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1.
Biomédica (Bogotá) ; Biomédica (Bogotá);44(supl.1): 89-100, mayo 2024. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1574117

ABSTRACT

Introduction. Cine-MRI (cine-magnetic resonance imaging) sequences are a key diagnostic tool to visualize anatomical information, allowing experts to localize and determine suspicious pathologies. Nonetheless, such analysis remains subjective and prone to diagnosis errors. Objective. To develop a binary and multi-class classification considering various cardiac conditions using a spatiotemporal model that highlights kinematic movements to characterize each disease. Materials and methods. This research focuses on a 3D convolutional representation to characterize cardiac kinematic patterns during the cardiac cycle, which may be associated with pathologies. The kinematic maps are obtained from the apparent velocity maps computed from a dense optical flow strategy. Then, a 3D convolutional scheme learns to differentiate pathologies from kinematic maps. Results. The proposed strategy was validated with respect to the capability to discriminate among myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy, abnormal right ventricle, and normal cardiac sequences. The proposed method achieves an average accuracy of 78.00% and a F1 score of 75.55%. Likewise, the approach achieved 92.31% accuracy for binary classification between pathologies and control cases. Conclusion. The proposed method can support the identification of kinematically abnormal patterns associated with a pathological condition. The resultant descriptor, learned from the 3D convolutional net, preserves detailed spatiotemporal correlations and could emerge as possible digital biomarkers of cardiac diseases.


Introducción. Las secuencias del cine-resonancia magnética (cine-MRI, cine magnetic resonance imaging) son una herramienta diagnóstica clave para visualizar la información anatómica que les permite a los expertos localizar y determinar aquellas anomalías que resulten sospechosas. No obstante, este análisis sigue siendo subjetivo y propenso a errores de diagnóstico. Objetivo. Desarrollar una clasificación binaria y multiclase, considerando diferentes condiciones cardiacas, mediante un modelo espaciotemporal que permita resaltar los movimientos cinéticos para caracterizar cada enfermedad. Materiales y métodos. Este estudio se centra en el uso de una representación de convolución 3D para caracterizar los patrones cinéticos durante el ciclo cardiaco que puedan estar asociados con enfermedades. Para ello, se obtienen mapas cinéticos a partir de mapas de velocidad aparente, calculados mediante una estrategia de flujo óptico denso. A continuación, un esquema de convolución 3D "aprende" a diferenciar patologías a partir de mapas cinemáticos. Resultados. La estrategia propuesta se validó según la capacidad de discriminar entre infarto de miocardio, miocardiopatía dilatada, miocardiopatía hipertrófica, ventrículo derecho anormal y un examen normal. El método propuesto alcanza una precisión media del 78,0 % y una puntuación F1 score del 75,55 %. Asimismo, el enfoque alcanzó el 92,31 % de precisión para la clasificación binaria entre enfermedades y casos de control. Conclusiones. El método propuesto es capaz de apoyar la identificación de patrones cinéticos anormales asociados con una condición patológica. El descriptor resultante, aprendido de la red de convolución 3D, conserva correlaciones espaciotemporales detalladas y podría surgir como posible biomarcador digital de enfermedades cardiacas.


Subject(s)
Humans , Diagnostic Imaging , Magnetic Resonance Spectroscopy , Heart Diseases
2.
Rev. ADM ; 81(2): 100-108, mar.-abr. 2024. ilus, tab
Article in Spanish | LILACS | ID: biblio-1562435

ABSTRACT

Esta revisión ofrece un enfoque sistemático para establecer una prestación de atención dental segura, integral, coordinada y orientada a la familia del niño con complejidades médicas. Sugerimos que adoptar un enfoque individualizado basado en la fortaleza para la evaluación de niños con afecciones médicas complejas ofrece la base más segura para la prestación de atención en pacientes con enfermedad cardiaca y asma. El objetivo de esta revisión es brindar una visión razonada de atención en el paciente comprometido sistémicamente, basados en protocolos internacionales, y una serie de pasos y modificaciones que deben ser consideradas al momento del manejo odontológico. Se realizó la búsqueda científica en bases digitales contemplando información en idiomas inglés y español, acerca del manejo del paciente dependiendo de su diagnóstico médico y sus complicaciones. Concluimos que el tratamiento dental de pacientes pediátricos con enfermedades sistémicas se puede llevar a cabo de manera eficiente en presencia de un equipo dental bien equipado y apoyo de los padres. Un dentista pediátrico juega un papel importante en el alivio de la ansiedad del niño, manteniendo una relación positiva y haciendo que los servicios de atención se conviertan en experiencias cómodas y libres de complicaciones para pacientes infantiles con enfermedades sistémicas de base, como cardiopatías y/o asma (AU)


This review provides a systematic approach to establishing safe, comprehensive, coordinated, and family-oriented dental care delivery for the child with medical complexities. We suggest that adopting an individualized, strength-based approach to evaluating children with complex medical conditions provides the surest basis for delivering care to heart disease and asthma patients. This review aims to provide a reasoned care approach for the patient with a systemic compromise based on international protocols and a series of steps and modifications that should be considered during dental management. A scientific search was conducted in digital databases, including information in English and Spanish, on managing patients according to their medical diagnosis and complications. We conclude that dental treatment of pediatric patients with systemic diseases can be carried out efficiently in the presence of a well-equipped dental team and parental support. A pediatric dentist plays a vital role in relieving the child's anxiety, maintaining a positive relationship, and making care services become comfortable and complication-free experiences for pediatric patients with underlying systemic diseases, such as heart disease and/or asthma (AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Dental Care for Chronically Ill/methods , Dental Care for Children/methods , Oral Manifestations , Asthma/therapy , Clinical Protocols , Dental Anxiety/prevention & control , Antibiotic Prophylaxis/standards , Heart Diseases/therapy
4.
Ethiopian Journal of Reproductive Health ; 16(2): 10-16, 2024. figures, tables
Article in English | AIM | ID: biblio-1572624

