Medical Electronics Symposium Conference Proceedings


Authors: Valérie Eveloy, Yan Liu, and Michael G. Pecht
Company: University of Maryland
Date Published: 4/25/2005   Conference: Medical Electronics Symposium

Abstract: Cardiovascular disease (CVD) is currently the leading cause of death in many developed countries. This paper summarizes key requirements in CVD diagnosis and provides an overview of current and emerging CVD monitoring techniques, which could help reduce CVD mortality and cost, and improve the follow-up of CVD patients. The potential of auscultation for CVD assessment is discussed, in the light of advances in digital signal processing, wireless signal communications, sensor miniaturization, and the continued challenges in elucidating the mechanisms of heart sound genesis and propagation.

Cardiovascular disease (CVD), is the leading cause of death in many regions worldwide, accounting for nearly one third of global deaths in 2001 [1], and as much as 40% of deaths in the United States (US) and the European Union (EU) [2,3]. In the US, when considered as either a primary or contributing cause, CVD mortality represents nearly 60% of all mortality [2]. The total yearly cost of CVD has been projected to reach $394 billion in the US this year [2], and is currently estimated to be 169 billion Euros in the EU [3]. The two most frequent forms of CVD are coronary heart disease (CHD) and stroke (also termed cerebrovascular disease), which alone cause 53% and 18% of CVD-induced deaths in the US, respectively [2]. Other common types of CVD include congestive heart failure, high blood pressure, and diseases of the arteries [2].

Such conditions are wearout mechanisms, that develop over time and are referred to as chronic diseases. The elderly (age 65 or older) carry a higher risk of CVD-induced death compared with the rest of the population, and represent 39% of all patients affected by CVD in the US [2]. In addition, 32% of deaths from CVD are premature deaths (i.e., before the average life expectancy) [2]. The aging of the population, which will lead to 40 million Americans being aged 65 or older by 2010 [2], will result in an increased incidence of chronic CVDs. CVD also represents the second largest cause of death in the US population aged less than 15.

While most CVDs in children are due to congenital cardiovascular malformations, an increasing number of children are developing risk factors including high blood pressure, smoking, high blood cholesterol, physical inactivity, overweight, and the metabolic syndrome3. Furthermore, it is anticipated that cardiovascular complications resulting from other conditions, namely obesity and type 2 diabetes, which are affecting a growing portion of the population, will contribute to further fuel the cardiovascular outbreak for years to come [2]. In this context, progress in early, accurate and cost-effective diagnosis of chronic CVDs and their prevention are becoming critical to improve life expectancy and reduce the economic toll of CVD. It is estimated that if all forms of major CVD were eliminated, life expectancy in the US would rise by almost seven years [2].

Auscultation has been the core of cardiac examination in medical practice, and is typically the first diagnostic evaluation performed. The sounds emitted by the heart can denote many cardiovascular diseases. This technique is readily available, easily applicable and cost-effective [4]. Although cardiac auscultation received less attention in teaching and clinical practice in the 1990’s than in the past, due to preference to more direct and sophisticated diagnosis techniques (e.g., ultrasonic imaging, magnetic resonance imaging) [5-7], progress in digital signal processing [8], computing technology and wireless communications have prompted a renewed interest in cardiac sound analysis research.

This paper provides an overview of key requirements in CVD diagnosis, current and emerging monitoring techniques, and discusses the potential of auscultation for CVD screening and follow-up, in the light of advances in digital signal processing, wireless communications, sensor miniaturization, and difficulties in elucidating the mechanisms of heart sound genesis and propagation.

Key words: cardiovascular, heart, sound, health, monitoring.

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