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New Artificial Intelligence Tool Detects Often Overlooked Heart Diseases

Physician-scientists in the Smidt Heart Institute at Cedars-Sinai have created an artificial intelligence (AI) tool that can effectively identify and distinguish between two life-threatening heart conditions that are often easy to miss: hypertrophic cardiomyopathy and cardiac amyloidosis. The new findings were published in JAMA Cardiology.

“These two heart conditions are challenging for even expert cardiologists to accurately identify, and so patients often go on for years to decades before receiving a correct diagnosis,” said David Ouyang, MD, a cardiologist in the Smidt Heart Institute and senior author of the study. “Our AI algorithm can pinpoint disease patterns that can’t be seen by the naked eye, and then use these patterns to predict the right diagnosis.”

The two-step, novel algorithm was used on over 34,000 cardiac ultrasound videos from Cedars-Sinai and Stanford Healthcare’s echocardiography laboratories. When applied to these clinical images, the algorithm identified specific features – related to the thickness of heart walls and the size of heart chambers – to efficiently flag certain patients as suspicious for having the potentially unrecognized cardiac diseases.

“The algorithm identified high-risk patients with more accuracy than the well-trained eye of a clinical expert,” said Ouyang. “This is because the algorithm picks up subtle cues on ultrasound videos that distinguish between heart conditions that can often look very similar to more benign conditions, as well as to each other, on initial review.”

Without comprehensive testing, cardiologists find it challenging to distinguish between similar appearing diseases and changes in heart shape and size that can sometimes be thought of as a part of normal aging. This algorithm accurately distinguishes not only abnormal from normal, but also between which underlying potentially life-threatening cardiac conditions may be present – with warning signals that are now detectable well before the disease clinically progresses to the point where it can impact health outcomes. Getting an earlier diagnosis enables patients to begin effective treatments sooner, prevent adverse clinical events, and improve their quality of life.

Cardiac amyloidosis, often called “stiff heart syndrome,” is a disorder caused by deposits of an abnormal protein (amyloid) in the heart tissue. As amyloid builds up, it takes the place of healthy heart muscle, making it difficult for the heart to work properly. Cardiac amyloidosis often goes undetected because patients might not have any symptoms, or they might experience symptoms only sporadically.

The disease tends to affect older, Black men or patients with cancer or diseases that cause inflammation. Many patients belong to underserved communities, making the study results an important tool in improving healthcare equity, Ouyang said.

ai heart


Hypertrophic cardiomyopathy is a disease that causes the heart muscle to thicken and stiffen. As a result, it’s less able to relax and fill with blood, resulting in damage to heart valves, fluid buildup in the lungs, and abnormal heart rhythms.

Although separate and distinct conditions, cardiac amyloidosis and hypertrophic cardiomyopathy often look very similar to each other on an echocardiogram, the most commonly used cardiac imaging diagnostic.

Importantly, in the very early stages of disease, each of these cardiac conditions can also mimic the appearance of a non-diseased heart that has progressively changed in size and shape with aging.

“One of the most important aspects of this AI technology is not only the ability to distinguish abnormal from normal, but also to distinguish between these abnormal conditions, because the treatment and management of each cardiac disease is very different,” said Ouyang.

The hope, Ouyang said, is that this technology can be used to identify patients from very early on in their disease course. That’s because clinicians know that earlier is always better for getting the most benefit from therapies that are available today and that can be very effective for preventing the worst possible outcomes, such as heart failure, hospitalizations, and sudden death.

Researchers plan to soon launch clinical trials for patients flagged by the AI algorithm for suspected cardiac amyloidosis. Patients enrolled in the trial will be seen by experts in the cardiac amyloidosis program at the Smidt Heart Institute, one of only a handful of programs on the West Coast dedicated to the disease.

A clinical trial for patients flagged by the algorithm for suspected hypertrophic cardiomyopathy just started at Cedars-Sinai.