ABSTRACT

Background The demand of ICU care for obstetric patients is rising in low-income settings, where there is low ICU-bed capacity. Introduction of obstetric High-dependency unit (HDU) has been described as an effective strategy to bridge this gap in resource-restricted settings. Objective: To describe the clinical characteristic and maternal outcomes of obstetric patients admitted to the first obstetric HDU in Ethiopia. Study design: This was a descriptive study on clinical characteristics and maternal outcomes of obstetric patients admitted to obstetric HDU over one year (October 2021 to September 2022) at St. Paul's Hospital Millennium Medical College (Ethiopia). Data were collected retrospectively through reviewing patients' medical records using a data extraction format with KOBO collect tool. Data were analyzed using SPSS version 23 and simple descriptive statistics were employed. Proportions and percentages were used to present the results. RESULTS: After excluding 18 patients who did not meet the inclusion criteria, a total of 355 obstetric patients who were admitted to an obstetric HDU were included in the final analysis. Among these all-obstetric patients admitted to obstetric HDU, pre-eclampsia/ eclampsia (82/355, 23.1%) and postpartum hemorrhage (66/355, 18.6%) were the most frequent reasons for admission to the HDU whereas cardiac disease constituted 14.1% (50/355) of the indication for admissions to the unit. Majority (318/355, 89.6%) from the study participants were transferred to other wards with im-provement, while 37(7.9%) deteriorated with 9(2.53%) of them died. Septic shock (6/9, 66.6%) and DIC (2/9, 22.2%) were the leading causes of death in the HDU. Conclusion: Findings of our study demonstrate that opening HDU in a low-income setting is feasible and results in favorable maternal outcomes. Introduction of obstetric HDU in low-income settings is an effective intervention to reduce severe maternal morbidity and mortality associated with low ICU-bed capacity in those settings.


Subject(s)
Humans , Female , Shock, Septic , Cause of Death , Eclampsia , Emergencies , Heart Diseases , Postpartum Hemorrhage
5.
Rev. urug. cardiol ; 39(1): e203, 2024. ilus, graf, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1570057

ABSTRACT

Introducción: la amiloidosis cardíaca (AC) es una miocardiopatía infiltrativa producida por depósito miocárdico extracelular de amiloide. Las variantes más frecuentes son debidas a cadenas ligeras de inmunoglobulinas o transtiretina (ATTR). El centellograma con 99mTc-pirofosfato (99mTc-PYP) es una técnica de imagen molecular que permite diferenciar los subtipos más frecuentes de AC. El presente estudio analizó el rol del 99mTc-PYP y el SPECT-CT en la evaluación de pacientes con sospecha clínica de AC. Materiales y métodos: se realizó 99mTc-PYP y SPECT-CT en 16 pacientes con sospecha clínica de AC, con edad promedio de 63 años. Se realizó análisis cualitativo de las imágenes planares y del SPECT-CT (Mediso, AnyScan), adquiridas 1-3 horas tras la inyección del radiotrazador. Para el análisis cuantitativo de las imágenes planares se calculó la relación H/CL (cuentas promedio obtenidas sobre las regiones de interés del corazón y el hemitórax contralateral). El estudio se consideró positivo para ATTR cuando la relación H/CL fue ≥1.5. Las imágenes de SPECT-CT fueron interpretadas para observar la distribución del trazador a nivel cardíaco y extracardíaco. Resultados: se identificó captación miocárdica de 99mTc-PYP en el ventrículo izquierdo en 6 pacientes y en el ventrículo derecho en 3 pacientes. En estos casos, la relación H/CL fue >1.5. En el resto se descartó la captación miocárdica, con relación H/CL<1.5. Se detectó actividad de pool vascular en las imágenes tomográficas de 7 pacientes y captación extracardíaca ósea anormal de causas traumáticas/degenerativas en 9 pacientes. Cinco pacientes presentaron captación hepática difusa, sin alteración estructural en el TC. Conclusiones: el 99mTc-PYP es una técnica clínicamente relevante en pacientes con sospecha de AC. Constituye una herramienta mínimamente invasiva, ampliamente disponible, de bajo costo y útil en el diagnóstico, pudiendo orientar al subtipo de AC. La información que aporta permite además orientar las opciones terapéuticas y brindar información pronóstica adicional.


Introduction: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by extracellular myocardial amyloid deposition. The most frequent variants are due to immunoglobulin light chains or transthyretin (ATTR). 99mTc-pyrophosphate (99mTc-PYP) scintigraphy is a molecular imaging technique that allows differentiation of the most common subtypes of AC. The present study analyzed the role of 99mTc-PYP and SPECT-CT in the evaluation of patients with clinical suspicion of CA. Materials and methods: 99mTc-PYP and SPECT-CT were performed in 16 patients with clinical suspicion of AC, with an average age of 63 years. Qualitative analysis was performed on the planar and SPECT-CT images (Mediso, AnyScan), acquired 1-3 hours after the injection of the radiotracer. For the quantitative analysis of the planar images, the H/CL ratio (average counts obtained over the regions of interest of the heart and the contralateral hemithorax) was calculated. The study was considered positive for ATTR when the H/CL ratio was ≥1.5. The SPECT-CT images were interpreted to observe the distribution of the tracer at the cardiac and extracardiac level. Results: Myocardial uptake of 99mTc-PYP was identified in the left ventricle in 6 patients and in the right ventricle in 3 patients. In these cases, the H/CL ratio was >1.5. In the rest, myocardial uptake was ruled out, with a H/CL ratio of 1.5. Vascular pool activity was detected in the tomographic images of 7 patients and abnormal extracardiac bone uptake of traumatic/degenerative causes in 9 patients. Five patients presented diffuse hepatic uptake, without structural alteration on CT. Conclusions: 99mTc-PYP is a clinically relevant technique in patients with suspected CA. It constitutes a minimally invasive tool, widely available, low cost and useful in diagnosis, and can guide the AC subtype. The information it provides also makes it possible to guide therapeutic options and provide additional prognostic information.


