WO2023021142A1 - Dispositif d'auscultation simultanée au niveau de deux points d'auscultation - Google Patents

Dispositif d'auscultation simultanée au niveau de deux points d'auscultation Download PDF

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Publication number
WO2023021142A1
WO2023021142A1 PCT/EP2022/073086 EP2022073086W WO2023021142A1 WO 2023021142 A1 WO2023021142 A1 WO 2023021142A1 EP 2022073086 W EP2022073086 W EP 2022073086W WO 2023021142 A1 WO2023021142 A1 WO 2023021142A1
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WIPO (PCT)
Prior art keywords
detecting
acoustic signal
auscultation
point
acoustic
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PCT/EP2022/073086
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German (de)
English (en)
Inventor
Elric Zweck
Ralf Westenfeld
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Heinrich-Heine-Universität Düsseldorf
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Publication of WO2023021142A1 publication Critical patent/WO2023021142A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B7/00—Instruments for auscultation
    • A61B7/02—Stethoscopes
    • A61B7/026—Stethoscopes comprising more than one sound collector
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B7/00—Instruments for auscultation
    • A61B7/02—Stethoscopes
    • A61B7/04—Electric stethoscopes

Definitions

  • the invention relates to a device, in particular a medical device, comprising a means for detecting at least a first acoustic signal at a first auscultation point and a means for detecting at least a second acoustic signal at a second auscultation point.
  • the invention also relates to a method carried out by at least one device, in particular a device according to the invention, a computer program product and a computer-readable storage medium.
  • auscultation In medicine, auscultation is still a common means of detecting acoustic signals that are generated by various body structures. Auscultation means in particular the indirect listening to organ activities. For example, auscultation can be used to listen to patients' lungs, heart, intestines and blood vessels. As a rule, it allows initial conclusions to be drawn about abnormalities or diseases.
  • a stethoscope is an instrument for assessing sound phenomena inside hollow bodies. In human and veterinary medicine, the stethoscope is used to assess tones and noises that are associated, for example, with the activity of the heart, lungs or intestines. Every initial physical examination includes auscultation of the heart valves and sometimes also the carotid arteries to rule out pathological flow murmurs or transmitted pathological heart murmurs. When measuring blood pressure, a stethoscope is used to listen to the Korotkoff flow sounds.
  • Conventional mechanical stethoscopes include a stethoscope head in which a membrane is arranged, which is made to vibrate by acoustic waves and passes them on to the air column in the stethoscope tube. With the help of ear hooks, these waves are directed to the user's eardrum.
  • Electronic stethoscopes In addition to the mechanical tube stethoscopes, electronic stethoscopes are also known. Electronic stethoscopes record acoustic signals using a microphone, which converts them into electrical signals, directs them to the loudspeakers on the ear and amplifies them there. As a rule, noise is suppressed, with the frequencies inaudible to the human ear being filtered out. For example, electronic amplifiers and filters are used to improve the signals.
  • the object of the present invention is therefore to provide a device, in particular a medical device, with which auscultation is simplified, in particular improved, and a more objective assessment of noise properties is made possible.
  • the present invention is based on the object of proposing an advantageous method, computer program product and computer-readable storage medium.
  • the above-mentioned object for a device comprising a means for detecting at least one first acoustic signal at a first auscultation point and a means for detecting at least one second acoustic signal at a second auscultation point is achieved in that the means for detecting the at least one first acoustic signal at the first auscultation point and the means for detecting the at least one second acoustic signal at the second auscultation point are designed for essentially simultaneous detection of the signals.
  • the device is in particular a device for detecting heart valve disease.
  • the device may diagnose and/or assist in diagnosing heart valve disease, as described below.
  • the task outlined above for a (computer-implemented) method is carried out by at least one device, in particular a device according to the invention, comprising the steps:
  • Detection of at least one second acoustic signal at a second auscultation point solved in that the detection of the at least one first acoustic signal and the at least one second acoustic signal takes place essentially simultaneously.
  • a computer program product comprising program instructions for executing and/or controlling the method according to the invention when the program is executed on a processor.
  • Exemplary embodiments of the first, second, third and fourth aspects of the invention may be in accordance with one or more of the configurations described below and/or have one or more of the characteristics described below.
