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Cococcetta C, Coutant T, Bagur S, Wernick MB, Huynh M. Use of Digital Stethoscope to Measure Heart Rate in Birds: Comparison of Different Counting Methods Using Phonocardiograms. J Avian Med Surg 2023; 37:108-117. [PMID: 37733450 DOI: 10.1647/22-00047] [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] [Indexed: 09/23/2023]
Abstract
The high cardiac contractility of birds poses a challenge to traditional cardiac auscultation, particularly for the accurate determination of heart rate (HR). The objectives of this study were to 1) evaluate the feasibility of using phonocardiograms of adequate length and quality to assess HR in different avian species with a commercially available digital stethoscope, 2) compare 5 counting methods, including 2 direct reading methods (manual counting and using a semiautomatic computerized algorithm as a reference method) and 3 listening methods (progressive mental counting, counting by 10s, and counting with a smartphone application tap counter), and 3) obtain the HR in selected birds and identify a correlation between body weight and HR in different avian species. An inverse correlation on a logarithmic scale was identified between the mean body weight and HR in 60 different bird species (n = 211; R = -0.72, P < 0.0001). Manual reading of phonocardiograms was the most reliable method and had the highest agreement with the reference method; this was followed by the counting by 10s method, the tapping method, and the progressive mental counting method, which was the least reliable. The agreement levels for the different methods were comparable for HRs <200 beats per minute (bpm) in birds weighing >1 kg. For HRs >500 bpm in birds weighing <150 g, only the reading method maintained a good agreement level. A digital stethoscope can be a useful tool for accurately determining the HR in birds, including very small species with high HRs.
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Affiliation(s)
- Ciro Cococcetta
- Service des Nouveaux Animaux de Compagnie Centre Hospitalier Vétérinaire Frégis, 94250 Gentilly, France, cirocococ@ gmail.com
| | - Thomas Coutant
- Service des Nouveaux Animaux de Compagnie Centre Hospitalier Vétérinaire Frégis, 94250 Gentilly, France
| | - Sophie Bagur
- Institut de l'Audition, Institut Pasteur, 75012 Paris, France
| | | | - Minh Huynh
- Service des Nouveaux Animaux de Compagnie Centre Hospitalier Vétérinaire Frégis, 94250 Gentilly, France
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2
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Vezzosi T, Alibrandi L, Grosso G, Tognetti R. Evaluation of a new smartphone-based digital stethoscope featuring phonocardiography and electrocardiography in dogs and cats. Vet J 2023; 295:105987. [PMID: 37141934 DOI: 10.1016/j.tvjl.2023.105987] [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: 10/11/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023]
Abstract
This study assessed a new smartphone-based digital stethoscope (DS) featuring simultaneous phonocardiographic and one-lead electrocardiogram (ECG) recording in dogs and cats. The audio files and ECG traces obtained by the device were compared with conventional auscultation and standard ECG. A total of 99 dogs and nine cats were prospectively included. All cases underwent conventional auscultation using an acoustic stethoscope, standard six-lead ECG, standard echocardiography and recordings with the DS. All the audio recordings, phonocardiographic files and ECG traces were then blind reviewed by an expert operator. The agreement between methods was assessed using Cohen's kappa and the Bland-Altman test. Audio recordings were considered interpretable in 90% animals. Substantial agreement was found in the diagnosis of heart murmur (κ = 0.691) and gallop sound (k = 0.740). In nine animals with an echocardiographic diagnosis of heart disease, only the DS detected a heart murmur or gallop sound. ECG traces recorded with the new device were deemed interpretable in 88 % animals. Diagnosis of heart rhythm showed moderate agreement in the identification of atrial fibrillation (k = 0.596). The detection of ventricular premature complexes and bundle branch blocks revealed an almost perfect agreement (k = 1). Overall, the DS showed a good diagnostic accuracy in detecting heart murmurs, gallop sounds, ventricular premature complexes and bundle branch blocks. A clinically relevant overdiagnosis of atrial fibrillation was found but without evidence of false negatives. The DS could represent a useful screening tool for heart sound abnormalities and cardiac arrhythmias..