Introdução: a amiloidose cardíaca (AC) é uma cardiomiopatia infiltrativa causada pela deposição extracelular de amiloide no miocárdio. As variantes mais frequentes são devidas a cadeias leves de imunoglobulina ou transtirretina (ATTR). A cintilografia com 99mTc-pirofosfato (99mTc-PYP) é uma técnica de imagem molecular que permite a diferenciação dos subtipos mais comuns de QA. O presente estudo analisou o papel do 99mTc-PYP e do SPECT-CT na avaliação de pacientes com suspeita clínica de AC. Materiais e métodos: foram realizados 99mTc-PYP e SPECT-CT em 16 pacientes com suspeita clínica de QA, com idade média de 63 anos. A análise qualitativa foi realizada nas imagens planas e SPECT-CT (Mediso, AnyScan), adquiridas 1-3 horas após a injeção do radiotraçador. Para a análise quantitativa das imagens planas, foi calculada a relação H/CL (contagens médias obtidas nas regiões de interesse do coração e do hemitórax contralateral). O estudo foi considerado positivo para ATTR quando a relação H/CL era ≥1,5. As imagens SPECT-CT foram interpretadas para observar a distribuição do traçador em nível cardíaco e extracardíaco. Resultados: a captação miocárdica de 99mTc-PYP foi identificada no ventrículo esquerdo em 6 pacientes e no ventrículo direito em 3 pacientes. Nestes casos, a relação H/CL foi >1,5. Nos demais, foi descartada captação miocárdica, com relação H/CL de 1,5. Atividade do pool vascular foi detectada nas imagens tomográficas de 7 pacientes e captação óssea extracardíaca anormal de causas traumáticas/degenerativas em 9 pacientes. Cinco pacientes apresentaram captação hepática difusa, sem alteração estrutural na TC. Conclusões: o 99mTc-PYP é uma técnica clinicamente relevante em pacientes com suspeita de AC. Constitui uma ferramenta minimamente invasiva, amplamente disponível, de baixo custo e útil no diagnóstico, podendo orientar o subtipo AC. A informação que disponibiliza permite também orientar opções terapêuticas e fornecer informação prognóstica adicional.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Technetium Tc 99m Pyrophosphate , Single Photon Emission Computed Tomography Computed Tomography , Heart Diseases/diagnostic imaging , Amyloidosis/diagnostic imaging , Retrospective Studies
6.
In. Taranto, Eliseo; Nuñez, Edgardo. Esenciales en emergencia y trauma. Montevideo, Bibliomédica, 2024. p.323-342, ilus, tab.
Monography in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1567463
7.
Ribeirão Preto; s.n; mar.2024. 155 p.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1567622

ABSTRACT

As doenças cardiovasculares, com destaque para a síndrome coronariana aguda (SCA), representam a principal causa de mortalidade mundial. Essa síndrome é a manifestação clínica mais comum da doença arterial coronariana (DAC). O intervalo de tempo entre o início dos sintomas e a reperfusão do miocárdio é crucial para a sobrevivência dos pacientes. Contudo, a falta de conhecimento e a demora para reconhecer os sintomas isquêmicos são os principais fatores que influenciam no atraso do atendimento pré-hospitalar. Programas educativos e instrumentos de avaliação são importantes estratégias para educar a população e reduzir eventos recorrentes da SCA. Nossa revisão de literatura demonstrou que, no Brasil, não dispomos de um instrumento validado para avaliar o conhecimento dos indivíduos sobre esta síndrome. O Acute Coronary Syndrome (ACS) Response Index avalia a resposta do indivíduo à SCA, por meio de seu conhecimento, atitudes e crenças. Dessa forma, o objetivo deste estudo metodológico foi adaptar culturalmente e verificar as propriedades de medida da versão adaptada para o Brasil do ACS Response Index, em pacientes com 18 anos ou mais, de ambos os sexos e diagnosticados com DAC. O processo de adaptação cultural transcorreu de acordo com as seguintes etapas: tradução inicial; obtenção do consenso das versões em português; comitê de especialistas; retrotradução; obtenção do consenso das versões em inglês; avaliação pelo autor da versão original; análise semântica; e pré-teste. As seguintes propriedades de medida foram avaliadas: consistência interna, validade de face e de conteúdo, validade de construto entre grupos conhecidos, validade de constructo convergente, validade estrutural e presença de efeitos teto e chão. O nível de significância adotado foi de 0,05. Participaram do estudo 244 indivíduos com DAC. As pontuações médias para as subescalas de conhecimento, atitudes e crenças foram, respectivamente: 12,75 (DP=2,6), 13,48 (DP=3,39) e 22,40 (DP=3,16). A consistência interna da subescala de conhecimento foi avaliada pelo KR-20, cujo valor foi de 0,399. Os resultados dos alfas de Cronbach para as subescalas de atitudes e de crenças foram 0,735 e 0,577, respectivamente. A estrutura original do instrumento foi testada mediante análise fatorial confirmatória, para a qual obteve-se índices de ajuste satisfatórios para as subescalas de conhecimento (SRMR=0,065; RMSEA=0,058; CFI=0,792; TLI=0,761), atitudes (SRMR=0,027; RMSEA=0,053; CFI=0,988; TLI=0,970) e crenças (SRMR=0,047; RMSEA=0,048; CFI=0,971; TLI=0,952). As hipóteses prévias sobre a validade de constructo por grupos conhecidos foram testadas para comparar os valores das três subescalas segundo a faixa etária, presença de orientação prévia sobre sua doença cardíaca e nível escolaridade. Apenas as seguintes hipóteses foram confirmadas: na subescala de conhecimento, os indivíduos com até 59 anos apresentaram melhores níveis de conhecimento quando comparados aos indivíduos com 60 anos ou mais (p=0,003); na subescala de crenças, maiores valores foram obtidos no grupo que relatou orientação prévia sobre sua doença (p=0,008) e naqueles com maior escolaridade (p=0,022). A avaliação da validade de constructo convergente mostrou correlação fraca e positiva entre as subescalas de conhecimento e crenças (r=0,217; p<0,05), e de conhecimento e atitudes (r=0,128; p<0,05). Não encontramos correlação entre os valores das demais subescalas. Constatamos a presença do efeito teto em todos os itens das subescalas de atitudes e de crenças. Os resultados mostraram que o ACS Response Index-BR manteve as equivalências, validade de face e de conteúdo, validade de constructo entre grupos conhecidos nas subescalas de conhecimentos e crenças, ajuste adequado ao modelo estrutural original e confiabilidade satisfatória para a subescala de atitudes. Entretanto, dadas as particularidades da amostra, sugerimos a realização de estudos adicionais com a versão adaptada em diferentes instituições de saúde, assim como, em amostras com características sociodemográficas distintas.


