Study On Dynamic Monitoring Of Patients With Heart Failure By Wearable Remote Monitoring Device Of Heart Sound And Electrocardiogram

Objective:Explore the correlation between the relevant parameters of the wearable heart sound ECG remote monitoring device in the diagnosis of heart failure,ejection fraction,NT-proBNP,and its feasibility for remote monitoring of changes in heart failure.Methods:The first part was included from October 2019 to December 2019 in the outpatient department of the First Affiliated Hospital of Kunming Medical University.Heart failure patients with ejection fraction<40%(40 cases)and 1:1 according to gender and age 40 cases of matched normal examiners were used as the control group,a total of 80 cases,at the same time underwent cardiac color Doppler ultrasound examination and heart sound electrocardiography,the correlation analysis and group comparison of the data.In the second part,60 patients with heart failure who were admitted to the Department of Cardiology,the First Affiliated Hospital of Kunming Medical University from October 2020 to December 2020,dynamically observe the cardiac color Doppler ultrasound indicators,heart sound ECG indicators and heart failure related indicators during the treatment period.Analyze the trend of changes in various indicators over time and the consistency of changes between indicators,and conduct group analysis according to different EF patients._Measurement data are expressed as X±S categorical variables are described by frequency and ratio,group comparisons are by t-test,multi-sample means comparisons are by analysis of variance;multi-factor correlation is evaluated by linear regression analysis,and repeated measurements are measured by repeated measurements.Measure the analysis of variance,and analyze the difference with P<0.05 as statistically significant.Results:Part 1:80 cases were selected,including 30 males in the control group(75%),33 males in the heart failure group(82.5%),age 53±15 years old;compared with the control group,the left atrial diameter of the heart failure group was larger(38.3±6.1mm vs.28.7±2.5mm,P<0.01),the left ventricular diameter is larger(59,8±9.0mm vs.43.53±2.4mm,P<0.01),ejection fraction is lower(35.2±9.5%vs.72.9±5.5%,P<0.01),the electromechanical activation time(Electro Mechanical Activation Time,EMAT)and the electromechanical activation time percentage(Electro Mechanical Activation Time percentage,EMAT%)are longer(EMAT:106.06±11.12 vs.75.9±13.35,P<0.001,EMAT%:13.99±2.31%vs.8.76±1.38%,p<0.001).EMAT is correlated with EF(r=-0.78;p<0.001).In the multiple linear regression model,EMAT was negatively correlated with EF(β=-0.50,p<0.001),and positively correlated with left ventricular end diastolic volume(LVEDV)(β=0.45,p<0.001).We use ROC curve analysis to determine the critical value of EMAT for predicting EF<40%.When EMAT is 107ms,predicting EF<40%,and the sensitivity is 90.3%.The specificity was 75.9%,P<0.05.Part 2:Sixty patients were selected,including 35 males and 25 females,with an average length of stay of 7.9±3.2 days.NYHA cardiac function classification,with the highest number of grades Ⅱ-Ⅲ,accounting for 91%(1 case of grade Ⅰ,accounting for 1.7%,16 cases of grade Ⅱ,accounting for 26.7%,39 cases of grade Ⅲ,accounting for 65%,and 4 cases of grade Ⅳ,accounting for 6.7%);EMAT and EMAT%tend to decrease as the patient’s condition improves during hospitalization(The EMAT on the first,second,third,and fifth days of admission and the day of discharge were 128.93±22.56 ms,128.45±21.68 ms,125.53±25.01 ms,121.63±23.26 ms,and 117.73±22.18 ms.The EMAT%was 1.58±0.43%,respectively.1.53±0.42%,1.54±0.42%,1.48±0.39%,1.44±0.39%,P<0.01);compared with the time of admission,the EMAT and EMAT%at discharge were significantly shorter(EMAT:128.93±22.56 VS117.73±)22.18,EMAT%:1.58±0.43 vs.1.44±0.39,P<0.01),the EF value of cardiac color Doppler ultrasound did not change significantly,but there was a rising trend(33.66±8.89%vs.39.67±7.84%,P<0.001).According to the ejection fraction,it was divided into three groups:reduced ejection fraction,retained ejection fraction,and median ejection fraction.The weight,EMAT,and NT-proBNP of the three groups changed over time,and the changes were statistically significant(P<0.05).It shows that the weight,EMAT,and NT-proBNP of the three groups of patients decreased significantly with time,and there was an interaction between time and grouping.There were significant differences in the change patterns of the three groups over time,and the changes were correlated,indicating the time factor(the first day of admission,the second day of admission),The third day,the fifth day,the day of discharge),the effect varies with the group(HFrEF,HFpEF,HFmrEF).Conclusion:1.Electromechanical activation time EMAT is negatively correlated with left ventricular ejection fraction EF.2.EMAT has a higher predictive value for EF<40%.3.In hospitalized patients with heart failure,the changes of EMAT,EF and NT-proBNP were consistent,and changed with the improvement of the condition,and the trend was statistically significant.4.The acoustic and electrocardiographic parameters collected by the wearable device can reflect the systolic function of the heart,or can be used as an auxiliary index for the diagnosis and evaluation of patients with heart failure.5.The acoustic and electrocardiographic parameters collected by the wearable device can be changed with changes in the condition of patients with heart failure.The device may be used to remotely assess and monitor the heart function of patients with heart failure,so as to detect changes in the patient’s condition in time.