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Brložnik M, Lunka E, Avbelj V, Nemec Svete A, Domanjko Petrič A. Cardiac Electromechanical Activity in Healthy Cats and Cats with Cardiomyopathies. SENSORS (BASEL, SWITZERLAND) 2023; 23:8336. [PMID: 37837166 PMCID: PMC10574989 DOI: 10.3390/s23198336] [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: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Optimal heart function depends on perfect synchronization between electrical and mechanical activity. In this pilot study, we aimed to investigate the electromechanical activity of the heart in healthy cats and cats with cardiomyopathy with phonocardiography (PCG) synchronized to an electrocardiography (ECG) pilot device. We included 29 cats (12 healthy cats and 17 cats diagnosed with cardiomyopathy) and performed a clinical examination, PCG synchronized with ECG and echocardiography. We measured the following durations with the pilot PCG device synchronized with ECG: QRS (ventricular depolarization), QT interval (electrical systole), QS1 interval (electromechanical activation time (EMAT)), S1S2 (mechanical systole), QS2 interval (electrical and mechanical systole) and electromechanical window (end of T wave to the beginning of S2). The measured parameters did not differ between healthy cats and cats with cardiomyopathy; however, in cats with cardiomyopathy, EMAT/RR, QS2/RR and S1S2/RR were significantly longer than in healthy cats. This suggests that the hypertrophied myocardium takes longer to generate sufficient pressure to close the mitral valve and that electrical systole, i.e., depolarization and repolarization, and mechanical systoles are longer in cats with cardiomyopathy. The PCG synchronized with the ECG pilot device proved to be a valuable tool for evaluating the electromechanical activity of the feline heart.
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Affiliation(s)
- Maja Brložnik
- Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (E.L.); (A.N.S.)
| | - Ema Lunka
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (E.L.); (A.N.S.)
| | - Viktor Avbelj
- Department of Communication Systems, Jožef Stefan Institute, 1000 Ljubljana, Slovenia;
| | - Alenka Nemec Svete
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (E.L.); (A.N.S.)
| | - Aleksandra Domanjko Petrič
- Small Animal Clinic, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (E.L.); (A.N.S.)
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2
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Wang W, Hao H, Fan T, Yue J, Wang M, Chen M, Deng G, Si L, Zhang F. Predictive value of acoustic cardiography for post-PCI early ventricular remodeling in acute myocardial infarction. Sci Rep 2023; 13:7192. [PMID: 37137970 PMCID: PMC10156721 DOI: 10.1038/s41598-023-34370-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/28/2023] [Indexed: 05/05/2023] Open
Abstract
Acoustic cardiography is a completely new technology, it has great advantages in the rapid diagnosis of cardiovascular diseases. The purpose of this study was to investigate the clinical value of the fourth heart sound (S4), cardiac systolic dysfunction index (SDI), and the cardiac cycle time-corrected electromechanical activation time (EMATc) in the prediction of post-percutaneous coronary intervention (PCI) early ventricular remodeling (EVR) in patients with acute myocardial infarction (AMI). We recruited 161 patients with AMI of 72-h post-PCI, including 44 EVR patients with left ventricular ejection fraction (LVEF) < 50% and 117 Non-EVR patients (normal left ventricular systolic function group, LVEF ≥ 50%). EMATc, S4, and SDI were independent risk factors for post-PCI early ventricular remodeling in patients with AMI [S4 (OR 2.860, 95% CI 1.297-6.306, p = 0.009), SDI (OR 4.068, 95% CI 1.800-9.194, p = 0.001), and EMATc (OR 1.928, 95% CI 1.420-2.619, p < 0.001)]. The area under the receiver operating characteristic curve for EMATc was 0.89, with an optimal cutoff point of 12.2, EMATc had a sensitivity of 80% and a specificity of 83%. By contrast, an optimal cutoff point of 100 pg/ml, Serum brain natriuretic peptide had a sensitivity of 46% and a specificity of 83%. Our findings suggest the predictive value of EMATc for the occurrence of EVR in these patients was also identified; EMATc may be a simple, quick, and effective way to diagnose EVR after AMI.