Cardiovascular diseases, especially Acute Coronary Syndrome (ACS), represent the main cause of mortality worldwide. This syndrome is the most common clinical presentation of coronary artery disease (CAD). The time interval between the onset of symptoms and myocardial reperfusion is crucial for patient survival. However, lack of knowledge and delay in recognizing ischemic symptoms are the main factors that influence delays in pre-hospital care. Educational programs and assessment tools are important strategies to educate the population and reduce recurrent ACS events. Our literature review demonstrated that, in Brazil, we do not have a validated instrument to assess individuals' knowledge about this syndrome. The ACS Response Index assesses an individual's response to ACS, through their knowledge, attitudes and beliefs. Therefore, the objective of this methodological study was to culturally adapt and verify the measurement properties of the version adapted for Brazil of the ACS Response Index, in patients aged 18 or over, of both genders and diagnosed with CAD. The cultural adaptation process occurred according to the following stages: initial translation; obtaining consensus on the Portuguese versions; expert committee; back translation; obtaining consensus on English versions; evaluation by the author of the original version; semantic analysis; and pre-test. The following measurement properties were evaluated: internal consistency, face and content validity, construct validity by known groups, convergent construct validity, structural validity and ceiling and floor effects presence. The significance level adopted was 0.05. This study included 244 individuals with CAD. The mean scores for the knowledge, attitudes and beliefs subscales were, respectively: 12.75 (SD=2.6), 13.48 (SD=3.39) and 22.40 (SD=3.16). The internal consistency of the knowledge subscale was assessed using the KR-20, the value of which was 0.399. Cronbach's alpha results for the attitudes and beliefs subscales were 0.735 and 0.577, respectively. The original instrument's structure was tested using confirmatory factor analysis, for which satisfactory fit indices were obtained for the knowledge (SRMR=0.065; RMSEA=0.058; CFI=0.792; TLI=0.761), attitudes (SRMR=0.027; RMSEA =0.053; CFI=0.988; TLI=0.970) and beliefs subscales (SRMR=0.047; RMSEA=0.048; CFI=0.971; TLI=0.952). Previous hypotheses about construct validity by known groups were tested to compare the values of the three subscales according to age range, presence of previous guidance about heart disease and education level. Only the following hypotheses were confirmed: in the knowledge subscale, individuals aged 59 years or younger presented better levels of knowledge when compared to individuals aged 60 years or older (p=0.003); in the beliefs subscale, higher values were obtained in the group that reported previous guidance about their disease (p=0.008) and in those with higher education level (p=0.022). The evaluation of the convergent construct validity showed a weak and positive correlation between the knowledge and beliefs subscales (r=0.217; p<0.05), and knowledge and attitudes subscales (r=0,128; p<0,05). We did not find any correlation between the values of the other subscales. We found the presence of the ceiling effect in all items of the attitudes and beliefs subscales. The results showed that the ACS Response Index-BR maintained equivalences, face and content validity, construct validity by known groups in the knowledge and beliefs subscales, adequate fit to the original structural model, and satisfactory reliability for the attitudes subscale. However, given the particularities of the sample, we recommend conducting additional studies with the adapted version in different healthcare institutions, as well as in samples with different sociodemographic characteristics.


Subject(s)
Humans , Psychometrics , Health Knowledge, Attitudes, Practice , Validation Study , Acute Coronary Syndrome , Heart Diseases
8.
Rio de Janeiro; s.n; 2024. 100 p. tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-1579270

ABSTRACT

Introdução: A aposentadoria por invalidez é o benefício concedido aos servidores públicos quando considerados incapazes de forma permanente para o trabalho. As doenças não comunicáveis são a principal causa de incapacidade permanente e aposentadoria por invalidez no Brasil, com destaque para as doenças cardiovasculares. Em 2006, a Sociedade Brasileira de Cardiologia definiu os critérios de enquadramento das doenças cardiovasculares através da II Diretriz Brasileira de Cardiopatia Grave. Poucos são os estudos sobre este tema, envolvendo uma instituição federal, com regime jurídico próprio, planos de carreira, condições de trabalho e remunerações salariais distintos. Objetivo: Descrever o perfil demográfico, avaliar a mortalidade e analisar a sobrevida dos servidores aposentados por invalidez na Universidade Federal do Rio de Janeiro de 2003 a 2017, com ênfase na cardiopatia grave. Métodos: Foi realizado um estudo de coorte retrospectiva baseado nos registros das aposentadorias por invalidez e nas causas de óbitos dos servidores ao longo de 15 anos. As informações sobre os óbitos foram obtidas através do Subsistema Integrado de Atenção à Saúde do Servidor, SIAPENET, Sistema Integrado de Recursos Humanos e das Certidões de Óbito fornecidas pela Coordenação de Gestão de Pessoal da UFRJ. Adicionalmente, foram recolhidas informações do Sistema de Informações sobre Mortalidade do Estado do Rio de Janeiro. Os resultados foram apresentados em números absolutos e percentuais para variáveis categóricas, enquanto média, desvio-padrão e mediana foram utilizados para variáveis numéricas. A comparação entre variáveis categóricas foi realizada por meio do teste qui-quadrado. Para avaliar a diferença na variável idade entre os sexos e dentro de cada tipo de aposentadoria, empregou-se o teste de Mann-Whitney. Na comparação entre os cargos utilizou-se o teste de Kruskall-Wallis. Modelos de regressão logística univariada e multivariada foram utilizados para analisar os grupos de aposentadorias proporcionais e integrais e a associação com os dados demográficos. As taxas de mortalidade foram calculadas considerando o tempo total até o óbito, ajustadas pelo total de pessoas-ano por categoria e estimadas para cada variável. A sobrevida foi representada por meio de gráficos de Kaplan-Meier. Foram ajustados modelos univariados e multivariados de Cox para analisar a mortalidade em relação às variáveis, com cálculo dos hazard ratio brutos (HR) e ajustados (HRaj). A presença de diagnósticos concordantes na ocasião da aposentadoria e do óbito foi avaliada através do teste qui-quadrado. A significância estatística foi determinada com um intervalo de confiança de 95%, considerando um valor de p < 0,05. Resultados: Foram analisadas 630 aposentadorias, com 368 (51,4%) ocorrendo no sexo feminino. Do total, 334 (53%) foram integrais e 296 (47%) proporcionais. Na ocasião da aposentadoria, 499 (79,2%) servidores apresentaram idade entre 30 e 59 anos, com média de idade de 52,9 (dp = 7,8) anos. Nos cargos de nível superior houve maior ocorrência de aposentadorias integrais (p < 0,001), assim como nas faixas etárias mais elevadas (p < 0,001) e no sexo masculino (p = 0,012). Foram 169 (26,8%) óbitos. A mortalidade foi maior nos professores (37,0%; p = 0,113), entre 65 e 70 anos (48,4%; p = 0,004), no sexo masculino (34,0%; p = 0,001) e nas aposentadorias por cardiopatia grave (41,5%; p < 0,001). A média de sobrevida global foi de 15 anos após a aposentadoria. Diagnósticos concordantes foram observados entre as causas das aposentadorias e as causas dos óbitos, de acordo com o cargo e tipo de aposentadoria. Entre os cargos, as seguintes frequências foram observadas: 74% para os professores, 69% para os técnico-administrativos de nível superior e 49% para os de nível médio ou elementar (p = 0,026). Entre os tipos de aposentadorias as frequências foram: 72% nas integrais por cardiopatia grave, 70% nas integrais por outras causas e 16% nas proporcionais (p< 0,001). Conclusão: As doenças não comunicáveis predominaram como causa das aposentadorias por invalidez na Universidade Federal do Rio de Janeiro. Notavelmente, a média da idade de aposentadoria por invalidez foi precoce, independentemente do sexo e do tipo de aposentadoria. Além disso, servidores de cargos de nível médio ou elementar enfrentaram uma maior incidência de incapacidade permanente. O sexo feminino foi o mais afetado. A proporção de óbitos e a taxa de mortalidade demonstraram ser mais elevadas no cargo de professor, entre indivíduos do sexo masculino, nas faixas etárias mais avançadas e nos grupos de aposentadorias integrais por cardiopatia grave e integrais por outras doenças. Notou-se, nestes últimos grupos, uma frequência mais significativa de diagnósticos concordantes entre a condição que levou à aposentadoria e a causa do falecimento do servidor. Houve um aumento substancial no risco de mortalidade em casos de aposentadoria integral. Em contrapartida, a sobrevida foi estendida em situações de aposentadoria precoce e quando a aposentadoria é proporcional.(AU)