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Affiliation(s)
- T Vezzosi
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, San Piero a Grado, 56122 Pisa, Italy.
| | - L Alibrandi
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, San Piero a Grado, 56122 Pisa, Italy
| | - G Grosso
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, San Piero a Grado, 56122 Pisa, Italy
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, via Livornese lato monte, San Piero a Grado, 56122 Pisa, Italy
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Balogh M, Koch F, Siver L, Krima A, Vörös K. Digital phonocardiography of cardiac arrhythmias in dogs - Preliminary experiences. Acta Vet Hung 2021; 69:116-124. [PMID: 34270460 DOI: 10.1556/004.2021.00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022]
Abstract
Electronic stethoscopes and digital phonocardiograms (DPCGs) can be applied when diagnosing cardiac murmurs, but their use for cardiac arrhythmias is not described in veterinary medicine. Data of 10 dogs are presented in this preliminary study, demonstrating the applicability of these techniques. Although the number of artefacts and the amount of baseline noise produced by the two digitising systems used did not differ, the Welch Allyn Meditron system or similar ones capable of simultaneous recording of electrocardiograms (ECGs) and DPCGs provide a better option for clinical research and education, whilst the 3M Littmann 3200 system might be more suitable for everyday clinical settings. A combined system with simultaneous phonocardiogram and ECG, especially with wireless transmission, might be a solution in the future.
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Affiliation(s)
- Márton Balogh
- 1Department and Clinic of Internal Medicine, University of Veterinary Medicine Budapest, István u. 2, H-1078 Budapest, Hungary
| | | | | | | | - Károly Vörös
- 1Department and Clinic of Internal Medicine, University of Veterinary Medicine Budapest, István u. 2, H-1078 Budapest, Hungary
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Ramanathan A, Zhou L, Marzbanrad F, Roseby R, Tan K, Kevat A, Malhotra A. Digital stethoscopes in paediatric medicine. Acta Paediatr 2019; 108:814-822. [PMID: 30536440 DOI: 10.1111/apa.14686] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 12/30/2022]
Abstract
AIM To explore, synthesise and discuss currently available digital stethoscopes (DS) and the evidence for their use in paediatric medicine. METHODS Systematic review and narrative synthesis of digital stethoscope use in paediatrics following searches of OVID Medline, Embase, Scopus, PubMed and Google Scholar databases. RESULTS Six digital stethoscope makes were identified to have been used in paediatric focused studies so far. A total of 25 studies of DS use in paediatrics were included. We discuss the use of digital stethoscope technology in current paediatric medicine, comment on the technical properties of the available devices, the effectiveness and limitations of this technology, and potential uses in the fields of paediatrics and neonatology, from telemedicine to computer-aided diagnostics. CONCLUSION Further validation and testing of available DS devices is required. Comparison studies between different types of DS would be useful in identifying strengths and flaws of each DS as well as identifying clinical situations for which each may be most appropriately suited.
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Affiliation(s)
| | - Lindsay Zhou
- Monash Newborn Monash Children's Hospital Melbourne VIC Australia
| | - Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering Monash University Melbourne VIC Australia
| | - Robert Roseby
- Department of Paediatrics Monash University Melbourne VIC Australia
- Department of Paediatric Respiratory Medicine Monash Children's Hospital Melbourne VIC Australia
| | - Kenneth Tan
- Department of Paediatrics Monash University Melbourne VIC Australia
- Monash Newborn Monash Children's Hospital Melbourne VIC Australia
- The Ritchie Centre Hudson Institute of Medical Research Melbourne VIC Australia
| | - Ajay Kevat
- Department of Paediatrics Monash University Melbourne VIC Australia
| | - Atul Malhotra
- Department of Paediatrics Monash University Melbourne VIC Australia
- Monash Newborn Monash Children's Hospital Melbourne VIC Australia
- The Ritchie Centre Hudson Institute of Medical Research Melbourne VIC Australia
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Bozkurt B, Germanakis I, Stylianou Y. A study of time-frequency features for CNN-based automatic heart sound classification for pathology detection. Comput Biol Med 2018; 100:132-143. [PMID: 29990646 DOI: 10.1016/j.compbiomed.2018.06.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 06/24/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
Abstract
This study concerns the task of automatic structural heart abnormality risk detection from digital phonocardiogram (PCG) signals aiming at pediatric heart disease screening applications. Recently, various systems based on convolutional neural networks trained on time-frequency representations of segmental PCG frames have been presented that outperform systems using hand-crafted features. This study focuses on the segmentation and time-frequency representation components of the CNN-based designs. We consider the most commonly used features (MFCC and Mel-Spectrogram) used in state-of-the-art systems and a time-frequency representation influenced by domain-knowledge, namely sub-band envelopes as an alternative feature. Via tests carried on two high quality databases with a large set of possible settings, we show that sub-band envelopes are preferable to the most commonly used features and period synchronous windowing is preferable over asynchronous windowing.