“The use of artificial intelligence in cardiology has evolved rapidly and dramatically in a relatively short period of time,” said Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and co-senior author of the study. “These remarkable strides – which span research and clinical care – can make a tremendous impact in the lives of our patients.

Source:   Cedars-Sinai Medical Center     February 23, 2022

Story Source:   Materials provided by Cedars-Sinai Medical Center. Note: Content may be edited for style and length.

Journal Reference:   Grant Duffy, Paul P. Cheng, Neal Yuan, Bryan He, Alan C. Kwan, Matthew J. Shun-Shin, Kevin M. Alexander, Joseph Ebinger, Matthew P. Lungren, Florian Rader, David H. Liang, Ingela Schnittger, Euan A. Ashley, James Y. Zou, Jignesh Patel, Ronald Witteles, Susan Cheng, David Ouyang. High-Throughput Precision Phenotyping of Left Ventricular Hypertrophy With Cardiovascular Deep Learning. JAMA Cardiology, 2022; DOI: 10.1001/jamacardio.2021.6059


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Smart Speakers May Detect Cardiac Arrest

Home devices that use A I may be able to pick up signs of distress and call for help.

Amazon Alexa and Google Home could be lifesavers — quite literally. A team at the University of Washington (UW) created a new tool that can monitor people for cardiac arrest through your at-home smart speaker.

When someone experiences cardiac arrest, they become unresponsive and may stop breathing or gasp for air. The tool can detect that gasp, known as agonal breathing, and then alert authorities for help.

About 475,000 Americans die each year from cardiac arrest. This occurs when the heart suddenly stops beating. Receiving CPR can greatly improve a person’s chance of survival, but only if someone is present.

“Just like smart speakers can listen to Alexa, what we are showing is that they can also passively listen to agonal breathing sounds and either raise an audible alarm or call emergency services when it detects one,” Shyam Gollakota, PhD, an associate professor in UW’s Paul G. Allen School of Computer Science & Engineering, told Healthline. Gollakota was one of the authors of a new study looking at if Alexa can detect signs of cardiac arrest.

How AI can help save your life

The new tool that UW researchers created is a “skill,” similar to an app, which is a built-in capability that can be used on voice devices that incorporate artificial intelligence (AI). These voice devices include Amazon Echo, whose virtual assistant is dubbed Alexa. Skills can be added to an existing Amazon Echo, Google Home, or smartphone.

Researchers tested out the tool, which was developed using real agonal breathing recordings captured from 911 calls. They collected data from 162 calls between 2009 and 2017, and created 236 clips from the calls. The recordings were captured from Alexa-enabled, iPhone 5s, and Samsung Galaxy S4 devices. After different machine learning techniques were applied, the team came up with 7,316 positive clips.

They were played at different distances to simulate possible locational differences. They also added in sounds that may interfere such as air conditioning running or the sound of a pet.

The team then used a negative dataset that had 7,305 sound samples of noises from people such as snoring.

The technology was able to detect agonal breathing 97 percent of the time from up to 20 feet away. The findings were published in NPJ Digital Medicine.

“We envision a contactless system that works by continuously and passively monitoring the bedroom for an agonal breathing event, and alerts anyone nearby to come provide CPR. And then if there’s no response, the device can automatically call 911,” Gollakota said in a statement.

He told Healthline the technology is being licensed and could be commercially available in a year or so.

“We also envision that our system would give users a warning before contacting emergency medical services or other forms of support and provide them a chance to cancel any false alarms,” Justin Chan, a doctoral student and fellow researcher, who also worked on the study, told Healthline.

The researchers plan to commercialize this technology through Sound Life Sciences, Inc. They want to test it on more calls across the country and in other countries.

Chan noted that the technology preserves privacy. It only runs on a smart device and doesn’t send data to the cloud or a third party. Data is only stored locally for a few seconds as required for processing, and is then discarded, he said.

Despite any potential privacy issues, many AI experts find the cardiac arrest detection skill quite a discovery.