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Affiliation(s)
- Weiwei Wang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haizhen Hao
- Department of Neurology, Haikou People's Hospital, Central South University, Haikou, China
| | - Tingting Fan
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Yue
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingyang Wang
- Department of Critical Care Medicine, Peoples Hospital of Jiangbei District, Chongqing, China
| | - Moshui Chen
- Department of Neurology, Haikou People's Hospital, Central South University, Haikou, China
| | - Guolan Deng
- Division of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liangyi Si
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Fuwei Zhang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Nogueira MA, Calcagno S, Campbell N, Zaman A, Koulaouzidis G, Jalil A, Alam F, Stankovic T, Szabo E, Szabo AB, Kecskes I. Detecting heart failure using novel bio-signals and a knowledge enhanced neural network. Comput Biol Med 2023; 154:106547. [PMID: 36696813 DOI: 10.1016/j.compbiomed.2023.106547] [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: 07/19/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clinical decisions about Heart Failure (HF) are frequently based on measurements of left ventricular ejection fraction (LVEF), relying mainly on echocardiography measurements for evaluating structural and functional abnormalities of heart disease. As echocardiography is not available in primary care, this means that HF cannot be detected on initial patient presentation. Instead, physicians in primary care must rely on a clinical diagnosis that can take weeks, even months of costly testing and clinical visits. As a result, the opportunity for early detection of HF is lost. METHODS AND RESULTS The standard 12-Lead ECG provides only limited diagnostic evidence for many common heart problems. ECG findings typically show low sensitivity for structural heart abnormalities and low specificity for function abnormalities, e.g., systolic dysfunction. As a result, structural and functional heart abnormalities are typically diagnosed by echocardiography in secondary care, effectively creating a diagnostic gap between primary and secondary care. This diagnostic gap was successfully reduced by an AI solution, the Cardio-HART™ (CHART), which uses Knowledge-enhanced Neural Networks to process novel bio-signals. Cardio-HART reached higher performance in prediction of HF when compared to the best ECG-based criteria: sensitivity increased from 53.5% to 82.8%, specificity from 85.1% to 86.9%, positive predictive value from 57.1% to 70.0%, the F-score from 56.4% to 72.2%, and area under curve from 0.79 to 0.91. The sensitivity of the HF-indicated findings is doubled by the AI compared to the best rule-based ECG-findings with a similar specificity level: from 38.6% to 71%. CONCLUSION Using an AI solution to process ECG and novel bio-signals, the CHART algorithms are able to predict structural, functional, and valve abnormalities, effectively reducing this diagnostic gap, thereby allowing for the early detection of most common heart diseases and HF in primary care.
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Affiliation(s)
- Marta Afonso Nogueira
- Consultant Cardiologist Heart Failure and Cardiomyopathies, Department of Cardiology, Cascais Hospital, Lusíadas Saúde - UnitedHealth Group, Lisbon, Portugal
| | - Simone Calcagno
- Division of Cardiology, Santa Maria Goretti Hospital, Via Canova Snc, 04100, Latina, Italy
| | - Niall Campbell
- Manchester University NHS Foundation Trust, Department of Cardiology, Manchester, UK
| | - Azfar Zaman
- Freeman Hospital, Newcastle University, and Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
| | | | - Anwar Jalil
- Cardiology of Karachi, Hill Park General Hospital, Karachi, Pakistan
| | - Firdous Alam
- Cardiology of Karachi, Hill Park General Hospital, Karachi, Pakistan
| | - Tatjana Stankovic
- Division of Cardiology, Regional Hospital Dr Radivoj Simonovic Sombor, Sombor, Serbia
| | - Erzsebet Szabo
- Division of Cardiology, General Hospital Senta, Senta, Serbia
| | - Aniko B Szabo
- Division of Cardiology, General Hospital Senta, Senta, Serbia
| | - Istvan Kecskes
- Dir. Cardiology Research and Scientific Advancements, UVA Research Corp., 24000, Subotica, Henrike Sjenkjevica 14, Serbia.