  • acoustic signals which are generated, for example, by breathing, heart or bowel activities, can be recorded and preferably evaluated essentially simultaneously at at least two auscultation points, as will be described below. It has been shown that through the essentially simultaneous detection of the first acoustic signal at the first auscultation point and the second acoustic signal at the second auscultation point, a local differentiation of the detected signals can take place, whereby, for example, noises on one side of the chest immediately appear with noises can be compared on the other side, allowing conclusions to be drawn about asymmetries, for example.
  • the temporal detection takes place, for example, over a certain (approximately predefined) interval.
  • Essentially simultaneous detection is understood in particular to mean that the detection, for example, only needs to have a temporal overlap of the time intervals in which the respective acoustic signals are detected, which is sufficient for the purposes mentioned, but in this respect it is not absolutely essential that they are detected at the same time ( but of course this is possible).
  • a detection at exactly two Auscultation points is sufficient, which means that reliable results can already be achieved with little outlay in terms of device technology.
  • an essentially simultaneous detection of further acoustic signals at further auscultation points can take place, in particular by means of further means for detection, for example at the auscultation points described below.
  • the locally differentiated detection at at least two auscultation points can provide information about the most common heart valve diseases.
  • the auscultation points are preferably assigned to the area of a specific heart valve (aortic valve, pulmonary valve, tricuspid valve, mitral valve). In this area, the respective flap can be heard particularly well.
  • the aortic valve and the mitral valve can be recorded at different locations with different intensity and can thus be better differentiated.
  • the device can be designed to detect a heart valve disease in one (or more) of the heart valve(s) mentioned (aortic valve, pulmonary valve, tricuspid valve and/or mitral valve).
  • the device can be designed to detect a (potential) heart valve disease in general and/or a corresponding probability of this.
  • the device can be designed to detect one or more properties (for example insufficiency and/or stenosis) of one or more (in particular all four) heart valves.
  • Preferred auscultation points of the heart valves are the second intercostal space to the left of the breastbone (parasternal) for the pulmonary valve, the second intercostal space to the right of the breastbone (parasternal) for the aortic valve, the fourth intercostal space to the right of the breastbone (parasternal) for the tricuspid valve and the fourth intercostal space to the right of the breastbone (parasternal) for the mitral valve the fifth intercostal space, left middle clavicle line (medioclavicular).
  • the preferred auscultation point for the Erb's point is the third intercostal space, to the left of the breastbone (parasternal). While different ones of these auscultation points can be combined depending on the goal, it is preferred that the two auscultation points are the second right intercostal space and the third left intercostal space (parasternal).
  • the distance between the first auscultation point and the second auscultation point can also depend, for example, on the gender, age, height and/or shape of a patient.
  • the distance between the means for detecting the at least one first acoustic signal at the first auscultation point and the means for detecting the at least one second acoustic signal at the second auscultation point is adjustable.
  • the device in particular the connection part described below
  • the device is designed so that the device depends on the body size of a human patient, for example, z. B. can be adjusted in several, e.g. in three steps.
  • the distance between the means for detecting the first and the second acoustic signal depends in particular on the distance between the respective auscultation points.
  • the device can be placed on a patient's chest such that the means for substantially simultaneously detecting the acoustic signals in the second right intercostal space and in the third left intercostal space are positioned parasternally.
  • the means for detecting the at least one first acoustic signal at the first auscultation point and the means for detecting the at least one second acoustic signal at the second auscultation point detect acoustic signals that are locally separate from one another and are transmitted, for example, from the heart valves via the bloodstream to the front wall of the chest became.
  • the simultaneous detection of the first and the second acoustic signal at auscultation points that are separate from one another has the particular advantage that essentially at the same time information from two auscultation points can be used to predict heart valve disease. While the acquisition of acoustic signals at different auscultation points could only take place one after the other up to now, a local differentiation of the valve diseases can take place in this way.
  • any interference signals can be identified as such with the help of the essentially simultaneously recorded first and second acoustic signals, for example depending on whether and how the signals are recorded at both auscultation points.
  • the classic stethoscope can be supplemented or even replaced, particularly in the detection of relevant heart diseases worthy of treatment, in particular heart valve diseases.
  • the diagnostic accuracy can be significantly improved by means of the invention.
  • the means for detecting the at least one first acoustic signal at the first auscultation point and/or the means for detecting the at least one second acoustic signal at the second auscultation point comprises at least one membrane element.
  • the at least one membrane element can be used to generate, amplify, absorb, dampen or measure the vibration generated by the first and/or second acoustic signal.
  • the device comprises two separate membrane elements, one membrane element being used to detect the first acoustic signal at the first auscultation point and the other membrane element being used to detect the second acoustic signal at the second auscultation point.
