Automated Cardiac Auscultation for Detection of Pathologic Heart Murmurs

Thompson, William; Hayek, C. Scott; Tuchinda, Charles; Telford, J.K.; Lombardo, Joseph S.

doi:10.1007/s002460010253

Cited by 44 publications

(24 citation statements)

References 20 publications

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“…22,23 Our long-term goal is to incorporate these algorithms into the recording device itself, facilitating an immediate PCG interpretation at the bedside, with physician overview as required.…”

Section: Discussionmentioning

confidence: 99%

Utility of Store-and-Forward Pediatric Telecardiology Evaluation in Distinguishing Normal From Pathologic Pediatric Heart Sounds

Mahnke

Mulreany

Inafuku

et al. 2008

Clin Pediatr (Phila)

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Because pediatric cardiologists can accurately diagnose innocent murmurs by physical exam alone, the authors developed a system for remote cardiac auscultation. They hypothesized that their system could accurately classify auscultatory findings as normal/innocent or pathologic. Patients undergoing evaluation underwent examination, echocardiography, and heart sound recording. Pediatric cardiologists evaluated the heart sounds and classified the case as either normal/innocent or pathologic. They reviewed103 heart sound data sets; 85% of the cases were accurately classified as either normal/innocent or pathologic, with a sensitivity of 82% and specificity of 86%. However, when accounting for clinical diagnosis, reviewer uncertainty, and ECG abnormalities, the sensitivity and specificity improved to 91% and 88% (accuracy 89%), respectively. Degree of certainty with the telecardiology diagnosis correlated with correct interpretation (P < .005). Digital heart sound recordings evaluated via telemedicine can distinguish normal/innocent murmurs from pathologic ones. Such a system could improve the use of pediatric cardiology services.

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Section: Discussionmentioning

confidence: 99%

Utility of Store-and-Forward Pediatric Telecardiology Evaluation in Distinguishing Normal From Pathologic Pediatric Heart Sounds

Mahnke

Mulreany

Inafuku

et al. 2008

Clin Pediatr (Phila)

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“…Several groups have applied a variety of signal processing techniques to pediatric heart sound recordings and report sensitivity and specificity values approaching 100%. [120][121][122][123][124] Automatically generated computer-aided auscultation interpretation can also provide immediate decision support to the primary care provider. 125 With computer-aided auscultation used this way, the referral sensitivity and specificity of primary care providers increased, with the potential to significantly reduce unnecessary and costly referrals.…”

Section: Tele-auscultationmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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A dvancements in technology and broadband have revolutionized the current practice of medicine. The field of pediatric cardiology is no exception given the need for prompt diagnosis and reliance on cardiac imaging to identify infants and children with potentially life-threatening cardiovascular disease. As the relationship between telemedicine and pediatric cardiology has advanced, it has created a need to develop a broad, comprehensive document reviewing all the various aspects of telemedicine in pediatric cardiology. For more than a decade, a significant body of literature has been published describing individual experiences and practices, yet there remains no comprehensive statement or document summarizing this rapidly advancing field. In an effort to describe the collective experience and to provide structure and guidance for pediatric cardiology practitioners and healthcare providers, we have developed a scientific statement on the use of telemedicine in pediatric cardiology.Specific areas explored in this document include both neonatal and fetal teleechocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine and pediatric cardiology in the intensive care setting. Furthermore, a detailed review of the legislative, public policy, and legal aspects of telemedicine is provided, along with financial and reimbursement information.Several terms are used in the literature interchangeably; a brief explanation is provided to help readers of this document. The term telehealth is defined as the use of technology to bridge distances in any aspect of medicine; telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically, and tele-echocardiography is the most common application used within this field. ECHOCARDIOGRAPHY AND TELEMEDICINEEchocardiography is the most commonly used noninvasive cardiovascular imaging modality and is considered to be both safe and cost-effective. Tele-echocardiography can be described as a process in which a provider or a technician obtains cardiovascular ultrasound images from a given patient and these images are subsequently transmitted to an offsite location where a cardiologist can provide further analysis and interpretation. Thus, tele-echocardiography enables expert interpretation and consultation in a rapid and potentially geographically disparate fashion, enabling prompt and accurate decision making involving triage, transport, and therapeutic priorities. Tele-echocardiography is now routinely used across the age and subspecialty spectrum in pediatric cardiology.

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“…Automatically derived characteristics of heart sounds have been shown to provide a basis for accurate detection of pathological murmurs, 9 and identification of systolic murmurs that are louder in standing than supine position. 10 What has not yet been established is the potential improvement in clinical decision-making by physicians that can be achieved using computer-based analysis of heart sounds obtained at the point of care.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Computer‐assisted Auscultation on Physician Referrals of Asymptomatic Patients with Heart Murmurs

Watrous¹,

Thompson

Ackerman

2008

Clinical Cardiology

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BackgroundAs many as 50–70% of asymptomatic children referred for specialist evaluation or echocardiography because of a murmur have no heart disease.HypothesisComputer‐assisted auscultation (CAA) can improve the sensitivity and specificity of referrals for evaluation of heart murmurs.MethodsSeven board‐certified primary care physicians were evaluated both without and with use of a computer‐based decision‐support system using 100 prerecorded patient heart sounds (55 innocent murmurs, 30 pathological murmurs, 15 without murmur). The sensitivity and specificity of their murmur referral decisions relative to American College of Cardiology/American Heart Association (ACC/AHA) guidelines, and sensitivity and specificity of murmur detection and characterization (innocent versus pathological) were measured.ResultsSensitivity for detection of murmurs significantly increased with use of CAA from 76.6 to 89.1% (p <0.001), while specificity remained unaffected (80.0 versus 81.0%). Computer‐assisted auscultation improved sensitivity of correctly identifying pathological murmur cases from 82.4 to 90.0%, and specificity of correctly identifying benign cases (with innocent or no murmurs) from 74.9 to 88.8%. (p <0.001). Referral sensitivity increased from 86.7 to 92.9%, while specificity increased from 63.5 to 78.6% using CAA (p <0.001).ConclusionsComputer‐assisted auscultation appears to be a promising new technology for informing the referral decisions of primary care physicians. Copyright © 2008 Wiley Periodicals, Inc.

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Automated Cardiac Auscultation for Detection of Pathologic Heart Murmurs

Cited by 44 publications

References 20 publications

Utility of Store-and-Forward Pediatric Telecardiology Evaluation in Distinguishing Normal From Pathologic Pediatric Heart Sounds

Utility of Store-and-Forward Pediatric Telecardiology Evaluation in Distinguishing Normal From Pathologic Pediatric Heart Sounds

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

The Impact of Computer‐assisted Auscultation on Physician Referrals of Asymptomatic Patients with Heart Murmurs

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