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1.
Sci Rep ; 13(1): 15187, 2023 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-37704692

RESUMO

Despite challenges in severity scoring systems, artificial intelligence-enhanced electrocardiography (AI-ECG) could assist in early coronavirus disease 2019 (COVID-19) severity prediction. Between March 2020 and June 2022, we enrolled 1453 COVID-19 patients (mean age: 59.7 ± 20.1 years; 54.2% male) who underwent ECGs at our emergency department before severity classification. The AI-ECG algorithm was evaluated for severity assessment during admission, compared to the Early Warning Scores (EWSs) using the area under the curve (AUC) of the receiver operating characteristic curve, precision, recall, and F1 score. During the internal and external validation, the AI algorithm demonstrated reasonable outcomes in predicting COVID-19 severity with AUCs of 0.735 (95% CI: 0.662-0.807) and 0.734 (95% CI: 0.688-0.781). Combined with EWSs, it showed reliable performance with an AUC of 0.833 (95% CI: 0.830-0.835), precision of 0.764 (95% CI: 0.757-0.771), recall of 0.747 (95% CI: 0.741-0.753), and F1 score of 0.747 (95% CI: 0.741-0.753). In Cox proportional hazards models, the AI-ECG revealed a significantly higher hazard ratio (HR, 2.019; 95% CI: 1.156-3.525, p = 0.014) for mortality, even after adjusting for relevant parameters. Therefore, application of AI-ECG has the potential to assist in early COVID-19 severity prediction, leading to improved patient management.


Assuntos
Inteligência Artificial , COVID-19 , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Feminino , COVID-19/diagnóstico , Algoritmos , Eletrocardiografia , Área Sob a Curva
2.
Heart Vessels ; 35(2): 214-222, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31482215

RESUMO

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease that represents a broad spectrum of morphologic features and clinical presentations. However, little is known about the impact of gender differences in heart failure (HF) development in non-obstructive HCM. We assessed clinical and echocardiographic parameters according to gender in patients with non-obstructive HCM and evaluated the impact of gender on HF presentation and cardiovascular (CV) outcomes in this population. We investigated 202 consecutive patients with non-obstructive HCM. Clinical parameters and conventional echocardiographic measurements including tissue Doppler measurements were evaluated and compared according to gender. Additionally, left ventricular (LV) deformation was assessed with global longitudinal strain (GLS) utilizing 2D speckle tracking software. Of the 202 patients (age = 63 ± 14 years, male: female = 141: 61), 51 patients (24.8%) presented with HF and female patients had HF more frequently (52.5% vs. 12.8%, P < 0.001). Females were older, had a higher prevalence of atrial fibrillation, had increased left atrial volume (LAV), and a higher ratio of early diastolic mitral inflow to early annular velocity (E/e') than males (70 ± 12 years vs. 59 ± 14 years, P < 0.001 for age; 51.4 ± 19.3 mL/m2 vs. 40.0 [Formula: see text] 13.4 mL/m2, P < 0.001 for indexed LAV; 17.2 [Formula: see text] 6.0 vs. 13.0 [Formula: see text] 4.3, P < 0.001 for E/e'). While LV maximal thickness and LV ejection fraction were comparable between men and women, GLS was decreased significantly in female patients (- 13.5 [Formula: see text] 3.4% vs. - 15.6 [Formula: see text] 4.0%, P = 0.001 for GLS). Even after adjusting for clinical factors, female was independently associated with HF presentation (Odd ratio 5.19, 95% CI 2.24-12.03, P < 0.001). During a median follow-up duration 34.0 months, 20 patients (9.9%) had HF hospitalization or CV death. In a multivariable analysis, female gender was associated with higher risk of the composite of HF hospitalization or CV death and HF hospitalization alone than male (Adjusted hazard ratio [HR] = 3.31, 95% CI 1.17-9.35, P = 0.024 for primary composite outcome of HF hospitalization or CV death; adjusted HR = 4.78, 95% CI 1.53-14.96, P = 0.007 for HF hospitalization). In patients with non-obstructive HCM, female patients presented with HF more frequently and showed a higher risk of CV events than male patients. LA volume, E/e' and LV mechanics were different between the genders, suggesting that these might contribute to greater susceptibility to HF in women with HCM.


Assuntos
Cardiomiopatia Hipertrófica/fisiopatologia , Disparidades nos Níveis de Saúde , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/mortalidade , Cardiomiopatia Hipertrófica/terapia , Progressão da Doença , Ecocardiografia Doppler , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
3.
J Phys Ther Sci ; 28(6): 1832-5, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27390427

RESUMO

[Purpose] This study aimed to determine appropriate measures for assessing balance ability according to difficulty level during standing tasks. [Subjects and Methods] The subjects were 56 old (>65 years) and 30 young (20-30 years) adults. By using the Berg balance scale, the subjects were divided into three groups: 29 healthy older (Berg score≥52), 27 impaired older (Berg score≥40), and 30 healthy young (Berg score≥55). One inertial measurement unit sensor was attached at the waist, and the subjects performed standing tasks (1 min/task) with six difficulty levels: eyes open and eyes closed on firm ground, one foam, and two foams. Thirty-nine (24 time-domain, 15 frequency-domain) measures were calculated by using acceleration data. The slope of each derived measure was calculated through the least-squares method. [Results] Five (95% ellipse sway area, root mean squares [anterior-posterior and resultant directions], and mean distance [anterior-posterior and resultant directions] in time domain) of the 39 measures showed significant differences among the groups under specific standing conditions. The slopes of derived measures showed significant differences among the groups and significant correlations with the Berg scores. [Conclusion] The slope according to the difficulty level can be used to assess and discriminate standing balance ability.