“What these researchers have done is brilliant and a glimpse of an important evolution for smart speakers and voice assistants,” Bradley Metrock, an AI and voice expert and CEO of tech-focused Score Publishing, told Healthline.


Physicians on a work in progress

Medical experts say the findings are interesting, but by the time Alexa can detect something is wrong, it may be too late.

Dr. Robert Glatter, an emergency department physician at Lennox Hill Hospital in New York City, says agonal breathing may start only after brain damage is already occurring.

“Lack of adequate blood flow to the brain for greater than three to five minutes — the amount of time it takes to result in irreversible brain damage — will typically occur well before the onset of agonal breathing,” he explained.

He says further research may help uncover other biomarkers that could help detect warning signs far earlier.

“I think the concept of monitoring breathing in a contactless fashion to detect a heart attack is a work in progress,” Glatter said. “Since early intervention is paramount in trying to save lives, we may need to evaluate biomarkers other than agonal breathing, since its appearance is a sign that death is imminent.”

Speak up for better health

It may seem odd to use a robotic device as a way to call for help, but AI is increasingly being used as a way to improve people’s health and detecting when something is wrong.

The reason is that AI is particularly good at detecting patterns, explained Marius Kierski, a partner with Sigmoidal.

His company specializes in machine learning and AI.

“I believe that AI advancements have a longer way to go to make it into everyday devices, because of the regulatory requirements,” he told Healthline.

Alexa also has a home security skill that can listen for sounds like glass breaking when you are not home. You just put your Amazon Echo (or Echo Dot) into security mode and tell it you are leaving. It listens.

In addition, the Alexa-enabled devices already have a host of healthcare-related skills. Express Scripts, for example, lets patients check the status of a home delivery and get notifications when orders are shipped. Atrium Health, a healthcare system in the South, allows people to find an urgent care location near them and schedule a same-day appointment.

“You don’t have privacy concerns then because you’re not home to be eavesdropped on,” said Freddie Feldman, president and CEO of VocoLabs. He is creating Alexa skills and other conversational interfaces that can help patients. “It’s a little different [than the cardiac arrest skill technology], but very much the same in that they’re using AI to detect a certain pattern of sounds and then act on it.”

“I think the advancement is really great and interesting,” he added. “Having a device in the home that is connected and ‘always listening’ is actually a benefit in a use case such as this.”

Henry O’Connell, president and CEO of Canary Speech, believes these applications will be primarily used in hospitals and in clinical trials rather than the home

O’Connell’s company is creating technology that integrates AI and machine learning for health. They are working to devise disease classification tools for Parkinson’s and Alzheimer’s disease, as well as conditions such as anxiety and depression.

O’Connell said hospitals and clinical trials may be a better fit for AI voice applications. In part, this is because in these locations, physicians have to be very clear about how their data will be use in order to get informed consent from patients. Only then can their voice data be used to evaluate them for diseases.

Other AI and health applications are in the pharmaceutical industry, which uses AI in the drug research process.

There’s even a chance radiologists may soon employ AI. A 2018 study found AI may beat dermatologists at detecting some skin cancer signs.

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Does Oral Health Predict Overall Health?

August 3, 2012 | By Katherine Schreiber, Greatist.com

Upwards of 6 billion bacteria live inside the average human mouth. (Kiss me, now?) The wrong buildup of microorganisms in the mouth can lead to infections, tooth decay, cavities, and gum disease. Oral bacteria can also travel into the blood stream, causing or contributing to an array of diseases that affect more than just that smile. Regular dental upkeep—flossing, brushing, mouthwashing, waterpicking, and chewing sugar-free gum—keeps these bad boys under control.

