Irbm最新文献

{"title":"User Centered Design May Apply to Public Health Issues: A Case Study on Arrhythmia Detection Service in Rural General Practice","authors":"Pierre Rumeau ,&nbsp;Marc Dupui","doi":"10.1016/j.irbm.2025.100920","DOIUrl":"10.1016/j.irbm.2025.100920","url":null,"abstract":"<div><div>User Centered Design (UCD) is widely used in computer science and service provision, not so in public health administration. As a regulatory body (e.santé Occitanie) we applied UCD to design, deploy and assess a new medical service (ambulatory ECG at the local medical practice) at the request of a local general practitioner (<em>GP</em>). Method. We used semi-directed interviews starting with the GP to define the user groups profiles, as-is scenario and personae. We organized a focus group with the local stakeholders and representatives of Social Security, Regional Health Agency and e.santé Occitanie to refine the expression of needs. We used a SWOT to categorize the internal and external factors impacting the service. We designed a first specification prototype and a preliminary assessment of additional costs from the point of view of the Social Security. When the service started we arranged an 8-week prospective survey to verify the medical indications adhered to best practices. We ran an observational costs analysis on the first full year of operation. Results. As the study started in 2018 we had to cope with COVID 19 induced delays and changes. End of 2021 we could observe the start of the operation of the optimized version of the service with 4 steps instead of 9 in the as-is version. The 8-week medical indication survey showed full compliance with best practices. In 2022, first full year of operation, 39 patients had an AECG, less than expected, probably due to a waiting list effect. The additional costs analysis gave a benefit for Social Security of 12,397.05 € at 95% of expectations. After absorption of investment costs, expected benefit is 16,479.45 € at 98%. Conclusion. As a regulatory body, we successfully implemented the full UCD cycle on a bottom-up medical service improvement proposal. The service is still operating and has been spontaneously adopted elsewhere. UCD applied to selected local proposals could unveil a wealth of quality of care improvement solutions while keeping the costs down.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 6","pages":"Article 100920"},"PeriodicalIF":4.2,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Stress Distributions in a Skeletal Muscle Affected by Post-Stroke Spastic Myopathy","authors":"Kalthoum Belghith,&nbsp;Ali Aghaei,&nbsp;Wael Maktouf,&nbsp;Mustapha Zidi","doi":"10.1016/j.irbm.2025.100918","DOIUrl":"10.1016/j.irbm.2025.100918","url":null,"abstract":"<div><div>This study aims to evaluate stress distributions in the medial gastrocnemius muscle (GM) of patients with spastic myopathy after stroke. Shear wave elastography was employed to measure the shear modulus in three specific regions (upper, middle, and lower) of the muscle in six participants (three healthy and three post-stroke). Shear modulus measurements served as inputs for a finite element model to estimate stress distributions during uniform muscle stretching. The skeletal muscle was modeled as a hyperelastic, incompressible, and inhomogeneous material. The results showed that the stress distribution tends to increase in the post-stroke group, particularly in the middle (+60%) and lower regions (+13%). These results demonstrate the feasibility of estimating stress distributions using SWE data in post-stroke conditions, highlighting potential for further optimization of both experimental protocols and numerical models. These advancements could ultimately provide valuable insights into the clinical challenges associated with understanding spastic myopathy pathologies.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 6","pages":"Article 100918"},"PeriodicalIF":4.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Sensory Integration Test for Locomotion: A Study Protocol","authors":"Esma Nur Kolbasi,&nbsp;Lotte Janssens,&nbsp;Joke Spildooren,&nbsp;Pieter Meyns","doi":"10.1016/j.irbm.2025.100915","DOIUrl":"10.1016/j.irbm.2025.100915","url":null,"abstract":"<div><div><strong>Background &amp; Aim:</strong> As falls are common during gait in older adults, investigating the factors contributing to stable gait has gained growing interest. In this context, the contribution of visual, somatosensory, and vestibular systems (i.e., sensory integration) to gait has been studied for years, albeit primarily as individual systems. Although an earlier attempt was made to develop a test to comprehensively assess the sensory integration during gait, this effort encountered certain limitations that impacted its overall effectiveness. Thus, this study aims to develop a new test to evaluate sensory integration during gait, called the “Sensory Integration in Walking (SensIWalk) Test” and assess its validity and reliability in both young and older adults.