Introduction: Disability retirement is the benefit granted to public servants when deemed permanently incapable of work. Noncommunicable diseases are the leading cause of permanent disability and disability retirement in Brazil, particularly cardiovascular diseases. In 2006, the Brazilian Society of Cardiology established criteria for the classification of cardiovascular diseases through the II Brazilian Guideline for Severe Heart Disease. There are few studies on this subject, especially involving a federal institution with its own legal framework, career plans, distinct working conditions, and salary progression. Goals: To describe the demographic profile, assess mortality, and analyze the survival of retired employees due to disability at the Federal University of Rio de Janeiro from 2003 to 2017, with emphasis on severe heart disease. Methods: A retrospective cohort study was conducted based on the records of disability retirements and causes of death of public servants over 15 years. The information regarding deaths was obtained through the Integrated Health Care Subsystem for Civil Servants, SIAPENET, the Integrated Human Resources System, and death certificates provided by the Personnel Management Coordination of UFRJ. Additionally, data from the Mortality Information System of the State of Rio de Janeiro were collected. The results were presented in absolute and percentage numbers for categorical variables, while mean, standard deviation, and median were used for numerical variables. The comparison between categorical variables was conducted through the chi-square test. The Mann-Whitney test was employed to assess the difference in age between genders and within each type of retirement. In comparing job positions, the Kruskall-Wallis test was used. Univariate and multivariate logistic regression models were applied to analyze proportional and full retirement groups and their association with demographic data. Mortality rates were calculated considering the total time until death, adjusted for total person-years per category, and estimated for each variable. Survival was depicted through Kaplan-Meier graphs. Univariate and multivariate Cox models were adjusted to analyze mortality in relation to variables, calculating crude (HR) and adjusted hazard ratios (HRaj). The presence of concordant diagnoses at the time of retirement and death was assessed using the chi-square test. Statistical significance was determined with a 95% confidence interval, considering a pvalue of < 0.05. Results: A total of 630 retirements were analyzed, 368 (51.4%) being female servants. Of the total, 334 (53%) were full retirements and 296 (47%) were proportional. It was observed that 499 (79.2%) of the servants retired between the ages of 30 and 59, with an average age of 52.9 (SD = 7.8) years. Positions related to higher academic level were associated with full retirements (p < 0.001), as did older age groups (p < 0.001) and servants being male (p = 0.012). A total of 169 (26.8%) deaths were recorded. Mortality was higher among teachers (37.0%; p = 0.113), in the age group between 65 and 70 years (48.4%; p = 0.004), males (34.0%; p = 0.001), and retirements from severe cardiopathyrelated (41.5%; p < 0.001). The overall average survival was 15 years. Concordant diagnoses were observed between the causes of retirements and the causes of deaths, according to the position and type of retirement. Among the positions, the following frequencies were observed: 74% for teachers, 69% for higher-level technical-administrative ones and 49% for those with secondary or elementary level (p = 0.026). Among the types of retirements, the frequencies were: 72% for full retirements due to severe heart disease, 70% for full retirements due to other causes, and 16% for proportional retirements (p < 0.001). Conclusions: Noncommunicable diseases predominated as the cause of disability retirements at the Federal University of Rio de Janeiro. Remarkably, the average age of disability retirement was early, regardless of gender and type of retirement. Additionally, employees in middle or elementary level positions faced a higher incidence of permanent disability. The female gender was the most affected. The proportion of deaths and the mortality rate were higher in the professorship position, among male individuals, in older age groups, and in full retirements due to severe heart disease and other illnesses. In these latter groups, a more significant frequency of consistent diagnoses between the condition leading to retirement and the cause of the employee's death was noted. There was a substantial increase in mortality risk in cases of full retirement. Conversely, survival was extended in situations of early retirement and when retirement is proportional.(AU)


Subject(s)
Humans , Adult , Middle Aged , Aged , Retirement , Survival , Universities , Cardiovascular Diseases , Cardiovascular Diseases/mortality , Demography , Mortality , Government Employees , Retiree , Heart Diseases , Heart Diseases/mortality
9.
Rev. urug. cardiol ; 39(1): e301, 2024. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1576752

ABSTRACT

La cardiopatía congénita es la afección cardíaca más frecuente que complica los embarazos en los países desarrollados. A su vez, los cambios en el estilo de vida, la mayor edad materna asociada a factores de riesgo cardiovasculares propios de la edad como hipertensión, diabetes y obesidad hace que aumente también la incidencia de enfermedades cardíacas adquiridas. Los cambios fisiológicos normales del embarazo pueden agravar cardiopatías preexistentes. La morbimortalidad materna relacionada con enfermedades cardiovasculares es significativa, por lo que es fundamental realizar un abordaje multidisciplinario e individualizado de estas pacientes. La estratificación del riesgo es esencial para guiar la gestión clínica. La planificación de la finalización de la gestación debe ser individualizada, considerando el riesgo materno y fetal, se debe realizar en un centro de tercer nivel de atención y preferentemente lo más cercano al término para disminuir la morbimortalidad perinatal. El parto vaginal es la vía de elección; en la mayoría de los casos, es fundamental la monitorización continua materna y fetal durante el trabajo de parto y el parto y la vigilancia estricta materna en el puerperio.