  • the membrane elements include, in particular, membranes that are caused to vibrate by the acoustic signals.
  • a membrane describes a thin structure, such as B. a skin or film has a large surface area in relation to its thickness.
  • the device detects acoustic signals transmitted from the heart valves via the blood stream to the front wall of the thorax by means of two separate membranes which are set in vibration. For this purpose, the membranes come into contact in particular with the body surface of the patient.
  • the device comprises at least one converter, in particular a piezoelectric sensor, for converting the at least one first and at least one second acoustic signal.
  • the vibrations caused by at least one acoustic signal can be converted into corresponding electrical signals with the aid of the converter.
  • the at least one converter is preferably an electroacoustic converter, which is used to convert mechanical sound energy into electrical energy.
  • the converter is set up in particular for detecting the movements through the at least one membrane element, in particular the at least one membrane. For this purpose, it is in particular mechanically or electrically coupled to the at least one membrane element. With the help of the converter, the movements of the membrane elements in particular are recorded and converted into electrical energy.
  • the converter is preferably a piezoelectric sensor.
  • the at least one membrane element is mechanically coupled to the piezoelectric sensor, which is deformed by pressure fluctuations and outputs them as electrical voltage fluctuations.
  • the movements of the at least one membrane element are preferably detected by an integrated piezoelectric sensor.
  • the piezo ceramic lead zirconate titanate (PZT) is usually used as the piezoelectric material.
  • the electrical voltage fluctuations of the piezoelectric material are transmitted to an amplifier and/or processor, for example.
  • the device comprises at least one means for detecting at least one electrocardiographic signal.
  • the method according to the second aspect preferably includes detecting at least one electrocardiographic signal.
  • the recorded electrocardiographic signal allows a more precise diagnosis with regard to heart diseases, in particular heart valve diseases, with the help of additional information, for example in the form of an electrocardiogram (ECG). If the at least two acoustic signals and the at least one electrocardiographic signal are present at the same time, a particularly precise diagnostic statement can be made.
  • ECG electrocardiogram
  • the means for detecting the at least one electrocardiographic signal preferably comprises at least one first electrode and one second electrode.
  • the device is designed to measure a voltage as a dipole moment between the first and the second electrode. For example, a single channel electrocardiogram or an equivalent of a single channel electrocardiogram is measured with the first electrode and the second electrode.
  • the device can advantageously be designed to use the first electrode and the second electrode to detect muscular excitations in the chest and/or movements of the patient and thus to identify movement artifacts more easily. If, for example, a movement artifact is detected, this can trigger the device to repeat (or suggest) the described acquisition of the acoustic signals, for example.
  • the electrocardiographic signal between the first auscultation point and the second auscultation point recorded.
  • the first electrode is preferably arranged on the means for detecting the first acoustic signal at the first auscultation point and/or the second electrode is arranged on the means for detecting the second acoustic signal at the second auscultation point.
  • the respective electrode is thus associated with the respective detection means. In this way, a particularly simple and compact construction of the device can be achieved.
  • the device includes at least one processor for processing the detected signals.
  • the steps described above and below may be performed or controlled in whole or in part by the processor.
  • the acoustic signals converted into electrical signals by means of a converter can be forwarded to the at least one processor.
  • the optionally recorded electrocardiographic signal can also be forwarded to the process.
  • the at least one processor allows, for example, processing, in particular evaluation, of the signals detected by the device.
  • the processor allows the acquired signals to be stored. Additionally or alternatively, the signals can be further processed with the aid of the at least one processor.
  • the device comprises at least one processor and at least one memory, wherein a program comprising program instructions is stored in the memory, wherein the memory and the program are set up to, with the processor, at least cause the device to execute the exemplary method (or parts thereof) according to the second aspect when the program is executed on the processor.
  • a processor is to be understood, for example, as a control unit, a microprocessor or a microcontrol unit such as a microcontroller.
  • an exemplary device further includes means for storing information, such as program memory and/or main memory.
  • an exemplary device according to the invention further comprises each Means for receiving and/or sending information over a network such as a network interface.
  • exemplary inventive devices are and/or are connectable to one another via one or more networks.
  • the device is designed in particular with appropriate means (for example with the aid of one or more processors, microcontrollers, (A/D) converters, filter units) to digitize the recorded acoustic and optionally electrocardiographic signals.
  • noise can be suppressed (e.g. with the aid of the microcontroller or a corresponding filter unit).