Say “ahhh” – The need-to-know
Think it’s just those pearly whites that benefit from dental hygiene? Think again. Not only does oral upkeep stave off mouth odor, cavities, and gum problems, it’s also linked to life satisfaction and overall happiness. Maintaining those pearly whites pays off, big time. Not convinced? Take a page from the perils of poor oral hygiene for incentive to maintain a cleaner mouth. Below are six diseases that either contribute to or are affected by neglecting the dentist’s advice.
  • Alzheimer’s disease. Impaired cognition doesn’t bode particularly well for remembering to brush, floss, and gargle. People suffering from Alzheimer’s and other forms of dementia are at a higher risk for poor oral health, primarily because they’re less able to independently attend to it. Many medications currently used to treat dementias also interfere with the mouth’s saliva production, which raises the risk of mouth and throat issues even higher.
  • Cardiovascular disease. The hoards of bacteria festering in our mouths can easily infiltrate our bloodstreams. Bleeding gums, mouth sores, and other scrapes or bruises between our cheeks provide a green light for mouth microbes to wiggle their way into the circulatory system, inflame the tissues that line our heart (a condition called endocarditis), contribute to plaque build up in the arteries, and precipitate aneurysms. Tooth loss has also been linked to cardiovascular problems. Need we say more?
  • Diabetes. The relationship between dental health and diabetes goes both ways: Oral infections interfere with blood sugar levels and diabetic symptoms set the stage for these infections to occur. An inflamed mouth is a breeding ground for chemical signals that interfere with sugar and fat metabolism by screwing with insulin secretion. Pesky proteins called cytokines build up around irritated or swelling tissues and can leak into the bloodstream to further throw off diabetics’ already impaired insulin secretion, marring the proper metabolism of sugar and fat found in the diet. Diabetics’ hyperglycemic state only worsens this inflammatory cycle: Too much sugar in the blood mars the structure of protein molecules in the blood, leading to swelling of tissues in the mouth…and elsewhere.
  • Osteoporosis. While this might not be a worry in younger years, what we do now directly influences bone health later in life. Bone-mineral density has been shown to predict periodontal disease—and vice versa. A recent study tracking the rates of periodontal disease in postmenopausal women for five years found that the severity of their mouth problems and osteoporosis increased at a similar rate. The researchers believe this has much to do with how mineral loss makes teeth more susceptible to the bad sides of oral bacteria.Granted, women seem to be at a higher risk for osteoporosis and its related oral health concerns. But that’s no excuse for guys to shy away from the toothpaste aisle. The bones of both sexes can benefit from brushing up. (Actually, guys may need to try and do it a bit more.)
  • Premature birth. Women who give birth to babies well before their due date tend to have more mouth infections than those who deliver babies closer to their ETAs. Molecular signals released by inflamed gums (cytokines and a species called C-reactive protein, to be exact) sneak out of the mouth and into the placenta via mom’s bloodstream. Damage done to still-in-the-oven offspring signals to her body that it’s time to get this puppy out, albeit ahead of schedule.
  • Stress. Life stressors at work, home, or in the environment at large can interfere with our mouth’s ability to tolerate even normal levels of plaque. One study found that stressed out moms had higher rates of cavities and fewer teeth than their less stressed, child-free counterparts (whose mouths were no less nastier, by the way—both groups had the same average rates of tooth plaque). Another found that people working in high stress environments also had higher rates of cavities and other periodontal problems. The culprit(s)? Those inflammatory agents that puff up your body’s tissues. Stress makes them crop up too. Do your mouth—and the rest of yourself—a favor and take a breath, please.

Put your money where your mouth is – The takeaway
Caring for those pearly whites (and the bacteria-laden box they inhabit) is crucial for overall health. Beyond yellow stains and icky breath, a dirty mouth can cause or significantly worsen some very serious health concerns.

