Más allá de los estetoscopios: avances en la precisión diagnóstica en cardiología pediátrica Una revisión narrativa
Barra lateral del artículo
Contenido principal del artículo
Resumen
La auscultación, un método de diagnóstico con una rica historia que se remonta a la época de Hipócrates, ha sido durante mucho tiempo un enfoque fundamental para identificar enfermedades cardíacas pediátricas. A pesar de su importancia histórica, el desafío de distinguir los soplos inocentes de los que indican defectos cardíacos estructurales en los neonatos persiste, y afecciones como la estenosis aórtica, la estenosis pulmonar y el defecto del tabique auricular pueden malinterpretarse como soplos inocentes, lo que resalta las limitaciones de los métodos tradicionales. Si bien la auscultación cardíaca sigue siendo una herramienta de preselección rentable, su eficacia se ve obstaculizada aún más por la subjetividad y la experiencia requeridas para la interpretación. Una comparación global de las habilidades de auscultación entre los residentes de medicina interna reveló un desempeño subóptimo, lo que enfatiza la necesidad de soluciones innovadoras. La integración de la tecnología y la inteligencia artificial (IA) en cardiología pediátrica ofrece una vía prometedora para mejorar la precisión del diagnóstico y la atención al paciente. Este artículo explora el impacto transformador de la tecnología y la IA en la cardiología diagnóstica abordando las limitaciones de la auscultación tradicional.
Descargas
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Citas
Morris JS. Laennec's stethoscope—the Welsh connection. Journal of the Royal Society of Medicine. 2004 Mar;97(3):137-41. Morris JS. Laennec's stethoscope—the Welsh connection. Journal of the Royal Society of Medicine. 2004 Mar;97(3):137-41.
Begic E, Begic Z. Accidental heart murmurs. Medical Archives. 2017 Aug;71(4):284.
Smith KM. The innocent heart murmur in children. Journal of Pediatric Health Care. 1997 Sep 1;11(5):207-14.
Pelech AN. The physiology of cardiac auscultation. Pediatric Clinics. 2004 Dec 1;51(6):1515-35.
Saeed S, Ali AM, Wasim D, Risnes I, Urheim S. Correlation between Murmurs and Echocardiographic Findings; From an Imaging Cardiologist Point of View. Current Problems in Cardiology. 2023 Feb 1;48(2):101479.
Botto LD, Correa A, Erickson JD. Racial and temporal variations in the prevalence of heart defects. Pediatrics. 2001 Mar 1;107(3):e32-.
Fyler DC, LP B, WE H, HE C, JW K, AS N. Report of the New England regional infant cardiac program.
Abu-Harb M, Wyllie J, Hey E, Richmond S, Wren C. Presentation of obstructive left heart malformations in infancy. Archives of disease in childhood Fetal and neonatal edition. 1994 Nov;71(3):F179.
Wren C, Richmond S, Donaldson L. Presentation of congenital heart disease in infancy: implications for routine examination. Archives of disease in childhood. Fetal and neonatal edition. 1999 Jan;80(1):F49.
Bull C. Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK. The Lancet. 1999 Oct 9;354(9186):1242-7.
Kardasevic M, Kardasevic A. The importance of heart murmur in the neonatal period and justification of echocardiographic review. Medical Archives. 2014 Aug;68(4):282.
Danford DA, Martin AB, Fletcher SE, Gumbiner CH. Echocardiographic yield in children when innocent murmur seems likely but doubts linger. Pediatric cardiology. 2002 Jul;23:410-4.
Norgård G, Greve G, Rosland GA, Berg A. Referral practice and clinical assessment of heart murmurs in children. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke. 2005 Apr 1;125(8):996-8.
Hoffman JI, Kaplan S. The incidence of congenital heart disease. Journal of the American college of cardiology. 2002 Jun 19;39(12):1890-900.
Danford DA. Effective use of the consultant, laboratory testing, and echocardiography for the pediatric patient with heart murmur. Pediatric Annals. 2000 Aug 1;29(8):482-8.
Koo S, Yung TC, Lun KS, Chau AK, Cheung YF. Cardiovascular symptoms and signs in evaluating cardiac murmurs in children. Pediatrics International. 2008 Apr;50(2):145-9.
Azhar AS, Habib HS. Accuracy of the initial evaluation of heart murmurs in neonates: do we need an echocardiogram?. Pediatric cardiology. 2006 Apr;27:234-7.
Mackie AS, Jutras LC, Dancea AB, Rohlicek CV, Platt R, Béland MJ. Can cardiologists distinguish innocent from pathologic murmurs in neonates?. The Journal of pediatrics. 2009 Jan 1;154(1):50-4.
Singh J, Anand RS. Computer aided analysis of phonocardiogram. Journal of Medical Engineering & Technology. 2007 Jan 1;31(5):319-23.
Marcus G, Vessey J, Jordan MV, Huddleston M, McKeown B, Gerber IL, Foster E, Chatterjee K, McCulloch CE, Michaels AD. Relationship between accurate auscultation of a clinically useful third heart sound and level of experience. Archives of internal medicine. 2006 Mar 27;166(6):617-22.
Ishmail AA, Wing S, Ferguson J, Hutchinson TA, Magder S, Flegel KM. Interobserver agreement by auscultation in the presence of a third heart sound in patients with congestive heart failure. Chest. 1987 Jun 1;91(6):870-3.
Mangione S, Nieman LZ. Cardiac auscultatory skills of internal medicine and family practice trainees: a comparison of diagnostic proficiency. Jama. 1997 Sep 3;278(9):717-22.