4.
J Phys Ther Sci ; 28(1): 33-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26957724

RESUMO

[Purpose] In this study, a program was developed for leg-strengthening exercises and balance assessment using Microsoft Kinect. [Subjects and Methods] The program consists of three leg-strengthening exercises (knee flexion, hip flexion, and hip extension) and the one-leg standing test (OLST). The program recognizes the correct exercise posture by comparison with the range of motion of the hip and knee joints and provides a number of correct action examples to improve training. The program measures the duration of the OLST and presents this as the balance-age. The accuracy of the program was analyzed using the data of five male adults. [Results] In terms of the motion recognition accuracy, the sensitivity and specificity were 95.3% and 100%, respectively. For the balance assessment, the time measured using the existing method with a stopwatch had an absolute error of 0.37 sec. [Conclusion] The developed program can be used to enable users to conduct leg-strengthening exercises and balance assessments at home.

5.
Coron Artery Dis ; 27(1): 34-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26492628

RESUMO

OBJECTIVES: A pathophysiological mechanism of microvascular dysfunction in ST-segment elevation myocardial infarction (STEMI) is multifactorial; thus, multiple modalities were needed to precisely evaluate a microcirculation. METHODS: We complementarily assessed microcirculation in STEMI by the index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) immediately after a primary percutaneous intervention in 89 STEMI patients. Cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, target vessel failure, heart failure, and stroke were assessed during a mean follow-up period of 3.0 years. RESULTS: The microcirculation of enrolled patients was classified into four groups using cutoff CFR and IMR values (CFR>2 and mean IMR): group-1 (n=23, CFR>2 and IMR ≤ 27); group-2 (n=31, CFR ≤ 2 and IMR ≤ 27); group-3 (n=9, CFR>2 and IMR>27); and group-4 (n=26, CFR<2 and IMR>27). On echocardiography 3 months later, improvement in the wall motion score index was shown in group-1 (P<0.01), group-2 (P<0.01), and group-3 (P=0.04), whereas group-4 did not show improvement in wall motion score index (P=0.06). During clinical follow-up, there were no MACCE in group-1 and the patients in group-2 and group-3 showed significantly lower MACCE compared with group-4 (group-1=0%, group-2, and group-3=10%, group-4=23.1%, P=0.04). CONCLUSION: Complimentary assessment of microcirculation by the IMR and CFR may be useful to evaluate myocardial viability and the long-term prognosis of STEMI patients.


Assuntos
Vasos Coronários/fisiopatologia , Eletrocardiografia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Microcirculação/fisiologia , Infarto do Miocárdio/fisiopatologia , Intervenção Coronária Percutânea , Resistência Vascular/fisiologia , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Termodiluição/métodos
6.
Eur J Heart Fail ; 9(1): 62-7, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16890014

RESUMO

BACKGROUND: Recent technical developments with high-resolution real-time 3 dimensional echocardiography (RT3DE) facilitate the acquisition of high quality images and the analysis of segmental volume-time curves (VTCs). AIMS: To assess left ventricular (LV) asynchrony using the VTCs of 16 segments by RT3DE, and to evaluate accuracy compared to tissue Doppler imaging (TDI). METHODS: Twenty-three heart failure (HF) patients (LVEF: 25+/-6%, age: 60+/-13 years) and 16 normal controls underwent TDI and RT3DE. The standard deviation (SD3) of the end systolic time reaching minimal systolic volume for the 16 segments on VTCs was obtained by RT3DE. The standard deviation (SD2) of the electromechanical coupling time for the 8 segments was measured using TDI. RESULTS: SD3 was markedly higher in HF patients than in controls (7.7+/-2.5 vs 1.5+/-1.0%, P<0.01) and increased as LVEF decreased (r=-0.85, P<0.01). SD2 was also significantly higher in HF patients (27.0+/-8.6 vs 12.6+/-5.0 ms, P<0.01) and had a good negative correlation with LVEF (r=-0.72, P<0.01). SD3 was well correlated to SD2 (r=0.66, P<0.01). CONCLUSIONS: We suggest that analysis of VTCs in 16 segments using RT3DE may be a useful alternative to TDI for the evaluation of LV asynchrony.


Assuntos
Ecocardiografia Tridimensional/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Ecocardiografia Doppler/métodos , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Ultrassonografia Doppler
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