  • the determination of an item of evaluation information can also be based, at least in part, on acoustic information outside of the typically human perceptible frequency spectrum, ie in particular also on acoustic information less than 20 Hz and greater than 20 kHz.
  • the method comprises (or the device means for) determining at least one item of evaluation information associated with the acoustic signals and optionally with the at least one electrocardiographic signal, the evaluation information being at least partially based on the acoustic signals and optionally on the at least based on an electrocardiographic signal.
  • the determination can also be based on further information (in particular about the patient, such as age and/or gender).
  • the evaluation information supplies the user with a diagnosis, for example, or supports the user in such a diagnosis, ie the evaluation information associated with the signals enables the user of the method, for example, making a diagnosis based on the evaluation information, or this can already be such a diagnosis.
  • the evaluation information at least partially based on the acoustic signals, conclusions can be drawn about the functionality of an organ, in particular the heart, lungs or intestines, of a patient.
  • the evaluation information is preferably based at least partially on the at least one electrocardiographic signal. In particular, this allows improved conclusions to be drawn about the functionality of the heart, in particular the heart valves.
  • a (potential) presence and/or probability of heart valve disease and/or (particularly in a second step) one or more properties (e.g. insufficiency and/or stenosis) of one or more (particularly all four) heart valves is determined.
  • the evaluation information indicates the presence, a probability of heart valve disease and/or one or more properties (for example insufficiency and/or stenosis) of one or more (in particular all four) heart valves.
  • the evaluation information can thus in particular be diagnostic information.
  • the evaluation information is determined using (classical) methods, such as by determining one or more parameters of the acoustic (and optionally electrocardiographic) signals obtained and comparing these signals with predetermined parameters, which are determined, for example, by previously analyzed and categorized signals ( For example, the signals detected by other patients or subjects and corresponding evaluation information) were determined.
  • predetermined parameters For example, the signals detected by other patients or subjects and corresponding evaluation information
  • value formations determined for other patients can be stored in entries in a database together with acoustic and optionally electrocardiographic signals from these other patients, so that a comparison can be made between the data generated by the database represented signals and the detected signals can take place. If, for example, the comparison shows that a set of signals represented by the database (i.e.
  • corresponding parameters thereof are at least substantially similar to the detected signals (i.e. corresponding parameters thereof) (e.g. based on a similarity measure and/or a predetermined similarity threshold value). or correspond, it can be provided, for example, that the evaluation information stored together with the signals in the database is assigned to the detected signals.
  • the determination of the evaluation information is based at least partially on an algorithm based on artificial intelligence (which in this respect can also be viewed or referred to as a data model).
  • an algorithm based on machine learning is an algorithm based on machine learning.
  • the algorithm is a classification algorithm, for example.
  • the algorithm based on artificial intelligence is or includes an artificial neural network, multi-layer perceptron or a network based on LSTM (long short-term memory).
  • the determination can advantageously take place locally in the device, in particular by means of the processor of the device.
  • such an algorithm receives the acoustic signals and optionally the electrocardiographic signal (which, for example, can be processed, in particular filtered) as input data.
  • the algorithm can assign the evaluation information (for example the presence or the probability of the presence of a disease) to the acoustic signals and optionally to the at least one electrocardiographic signal as output data.
  • the algorithm in particular the classification algorithm based on machine learning, was trained, for example, using data from subjects with known heart valve status (with or without heart valve defects).
  • a Training can be based, for example, on the fact that such an algorithm - as in the later application - receives a large number of sets of acoustic signals and optionally electrocardiographic signals as input training data in, for example, Fourier-transformed form and corresponding known evaluation information (e.g. the presence or the Probability of the presence of a disease) are specified as corresponding initial training data.
  • the training data and/or the performance of various algorithms are analyzed and an algorithm based on artificial intelligence (for example an algorithm based on an artificial neural network, on a multi-layer perceptron or on an LSTM-based network) is selected.
  • an algorithm based on artificial intelligence for example an algorithm based on an artificial neural network, on a multi-layer perceptron or on an LSTM-based network
  • the training data is analyzed, for example, by an internal k-fold cross-validation in the training data set.
  • an algorithm is selected based on target values such as a receiver operating characteristics "ROC" approach (also known as limit optimization curve or isosensitivity curve for evaluating and optimizing analysis strategies, which typically represents the dependence of efficiency on error rate for different parameter values), the Fl measure (in which accuracy and hit rate are weighted equally, or more generally a differently weighted measure F a ) or based on similar metrics or appropriate quantitative measures to assess a classifier.
