Improving Valvular Pathologies and Ventricular Dysfunction Diagnostic Efficiency Using Combined Auscultation and Electrocardiography Data: A Multimodal AI Approach.

Simple sensor-based procedures, including auscultation and electrocardiography (ECG), can facilitate early diagnosis of valvular diseases, resulting in timely treatment. This study assessed the impact of combining these sensor-based procedures with machine learning on diagnosing valvular abnormalities and ventricular dysfunction. Data from auscultation at three distinct locations and 12-lead ECGs were collected from 1052 patients undergoing echocardiography. An independent cohort of 103 patients was used for clinical validation. These patients were screened for severe aortic stenosis (AS), severe mitral regurgitation (MR), and left ventricular dysfunction (LVD) with ejection fractions ≤ 40%. Optimal neural networks were identified by a fourfold cross-validation training process using heart sounds and various ECG leads, and their outputs were combined using a stacking technique. This composite sensor model had high diagnostic efficiency (area under the receiver operating characteristic curve (AUC) values: AS, 0.93; MR, 0.80; LVD, 0.75). Notably, the contribution of individual sensors to disease detection was found to be disease-specific, underscoring the synergistic potential of the sensor fusion approach. Thus, machine learning models that integrate auscultation and ECG can efficiently detect conditions typically diagnosed via imaging. Moreover, this study highlights the potential of multimodal artificial intelligence applications.

Predictors of Functional Decline in Activities of Daily Living at Discharge in Patients After Cardiovascular Surgery.

BACKGROUND: This study aimed to investigate the trajectory of functional recovery of activities of daily living (ADL) from the time of admission up to hospital discharge, and explored which preoperative and postoperative variables were independently associated with functional decline in ADL at discharge of patients after cardiovascular surgery.Methods and Results:In this observational study, we evaluated ADL preoperatively and at discharge using the Functional Independence Measure (FIM) in patients after cardiovascular surgery. Functional decline in ADL was defined as scoring 1-5 on any one of the FIM items at discharge. Multiple logistic regression was performed to predict the functional decline in ADL at discharge. We found that 18.8% of elective cardiovascular surgery patients suffered from decreased ADL at discharge. The Mini-Mental State Examination (odds ratio (OR): 0.573, 95% confidence interval (CI): 0.420-0.783), gait speed (OR: 0.032, 95% CI: 0.003-0.304) and initiation of walking around the bed (OR: 1.277, 95% CI: 1.103-1.480) were independently associated with decreased ADL at discharge. CONCLUSIONS: A functional decline in ADL at discharge can be predicted using preoperative measures of cognitive function, preoperative gait speed and postoperative day of initiation of walking. These results show that preoperative cognitive screening and gait speed assessments can be used to identify patients who might require careful postoperative planning, and for whom early postoperative rehabilitation is needed to prevent serious functional ADL deficits.

Relationship Between Corticosteroid Dose and Muscle Oxygen Consumption in Recipients of Hematopoietic Stem-Cell Transplantation.

INTRODUCTION: After hematopoietic stem-cell transplantation (HSCT), patients exhibit decreased muscle strength and muscle oxygen consumption. Furthermore, total corticosteroid dose affects the reduction in muscle strength after HSCT. However, to date, no studies have investigated the relationship between corticosteroid dose and muscle oxygen consumption and saturation in these patients. The purpose of this study was to investigate the relationship between steroid dose and deoxyhemoglobin (ΔHHb) and muscle oxyhemoglobin saturation (ΔSmO2) in patients undergoing HSCT. METHODS: This study included 17 men with hematologic disease who underwent allogeneic HSCT. We evaluated ankle dorsiflexor muscle force, ΔHHb, and ΔSmO2 in skeletal muscles by near-infrared spectroscopy (NIRS) in patients before and after HSCT. RESULTS: Peak ankle dorsiflexion, ΔHHb, and ΔSmO2 decreased significantly after transplantation as compared to measurements taken before transplantation (p < 0.01). The change in peak ankle dorsiflexion from before to after HSCT was not significantly correlated with total steroid dose. However, ΔHHb and ΔSmO2 from before to after HSCT were significantly correlated with total steroid dose (p < 0.01). CONCLUSION: This study showed that higher corticosteroid doses are associated with diminished skeletal muscle O2 consumption and skeletal muscle O2 demand relative to supply. Therefore, rehabilitation staff, nurses, and physicians should take note of these findings in patients undergoing HSCT. Moreover, physiotherapists should be carefully measuring muscle oxidative metabolism on skeletal muscle when planning physical exercise in such patients.

