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Transforming Multimodal Stethoscope Signal Quality: The Role of Operator Training and Feedback in ECG and PCG Clarity
Session:
SESSÃO DE POSTERS 04 - AMILOIDOSE E AORTA
Speaker:
Andre Lobo
Congress:
CPC 2025
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
33. e-Cardiology / Digital Health
Subtheme:
33.4 Digital Health
Session Type:
Cartazes
FP Number:
---
Authors:
André Lobo; Marta Catarina Almeida; Cátia Costa; Cristina Oliveira; Daniel Proaño-Guevara; Hugo Silva; Francesco Renna; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Introduction: </span></strong><span style="font-family:"Calibri",sans-serif">The acquisition of high-quality multimodal auscultation signals, including electrocardiography (ECG) and phonocardiography (PCG), has emerged as a promising tool for cardiovascular disease (CVD) screening, especially when combined with artificial intelligence automatic analysis. Capturing high-quality signals reliably is critical for its application in clinical practice. However, the quality of signal acquisition depends heavily on operator proficiency. Differences in experience and training significantly affect the clarity of key cardiac landmarks, such as the QRS complex and T-wave (ECG) and the S1 and S2 sounds (PCG), which must be distinguished from background noise. This study evaluates the feasibility of achieving adequate signal quality using a multimodal stethoscope and investigates whether targeted training and feedback can enhance operators' performance.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Methods: </span></strong><span style="font-family:"Calibri",sans-serif">This study evaluated ECG and PCG acquisitions using Rijuven’s Cardiosleeve, a device capable of recording ECG and PCG simultaneously. PCG acquisition was the primary focus, with ECG recorded opportunistically. Acquisitions were grouped by operator experience and training level: Group 1 (acquisitions 1–50) included experienced operators blinded to signal quality; Group 2 (acquisitions 51–144) comprised inexperienced operators without feedback on signal quality; and Group 3 (acquisitions 145–190) consisted of operators who received a small amount of specialized training and regular feedback.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Calibri",sans-serif">An external reviewer scored each acquisition on a 0–5 scale, assessing the presence and clarity of key cardiac landmarks relative to background noise. For ECG, the QRS complex and T-wave were evaluated, while for PCG, the S1 and S2 sounds were analyzed. Scores of 3 or higher indicated the presence of key landmarks, albeit with varying noise.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Results: </span></strong><span style="font-family:"Calibri",sans-serif">Group 1 achieved moderate signal quality (ECG Score: mean = 1.73, SD = 1.39; PCG Score: mean = 2.53, SD = 1.65), performing better than Group 2 (ECG Score: mean = 0.59, SD = 0.87; PCG Score: mean = 1.04, SD = 1.49), where most ECG signals were unusable. Group 3, with a small amount of training and feedback, achieved the highest signal quality (ECG Score: mean = 3.02, SD = 1.66; PCG Score: mean = 2.78, SD = 1.50), significantly outperforming the other groups<strong>.</strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusions: </span></strong><span style="font-family:"Calibri",sans-serif">While multimodal auscultation has potential, achieving good clarity of key cardiac landmarks remains challenging. Even experienced operators often faced difficulties due to noise, highlighting the complexity of signal acquisition. However, notable improvements observed with minimal training and feedback demonstrate the feasibility of improving signal quality with targeted interventions. Enhanced training programs and robust feedback systems could make this technology a reliable tool in clinical practice.</span></span></span></p>
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