Congenital heart disease is the most common heart condition that complicates pregnancies in developed countries. Additionally, changes in lifestyle and older maternal age, along with age-related cardiovascular risk factors such as hypertension, diabetes, and obesity contribute to an increased incidence of acquired heart diseases. The normal physiological changes of pregnancy can exacerbate pre-existing heart conditions. Maternal morbidity and mortality related to cardiovascular diseases are significant, highlighting the need for a multidisciplinary and individualized approach to these patients. Risk stratification is essential for guiding clinical management. Planning the timing of delivery should be individualized, considering both maternal and fetal risks, ideally in a tertiary care center and preferably close to term to reduce perinatal morbidity and mortality. Vaginal delivery is the preferred mode, in most cases, with continuous monitoring of both maternal and fetal well-being during labor and delivery, and strict maternal surveillance in the postpartum period.


A cardiopatia congênita é a condição cardíaca mais comum que complica gestações em países desenvolvidos. Além disso, mudanças no estilo de vida e a idade materna avançada, associadas a fatores de risco cardiovascular relacionados à idade como hipertensão, diabetes e obesidade, contribuem para o aumento da incidência de doenças cardíacas adquiridas. As mudanças fisiológicas normais da gravidez podem agravar condições cardíacas pré-existentes. A morbimortalidade materna relacionada a doenças cardiovasculares é significativa, destacando a necessidade de uma abordagem multidisciplinar e individualizada para essas pacientes. A estratificação de risco é essencial para orientar o manejo clínico. O planejamento da terminação da gestação deve ser individualizado, considerando os riscos maternos e fetais, idealmente em um centro de atendimento terciário e preferencialmente próximo ao termo para reduzir a morbimortalidade perinatal. O parto vaginal é o método preferido na maioria dos casos, com monitoramento contínuo do bem-estar materno e fetal durante o trabalho de parto e o parto, além de uma vigilância rigorosa materna no pós-parto.


Subject(s)
Humans , Pregnancy Complications , Pregnancy/physiology , Heart Diseases/complications , Heart Diseases/prevention & control , Case Management
10.
Diagn. tratamento ; 28(3): 126-32, jul-set de 2023. tab 2
Article in Portuguese | LILACS, SES-SP | ID: biblio-1517921

ABSTRACT

Contextualização: As doenças cardiovasculares (DCV) representam a principal causa de morte no Brasil e no mundo e a dieta mediterrânea (DM) surgiu como possibilidade de prevenção dessas doenças. Ela envolve o alto consumo de frutas, vegetais, frutos do mar, nozes, legumes, grãos e azeite, e ingestão moderada de vinho nas refeições, além de menor ingestão de carnes vermelhas e processadas, gordura saturada, doces e bebidas açucaradas. Objetivo: Avaliar a efetividade da DM para prevenção de DCV. Métodos: Trata-se de overview de revisões sistemáticas. Procedeu-se à busca por estudos que associavam a DM às DCV em quatro bases eletrônicas de dados: Cochrane - Central de Registros de Ensaios Clínicos - CENTRAL (2023), PubMed (1966-2023), Portal BVS (1982-2023) e EMBASE (1974-2023). Dois pesquisadores, independentemente extraíram os dados e avaliaram a qualidade dos estudos para a síntese. O desfecho primário de análise envolveu a prevenção de doença cardiovascular e a redução de mortalidade. Resultados: 5 revisões sistemáticas foram incluídas, totalizando 74 ensaios clínicos (n = 124.820) e 16 coortes prospectivas (n = 722.495). Discussão: Embora os estudos incluídos relatem benefícios favoráveis à DM para prevenção de DCV, as evidências são de baixa a moderada qualidade, diante da heterogeneidade e fragilidades metodológicas. Sugere-se a realização de novos estudos clínicos com padronização de relato dos resultados. Conclusão: Parece haver benefício da DM para prevenção de DCV, mas diante das evidências limitadas, há incertezas que tornam lícita a recomendação por novos ensaios clínicos com comparação a outras dietas, para maior robustez dos achados.


Subject(s)
Diet, Mediterranean , Heart Diseases , Clinical Trial , Disease Prevention , Evidence-Based Practice
11.
Rev. bras. ciênc. vet ; 30(3): 87-91, jul./set. 2023. il.
Article in English | LILACS, VETINDEX | ID: biblio-1567792

ABSTRACT

Chronic degenerative mitral valve disease is the most common acquired heart disease and the main cause of congestive heart failure (CHF) in middle-aged to elderly dogs, being more frequent in small and miniature breeds, being rare in breeds of medium to large size. This disease is characterized by nodular deformity of the valve leaflets, as well as thickening and, in some cases, distension of the chordae tendineae. Echocardiographic findings include cardiomegaly, thickening of the atrioventricular valves, valve insufficiency and myocardial dysfunction, which, in turn, become more common with the progression of the disease. According to the consensus of the American College of Veterinary Internal Medicine, endocardiosis can be classified into stages, according to its clinical evolution. The objective of the present study was to determine the clinical, electrocardiographic, radiographic and echocardiographic profile of dogs with chronic degenerative mitral valve disease in a cardiology service between the years 2017 to 2022. The selected animals were those whose diagnoses involved valve alteration with association with echocardiographic evaluation. The data obtained were compiled in Microsoft Excel® spreadsheets and evaluated using descriptive statistics and Pearson's correlation using the BioEstat® software. Through the observations and results obtained, it was possible to relate that the hypothesis of the correlation between the severity of clinical signs and the exacerbation of the structural alteration of the heart valves may be indicators of a worse prognosis for the evolution of chronic degenerative mitral valve disease.