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Fudim M, Mirro M, Cheng HM. Audicor Remote Patient Monitoring: FDA Breakthrough Device and Technology for Heart Failure Management. JACC Basic Transl Sci 2022; 7:313-315. [PMID: 35411320 PMCID: PMC8993761 DOI: 10.1016/j.jacbts.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marat Fudim
- Duke University Hospital, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710, USA @FudimMarat
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5
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Zhang FW, Zhang YX, Si LY, Chen MS, Wang WW, Liang HR. Value of acoustic cardiography in the clinical diagnosis of coronary heart disease. Clin Cardiol 2021; 44:1386-1392. [PMID: 34486123 PMCID: PMC8495079 DOI: 10.1002/clc.23694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background To investigate the clinical value of acoustic cardiography in the diagnosis of coronary artery disease (CAD) and post‐percutaneous coronary intervention (PCI) early asymptomatic left ventricular systolic dysfunction. Methods Inpatients in the department of cardiology were included in the research (n = 315); including 180 patients with angina pectoris and 135 patients with acute anterior wall myocardial infarction after emergency PCI did not present with signs and symptoms of heart failure. Color Doppler echocardiography, brain natriuretic peptide, acoustic cardiography examination were performed. The patients were divided into four groups: non‐CAD group (n = 60), CAD group (n = 120), MIREF group (EF% < 50%, n = 75), and MINEF group (EF% ≥ 50%, n = 60). Results Acoustic cardiography parameters EMATc, systolic dysfunction index, S3 strength and S4 strength in the MIREF group were higher than those in MINEF group (p < .05), and the MINEF group was higher than CAD group (p < .05). S3 strength (area under the curve [AUC] 0.67, 95% CI 0.585–0.755, p < .001) and S4 strength (AUC 0.617, 95% CI 0.536–0.698, p = .011) are useful in the diagnosis of CAD. S3 strength (AUC 0.942, 95% CI 0.807–0.978, p < .001) was superior to other indicators in the diagnosis of early left ventricular systolic dysfunction after myocardial infarction. Conclusion S4 combined with STT standard change can improve the diagnosis of CAD. Acoustic cardiography can be used as a non‐invasive, rapid, effective, and simple method for the diagnosis of asymptomatic left ventricular systolic dysfunction in the early stage after myocardial infarction.
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Affiliation(s)
- Fu Wei Zhang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Xue Zhang
- Division of Cardiology, Haikou People's Hospital, Central South University, Haikou, China
| | - Liang Yi Si
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mo Shui Chen
- Division of Cardiology, Haikou People's Hospital, Central South University, Haikou, China
| | - Wei Wei Wang
- Division of Cardiology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Rong Liang
- Division of Cardiology, Haikou People's Hospital, Central South University, Haikou, China
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Changes in acoustic cardiographic parameters before and after hemodialysis are associated with overall and cardiovascular mortality in hemodialysis patients. Sci Rep 2021; 11:1559. [PMID: 33452428 PMCID: PMC7810842 DOI: 10.1038/s41598-021-81286-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
Acoustic cardiography can provide simultaneous electrocardiography and acoustic cardiac data to assess the electronic and mechanical heart functions. The aim of this study was to assess whether changes in acoustic cardiographic parameters (ACPs) before and after hemodialysis (HD) are associated with overall and cardiovascular (CV) mortality in HD patients. A total of 162 HD patients was enrolled and ACPs were measured before and after HD, including left ventricular systolic time (LVST), systolic dysfunction index (SDI), third (S3) and fourth (S4) heart sounds, and electromechanical activation time (EMAT). During a follow-up of 2.9 years, 25 deaths occurred with 16 from CV causes. Multivariate analysis showed that high △SDI (per 1; hazard ratio [HR], 2.178; 95% confidence interval [CI], 1.189–3.990), high △EMAT (per 1%; HR, 2.218; 95% CI 1.382–3.559), and low △LVST (per 1 ms; HR, 0.947; 95% CI 0.912–0.984) were independently associated with increased overall mortality. In addition, high △EMAT (per 1%; HR, 2.141; 95% CI 1.117–4.102), and low △LVST (per 1 ms; HR, 0.777; 95% CI 0.637–0.949) were associated with increased CV mortality. In conclusion, the changes in ACPs before and after HD may be a useful clinical marker and stronger prognostic marker of overall and CV mortality than ACPs before HD.