Nieman MS. Cardiac auscultatory skills of internal medicine and family practice trainees: A comparison of diagnostic proficiency. Clinical Pediatrics. 1998 Aug 1;37(8):519.
Mangione S. Cardiac auscultatory skills of physicians-in-training: a comparison of three English-speaking countries. The American journal of medicine. 2001 Feb 15;110(3):210-6.
Leatham A. Phonocardiography. British medical bulletin. 1952 Jan 1;8(4):333-42.
Nixdorff U. The inaugurator of transmitted echocardiography: Prof. Dr Wolf-Dieter Keidel. European Journal of Echocardiography. 2009 Jan 1;10(1):48-9.
Lalani AV, Lee SJ. Clinical echocardiography-an overview. Canadian Medical Association Journal. 1976 Jan 1;114(1):46. Lalani AV, Lee SJ. Clinical echocardiography-an overview. Canadian Medical Association Journal. 1976 Jan 1;114(1):46.
Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ. Three-dimensional echocardiography: the benefits of the additional dimension. Journal of the American College of Cardiology. 2006 Nov 21;48(10):2053-69.
Stanger P, Silverman NH, Foster E. Diagnostic accuracy of pediatric echocardiograms performed in adult laboratories. The American journal of cardiology. 1999 Mar 15;83(6):908-14.
Erne P. Beyond auscultation--acoustic cardiography in the diagnosis and assessment of cardiac disease. Swiss medical weekly. 2008 Aug 1;138(31-32):439-52.
Peacock WF, Harrison A, Maisel AS. The utility of heart sounds and systolic intervals across the care continuum. Congestive Heart Failure. 2006 Jul;12:2-7.
Collins SP, Lindsell CJ, Peacock WF, Hedger VD, Askew J, Eckert DC, Storrow AB. The combined utility of an S3 heart sound and B-type natriuretic peptide levels in emergency department patients with dyspnea. Journal of cardiac failure. 2006 May 1;12(4):286-92.
Collins SP, Lindsell CJ, Peacock IV WF, Hedger VD, Storrow AB. The effect of treatment on the presence of abnormal heart sounds in emergency department patients with heart failure. The American journal of emergency medicine. 2006 Jan 1;24(1):25-32.
Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, Paquet C, Jacob S, Sidi D, Jouven X. Prevalence of rheumatic heart disease detected by echocardiographic screening. New England Journal of Medicine. 2007 Aug 2;357(5):470-6.
Davenport T, Kalakota R. The potential for artificial intelligence in healthcare. Future healthcare journal. 2019 Jun;6(2):94.
Krittanawong C, Zhang H, Wang Z, Aydar M, Kitai T. Artificial intelligence in precision cardiovascular medicine. Journal of the American College of Cardiology. 2017 May 30;69(21):2657-64.
Kwon JM, Kim KH, Akkus Z, Jeon KH, Park J, Oh BH. Artificial intelligence for detecting mitral regurgitation using electrocardiography. Journal of electrocardiology. 2020 Mar 1;59:151-7.
Fatima H, Mahmood F, Sehgal S, Belani K, Sharkey A, Chaudhary O, Baribeau Y, Matyal R, Khabbaz KR. Artificial intelligence for dynamic echocardiographic tricuspid valve analysis: a new tool in echocardiography. Journal of Cardiothoracic and Vascular Anesthesia. 2020 Oct 1;34(10):2703-6.
Wang JK, Chang YF, Tsai KH, Wang WC, Tsai CY, Cheng CH, Tsao Y. Automatic recognition of murmurs of ventricular septal defect using convolutional recurrent neural networks with temporal attentive pooling. Scientific Reports. 2020 Dec 11;10(1):21797.
Dey D, Slomka PJ, Leeson P, Comaniciu D, Shrestha S, Sengupta PP, Marwick TH. Artificial intelligence in cardiovascular imaging: JACC state-of-the-art review. Journal of the American College of Cardiology. 2019 Mar 26;73(11):1317-35.
Zolgharni M, Dhutia NM, Cole GD, Bahmanyar MR, Jones S, Sohaib SA, Tai SB, Willson K, Finegold JA, Francis DP. Automated aortic Doppler flow tracing for reproducible research and clinical measurements. IEEE transactions on medical imaging. 2014 Jan 30;33(5):1071-82.
Medvedofsky, D., Mor-Avi, V., Amzulescu, M., Fernandez-Golfin, C., Hinojar, R., Monaghan, M.J., Otani, K., Reiken, J., Takeuchi, M., Tsang, W. and Vanoverschelde, J.L., 2018. Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics algorithm: multicentre validation study. European Heart Journal-Cardiovascular Imaging, 19(1), pp.47-58.
Bhavnani SP, Sola S, Adams D, Venkateshvaran A, Dash PK, Sengupta PP. A randomized trial of pocket-echocardiography integrated mobile health device assessments in modern structural heart disease clinics. JACC: Cardiovascular Imaging. 2018 Apr;11(4):546-57.
Ogawa S, Namino F, Mori T, Sato G, Yamakawa T, Saito S. AI diagnosis of heart sounds differentiated with super StethoScope. Journal of Cardiology. 2023 Sep 20.
Thompson WR, Reinisch AJ, Unterberger MJ, Schriefl AJ. Artificial intelligence-assisted auscultation of heart murmurs: validation by virtual clinical trial. Pediatric cardiology. 2019 Mar 15;40:623-9.
Zuhlke L, Myer L, Mayosi BM. The promise of computer-assisted auscultation in screening for structural heart disease and clinical teaching. Cardiovascular journal of Africa. 2012 Aug 1;23(7):405-8.