A doença valvar degenerativa crônica de mitral (DVDCM) é a cardiopatia adquirida mais comum e principal causa de insuficiência cardíaca congestiva (ICC) em cães de meia idade a idosos, sendo mais frequente em raças de pequeno porte e miniaturas, sendo rara nas raças de médio a grande porte. Essa doença é caracterizada pela deformidade nodular dos folhetos valvulares, assim como espessamento e, em alguns casos, distensão das cordas tendíneas. Os achados ecocardiográficos incluem cardiomegalia, espessamento das válvulas atrioventriculares, insuficiência valvar e disfunção miocárdica que, por sua vez, tornam-se mais comuns com a progressão da doença. De acordo com o consenso do American College of Veterinary Internal Medicine, a endocardiose pode ser classificada em estágios, de acordo com a sua evolução clínica. O objetivo do presente estudo foi determinar o perfil clínico, eletrocardiográfico, radiográfico e ecocardiográfico de cães portadores de doença valvar degenerativa crônica de mitral em um serviço de cardiologia entre os anos de 2017 a 2022. Os animais selecionados foram aqueles cujos diagnósticos envolveram alteração valvar com associação a avaliação ecocardiográfica. Os dados obtidos foram compilados em planilhas do programa Microsoft Excel® e avaliados por meio de estatística descritiva e correlação de Pearson utilizando o software BioEstat®. Por meio das observações e resultados obtidos, possibilitou-se relacionar que a hipótese da correlação entre gravidade dos sinais clínicos com a exacerbação da alteração estrutural das valvas cardíacas podem ser indicadores de prognóstico pior para a evolução da doença valvar degenerativa crônica de mitral.


Subject(s)
Animals , Dogs , Health Profile , Echocardiography/veterinary , Clinical Diagnosis/veterinary , Dogs/abnormalities , Electrocardiography/veterinary , Heart Diseases/veterinary , Heart Valve Diseases/veterinary , Mitral Valve/abnormalities , Mitral Valve Insufficiency/veterinary
14.
Article in Chinese | WPRIM | ID: wpr-1009196

ABSTRACT

OBJECTIVE@#To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture.@*METHODS@#A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups.@*RESULTS@#There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012).@*CONCLUSION@#Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.


Subject(s)
Aged , Female , Humans , Male , Aged, 80 and over , Retrospective Studies , Hip Fractures/surgery , Femoral Neck Fractures , Heart Failure/etiology , Prognosis , Heart Diseases , Risk Factors , Postoperative Complications/etiology , Dementia , Arrhythmias, Cardiac
15.
Article in Chinese | WPRIM | ID: wpr-1009283

ABSTRACT

OBJECTIVE@#To explore the genetic basis for a Chinese pedigree affected with rare type heart disease.@*METHODS@#A pedigree identified at Shenzhen Maternity and Child Health Care Hospital Affiliated to Southern Medical University on July 9, 2021 was selected as the study subject. Clinical data were collected. Trio-whole exome sequencing (WES) was carried out for the proband and his parents. Candidate variants were validated by Sanger sequencing of his family members and bioinformatic analysis.@*RESULTS@#The proband, a 5-month-old male, was found to have Barth syndrome (dilated myocardiopathy and left ventricular non-compaction). Trio-WES revealed that he has harbored a hemizygous c.542G>A (p.G181A) variant of the TAZ gene, which was inherited from his mother. In addition, his mother, aunt and maternal grandmother were also found to harbor a c.557G>A (p.R186Q) variant of the TNNI3 gene. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the c.542G>A (p.G181A) variant of the TAZ gene was classified as likely pathogenic (PS2_Strong+PM2_Supporting+PP3), whilst the c.557G>A (p.R186Q) variant of the TNNI3 gene was classified as pathogenic (PP1_Strong+PS4_Strong+PP3+PP4+PM2_Supporting).@*CONCLUSION@#The c.542G>A (p.G181A) variant of the TAZ gene probably underlay the Barth syndrome in the proband, and the c.557G>A (p.R186Q) variant of the TNNI3 gene may be responsible for the hypertrophic cardiomyopathy in his mother, aunt and maternal grandmother. Above finding has expanded the mutational spectrum of the TAZ gene and facilitated the diagnosis of this pedigree.


Subject(s)
Female , Humans , Infant , Male , Pregnancy , Barth Syndrome , Cardiomyopathy, Hypertrophic , East Asian People , Heart Diseases , Pedigree
16.
Zhongguo dangdai erke zazhi ; Zhongguo dangdai erke zazhi;(12): 1198-1210, 2023.
Article in Chinese | WPRIM | ID: wpr-1009870

ABSTRACT

Kawasaki disease (KD) is an acute self-limiting vasculitis, and it is the most common cause of acquired heart disease in children under 5 years old. One of the improvement goals in pediatric quality control work for the year 2023, as announced by the National Health Commission, is to reduce the incidence of cardiac events and KD-related mortality in children with KD. In order to standardize the diagnosis, treatment, and long-term management practices of KD in China, and effectively prevent and reduce the incidence of coronary artery lesions and long-term adverse effects, the guideline working group followed the principles and methods outlined by the World Health Organization and referenced existing evidence and experiences to develop the "Evidence-based guidelines for the diagnosis and treatment of Kawasaki disease in children in China (2023)". The guidelines address the clinical questions regarding the classification and definition of KD, diagnosis of different types of KD, treatment during the acute phase of KD, application of echocardiography in identifying complications of KD, and management of KD combined with macrophage activation syndrome. Based on the best evidence and expert consensus, 20 recommendations were formulated, aiming to provide guidance and decision-making basis for healthcare professionals in the diagnosis and treatment of KD in children.


Subject(s)
Child , Humans , Child, Preschool , Mucocutaneous Lymph Node Syndrome/complications , Vasculitis/drug therapy , Heart , Heart Diseases , China , Immunoglobulins, Intravenous/therapeutic use
17.
Zhongguo Zhong Yao Za Zhi ; (24): 1792-1799, 2023.
Article in Chinese | WPRIM | ID: wpr-981396

ABSTRACT

Arrhythmia is an external manifestation of cardiac electrophysiological disorder. It exists in healthy people and patients with various heart diseases, which is often associated with other cardiovascular diseases. The contraction and diastole of myocardium are inseparable from the movement of ions. There are many ion channels in the membrane and organelle membrane of myocardium. The dynamic balance of myocardial ions is vital in maintaining myocardial electrical homeostasis. Potassium ion channels that have a complex variety and a wide distribution are involved in the whole process of resting potential and action potential of cardiomyocytes. Potassium ion channels play a vital role in maintaining normal electrophysiological activity of myocardium and is one of the pathogenesis of arrhythmia. Traditional Chinese medicine(TCM)has unique advantages in treating arrhythmia for its complex active components and diverse targets. A large number of TCM preparations have definite effect on treating arrhythmia-related diseases, whose antiarrhythmic mechanism may be related to the effect on potassium channel. This article mainly reviewed the relevant studies on the active components in TCM acting on different potassium channels to provide references for clinical drug use and development.