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Effect of Acoustic Cardiography-guided Management on 1-year Outcomes in Patients With Acute Heart Failure. J Card Fail 2020; 26:142-150. [DOI: 10.1016/j.cardfail.2019.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 12/20/2022]
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8
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Predictive Value of Electromechanical Activation Time for In-Hospital Major Cardiac Adverse Events in Heart Failure Patients. Cardiovasc Ther 2020; 2020:4532596. [PMID: 31969933 PMCID: PMC6961597 DOI: 10.1155/2020/4532596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/24/2019] [Accepted: 10/22/2019] [Indexed: 12/28/2022] Open
Abstract
Objective This prospective study aimed to evaluate the value of the cardiac cycle time-corrected electromechanical activation time (EMATc) measured at admission for predicting major cardiac adverse events (MACEs) in hospitalized patients with chronic heart failure (CHF). Methods CHF patients with a left ventricular ejection fraction (LVEF) lower than 50% (N = 145) were enrolled in this study. Documented clinical end-points (MACEs) included cardiogenic death, onset of acute HF as assessed with invasive and noninvasive mechanical ventilation, and cardiogenic shock. According to the different clinical end-points, patients were divided into two groups: a MACE group (n = 22) and a nonMACE group (n = 123). EMATc, LVEF, and circulating levels of B type natriuretic peptide (BNP) and Troponin I (TnI) were measured. Multivariate logistic regression analysis was used to examine the association between EMATc and MACEs. The parameters adjusted in the multivariable model included EMATc, BNP, and heart rate. The predictive value of EMATc was evaluated by receiver operating characteristic (ROC) curve analysis. Results Elevated EMATc was an independent risk factor for MACEs (odds ratio [OR] 1.1443, 95% confidence interval [CI] 1.016–1.286, P = 0.027). The area under the ROC curve for EMATc was 0.799 (95% CI 0.702–0.896, P < 0.001). The optimal cutoff EMATc value was >13.8% with a sensitivity of 81.8% and a specificity of 65.9%. Conclusions We demonstrated that an elevated EMATc measured at admission is an independent risk factor for MACEs among hospitalized CHF patients. Acoustic cardiography measured at admission may provide a simple, noninvasive method for risk stratification of CHF patients. This trial is registered with ChiCTR1900021470.
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9
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Chang HC, Cheng HM. P wave peak time: A time window to evaluate left ventricular diastolic function. J Clin Hypertens (Greenwich) 2019; 21:616-617. [PMID: 30950576 DOI: 10.1111/jch.13528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 11/27/2022]
Abstract
The activation time from electrical signals to chamber conformational change has long been demonstrated to associate with LV performance and ventriculo-arterial coupling with prognostic implications in heart failure patients. P wave peak time (PWPT), an easily obtainable parameter from conventional surface electrocardiography, represents the time taken for excitation spreading from sinoatrial node to the maximal summation of positive deflection from both atria. Increased PWPT denotes prolonged intra- or inter-atrial conduction time and indicates elevated intra-atrial pressure. As shown in a recently published study, PWPT was highly correlated with LV end diastolic pressure (LVEDP) derived from direct measurement during cardiac catheterization. With its objective and easily obtainable nature, clinical application of PWPT to evaluate diastolic function can be expected, if more studies in different populations can confirm its clinical utility.
