Initial Field Test of a Cloud-Based Cardiac Auscultation System to Determine Murmur Etiology in Rural China

Abstract

A system for collection, distribution, and long distant, asynchronous interpretation of cardiac auscultation has been developed and field-tested in rural China. We initiated a proof-of-concept test as a critical component of design of a system to allow rural physicians with little experience in evaluation of congenital heart disease (CHD) to obtain assistance in diagnosis and management of children with significant heart disease. The project tested the hypothesis that acceptable screening of heart murmurs could be accomplished using a digital stethoscope and internet cloud transmittal to deliver phonocardiograms to an experienced observer. Of the 7993 children who underwent school-based screening in the Menghai District of Yunnan Province, Peoples Republic of China, 149 had a murmur noted by a screener. They had digital heart sounds and phonocardiograms collected with the HeartLink tele auscultation system, and underwent echocardiography by a cardiology resident from the First Affiliated Hospital of Kunming Medical University. The digital phonocardiograms, stored on a cloud server, were later remotely reviewed by a board-certified American pediatric cardiologist. Fourteen of these subjects were found to have CHD confirmed by echocardiogram. Using the HeartLink system, the pediatric cardiologist identified 11 of the 14 subjects with pathological murmurs, and missed three subjects with atrial septal defects, which were incorrectly identified as venous hum or Still's murmur. In addition, ten subjects were recorded as having pathological murmurs, when no CHD was confirmed by echocardiography during the field study. The overall test accuracy was 91% with 78.5% sensitivity and 92.6% specificity. This proof-of-concept study demonstrated the feasibility of differentiating pathologic murmurs due to CHD from normal functional heart murmurs with the HeartLink system. This field study is an initial step to develop a cost-effective CHD screening strategy in low-resource settings with a shortage of trained medical professionals and pediatric heart programs.

Cardiological «patterns» in term newborn with no symptoms

“…Це група так званих німих, або «тихих» протоків [13]. Суттєво розширяє можливості аускультації у діагностиці структурних аномалій серця використання електронного стетоскопу, з одночасним цифровим записом серцевих звуків та їх аналізом [14,15].…”

Digital stethoscopes in paediatric medicine

“…Telemedicine is an important and innovative area with the immense potential for operation in rural and isolated locations, or low‐resource settings where access to specialised medical care such as paediatric cardiologists or respiratory physicians may not be easily accessible. Telemedicine use in the paediatric population with cardiac auscultation recordings from electronic stethoscopes has already been shown to be feasible and effective for online diagnosis without the presence of the specialist at the bedside and has been expanded for use in teaching medical students cardiovascular examination remotely . In one study, telemedicine consultations for the monitoring of children with asthma via DS achieved comparable levels of satisfaction and outcomes in terms of asthma control when compared with in‐person consultations .…”

“…The Thinklabs DS has been used in trials investigating the accuracy of cardiac murmur detection and diagnosis in children made by specialists via telemedicine . In the respiratory field, this stethoscope has effectively been implemented to describe the frequency characteristics of normal pulmonary sounds in the paediatric population and was successful in describing a difference in sound characteristics between various parameters such as age, height and weight .…”

“…There is the opportunity to extend this into a paediatric and neonatal database of sound. Application to the burgeoning field of telemedicine has already begun; DS have been shown to be both practical and effective in telehealth in multiple studies . The potential implications of being able to easily record and transmit patient sound recordings from one location to another are significant.…”

Phonocardiography: new opportunities in the light of digital technologies

“…Исключая детей с предыдущим диагнозом заболеваний сердца, чувствительность программы скрининга соста-вила 83%, специфичность и прогностическая ценность положительного результата составили соответственно 98 и 29%. Система сбора, передачи и дистанционной интер-претации данных аускультации сердца была разработана и испытана в сельских районах Китая [37]. Предполага-лось, что использование цифрового стетоскопа и облач-ной передачи данных позволит сельским врачам с не-большим опытом работы проводить приемлемый скри-нинг для выявления врожденных пороков сердца.…”