Subject(s)
Humans , Potassium Channels , Medicine, Chinese Traditional , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , Heart Diseases/drug therapy , Ions
18.
Zhonghua xinxueguanbing zazhi ; (12): 656-661, 2023.
Article in Chinese | WPRIM | ID: wpr-984699

ABSTRACT

Objective: To recognize the potential factors that contribute to the eradication of migraine headache in patients with patent foramen ovale (PFO) at one year after percutaneous closure. Methods: A prospective cohort study was conducted, which enrolled patients diagnosed with migraines and PFO at the Department of Structural Heart Disease, First Affiliated Hospital of Xi'an Jiaotong University between May 2016 and May 2018. The patients were segregated into two groups based on their response to treatment, and one group showed elimination of migraines while another did not. Elimination of migraines was defined as a Migraine Disability Assessment Score (MIDAS) score of 0 at one year postoperatively. Least Absolute Shrinkage and Selection Operator (LASSO) regression model was utilized to identify the predictive variables for migraine elimination post-PFO closure. Multiple logistic regression analysis was employed to determine the independent predictive factors. Results: The study enrolled a total of 247 patients, with an average age of (37.5±13.6) years, comprising 81 male individuals (32.8%). One year after closure, 148 patients (59.9%) reported eradication of their migraines. Multivariate logistic regression analysis revealed that migraine with or without aura (OR=0.003 9, 95%CI 0.000 2-0.058 7, P=0.000 18), a history of antiplatelet medication use (OR=0.088 2, 95%CI 0.013 7-0.319 3, P=0.001 48) and resting right-to-left shunt (RLS) (OR=6.883 6, 95%CI 3.769 2-13.548 0, P<0.001) were identified as independent predictive factors for elimination of migraine. Conclusion: Migraine with or without aura, a history of antiplatelet medication use, and resting RLS are the independent prognostic factors associated with elimination of migraine. These results provide important clues for clinicians to choose the optimal treatment plan for PFO patients. However, further studies are needed to confirm these findings.


Subject(s)
Humans , Male , Young Adult , Adult , Middle Aged , Foramen Ovale, Patent/surgery , Prospective Studies , Heart Diseases , Hospitals , Migraine Disorders/surgery
19.
Zhonghua xinxueguanbing zazhi ; (12): 750-758, 2023.
Article in Chinese | WPRIM | ID: wpr-984713

ABSTRACT

Objective: To investigate the diagnostic efficiency and clinical application value of an artificial intelligence-assisted diagnosis model based on a three-dimensional convolutional neural network (3D CNN) on echocardiographic videos of patients with hypertensive heart disease, chronic renal failure (CRF) and hypothyroidism with cardiac involvement. Methods: This study is a retrospective study. The patients with hypertensive heart disease, CRF and hypothyroidism with cardiac involvement, who admitted in Henan Provincial People's Hospital from April 2019 to October 2021, were enrolled. Patients were divided into hypertension group, CRF group, and hypothyroidism group. Additionally, a simple random sampling method was used to select control healthy individuals, who underwent physical examination at the same period. The echocardiographic video data of enrolled participants were analyzed. The video data in each group was divided into a training set and an independent testing set in a ratio of 5 to 1. The temporal and spatial characteristics of videos were extracted using an inflated 3D convolutional network (I3D). The artificial intelligence assisted diagnosis model was trained and tested. There was no case overlapped between the training and validation sets. A model was established according to cases or videos based on video data from 3 different views (single apical four chamber (A4C) view, single parasternal left ventricular long-axis (PLAX) view and all views). The statistical analysis of diagnostic performance was completed to calculate sensitivity, specificity and area under the ROC curve (AUC). The time required for the artificial intelligence and ultrasound physicians to process cases was compared. Results: A total of 730 subjects aged (41.9±12.7) years were enrolled, including 362 males (49.6%), and 17 703 videos were collected. There were 212 cases in the hypertensive group, 210 cases in the CRF group, 105 cases in the hypothyroidism group, and 203 cases in the normal control group. The diagnostic performance of the model predicted by cases based on single PLAX view and all views data was excellent: (1) in the hypertensive group, the sensitivity, specificity and AUC of models based on all views data were 97%, 89% and 0.93, respectively, while those of models based on a single PLAX view were 94%, 95%, and 0.94, respectively; (2) in the CRF group, the sensitivity, specificity and AUC of models based on all views data were 97%, 95% and 0.96, respectively, while those of models based on a single PLAX view were 97%, 89%, and 0.93, respectively; (3) in the hypothyroidism group, the sensitivity, specificity and AUC of models based on all views data were 64%, 100% and 0.82, respectively, while those of models based on a single PLAX view were 82%, 89%, and 0.86, respectively. The time required for the 3D CNN model to measure and analyze the echocardiographic videos of each subject was significantly shorter than that for the ultrasound physicians ((23.96±6.65)s vs. (958.25±266.17)s, P<0.001). Conclusions: The artificial intelligence assisted diagnosis model based on 3D CNN can extract the dynamic temporal and spatial characteristics of echocardiographic videos jointly, and quickly and efficiently identify hypertensive heart disease and cardiac changes caused by CRF and hypothyroidism.


Subject(s)
Male , Humans , Artificial Intelligence , Retrospective Studies , Echocardiography/methods , Heart Diseases , Hypertension , Hypothyroidism
20.
J. biomed. eng ; Sheng wu yi xue gong cheng xue za zhi;(6): 736-742, 2023.
Article in Chinese | WPRIM | ID: wpr-1008894

ABSTRACT

Electrocardiogram (ECG) signal is an important basis for the diagnosis of arrhythmia and myocardial infarction. In order to further improve the classification effect of arrhythmia and myocardial infarction, an ECG classification algorithm based on Convolutional vision Transformer (CvT) and multimodal image fusion was proposed. Through Gramian summation angular field (GASF), Gramian difference angular field (GADF) and recurrence plot (RP), the one-dimensional ECG signal was converted into three different modes of two-dimensional images, and fused into a multimodal fusion image containing more features. The CvT-13 model could take into account local and global information when processing the fused image, thus effectively improving the classification performance. On the MIT-BIH arrhythmia dataset and the PTB myocardial infarction dataset, the algorithm achieved a combined accuracy of 99.9% for the classification of five arrhythmias and 99.8% for the classification of myocardial infarction. The experiments show that the high-precision computer-assisted intelligent classification method is superior and can effectively improve the diagnostic efficiency of arrhythmia as well as myocardial infarction and other cardiac diseases.


Subject(s)
Humans , Electrocardiography , Heart Diseases , Myocardial Infarction/diagnostic imaging , Algorithms , Electric Power Supplies
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