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Affiliation(s)
- Hao-Chih Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Zuber N, Zuber M, Schwarzwald CC. Assessment of systolic and diastolic function in clinically healthy horses using ambulatory acoustic cardiography. Equine Vet J 2018; 51:391-400. [DOI: 10.1111/evj.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Affiliation(s)
- N. Zuber
- Clinic for Equine Internal Medicine, Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - M. Zuber
- Division of Cardiology University of Zurich Zurich Switzerland
| | - C. C. Schwarzwald
- Clinic for Equine Internal Medicine, Vetsuisse Faculty University of Zurich Zurich Switzerland
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Erne P, Resink TJ, Mueller A, Coslovsky M, Kobza R, Conen D, Bauer P, Arand P. Use of acoustic cardiography immediately following electrical cardioversion to predict relapse of atrial fibrillation. J Atr Fibrillation 2017; 10:1527. [PMID: 29250219 DOI: 10.4022/jafib.1527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/19/2017] [Accepted: 05/14/2017] [Indexed: 11/10/2022]
Abstract
Predicting atrial fibrillation (AF) recurrence after successful electrical cardioversion (ECV) is difficult. The main aim of this study was to investigate whether acoustic cardiography (AUDICOR® 200) immediately post-ECV might provide indices for AF relapse following cardioversion. Acoustic cardiography parameters included Electromechanical Activation Time (EMAT), Left Ventricular Systolic Time (LVST), QRS duration, heart rate and third heart sound intensity (S3 Strength). We analysed data from 140 patients who underwent successful cardioversion and in whom AUDICOR results and echocardiographic measurements immediately after (baseline) ECV were available. Patients were prospectively followed-up at 4-6 weeks, 3 and 12 months post-ECV, and sinus rhythm maintenance was evaluated using acoustic cardiography and Holter electrocardiography. The effect of each baseline AUDICOR parameter on the hazard of AF relapse was investigated using Cox proportional hazards (PH) models. Fifty patients (35.7%) had AF relapse. Of all the AUDICOR parameters, only S3 Strength exhibited consistent predictive value. Increasing S3 Strength increased the hazard of relapse in a univariable Cox PH model (HR=2.52, p=0.003), and in two multivariable Cox PH model constructions (Model 1 excluded heart rate and Model II excluded EMAT/RR, LVST and LVST/RR) both of which included the parameters as continuous variables (Model I: HR=1.15, p=0.042; Model II: HR=1.14, p=0.045) or the parameters dichotomized according to suggested cut-points (Model I: HR=2.5, p=0.007; Model II: HR=2.09, p=0.031). In conclusion, this study suggests that acoustic cardiography may be a simple inexpensive and quantitative bedside method to assist in prediction of AF recurrence after ECV.
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Affiliation(s)
- Paul Erne
- Laboratory of Signal Transduction, Department of Biomedicine, Basel University Hospital and Basel University, Basel, Switzerland
| | - Therese J Resink
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Andrea Mueller
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - David Conen
- Department of Cardiology, Basel University Hospital, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Peter Bauer
- Inovise Medical, Inc., Beaverton, Oregon, USA
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Wang S, Liu M, Fang F, Shang Q, Sun JP, Sanderson JE, Yu CM. Prognostic value of acoustic cardiography in patients with chronic heart failure. Int J Cardiol 2016; 219:121-6. [DOI: 10.1016/j.ijcard.2016.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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13
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Systolic Time Intervals and New Measurement Methods. Cardiovasc Eng Technol 2016; 7:118-25. [DOI: 10.1007/s13239-016-0262-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
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14
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Chang CC, Sung SH, Yu WC, Cheng HM, Chen CH. Night-time electromechanical activation time, pulsatile hemodynamics, and discharge outcomes in patients with acute heart failure. ESC Heart Fail 2015; 2:184-193. [PMID: 28834674 PMCID: PMC6410547 DOI: 10.1002/ehf2.12044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/07/2015] [Accepted: 05/10/2015] [Indexed: 11/11/2022] Open
Abstract
Aims Both electromechanical activation time (EMAT) and pulsatile hemodynamics measured during the hospitalization course are useful in the prediction of cardiovascular outcomes in patients with acute heart failure syndrome (AHFS). We investigated whether night‐time monitoring of EMAT with the ambulatory acoustic cardiography is superior to the measures of pulsatile hemodynamics for prediction of AHFS post‐discharge outcomes. Methods and results A total of 97 patients (71.1 ± 15.4 years old, 81% male, and 73.8% systolic heart failure) hospitalized for AHFS were included. Before discharge, 24 h ambulatory acoustic cardiography and a comprehensive echocardiographic and pulsatile hemodynamic study were performed to assess the mean 24 h, daytime, and night‐time EMAT, carotid systolic blood pressure (SBP) and pulse pressure (PP), amplitude of the reflected pressure wave from a decomposed carotid pressure wave (Pb), and carotid–femoral pulse wave velocity (cfPWV), in addition to measurement of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels. During a mean follow‐up of 389 ± 281 days, 49 patients (50.5%) experienced events including re‐hospitalization for heart failure, myocardial infarction, stroke, or death. Pulsatile hemodynamics, including carotid SBP and PP and Pb, but not cfPWV, and night‐time EMAT, but not daytime EMAT, significantly predicted post‐discharge events when age and NT‐proBNP were accounted for (all P < 0.05). In a final model with adjustment for age and NT‐proBNP, night‐time EMAT, but not Pb, significantly predicted post‐discharge events [hazard ratio per 1 SD and 95% confidence intervals: 1.33 (1.05–1.69), P < 0.05]. Conclusion Pre‐discharge night‐time EMAT may be a better predictor for post‐discharge adverse events than the measures of the pulsatile hemodynamics in patients with AHFS.