</div><div><strong>Methods:</strong> This study is planned as an observational study. Younger (n=24, 18-35 years old) and older adults (n=24, ≥65 years old) will be invited to participate, and all measurements will be performed at the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical BV, Amsterdam, The Netherlands). SensIWalk, adapted from the framework of the Clinical Test of Sensory Interaction and Balance (CTSIB) with the same six conditions, will be modified to accommodate locomotion. The conditions of SensIWalk will be as follows: 1) Walking at preferred speed on a firm surface (i.e., on the treadmill) with eyes open, 2) Walking at preferred speed on a firm surface in the dark (1.3 lux), 3) Walking at preferred speed on a firm surface with sways of the virtual reality (VR) environment (i.e., visual conflict), 4) Walking at preferred speed with foam insoles (2 cm thick) with eyes open, 5) Walking at preferred speed with foam insoles in the dark, 6) Walking at preferred speed with foam insoles with sways of the VR environment.</div><div><strong>Discussion:</strong> This study will allow delving into the underlying sensory mechanisms explaining suboptimal balance during walking by assessing the effects of sensory strategies on movement patterns. This may provide a deeper insight into the underlying mechanisms of falls in older adults, which could foster novel training or rehabilitation paradigms to decrease the risk of falls in older adults.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 6","pages":"Article 100915"},"PeriodicalIF":4.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Chemotherapy Response in Osteosarcoma Using Quantitative Ultrasound: A Pilot Study Relating Ultrasound Parameters to Molecular Response","authors":"Cyril Malinet ,&nbsp;Celia Mansilla ,&nbsp;Iveta Fajnorova ,&nbsp;Coline Ducrot ,&nbsp;Adrien Rohfritsch ,&nbsp;David Melodelima ,&nbsp;Aurélie Dutour ,&nbsp;Pauline Muleki-Seya","doi":"10.1016/j.irbm.2025.100914","DOIUrl":"10.1016/j.irbm.2025.100914","url":null,"abstract":"<div><h3>Objectives</h3><div>Currently, the response to chemotherapeutic treatment for most solid tumors is assessed using the surgical specimen obtained after the tumor is surgically removed, following a whole chemotherapy cycle (<em>e.g.</em> 8 weeks). Therefore, early detection of tumor response is of paramount importance. Parameters derived from the backscatter coefficient (BSC) and envelope statistics provide information on tissue microstructure and may therefore be of interest for monitoring therapies that induce morphological changes in the tumor. In this study, our objective was to detect ex vivo early response to chemotherapy in ex vivo murine osteosarcoma model.</div></div><div><h3>Material an Methods</h3><div>BSC-derived parameters using Lizzi-Feleppa approach and the Gaussian model and envelop statistics parameters using Nakagami and Homodyned-K distributions were extracted on control and treated tumors. Tumors received either 2, 4, or 5 doses of chemotherapy. To investigate the underlying causes of changes in ultrasound parameters, histological and molecular analyses (RNA sequencing) were conducted.</div></div><div><h3>Results</h3><div>Although the tumor models show resistance to chemotherapy as evidenced by continued tumor growth at the therapeutic dose used, significant differences between treated and control tumors were observed in several BSC-derived and envelope statistics parameters depending on the number of treatments received.</div></div><div><h3>Conclusion</h3><div>These differences might reflect early molecular changes occurring before the establishment of chemoresistance mechanisms. They might be attributed to morphological changes linked to the underexpression of genes involved in chromatin condensation and/or collagen within the extracellular matrix. These initial findings require further investigation in a larger cohort.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 6","pages":"Article 100914"},"PeriodicalIF":4.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADNP-15: An Open-Source Histopathological Dataset for Neuritic Plaque Segmentation in Human Brain Whole Slide Images with Frequency Domain Image Enhancement for Stain Normalization","authors":"Chenxi Zhao ,&nbsp;Jianqiang Li ,&nbsp;Qing Zhao ,&nbsp;Jing Bai ,&nbsp;Susana Boluda ,&nbsp;Benoit Delatour ,&nbsp;Lev Stimmer ,&nbsp;Daniel Racoceanu ,&nbsp;Gabriel Jimenez ,&nbsp;Guanghui Fu","doi":"10.1016/j.irbm.2025.100913","DOIUrl":"10.1016/j.irbm.2025.100913","url":null,"abstract":"<div><div>Alzheimer's Disease (AD) is a neurodegenerative disorder characterized by amyloid-<em>β</em> plaques and tau neurofibrillary tangles, which serve as key histopathological features. The identification and segmentation of these lesions are crucial for understanding AD progression but remain challenging due to the lack of large-scale annotated datasets and the impact of staining variations on automated image analysis. Deep learning has emerged as a powerful tool for pathology image segmentation; however, model performance is significantly influenced by variations in staining characteristics, necessitating effective stain normalization and enhancement techniques. In this study, we address these challenges by introducing an open-source dataset (ADNP-15) of