Relationship Between Exercise Capacity and Muscle O2Hb Saturation in Patients Before Hematopoietic Stem-Cell Transplantation.

Patients with hematological malignancy might already have decreased muscle oxygen saturation at rest and exercise capacity before undergoing hematopoietic stem cell transplantation (HSCT). However, to date, no studies have investigated the relationship between exercise capacity and muscle oxygen saturation at rest in these patients. Therefore, purpose of this study was to investigate the relationship between exercise capacity and muscle oxygen-hemoglobin (O2Hb) saturation (SmO2) at rest and patients' hemoglobin level before undergoing HSCT. METHODS: This study included 60 men with hematologic disease who underwent allo-HSCT. Patients performed a 6-minute walk test (6MWT) to determine exercise capacity, and muscle O2Hb saturation at rest was evaluatabed using near-infrared spectroscopy (BOM-L1TRW, Omegawave Inc., Japan); hemoglobin levels in hematological malignancy patients before undergoing HSCT were also evaluated. RESULTS: There was a significant correlation between the 6MWT and muscle O2Hb saturation at rest in hematological malignancy patients (p < 0.05). Additionally, the 6MWT was significantly correlated to the hemoglobin level (p < 0.05). Furthermore, muscle O2Hb saturation at rest was significantly related to hemoglobin level (p < 0.05). CONCLUSION: In patients with hematological malignancy, a relationship exists between exercise capacity, muscle O2Hb saturation, and hemoglobin level before they undergo HSCT. Therefore, rehabilitation staff, nurses, and physicians should recognize these relationships in patients who undergo allo-HSCT. Moreover, physiotherapists may need to promote muscle oxidative metabolism through exercise to increase exercise capacity in these patients.

Relationship Between Muscle Oxygen Saturation and Exercise Load in Patients with Malignant Hematopoietic Disease.

Our previous research confirmed that patients with malignant hematopoietic disease already had a low hemoglobin level before allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, no study has determined whether a correlation exists between exercise load, hemoglobin level, and muscle oxygen saturation (SmO2), during exercise. Therefore, the purpose of this study was to investigate whether near-infrared spectroscopy (NIRS)-derived SmO2 is associated with exercise load, as determined by a dynamometer, before allo-HSCT. This study included 19 male patients who received allo-HSCT in Hyogo College of Medicine Hospital (Japan) between November 2009 and October 2012. Patients performed isometric repeated dorsiflexion at 50% maximum voluntary contraction for 180 s to determine exercise load, and SmO2 was evaluated during exercise at the same time using NIRS (BOM-L1TRW, Omega Wave, Inc., Japan). The hemoglobin level was also evaluated before allo-HSCT. Patients with hematopoietic disease before allo-HSCT already had a low hemoglobin level. There was a significant correlation between exercise load and ∆SmO2; however, the hemoglobin level was not correlated with exercise load. In these patients, exercise load might be affected by muscle oxygen consumption rather than by the hemoglobin level. This finding shows that NIRS can used to assess fatigue in patients with malignant hematopoietic disease.

Impaired skeletal muscle oxygenation following allogeneic hematopoietic stem cell transplantation is associated with exercise capacity.

INTRODUCTION: Impaired skeletal muscle oxygenation potentially contributes to reduced exercise capacity in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients during early recovery and may explain altered hemoglobin responses to exercise following allo-HSCT. We investigated whether skeletal muscle oxygenation parameters and hemoglobin parameters in the tibialis anterior decreased following allo-HSCT, and whether these results were associated with declines in exercise capacity. METHODS: We used near-infrared spectroscopy during and following a repeated isometric contraction task at 50% of maximal voluntary contraction in 18 patients before and after allo-HSCT. RESULTS: The rate of decrease in the muscle oxy-hemoglobin saturation (SmO2; an index of skeletal muscle oxygenation) was significantly lower after allo-HSCT (P < 0.01). In contrast, total hemoglobin (an index of hemoglobin) was not different after allo-HSCT. Furthermore, SmO2 during and following exercise was associated with exercise capacity (r = 0.648; P = 0.004 vs. r = 0.632; P = 0.005). CONCLUSION: The results of this study reveal that although the peripheral hemoglobin response was not altered by allo-HSCT, skeletal muscle oxygenation was decreased following allo-HSCT. Furthermore, the decrease in skeletal muscle oxygenation was associated with a reduction in exercise capacity.