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Affiliation(s)
- Chun-Chin Chang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Public Health, National Yang-Ming University, Taipei, Taiwan
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15
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Beyond auscultation: Acoustic cardiography in clinical practice. Int J Cardiol 2014; 172:548-60. [DOI: 10.1016/j.ijcard.2013.12.298] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 11/24/2022]
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16
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Beeler R, Schoenenberger AW, Bauer P, Kobza R, Bergner M, Mueller X, Schlaepfer R, Zuber M, Erne S, Erne P. Improvement of cardiac function with device-based diaphragmatic stimulation in chronic heart failure patients: the randomized, open-label, crossover Epiphrenic II Pilot Trial. Eur J Heart Fail 2013; 16:342-9. [DOI: 10.1002/ejhf.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 01/21/2023] Open
Affiliation(s)
- Remo Beeler
- FESC, Department of Cardiology; St Anna Klinik; St Anna Strasse 32, CH-6006 Luzern Switzerland
| | - Andreas W. Schoenenberger
- Division of Geriatrics, Department of General Internal Medicine; Inselspital, Bern University Hospital and University of Bern; Bern Switzerland
| | | | - Richard Kobza
- FESC, Department of Cardiology; St Anna Klinik; St Anna Strasse 32, CH-6006 Luzern Switzerland
| | - Michael Bergner
- FESC, Department of Cardiology; St Anna Klinik; St Anna Strasse 32, CH-6006 Luzern Switzerland
| | - Xavier Mueller
- Department of Heart Surgery; Luzerner Kantonsspital; Luzern Switzerland
| | | | - Michel Zuber
- FESC, Department of Cardiology; St Anna Klinik; St Anna Strasse 32, CH-6006 Luzern Switzerland
| | - Susanne Erne
- FESC, Department of Cardiology; St Anna Klinik; St Anna Strasse 32, CH-6006 Luzern Switzerland
| | - Paul Erne
- FESC, Department of Cardiology; St Anna Klinik; St Anna Strasse 32, CH-6006 Luzern Switzerland
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Frommelt PC, Gerstenberger E, Baffa J, Border WL, Bradley TJ, Colan S, Gorentz J, Heydarian H, John JB, Lai WW, Levine J, Lu JC, McCandless RT, Miller S, Nutting A, Ohye RG, Pearson GD, Wong PC, Cohen MS. Doppler flow patterns in the right ventricle-to-pulmonary artery shunt and neo-aorta in infants with single right ventricle anomalies: impact on outcome after initial staged palliations. J Am Soc Echocardiogr 2013; 26:521-9. [PMID: 23540728 PMCID: PMC4208752 DOI: 10.1016/j.echo.2013.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND A Pediatric Heart Network trial compared outcomes in infants with single right ventricle anomalies undergoing Norwood procedures randomized to modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS). Doppler patterns in the neo-aorta and RVPAS may characterize physiologic changes after staged palliations that affect outcomes and right ventricular (RV) function. METHODS Neo-aortic cardiac index (CI), retrograde fraction (RF) in the descending aorta and RVPAS conduit, RVPAS/neo-aortic systolic ejection time ratio, and systolic/diastolic (S/D) ratio were measured early after Norwood, before stage II palliation, and at 14 months. These parameters were compared with transplantation-free survival, length of hospital stay, and RV functional indices. RESULTS In 529 subjects (mean follow-up period, 3.0 ± 2.1 years), neo-aortic CI and descending aortic RF were significantly higher in the MBTS cohort after Norwood. The RVPAS RF averaged <25% at both interstage intervals. Higher pre-stage II descending aortic RF was correlated with lower RV ejection fraction (R = -0.24; P = .032) at 14 months for the MBTS cohort. Higher post-Norwood CI (5.6 vs 4.4 L/min/m(2), P = .04) and lower S/D ratio (1.40 vs 1.68, P = .01) were correlated with better interstage transplantation-free survival for the RVPAS cohort. No other Doppler flow patterns were correlated with outcomes. CONCLUSIONS After the Norwood procedure, infants tolerated significant descending aortic RF (MBTS) and conduit RF (RVPAS), with little correlation with clinical outcomes or RV function. Neo-aortic CI, ejection time, and S/D ratios also had limited correlations with outcomes or RV function, but higher post-Norwood neo-aortic CI and lower S/D ratio were correlated with better interstage survival in those with RVPAS.