  • ROC receiver operating characteristics
  • the most suitable algorithm is selected in a consensus process, in which the results of different test combinations of the training data set are fed in and the one that performs best on average, e.g. B. the most accurate (eg in terms of sensitivity and / or specificity or other accuracy criteria) and / or the fastest algorithm is selected.
  • a particularly efficient algorithm can be selected in this way. This step can be done on a server, for example.
  • the selected algorithm or parameter for this can then be transferred to the device.
  • the device can in this way basically use several algorithms depending on the training data, but in a specific case advantageously always needs to use only one algorithm (the one prescribed and in particular determined to be the most efficient).
  • the actual analysis of a patient's signals can then preferably take place directly in the device (for example by means of an integrated microcontroller).
  • the device preferably comprises at least one input and/or output device.
  • the device includes a display device for displaying the signals detected by the device.
  • the device comprises at least one display device for displaying the signals detected by the device and/or the specific evaluation information.
  • the display device can be controlled, for example, by means of the at least one processor.
  • a display device is, for example, a display, in particular a liquid crystal display, or an LED control light.
  • the input device which can also be integrated with the output device, for example by means of a touch display
  • information to be taken into account for determining the evaluation information, such as the age and/or the sex of the patient can be recorded.
  • the output device can be used by the user, for example the doctor and/or an assistant, in particular to operate the device.
  • the output and/or input device includes various display fields and/or input fields, for example.
  • the display fields can have information about a heart rate or an EKG.
  • the device can preferably be operated with the help of the input fields.
  • the device preferably comprises at least one communication interface, in particular for communication with a communication device.
  • the communication device is preferably a different device from the device.
  • the communication device can, for. a local one device or a remote server.
  • the communication device is a portable computer, such as a laptop computer, a tablet computer, a wearable, a personal digital assistant, or a smartphone.
  • the communication can take place in particular via a wired connection or preferably via a wireless connection using a communication system. Examples of a communication system are a local area network (LAN), a wide area network (WAN), a wireless network (WLAN), a wired network, a cellular network, a telephone network, a satellite network and/or the Internet.
  • LAN local area network
  • WAN wide area network
  • WLAN wireless network
  • wired network a cellular network
  • telephone network a satellite network and/or the Internet.
  • the communication device preferably communicates with the device via (at least) a local wireless network (e.g. according to the 1EEE-8O2.11 standard, the Bluetooth standard (e.g. version 1, 2, 3, 4 (in particular Bluetooth LE) and /or a future standard), a mobile radio standard (e.g. the 2G, 3G, 4G and/or 5G standard) and/or the NFC standard).
  • a local wireless network e.g. according to the 1EEE-8O2.11 standard, the Bluetooth standard (e.g. version 1, 2, 3, 4 (in particular Bluetooth LE) and /or a future standard
  • a mobile radio standard e.g. the 2G, 3G, 4G and/or 5G standard
  • Wired communication for example by means of a Universal Serial Bus (USB) cable
  • USB Universal Serial Bus
  • the device preferably has a corresponding communication interface, for example a USB port.
  • the communication interface serves in particular to receive or update the algorithm or specific parameters for determining the evaluation information, for example from a server.
  • the USB cable can be used not only for data transmission but also for charging a secondary cell integrated or used in the device, for example a rechargeable battery.
  • the communication device can also preferably also have at least one input device and at least one output device exhibit.
  • the communication device can be used by the user, for example the doctor and/or an assistant, in particular to operate the device.
  • the device comprises a connecting part for connecting the means for detecting the first acoustic signal at the first auscultation point to the means for detecting the second acoustic signal at the second auscultation point, with at least one flexible connecting element for connecting the means for detecting the first acoustic signal at the first auscultation point and/or the means for detecting the second acoustic signal at the second auscultation point with the connecting part.
  • the connecting part can be designed as a handle, for example.
  • the at least one flexible connecting element enables the means for detecting the first acoustic signal at the first auscultation point and/or the means for detecting the second acoustic signal at the second auscultation point to lie flat, in particular on uneven surfaces. In this way, particularly good contact can be established between the means for detecting the acoustic signals and optionally the at least one electrocardiographic signal and the body surface of a patient.
  • the device is preferably portable.
  • a portable device is understood to mean in particular that it weighs less than 5 kg, in particular less than 3 kg, more preferably less than 1 kg.
  • the device preferably comprises a secondary cell, in particular an accumulator.