Fatigue, Muscle Oxygen Consumption and Blood Flow to the Skeletal Muscle After Allogeneic Hematopoietic Stem Cell Transplantation.

The purpose of this study was to compare the differences in fatigue to those in muscle oxygen consumption and blood flow to the skeletal muscles before and after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study included 25 male patients who had received allo-HSCT between November 2009 and August 2012. Fatigue was assessed by using the Piper fatigue scale. Muscle oxygen consumption, shown by the change in deoxyhemoglobin (ΔHHb), and blood flow to the skeletal muscle, shown by the change in total hemoglobin (ΔtHb), were measured non-invasively in the tibialis anterior muscle during endurance exercise using near-infrared spectroscopy. ΔHHb and ΔtHb were significantly lower following allo-HSCT than before it (p < 0.05). Before allo-HSCT, no relationship was observed between fatigue and either ΔHHb or ΔtHb. However, after allo-HSCT, a significant relationship was found between fatigue and ΔHHb (p < 0.05). Patients experience decreased muscle oxygen consumption and blood flow to skeletal muscles after allo-HSCT. Furthermore, fatigue may have a relationship with decreased muscle oxygen consumption in patients after allo-HSCT. Rehabilitation staff, nurses, and physicians should recognise both decreases in muscle oxygen consumption and blood flow in patients who have undergone allo-HSCT, and physiotherapists may need to promote muscle oxidative metabolism through exercise in order to maintain muscle strength.

Hemoglobin Dynamics in the Skeletal Muscle of Patients with Malignant Hematopoietic Disease.

Impaired oxygen utilization in skeletal muscle potentially contributes to muscle weakness in patients with malignant hematopoietic disease and may explain altered hemodynamic responses to exercise in these patients. We investigated whether changes in hemoglobin parameters in the tibialis anterior muscle in patients with malignant hematopoietic diseases were different from those in age-matched healthy controls and whether these results were associated with a decline in muscle strength. Near-infrared spectroscopy was used during and after a repeated isometric contraction task at 50% of maximal voluntary contraction in 16 patients and 21 age- and sex-matched healthy controls. In the healthy control group, there was a correlation between muscle strength and hemoglobin dynamics, (ΔtHbmean: r = 0.42, p < 0.05; ΔtHbmax: r = 0.575, p < 0.01, respectively) but not in patients with malignant hematopoietic disease. The results of this study may suggest that haemoglobin dynamics during and following exercise were different between patients with malignant hematopoietic disease and healthy controls.

Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is a rare cancer that affects the thin cell wall lining of internal organs and structures. Studies have shown that patients with lung cancer have decreased pulmonary function and exercise capacity after pneumonectomy. However, to date, physical function and health-related quality of life (HRQOL) in surgically treated MPM patients have not been evaluated in detail. The aim of this study was to assess physical function and HRQOL of MPM patients following pleurectomy/decortication (P/D). METHODS: The subjects were 22 MPM patients (20 men and 2 women) who completed P/D between December 2013 and March 2015. Physical function was assessed using handgrip strength and knee extensor strength tests, the 6-min walk distance (6MWD), and pulmonary function tests, including forced expiratory vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). HRQOL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36). RESULTS: The handgrip strength (P < 0.05), 6MWD, FVC, and FEV1 values following P/D decreased significantly compared to baseline (P < 0.001 for each comparison). Additionally, scores of three of the eight SF-36 domains were significantly lower following P/D: physical functioning (P < 0.001), body pain (P = 0.002), and vitality (P = 0.005). 6MWD correlated role physical (P < 0.05) and vitality (P < 0.01). Significant correlations were also observed between FEV1 and physical functioning (P < 0.05) and social functioning (P < 0.05). CONCLUSION: Patients with MPM who completed P/D have decreased physical function and HRQOL. Following surgery, exercise capacity and pulmonary function decreased more than limb muscle strength. Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies for patients with MPM who completed P/D.

Prevalence of sarcopenia and relevance of body composition, physiological function, fatigue, and health-related quality of life in patients before allogeneic hematopoietic stem cell transplantation.