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Affiliation(s)
- Baris Bozkurt
- Electrical and Electronics Engineering Department, Izmir Democracy University, Turkey.
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Chatzakis I, Vassilakis K, Lionis C, Germanakis I. Electronic health record with computerized decision support tools for the purposes of a pediatric cardiovascular heart disease screening program in Crete. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 159:159-166. [PMID: 29650310 DOI: 10.1016/j.cmpb.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/31/2018] [Accepted: 03/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Early detection of cardiovascular (CV) disease or associated risk factors during childhood is of paramount importance, allowing for early treatment or lifestyle modifications, respectively. The objective of this study was to describe the development of an electronic health record (EHR), with integrated computerized decision support system (CDSS), specifically designed for supporting the needs of a pilot pediatric CV disease screening program applied on primary school students of a Mediterranean island. METHODS Evidence-based knowledge, national and international practice guidelines regarding sport preparticipation CV screening of children and young athletes has been used for the design of the designated EHR. A CDSS, capable for providing alerts for further cardiology evaluation need, has been incorporated into the EHR, based on normative anthropometric and electrocardiographic data as well as predefined positive history responses. RESULTS We developed a designated EHR with integrated CDSS supporting pediatric CV disease screening, capable for documenting CV-related personal and family history responses, physical evaluation data (weight, height, blood pressure), allowing for entering electrocardiogam (ECG) measurements and for uploading of multimedia files (including ECG images and digital phonocardiogram audio files). The EHR incorporates clinical calculators and referral alerts for the presence (and degree) of adiposity, hypertension, ECG abnormalities and positive history responses indicative of high CV disease risk. In a preliminary EHR validation, performed by entering data from 53 previously available paper-based health records, the EHR was proven to be fully functional. CONCLUSIONS The pediatric cardiology EHR with CDSS features which we developed might serve as a model for EHR for primary health care purposes, capable to document and early detect CV disease and associated risk factors in pediatric populations.
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Affiliation(s)
| | | | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece
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Germanakis I, Petridou ET, Varlamis G, Matsoukis IL, Papadopoulou-Legbelou K, Kalmanti M. Skills of primary healthcare physicians in paediatric cardiac auscultation. Acta Paediatr 2013; 102:e74-8. [PMID: 23082851 DOI: 10.1111/apa.12062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/04/2012] [Accepted: 10/17/2012] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the performance of primary healthcare physicians in paediatric cardiac auscultation and the impact of a multimedia-based teaching intervention. METHODS A total of 106 primary healthcare physicians (77 paediatricians, 14 general practitioners and 15 medical graduates) attended four paediatric cardiac auscultation teaching courses based on virtual patients' presentation (digital phonocardiography). Their auscultatory performance was documented at the beginning of each course and at the end of two of the courses. RESULTS Participants initially detected 73% of abnormal murmurs and 17% of additional sounds, while 22% of innocent murmurs were interpreted as abnormal. Overall cardiac auscultation performance, assessed by a combined auscultation score, was low and independent of training level (graduates: 39.5/trainees: 42.8/board certified: 42.6, p = 0.89) or specialty (paediatricians: 42.7/general practitioners: 43.1, p = 0.89). Multimedia-based teaching was associated with a significant improvement in abnormal murmur (92.5%) and additional sound (40%) detection (p < 0.001), while 25% of innocent murmurs were still interpreted as abnormal (p = 0.127). CONCLUSION Clinical skills of primary healthcare physicians in paediatric cardiac auscultation, independent of training level or specialty, still leave potential for improvement. Multimedia-based teaching interventions represent an effective means of improving paediatric cardiac auscultatory skills.