neuritic plaques (i.e., amyloid deposits combined with a crown of dystrophic tau-positive neurites) in human brain whole slide images. We establish a comprehensive benchmark by evaluating five widely adopted deep learning models across four stain normalization techniques, providing deeper insights into their influence on neuritic plaque segmentation. Additionally, we propose a novel image enhancement method that improves segmentation accuracy, particularly in complex tissue structures, by enhancing structural details and mitigating staining inconsistencies. Our experimental results demonstrate that this enhancement strategy significantly boosts model generalization and segmentation accuracy. All datasets and code are open-source, ensuring transparency and reproducibility while enabling further advancements in the field.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 6","pages":"Article 100913"},"PeriodicalIF":4.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ankle Exoskeletons in Walking and Load-Carrying Tasks: Insights into Biomechanics and Human-Robot Interaction","authors":"Joana F. Almeida ,&nbsp;João C. André ,&nbsp;Cristina P. Santos","doi":"10.1016/j.irbm.2025.100911","DOIUrl":"10.1016/j.irbm.2025.100911","url":null,"abstract":"<div><div>Background: Lower limb exoskeletons are in the focus of the scientific community due to their potential to enhance human quality of life across diverse scenarios. However, their widespread adoption remains limited by the lack of comprehensive frameworks to understand their biomechanical and human-robot interaction (HRI) impacts, which are essential for developing adaptive and personalized control strategies. To address this, understanding the exoskeleton's effects on kinematic, kinetic, and electromyographic signals, as well as HRI dynamics, is paramount to achieve improved usability of wearable robots. Objectives: This study aims to provide a systematic methodology to evaluate the impact of an ankle exoskeleton on human movement during walking and load-carrying (10 kg front pack) tasks, focusing on joint kinematics, muscle activity, and HRI torque signals. The methodology is designed to account for individual and device-specific factors, ensuring adaptability across users and exoskeletons. Materials and Methods: The study employed an inertial data acquisition system (Xsens MVN), electromyography (Delsys), and a unilateral ankle exoskeleton. Three complementary experiments were performed. The first examined basic dorsiflexion and plantarflexion movements. The second analysed the gait of two subjects without and with the device under passive and active assistance modes. The third investigated load-carrying tasks under the same assistance modes. Results and Conclusions: The first experiment confirmed that the HRI sensor captured both voluntary and involuntary torques, providing directional torque insights. The second experiment showed that the device slightly restricted ankle range of motion (RoM) but supported normal gait patterns across all assistance modes. The exoskeleton reduced muscle activity, particularly in active mode. HRI torque varied according to gait phases and highlighted reduced synchronisation, suggesting a need for improved support. The third experiment revealed that load-carrying increased GM and TA muscle activity, but the device partially mitigated user effort by reducing muscle activity compared to unassisted walking. HRI increased during load-carrying, providing insights into user-device dynamics. These results demonstrate the importance of tailoring exoskeleton evaluation methods to specific devices and users, while offering a framework for future studies on exoskeleton biomechanics and HRI.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 5","pages":"Article 100911"},"PeriodicalIF":4.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformer-Based RT-DETR Framework for Accurate Chest X-Ray Disease Detection","authors":"Rakesh Mutukuru ,&nbsp;Akula Rajesh ,&nbsp;Vasanthi Ponduri ,&nbsp;Javeed Ahammed ,&nbsp;Lakshmi Prasanna Kothala","doi":"10.1016/j.irbm.2025.100912","DOIUrl":"10.1016/j.irbm.2025.100912","url":null,"abstract":"<div><h3>Objectives</h3><div>Chest X-ray (CXR) analysis is a vital tool for early disease detection, enabling timely diagnosis and treatment. However, achieving accurate CXR disease detection remains challenging due to low image contrast, overlapping anatomical structures, and variations in imaging conditions. This study aims to develop a robust and efficient disease detection framework using the RT-DETR model to address these limitations and improve diagnostic accuracy.</div></div><div><h3>Material and Methods</h3><div>The proposed framework integrates transformer-based components within the RT-DETR architecture for enhanced feature representation. The backbone incorporates HGBlock and HGStem modules to capture multi-scale spatial representations through hierarchical gradient flow. In the neck network, the Attention-Intensified Feature Interaction (AIFI) module and the Reparameterized Efficient Path Aggregation (REpc3) module refine feature fusion and strengthen contextual understanding. The detection head employs the RT-DETR decoder with an efficient query-based mechanism to improve localization and classification precision. Statistical validation was conducted using the Wilcoxon Test, Paired T-Test, and Kruskal-Wallis Test to ensure the reliability of performance outcomes.