Here are some tips to protect your body and mind, via your mouth.
  • Brush up. Twice a day, for two minutes is the recommended amount for those interested in reducing plaque, avoiding cavities, and staving off gingivitis. Bristles can’t get everything. Floss at least once a day to make sure those between-teeth spaces don’t become home base for yesterday’s lunch. Regular flossing cuts down on the harder to reach plaque that leads to periodontal problems.
  • Rinse with antimicrobial mouthwash for 30 to 60 seconds each day and see bad breath, plaque and that gingivitis-causing oral bio-film melt away. (Just remember not to swallow.)
  • Get a new toothbrush at least once every four months. Those mouth microbes also build up on bristles and handles. While many are harmless, some can cause colds, flus, viruses, and infections.
  • Don’t ignore that pile of friendly reminder postcards. Pay your dentist a visit once every six months to catch cavities, gum disease, decay, or oral cancer before they get out of hand. That cleaning won’t hurt either. (Actually, it might. But it’s worth it.)
  • Chew a stick of sugar-free gum after meals or snacks to promote the human mouth’s most trusted health maintenance mechanism: saliva. Frequent chewers have fewer cavities, less plaque, and stronger teeth. Added benefits include a brain power boost.
source: health.com

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Insomnia May Boost Heart Attack Risk

By Matt McMillen

MONDAY, October 24, 2011 (Health.com) — People who struggle with insomnia appear to be more prone to heart attacks than those who typically get a good night’s sleep, a large Norwegian study has found.

In the study, published today in the American Heart Association journalCirculation, researchers conducted a comprehensive health survey of more than 52,000 adults, which included questions about slee

p quality. Over the next 11 years, roughly 5% of the participants had a heart attack for the first time.

Compared to solid sleepers, those who had trouble falling or staying asleep nearly every night were 45% and 30% more likely to have a heart attack, respectively, even after the researchers took into account age, blood pressure,cholesterol levels, and other factors that can contribute to heart disease. People who reported feeling tired or unrefreshed after waking up at least two mornings per week were also at greater risk.

“Cardiologists do not talk regularly about sleep issues with their patients,” says lead researcher Lars Erik Laugsand, MD, an internist in the public health department of the Norwegian University of Science and Technology, in Trondheim. Although he and his coauthors suggest that these conversations may be helpful for assessing heart disease risk, Dr. Laugsand says that further research will be needed to determine how insomnia might affect heart health, and whether treating sleep problems can actually prevent heart attacks.

Cardiologist Suzanne Steinbaum, DO, who directs the Women and Heart Disease program at Lenox Hill Hospital, in New York City, agrees that more research in this area is needed, but she says she already discusses sleep issues with her patients. Stress reduction is a key to preventing heart attacks, she says, and lowering stress is all but impossible if you’re not getting enough sleep.

“We don’t know how significant the sleep disturbance must be, or how long it must persist for it to become significant for heart disease,” Steinbaum says. “But it is safe to say that there is some correlation.”

Stress, depression, and other psychological problems often overlap with sleep difficulties. Dr, Laugsand and his colleagues did factor depression and anxiety symptoms into their analysis, but neither condition had a substantial impact on the results. Other factors involving metabolism or blood-vessel health—such as inflammation—may be involved in the apparent link between insomnia and heart disease, the study notes.

Insomnia is the most common sleep problem in the United States. Roughly one-third of Americans experience occasional symptoms, and nearly 10% say they have chronic insomnia, according to the National Center on Sleep Disorders Research. Insomnia tends to occur more frequently with age, and some studies suggest it may be more prevalent in women.

Although insomnia is common, adequate and lasting treatment for it is not, says Susan Zafarlotfi, PhD, clinical director of the Institute for Sleep-Wake Disorders at Hackensack University, in Hackensack, N.J. “Clinicians often simply medicate their patients, but that is not the way to do it,” she says. “Pharmacology is only for the short term. They need to get at the depth of the problem.”

Previous research has reported a higher risk of heart attack among people with insomnia, but the new study is among the largest of its kind. It should be an eye-opener for cardiologists as well as for neurologists and doctors of all kinds, Zafarlotfi says, adding that future research is likely to strengthen the link between insomnia, heart disease, and related conditions such as stroke. “They have to ask their patients about sleep,” she says. “Sleep has to be a big part of working with patients.”

source: Health.com