  • a computer program product comprising program instructions to carry out a method according to the second aspect when the program is run on a processor.
  • a computer-readable storage medium comprising a computer program product of the third aspect.
  • a computer-readable storage medium can be embodied, for example, as a magnetic, electrical, electromagnetic, optical and/or other type of storage medium.
  • Such a computer-readable storage medium is preferably physical (ie “touchable”), for example it is designed as a data carrier device.
  • a data carrier device is, for example, portable or permanently installed in a device.
  • RAM volatile or non-volatile random-access
  • NOR flash memory sequential-access memory
  • ROM read-only access
  • write memory -Read access examples of such a data carrier device are volatile or non-volatile random-access (RAM) memory such as NOR flash memory or sequential-access memory such as NAND flash memory and/or read-only access (ROM) or write memory -Read access.
  • RAM volatile or non-volatile random-access
  • NOR flash memory such as NOR flash memory
  • sequential-access memory such as NAND flash memory and/or read-only access (ROM) or write memory -Read access.
  • Computer-readable should be understood to mean, for example, that the storage medium can be read (from) and/or written to by a computer or a data processing system, for example by a processor.
  • the disclosure of a method step should also disclose a corresponding means for carrying out the method step, and conversely, the method step itself should also be disclosed through the disclosure of a means for carrying out a method step.
  • the disclosure of features relating to the device according to the first aspect corresponding features relating to the method, the computer program product and the computer-readable storage medium according to the second, third and fourth aspects are also disclosed.
  • the exemplary embodiments of the present invention described above in this description should also be understood to be disclosed in all combinations with one another. Rather, it is to be understood that the presentation of embodiments of the invention is merely exemplary and not limiting.
  • FIG. 1 shows a schematic representation of the cross section of an embodiment of the device according to the invention of the first aspect
  • FIG. 2 shows a schematic representation of exemplary embodiments of the computer-readable storage medium according to the invention of the fourth aspect.
  • the device 1 shows an exemplary embodiment of the device according to the invention.
  • the device 1 can be a medical device, for example.
  • the device 1 comprises means 2a for detecting at least one first acoustic signal at a first auscultation point 3a and means 2b for detecting at least one second acoustic signal at a second auscultation point 3b.
  • the auscultation points 3a, 3b are spatially separated from one another.
  • the first auscultation point 3a is located in the second right intercostal space and the second auscultation point 3b is located in the third left intercostal space parasternal of a human patient to be examined.
  • the means 2a, 2b for detecting the acoustic signals are designed for essentially simultaneous detection of the acoustic signals.
  • signals from two auscultation points 3a, 3b can be used in the evaluation, in particular to predict heart valve diseases. This offers an advantage in the local differentiation of the most common heart valve diseases. For example, the aortic valve and the mitral valve can be heard with different intensity at the two locations mentioned and are therefore easier to differentiate. Furthermore, the signals can be used to identify any interference signals as such, for example depending on whether and how they are detected in both means 2a, 2b.
  • the means 2a, 2b for detecting the acoustic signals are connected to one another by a connecting part 10.
  • the connecting part 10 is formed, for example, in an arc shape, such as an inverted U. In this way, the device 1 is particularly handy and can be gripped and positioned particularly well by a user, for example a doctor.
  • the device 1, in particular the connecting part 10, is preferably adjustable.
  • the device 1, in particular the connecting part 10 can be adjusted in several sizes that depend on the body size of the patient, for example in three stages “up to 169 cm”, “170 to 189 cm” and “190 cm or larger”.
  • the distance between the means 2a, 2b for detecting the acoustic signals can be adjusted, in particular adapted to the distance between the auscultation points 3a, 3b.
  • the means 2a, 2b are particularly preferably connected to the connecting part 10 with the aid of flexible connecting elements 11.
  • the flexible connecting elements 11 ensure that the two means 2a, 2b lie flat, in particular on uneven surfaces (i.e. two surfaces that are inclined relative to one another), for example a human thorax. In this way, improved contact can be established and easy placement is made possible.
  • the means 2a, 2b for detecting the acoustic signals each comprise a membrane element 4a, 4b.
  • the membrane elements 4a, 4b each comprise a membrane which absorbs the pressure fluctuations generated by the acoustic signals and is made to vibrate.
  • the converters 5 which are preferably designed as piezoelectric sensors, the mechanical movements of the membranes are converted into electrical signals, which in turn are forwarded to the processor 7 integrated into the device 1.
  • the processor 7 is a microcontroller, for example.
