Initial Field Test of a Cloud-Based Cardiac Auscultation System to Determine Murmur Etiology in Rural China
Initial Field Test of a Cloud-Based Cardiac Auscultation System to Determine Murmur Etiology in Rural China
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DOI：
10.1007/s00246-016-1563-8
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发表时间：
2017-04-01
影响因子：
1.6
通讯作者：
Ni, Quan
中科院分区：
文献类型：
--
作者：
Pyles, Lee;Hemmati, Pouya;Ni, Quan
开发了心脏听诊的采集、分发和远距离、异步判读系统，并在农村中国进行了现场测试。我们启动了一项概念验证测试，作为系统设计的关键组成部分，允许在先天性心脏病(CHD)评估方面缺乏经验的乡村医生在诊断和治疗患有严重心脏病的儿童方面获得帮助。该项目测试了这样一种假设，即可以使用数字听诊器和互联网云传输来将心音图传递给有经验的观察者，从而实现对心脏杂音的可接受筛选。在中华人民共和国中国云南省勐海区接受校本筛查的7,993名儿童中，有149名儿童的杂音被筛查员注意到。用HeartLink远程听诊系统采集数字化心音和心音图，由昆明医科大学第一附属医院心内科住院医师进行超声心动图检查。存储在云服务器上的数字心音图后来由一名获得委员会认证的美国儿科心脏病专家远程审查。这些受试者中有14人被超声心动图确诊为冠心病。使用HeartLink系统，这位儿科心脏病专家在14名患有病理性杂音的受试者中确定了11名，并漏掉了3名患有房间隔缺陷的受试者，这些受试者被错误地识别为静脉嗡嗡声或斯蒂尔杂音。此外，在现场研究期间，当超声心动图没有证实冠心病时，10名受试者被记录为有病理性杂音。总体检测准确率为91%，敏感性为78.5%，特异性为92.6%。这项概念验证研究证明了使用HeartLink系统区分冠心病引起的病理性杂音和正常功能性心脏杂音的可行性。这项实地研究是在缺乏训练有素的医疗专业人员和儿科心脏计划的低资源环境下开发成本效益高的CHD筛查策略的第一步。
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.