PURPOSE: Cachexia in patients with hematological malignancies is often related to sarcopenia. We believe that allogeneic hematopoietic stem cell transplant (allo-HSCT) patients often exhibit sarcopenia prior to transplantation. Here, we aimed to investigate the prevalence of sarcopenia and its relationship with body composition, physiological function, nutrition, fatigue, and health-related quality of life (QOL) in patients before allo-HSCT. We further investigated the confounding factors associated with sarcopenia. METHODS: We included 164 patients with allo-HSCT in this study. Body composition, handgrip, knee extensor strength, and 6-min walk test were evaluated. Furthermore, fatigue, nutritional status, and health-related QOL were also evaluated. RESULTS: Eighty-three patients (50.6 %) enrolled in our study had sarcopenia prior to allo-HSCT. Patients with sarcopenia experienced decreased muscular strength and increased fatigue compared with patients without sarcopenia (p < 0.05). Patients with sarcopenia showed significantly lower scores in physical functioning, bodily pain, and vitality in health-related QOL than those without sarcopenia. Multivariate regression analysis revealed that only gender and body mass index were significantly related to sarcopenia (gender, odds ratio, 3.09; body mass index, odds ratio, 0.70; p < 0.01). CONCLUSIONS: Sarcopenia is common in patients before allo-HSCT and related to low muscle strength, fatigue, and health-related QOL. Male patients may be more susceptible to sarcopenia than female patients before allo-HSCT. Further study of rehabilitation with gender insight is warranted for patients receiving allo-HSCT.

Impact of early interventions by a cardiac rehabilitation team on the social rehabilitation of patients resuscitated from cardiogenic out-of-hospital cardiopulmonary arrest.

OBJECTIVE: We examined the effects of intervention performed by a multidisciplinary cardiac rehabilitation (CR) team on the social rehabilitation of patients with cardiogenic out-of-hospital cardiopulmonary arrest (OHCA) in the acute phase. METHODS: This study included 122 patients who were resuscitated after cardiogenic OHCA during a 10-year period. They were divided into two groups: including a non-CR group of patients (n=58) who were admitted before the CR team started performing systematic intervention and a CR group (n=64) who were admitted after the intervention was initiated. The following items were examined for each group: treatment condition at onset, contents of treatment, primary disease, presence or absence of underlying disease, presence or absence of complications, general physical and neurological outcome, duration of hospital stay, and status of social rehabilitation. RESULTS: Although the number of patients with cardiogenic OHCA did not markedly change, the number of bystanders participating in cardiopulmonary resuscitation (CPR) was significantly higher in the CR group versus the non-CR group (p<0.01). The effect of bystanders participating in CPR also significantly reduced the mortality outcome (p<0.05 versus the group without CPR), and patients in the CR group were more likely to achieve social rehabilitation (p<0.05 versus the group without CPR). Moreover, the number of patients who returned to society one year later was increased in the CR group versus the non-CR group (p<0.05). The incidence of respiratory complications was also significantly lower in the CR group versus the non-CR group (p<0.05). CONCLUSION: Along with the usefulness of rapid pre-hospital aid, our results suggest that systemic intervention performed by the CR team administered while the patient was in the acute phase may have promoted social rehabilitation of patients resuscitated after cardiogenic OHCA.

A five-year follow-up of a patient with fulminant myocarditis who underwent a stepwise and goal-oriented individualized comprehensive cardiac rehabilitation program.

A 39-year-old man developed fulminant myocarditis and was transferred on mechanical ventilation and a ventricular-assist device to our hospital. On Hospital Day 10, he was weaned from all medical engineering devices, and bedside rehabilitation was initiated. Although a multidisciplinary cardiac rehabilitation team had intervened since Hospital Day 3, he could not be encouraged to begin ambulation because of hypotension and tachycardia. Moreover, he complained of loss of self-confidence and anxiety regarding physical strength, and expansion of activities was difficult. Exercises reflecting his immediate desires and daily activities were used as activity goals, and we developed an individualized exercise program with stepwise increase in load to motivate him to perform rehabilitation. At the time of discharge, his cardiac function recovered to nearly normal levels; however, muscle strength and respiratory function had not recovered. While the intervention was continued at the cardiac rehabilitation outpatient unit, improvement was observed in physical health and mental health-related scale scores. The patient returned to work 4 months after onset of his myocarditis. Moreover, the cardiac rehabilitation team provided support to him for his long-term overseas assignment in the fifth year after myocarditis onset. Long-term comprehensive support by the cardiac rehabilitation team was feasible and useful. .