College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - Jonas McAninch
- College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - David W. Matolak
- College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - Sarah Burkart
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | | | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
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Cao YT, Zhao XX, Yang YT, Zhu SJ, Zheng LD, Ying T, Sha Z, Zhu R, Wu T. Potential of electronic devices for detection of health problems in older adults at home: A systematic review and meta-analysis. Geriatr Nurs 2023; 51:54-64. [PMID: 36893611 DOI: 10.1016/j.gerinurse.2023.02.007] [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: 12/11/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aim of this review was to evaluate the overall diagnostic performance of e-devices for detection of health problems in older adults at home. METHODS A systematic review was conducted following the PRISMA-DTA guidelines. RESULTS 31 studies were included with 24 studies included in meta-analysis. The included studies were divided into four categories according to the signals detected: physical activity (PA), vital signs (VS), electrocardiography (ECG) and other. The meta-analysis showed the pooled estimates of sensitivity and specificity were 0.94 and 0.98 respectively in the 'VS' group. The pooled sensitivity and specificity were 0.97 and 0.98 respectively in the 'ECG' group. CONCLUSIONS All kinds of e-devices perform well in diagnosing the common health problems. While ECG-based health problems detection system is more reliable than VS-based ones. For sole signal detection system has limitation in diagnosing specific health problems, more researches should focus on developing new systems combined of multiple signals.
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Affiliation(s)
- Yu-Ting Cao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, 200065 Shanghai, China
| | - Xin-Xin Zhao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China
| | - Yi-Ting Yang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, 200065 Shanghai, China
| | - Shi-Jie Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, 200065 Shanghai, China
| | - Liang-Dong Zheng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, 200065 Shanghai, China
| | - Ting Ying
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, 200065 Shanghai, China
| | - Zhou Sha
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, 200065 Shanghai, China
| | - Rui Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai 200092, China; Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, 200065 Shanghai, China.
| | - Tao Wu
- Shanghai University of Medicine & Health Sciences, 201318 Shanghai, China
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Abstract
Wearable devices, such as smartwatches and activity trackers, are commonly used by patients in their everyday lives to manage their health and well-being. These devices collect and analyze long-term continuous data on measures of behavioral or physiologic function, which may provide clinicians with a more comprehensive view of a patients' health compared with the traditional sporadic measures captured by office visits and hospitalizations. Wearable devices have a wide range of potential clinical applications ranging from arrhythmia screening of high-risk individuals to remote management of chronic conditions such as heart failure or peripheral artery disease. As the use of wearable devices continues to grow, we must adopt a multifaceted approach with collaboration among all key stakeholders to effectively and safely integrate these technologies into routine clinical practice. In this Review, we summarize the features of wearable devices and associated machine learning techniques. We describe key research studies that illustrate the role of wearable devices in the screening and management of cardiovascular conditions and identify directions for future research. Last, we highlight the challenges that are currently hindering the widespread use of wearable devices in cardiovascular medicine and provide short- and long-term solutions to promote increased use of wearable devices in clinical care.
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Affiliation(s)
- Andrew Hughes
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, NC
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
| | - Evan Brittain
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
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Orini M, van Duijvenboden S, Young WJ, Ramírez J, Jones AR, Tinker A, Munroe PB, Lambiase PD. Premature atrial and ventricular contractions detected on wearable-format electrocardiograms and prediction of cardiovascular events. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:112-118. [PMID: 36974269 PMCID: PMC10039429 DOI: 10.1093/ehjdh/ztad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Aims Wearable devices are transforming the electrocardiogram (ECG) into a ubiquitous medical test. This study assesses the association between premature ventricular and atrial contractions (PVCs and PACs) detected on wearable-format ECGs (15 s single lead) and cardiovascular outcomes in individuals without cardiovascular disease (CVD). Methods and results Premature atrial contractions and PVCs were identified in 15 s single-lead ECGs from N = 54 016 UK Biobank participants (median age, interquartile range, age 58, 50-63 years, 54% female). Cox regression models adjusted for traditional risk factors were used to determine associations with atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), stroke, life-threatening ventricular arrhythmias (LTVAs), and mortality over a period of 11.5 (11.4-11.7) years. The strongest associations were found between PVCs (prevalence 2.2%) and HF (hazard ratio, HR, 95% confidence interval = 2.09, 1.58-2.78) and between PACs (prevalence 1.9%) and AF (HR = 2.52, 2.11-3.01), with shorter prematurity further increasing risk. Premature ventricular contractions and PACs were also associated with LTVA (P < 0.05). Associations with MI, stroke, and mortality were significant only in unadjusted models. In a separate UK Biobank sub-study sample [UKB-2, N = 29,324, age 64, 58-60 years, 54% female, follow-up 3.5 (2.6-4.8) years] used for independent validation, after adjusting for risk factors, PACs were associated with AF (HR = 1.80, 1.12-2.89) and PVCs with HF (HR = 2.32, 1.28-4.22). Conclusion In middle-aged individuals without CVD, premature contractions identified in 15 s single-lead ECGs are strongly associated with an increased risk of AF and HF. These data warrant further investigation to assess the role of wearable ECGs for early cardiovascular risk stratification.
