Bioimpedance-Based Heart Failure Deterioration Prediction Using a Prototype Fluid Accumulation Vest-Mobile Phone Dyad: An Observational Study.

BACKGROUND: Recurrent heart failure (HF) events are common in patients discharged after acute decompensated heart failure (ADHF). New patient-centered technologies are needed to aid in detecting HF decompensation. Transthoracic bioimpedance noninvasively measures pulmonary fluid retention. OBJECTIVE: The objectives of our study were to (1) determine whether transthoracic bioimpedance can be measured daily with a novel, noninvasive, wearable fluid accumulation vest (FAV) and transmitted using a mobile phone and (2) establish whether an automated algorithm analyzing daily thoracic bioimpedance values would predict recurrent HF events. METHODS: We prospectively enrolled patients admitted for ADHF. Participants were trained to use a FAV-mobile phone dyad and asked to transmit bioimpedance measurements for 45 consecutive days. We examined the performance of an algorithm analyzing changes in transthoracic bioimpedance as a predictor of HF events (HF readmission, diuretic uptitration) over a 75-day follow-up. RESULTS: We observed 64 HF events (18 HF readmissions and 46 diuretic uptitrations) in the 106 participants (67 years; 63.2%, 67/106, male; 48.1%, 51/106, with prior HF) who completed follow-up. History of HF was the only clinical or laboratory factor related to recurrent HF events (P=.04). Among study participants with sufficient FAV data (n=57), an algorithm analyzing thoracic bioimpedance showed 87% sensitivity (95% CI 82-92), 70% specificity (95% CI 68-72), and 72% accuracy (95% CI 70-74) for identifying recurrent HF events. CONCLUSIONS: Patients discharged after ADHF can measure and transmit daily transthoracic bioimpedance using a FAV-mobile phone dyad. Algorithms analyzing thoracic bioimpedance may help identify patients at risk for recurrent HF events after hospital discharge.

Detection of discrepancies in facilitated echocardiographic reporting using a prototype rule generator.

BACKGROUND: Although the use of facilitated reporting to generate echocardiographic reports has many advantages over traditional dictation and transcription, it is not perfect, because physicians can still select finding codes that are in conflict with each other. METHODS: The investigators developed a tool allowing the creation of combinations of finding codes that should not be (contradictory) or are typically not found (inconsistent) together and then analyzed a historical collection of finalized echocardiographic reports to determine the frequency with which reporting discrepancies were present. RESULTS: A total of 96,772 reports were evaluated over an 11-year period. The frequencies of contradictory findings in final reports were 4.0%, 3.6%, and 7.1% for transthoracic echocardiography, transesophageal echocardiography, and stress echocardiography, respectively. Nearly a quarter (24.1%) of finalized transthoracic reports and 10.1% of transesophageal reports had findings that were inconsistent with each other. CONCLUSIONS: This study demonstrates that facilitated reporting of echocardiographic studies, using a discrete set of finding codes, allows the generation of rules that can be used to identify discrepancies and alert readers to the need to correct or review their interpretations.

Initial Experience with an Internally Rotating Transthoracic Three-Dimensional Echocardiographic Probe and Image Acquisition on a Conventional Echocardiogram Machine.

Three-dimensional echocardiography has required motorized external scanning devices that move a standard echo transducer to obtain data sets before reconstruction. These transducer holders are susceptible to axis alignment errors and transducer movement. The use of a three-dimensional workstation makes acquisition cumbersome. An internally rotating 5-MHz "omniplane" transthoracic transducer, specifically designed for three-dimensional echocardiography, and an integrated three-dimensional acquisition software package that allows single machine acquisitions were validated in 50 pediatric patients. Children were 1 day to 16 years old and had 22 different cardiac pathological conditions imaged. Ninety-eight of the 104 (94%) data sets collected were successfully reconstructed in three dimensions. Acquisitions took 3-6 minutes depending on the increment of internal rotation. Minimum total study time to set up and complete the acquisition was 12 minutes. The new probe and software makes three-dimensional acquisitions and reconstructions of consistently high quality, rapid, reliable, and user friendly.