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Affiliation(s)
- Ioannis Germanakis
- Department of Paediatrics; Faculty of Medicine; University of Crete; University Hospital Heraklion; Crete; Greece
| | - Eleni Th Petridou
- Department of Hygiene; Epidemiology and Medical Statistics; Athens University Medical School; Athens; Greece
| | - George Varlamis
- 4th Department of Paediatrics; School of Medicine; General Hospital Papageorgiou; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Ioannis L Matsoukis
- Department of Hygiene; Epidemiology and Medical Statistics; Athens University Medical School; Athens; Greece
| | - Kiriaki Papadopoulou-Legbelou
- 4th Department of Paediatrics; School of Medicine; General Hospital Papageorgiou; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Maria Kalmanti
- Department of Paediatrics; Faculty of Medicine; University of Crete; University Hospital Heraklion; Crete; Greece
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Rouhani M, Abdoli R. A comparison of different feature extraction methods for diagnosis of valvular heart diseases using PCG signals. J Med Eng Technol 2011; 36:42-9. [PMID: 22149293 DOI: 10.3109/03091902.2011.634946] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article presents a novel method for diagnosis of valvular heart disease (VHD) based on phonocardiography (PCG) signals. Application of the pattern classification and feature selection and reduction methods in analysing normal and pathological heart sound was investigated. After signal preprocessing using independent component analysis (ICA), 32 features are extracted. Those include carefully selected linear and nonlinear time domain, wavelet and entropy features. By examining different feature selection and feature reduction methods such as principal component analysis (PCA), genetic algorithms (GA), genetic programming (GP) and generalized discriminant analysis (GDA), the four most informative features are extracted. Furthermore, support vector machines (SVM) and neural network classifiers are compared for diagnosis of pathological heart sounds. Three valvular heart diseases are considered: aortic stenosis (AS), mitral stenosis (MS) and mitral regurgitation (MR). An overall accuracy of 99.47% was achieved by proposed algorithm.
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Affiliation(s)
- M Rouhani
- Islamic Azad University, Gonabad branch, Gonabad, Iran.
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Vörös K, Nolte I, Hungerbühler S, Reiczigel J, Ehlers J, Tater G, Mischke R, Zimmering T, Schneider M. Sound recording and digital phonocardiography of cardiac murmurs in dogs by using a sensor-based electronic stethoscope. Acta Vet Hung 2011; 59:23-35. [PMID: 21354939 DOI: 10.1556/avet.59.2011.1.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The goals of this study were to present a technique of digitalised sound recordings and phonocardiograms (dPCGs), and to analyse its diagnostic capabilities. Heart sounds of 20 dogs were auscultated in vivo (on-line) and recorded with dPCGs by two authors using a Welch Allyn Meditron Stethoscope System. Sound recordings were auscultated off-line and blindly by four different observers having various auscultatory experiences, then listened to while viewing dPCGs. The results were compared to echocardiographic diagnoses. There was a significant agreement (p < 0.001) between on-line and off-line auscultatory findings regarding the four observers, ranging from 45% to 75% (weighted kappa values: 0.72 to 0.87). The best agreement was achieved by Observer 1 having the highest experience. Significant differences (p < 0.05) were found between Observer 1 and Observer 4 (with the lowest experience) in judging the quality of the murmurs during the off-line and blind auscultation. However, there were only minimal differences (95% to 100% agreements) in dPCG analyses among the four observers regarding intensity and quality of the murmurs while simultaneously listening to and viewing the dPCGs. Significant correlations were found between the traditional '0 to 6 scale' and a new '0 to 3 scale' murmur intensity gradings by all observers (correlation coefficients 0.640 to 0.908; p < 0.01 to p < 0.001). Analysis of dPCGs might be a valuable, additional tool helping with the diagnosis of canine cardiac murmurs, especially for those with less cardiological experience.
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Affiliation(s)
| | - Ingo Nolte
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Stephan Hungerbühler
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Jenő Reiczigel
- 3 Szent István University Department of Biomathematics and Informatics, Faculty of Veterinary Science Budapest Hungary
| | - Jan Ehlers
- 2 University of Veterinary Medicine Hanover E-Learning Consultant Bünteweg 9 D-30559 Hanover Germany
| | - Guy Tater
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Reinhard Mischke
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Tanja Zimmering
- 1 University of Veterinary Medicine Hanover Small Animal Clinic Bünteweg 9 D-30559 Hanover Germany
| | - Matthias Schneider
- 4 Justus-Liebig University Giessen Small Animal Clinic, Veterinary Faculty Giessen Germany
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