  • the received acoustic or electrical and optionally at least one electrocardiographic signal can be digitized in the microcontroller.
  • Noise suppression preferably also takes place.
  • no frequencies that are inaudible to the human ear are filtered out.
  • frequencies that are not in the spectrum that humans can hear can also contain information about the functionality of a heart valve.
  • the device 1 comprises at least one means 6 for detecting at least one electrocardiographic signal.
  • the means 6 for detecting the at least one electrocardiographic signal comprises at least one first electrode 6a and a second electrode 6b, the first electrode 6a being connected to the means 2a for detecting the first acoustic signal at the first auscultation point 3a and/or the second electrode 6b being connected the means 2b for detecting the second acoustic signal is arranged at the second auscultation point 3b, in particular associated with it.
  • the voltage is measured as the dipole moment between the electrodes 6a, 6b. In particular, this represents the equivalent of a single-channel electrocardiogram.
  • muscular excitations in the chest and movements of the patient can also be recorded, so that movement artifacts can be identified more easily and a repetition of a measurement can be initiated if necessary.
  • the device 1 can be used in particular to carry out an advantageous method, for example a method according to the second aspect of the invention.
  • the patient In order to perform the procedure on a patient, the patient should preferably lie on a flat examination table.
  • the method can be started with the aid of the device 1 .
  • the patient remains lying still for a certain time (for example 15 seconds) and the device 1 is left untouched on the chest.
  • the procedure includes the steps:
  • the method can include, for example, acquiring at least one electrocardiographic signal, with the electrocardiographic signal preferably being acquired between the first auscultation point 3a and the second auscultation point 3b.
  • the evaluation preferably takes place on the processor 7 integrated into the device 1, in particular a microcontroller.
  • the processor 7 can be used, for example, to determine at least one item of evaluation information associated with the acoustic signals and optionally with the at least one electrocardiographic signal, the evaluation information being at least partially based on the acoustic signals and optionally based on the at least one electrocardiographic signal.
  • the evaluation information can be used in particular for the user of the device 1 as a decision-making aid when making a diagnosis.
  • the detected signals are evaluated, for example, by a machine-learning-based classification algorithm that is trained using data from subjects with a known heart valve status, in particular with or without heart valve defects.
  • the analysis takes place, for example, using an optimized classification algorithm that is adapted to a continuously growing training data set. For example, internal 10-fold cross-validation in this training data set is used to determine the most efficient of several possible algorithms (e.g. convolutional neural networks, multilayer perceptron, long short-term memory).
  • the evaluation it can be calculated in a first step, for example, whether there is an at least moderately severe valve defect (moderate according to the European Society of Cardiology) of a heart valve.
  • a computer program product for example a computer program product according to the third aspect, preferably postulates the properties of all four heart valves, each with the parameters insufficiency or stenosis (each with the degree "none", “low-grade”, “medium to high-grade"), where the focus of precision is particularly on the first evaluation step.
  • the detected signals and/or the at least one piece of evaluation information can be displayed using the display device 8, for example.
  • the device 1 can be used, for example, by a doctor Assess whether there are signals and/or information that could indicate a disease. With the aid of the device 1 in particular, the doctor is thus able to make a diagnosis.
  • the display device 8 can have, for example, a control panel, via which the doctor can enter the data into the device 1.
  • the device 1 is particularly portable and can be used wirelessly. It includes, for example, a secondary cell, in particular an accumulator, and has a communication interface 9 for communication with a communication device.
  • the device 1 includes a USB port, via which the device can be charged using a USB cable on a computer or using an adapter on a socket. If the device 1 is loaded on a computer and a corresponding computer program product is started on this, the evaluation information can be downloaded from the device 1 and archived, for example.
  • the processor 7 preferably controls the communication interface 9, which can also be a network interface, for example, and can be embodied as a network card, network module and/or modem.
  • the communication interface 9 is set up in particular to connect the device 1 to other devices, in particular via a (wireless) communication system, for example a network, and to communicate with them.
  • the communication interface 9 can, for example, receive data via a communication system and forward it to the processor 7 and/or receive data from the processor 7 and send it via a communication system. Examples of a communication system are a local area network (LAN), a wide area network (WAN), a wireless network (e.g.
  • the device 1 can be updated via the Internet, so that the precision of the device 1 can be increased continuously even after it has been purchased.
  • the optimal classification algorithm is always updated when the device 1 is updated, so that the device 1 always uses only one, which makes it possible to reduce the on-site calculation time to milliseconds.