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18
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Dillier R, Baumann M, Young M, Erne S, Schwizer B, Zuber M, Erne P. Continuous respiratory monitoring for sleep apnea screening by ambulatory hemodynamic monitor. World J Cardiol 2012; 4:121-7. [PMID: 22558491 PMCID: PMC3342580 DOI: 10.4330/wjc.v4.i4.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 03/26/2012] [Accepted: 04/02/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To validate the sleep-disordered breathing components of a portable electrocardiography and hemodynamic monitor to be used for sleep apnea screening. METHODS Sleep-disordered breathing (SDB) is associated with cardiovascular disease. Patients with existing cardiovascular disease may have unrecognized SDB or may develop SDB while under the care of a cardiologist. A screening device for SDB, easy to use and appealing to cardiologists, would assist in referral of appropriate patients for full polysomnography (PSG). A cardiac and respiratory monitor (CPAM) was attached to patients undergoing PSG and an apnea/hypopnea index (AHI) generated. The CPAM device produced respiration rate, snoring rate, individual apnea/hypopnea events and an SDB severity score (SDBSS). In addition to AHI, an expert over-reader annotated individual breaths, snores and SDB breathing events to which the automated algorithms were compared. RESULTS The test set consisted of data from 85 patients (age: 50.5 ± 12.4 years). Of these, 57 had a positive PSG defined as AHI ≥ 5.0 (mean: 30.0 ± 29.8, negative group mean: 1.5 ± 1.2). The sensitivity and specificity of the SDBSS compared to AHI was 57.9% and 89.3%, respectively. The correlation of snoring rate by CPAM compared to the expert over-reader was r = 0.58 (mean error: 1.52 snores/min), while the automated respiration rate had a correlation of r = 0.90 (mean error: 0.70 breaths/min). CONCLUSION This performance assessment shows that CPAM can be a useful portable monitor for screening and follow-up of subjects for SDB.
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Affiliation(s)
- Roger Dillier
- Roger Dillier, Mabelle Young, Susanne Erne, Michel Zuber, Paul Erne, Division of Cardiology, Luzerner Kantonsspital, 6000 Lucerne 16, Switzerland
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Dillier R, Kobza R, Erne S, Zuber M, Arand P, Erne P. Noninvasive detection of left-ventricular systolic dysfunction by acoustic cardiography in atrial fibrillation. Cardiol Res Pract 2010; 2011:173102. [PMID: 20981304 PMCID: PMC2958491 DOI: 10.4061/2011/173102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 09/30/2010] [Indexed: 11/20/2022] Open
Abstract
Objectives. Assessment of left ventricular (LV) systolic function in patients with atrial fibrillation can be difficult. Acoustic cardiography provides several parameters for quantifying LV systolic function. We evaluated the ability of acoustic cardiography to detect LV systolic dysfunction in patients with and without atrial fibrillation. Design. We studied 194 patients who underwent acoustic cardiography and cardiac catheterization including measurement of angiographic ejection fraction (EF) and maximum LV dP/dt. LV systolic dysfunction was defined as LV maximum dP/dt <1600 mmHg/s. Acoustic cardiographic parameters included electromechanical activation time (EMAT) and the systolic dysfunction index (SDI). Results. Acoustic cardiography detected systolic dysfunction with high specificity and moderate sensitivity with similar performance to EF (sensitivity/specificity without afib: EMAT 30/96, SDI 40/90, EF at 35% 30/96; sensitivity/specificity with afib: EMAT 64/82, SDI 59/100, EF at 35% 45/82). Conclusions. Acoustic cardiography can be used for diagnosis of LV systolic dysfunction in atrial fibrillation.
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Affiliation(s)
- Roger Dillier
- Division of Cardiology, Luzerner Kantonsspital, 6000 Luzern 16, Switzerland
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