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Affiliation(s)
- Michele Orini
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
| | - Stefan van Duijvenboden
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - William J Young
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Julia Ramírez
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Aragon Institute of Engineering Research, University of Zaragoza and Centro de Investigación Biomédica en Red, Bioingeniería, Biomateriales y Nanotecnología Zaragoza, C/ de Mariano Esquillor Gómez, Zaragoza 50018, Spain
| | - Aled R Jones
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Andrew Tinker
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patricia B Munroe
- Clinical Pharmacology and Precision Medicine, Faculty of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
- Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
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Hoevelmann J, Sliwa K, Briton O, Ntsekhe M, Chin A, Viljoen C. Effectiveness of implantable loop recorder and Holter electrocardiographic monitoring for the detection of arrhythmias in patients with peripartum cardiomyopathy. Clin Res Cardiol 2023; 112:379-391. [PMID: 36131137 PMCID: PMC9998321 DOI: 10.1007/s00392-022-02101-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with peripartum cardiomyopathy (PPCM) are at increased risk of sudden cardiac death (SCD). However, the exact underlying mechanisms of SCD in PPCM remain unknown. By means of extended electrocardiographic monitoring, we aimed to systematically characterize the burden of arrhythmias occurring in patients with newly diagnosed PPCM. METHODS AND RESULTS Twenty-five consecutive women with PPCM were included in this single-centre, prospective clinical trial and randomised to receiving either 24 h-Holter ECG monitoring followed by implantable loop recorder implantation (ILR; REVEAL XT, Medtronic®) or 24 h-Holter ECG monitoring alone. ILR + 24 h-Holter monitoring had a higher yield of arrhythmic events compared to 24 h-Holter monitoring alone (40% vs 6.7%, p = 0.041). Non-sustained ventricular tachycardia (NSVT) occurred in four patients (16%, in three patients detected by 24 h-Holter, and multiple episodes detected by ILR in one patient). One patient deceased from third-degree AV block with an escape rhythm that failed. All arrhythmic events occurred in patients with a severely impaired LV systolic function. CONCLUSIONS We found a high prevalence of potentially life-threatening arrhythmic events in patients with newly diagnosed PPCM. These included both brady- and tachyarrhythmias. Our results highlight the importance of extended electrocardiographic monitoring, especially in those with severely impaired LV systolic function. In this regard, ILR in addition to 24 h-Holter monitoring had a higher yield of VAs as compared to 24 h-Holter monitoring alone. In settings where WCDs are not readily available, ILR monitoring should be considered in patients with severely impaired LV systolic dysfunction, especially after uneventful 24 h-Holter monitoring. TRIAL REGISTRATION Pan African Clinical Trials Registry: PACTR202104866174807. Extended electrocardiographic monitoring for the detection of arrhythmias in PPCM. (CHB, complete heart block/third degree AV block; ECG, electrocardiogram; ILR, implantable loop recorder; NSVT, non-sustained ventricular tachycardia; PPCM, peripartum cardiomyopathy).
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Affiliation(s)
- Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Observatory, Private Bag X3, Cape Town, 7935, South Africa. .,Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Homburg (Saar), Deutschland.
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Observatory, Private Bag X3, Cape Town, 7935, South Africa.,Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Olivia Briton
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Observatory, Private Bag X3, Cape Town, 7935, South Africa
| | - Mpiko Ntsekhe
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Observatory, Private Bag X3, Cape Town, 7935, South Africa.,Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Ashley Chin
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Observatory, Private Bag X3, Cape Town, 7935, South Africa.,Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Charle Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Observatory, Private Bag X3, Cape Town, 7935, South Africa.,Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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50
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Moshawrab M, Adda M, Bouzouane A, Ibrahim H, Raad A. Smart Wearables for the Detection of Cardiovascular Diseases: A Systematic Literature Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23020828. [PMID: 36679626 PMCID: PMC9865666 DOI: 10.3390/s23020828] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 06/02/2023]
Abstract
Background: The advancement of information and communication technologies and the growing power of artificial intelligence are successfully transforming a number of concepts that are important to our daily lives. Many sectors, including education, healthcare, industry, and others, are benefiting greatly from the use of such resources. The healthcare sector, for example, was an early adopter of smart wearables, which primarily serve as diagnostic tools. In this context, smart wearables have demonstrated their effectiveness in detecting and predicting cardiovascular diseases (CVDs), the leading cause of death worldwide. Objective: In this study, a systematic literature review of smart wearable applications for cardiovascular disease detection and prediction is presented. After conducting the required search, the documents that met the criteria were analyzed to extract key criteria such as the publication year, vital signs recorded, diseases studied, hardware used, smart models used, datasets used, and performance metrics. Methods: This study followed the PRISMA guidelines by searching IEEE, PubMed, and Scopus for publications published between 2010 and 2022. Once records were located, they were reviewed to determine which ones should be included in the analysis. Finally, the analysis was completed, and the relevant data were included in the review along with the relevant articles. Results: As a result of the comprehensive search procedures, 87 papers were deemed relevant for further review. In addition, the results are discussed to evaluate the development and use of smart wearable devices for cardiovascular disease management, and the results demonstrate the high efficiency of such wearable devices. Conclusions: The results clearly show that interest in this topic has increased. Although the results show that smart wearables are quite accurate in detecting, predicting, and even treating cardiovascular disease, further research is needed to improve their use.
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Affiliation(s)
- Mohammad Moshawrab
- Département de Mathématiques, Informatique et Génie, Université du Québec à Rimouski, 300 Allée des Ursulines, Rimouski, QC G5L 3A1, Canada
| | - Mehdi Adda
- Département de Mathématiques, Informatique et Génie, Université du Québec à Rimouski, 300 Allée des Ursulines, Rimouski, QC G5L 3A1, Canada
| | - Abdenour Bouzouane
- Département d’Informatique et de Mathématique, Université du Québec à Chicoutimi, 555 Boulevard de l’Université, Chicoutimi, QC G7H 2B1, Canada
| | - Hussein Ibrahim
- Institut Technologique de Maintenance Industrielle, 175 Rue de la Vérendrye, Sept-Îles, QC G4R 5B7, Canada
| | - Ali Raad
- Faculty of Arts & Sciences, Islamic University of Lebanon, Wardaniyeh P.O. Box 30014, Lebanon
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