  • the device 1 thus represents a handy instrument which, by simply being placed on a person's chest, can detect, for example, relevant heart valve diseases and can thus supplement or replace a conventional stethoscope.
  • FIG. 2 shows exemplary embodiments of a computer-readable storage medium 12 comprising an exemplary embodiment of a computer program product according to the invention.
  • the storage medium can be, for example, a magnetic, electrical, optical and/or other type of storage medium.
  • the storage medium can, for example, be part of a processor (e.g. the processor 7 of the device 1 shown in FIG. 1), for example a (non-volatile or volatile) program memory of the processor or a part thereof.
  • Examples of a storage medium are a flash memory 12a, an SSD hard disk 12b, a magnetic hard disk 12c, a memory card 12d, a memory stick 12e (e.g. a USB stick), a CD-ROM or DVD 12f or a floppy disk 12g.
  • a flash memory 12a an SSD hard disk 12b, a magnetic hard disk 12c, a memory card 12d, a memory stick 12e (e.g. a USB stick), a CD-ROM or DVD 12f or a floppy disk 12g.
  • a plurality of "Units, persons or the like" in the context of this specification means several units, persons or the like.
  • the use of the indefinite article does not exclude a plurality.
  • a single device can perform the functions of several units or devices named in the claims. Reference signs given in the claims are not to be construed as limitations on the means and steps used.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Physics & Mathematics (AREA)
  • Acoustics & Sound (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)

Abstract

L'invention concerne un dispositif, en particulier un dispositif médical, comprenant un moyen de détection d'au moins un premier signal acoustique à un premier point d'auscultation et un moyen de détection d'au moins un deuxième signal acoustique à un deuxième point d'auscultation. Le problème décrit par la présente invention, qui est de fournir un dispositif, en particulier un dispositif médical, au moyen duquel l'auscultation est simplifiée, en particulier améliorée, et grâce auquel une évaluation plus objective des propriétés sonores est permise, est résolu en ce que les moyens de détection dudit au moins un premier signal acoustique au premier point d'auscultation et des moyens de détection dudit au moins un deuxième signal acoustique au deuxième point d'auscultation sont conçus pour une détection sensiblement simultanée des signaux. L'invention concerne également : un procédé mis en oeuvre par au moins un dispositif, en particulier un dispositif selon l'invention ; un produit programme d'ordinateur ; et un support de stockage lisible par ordinateur.
PCT/EP2022/073086 2021-08-20 2022-08-18 Dispositif d'auscultation simultanée au niveau de deux points d'auscultation WO2023021142A1 (fr)

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DE102021121630.3A DE102021121630A1 (de) 2021-08-20 2021-08-20 Vorrichtung zur simultanen Auskultation an zwei Auskultationspunkten
DE102021121630.3 2021-08-20

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS54126484U (fr) * 1978-02-23 1979-09-04
JP2014045918A (ja) * 2012-08-31 2014-03-17 Jvc Kenwood Corp 胎児心音マイクロフォン
US20190059748A1 (en) * 2017-08-31 2019-02-28 The Regents Of The University Of California Multisensor cardiac function monitoring and analytics systems
US20190099152A1 (en) * 2017-10-04 2019-04-04 Ausculsciences, Inc. Auscultatory sound-or-vibration sensor
WO2021156679A1 (fr) * 2020-02-05 2021-08-12 Nuvo Group Ltd. Systèmes et procédés de détection de l'activité utérine maternelle

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3273857B1 (fr) 2015-03-27 2021-01-27 Zoll Medical Corporation Systèmes et procédés pour le positionnement d'un tube d'intubation
EP3824816A1 (fr) 2019-11-25 2021-05-26 Koninklijke Philips N.V. Système et procédé de détection d'anomalies pulmonaires

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS54126484U (fr) * 1978-02-23 1979-09-04
JP2014045918A (ja) * 2012-08-31 2014-03-17 Jvc Kenwood Corp 胎児心音マイクロフォン
US20190059748A1 (en) * 2017-08-31 2019-02-28 The Regents Of The University Of California Multisensor cardiac function monitoring and analytics systems
US20190099152A1 (en) * 2017-10-04 2019-04-04 Ausculsciences, Inc. Auscultatory sound-or-vibration sensor
WO2021156679A1 (fr) * 2020-02-05 2021-08-12 Nuvo Group Ltd. Systèmes et procédés de détection de l'activité utérine maternelle

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