</div></div><div><h3>Results</h3><div>The proposed RT-DETR framework achieved a precision of 55.7%, outperforming YOLOv7x's 47.7% by 8%. The recall was comparable, with our model achieving 43.0% versus YOLOv7x's 43.1%. Importantly, the mean Average Precision (mAP) of our model reached 45.3%, representing a 3.7% improvement over YOLOv7x's 41.6%. These results confirm the model's superior performance and its statistical significance as validated by the applied tests.</div></div><div><h3>Conclusion</h3><div>The RT-DETR-based disease detection framework demonstrates improved accuracy and robustness in CXR analysis compared to state-of-the-art models. Its integration of advanced transformer-based modules enhances feature representation and detection precision. The results highlight its potential as a reliable and efficient tool for automated chest X-ray disease diagnosis, offering strong applicability in real-world clinical settings.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 6","pages":"Article 100912"},"PeriodicalIF":4.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CPLAY: Upper Limb Functional Rehabilitation Tool for Children with Developmental Coordination Disorder or Cerebral Palsy","authors":"Youness El Marhraoui ,&nbsp;Stéphane Bouilland ,&nbsp;Marine Deseur ,&nbsp;Mehdi Boukallel ,&nbsp;Sylvain Bouchigny ,&nbsp;Sabrina Panëels ,&nbsp;Margarita Anastassova ,&nbsp;Fréderic Muhla ,&nbsp;Justine Monsaingeon ,&nbsp;Dominique Sauquet ,&nbsp;Léa Thamié ,&nbsp;Moad Doghmi ,&nbsp;Eric Desailly ,&nbsp;Mehdi Ammi","doi":"10.1016/j.irbm.2025.100907","DOIUrl":"10.1016/j.irbm.2025.100907","url":null,"abstract":"<div><div>CPLAY is a novel serious-game platform combining miniaturized, instrumented building bricks with a tablet interface and AI-driven activity recognition to deliver personalized, gamified upper-limb rehabilitation for children with Developmental Coordination Disorder or Cerebral Palsy. Developed through a co-design process with therapists, engineers, parents and children, two IMU-equipped brick form factors transmit 70 Hz motion data via Bluetooth to a tablet hosting fifteen progressively challenging 3D assembly tasks enriched with rewards and audiovisual feedback. In a clinical feasibility trial, 30 children (mean age 9.1 ± 1.0 years) performed each model twice under supervision; synchronized motion and video data were annotated to train signal-processing routines and deep-learning classifiers. Signal processing detected all 36 movement and fall events (one false positive), while the Transformer model outperformed other approaches, achieving 86.0% multi-class accuracy and 85–96% binary accuracy across activity labels. These results demonstrate CPLAY's ability to objectively detect and classify key rehabilitation movements, paving the way for adaptive, AI-driven therapy, with future work focused on embedding a recommendation engine, scaling trials and refining AI models.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 5","pages":"Article 100907"},"PeriodicalIF":4.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Related Changes in Longitudinal and Transversal Elastic Properties of Murine Skeletal Muscle Fibers","authors":"Vincent Dupres ,&nbsp;Philippe Pouletaut ,&nbsp;Mashhour Chakouch ,&nbsp;Alexandra Josse ,&nbsp;John R. Hawse ,&nbsp;Sabine F. Bensamoun","doi":"10.1016/j.irbm.2025.100908","DOIUrl":"10.1016/j.irbm.2025.100908","url":null,"abstract":"<div><div><em>Purpose</em>: Aging causes notable effects on skeletal muscle structure and function which accumulate over time to negatively impact quality of life in the elderly. To better understand how aging impacts the mechanical properties of muscle as a function of age, a series of studies were conducted, using mice as a model system, to assess responses to longitudinal and transversal stresses at a single muscle fiber resolution.</div><div><em>Methods</em>: Muscle fibers isolated from primarily slow-twitch fibered muscle (soleus) and a primarily fast-twitch fibered muscle (extensor digitorum longus, EDL) were extracted from young (3-month, N=5) and old (21-month, N=5) animals. Passive mechanical tests (ramp, relaxation) were performed in the longitudinal direction at 50% strain, and Atomic Force Microscopy (AFM) tests were applied transversally. Longitudinal stresses (dynamic (<span><math><msub><mrow><mi>σ</mi></mrow><mrow><mi>d</mi></mrow></msub></math></span>), instantaneous (<em>σ</em>_{i_Ramp}) and static (<em>σ</em>_{s_Relax})) and the Young's modulus were measured in both directions.</div><div><em>Results</em>: For both types of fibers, longitudinal stresses were shown to be significantly decreased (<em>p</em> &lt; 0.001) in aged mice, with accentuated decreases observed for the EDL. Transversal AFM tests were used to elucidate the cartographies of elasticity and revealed no global differences between young and old animals for either fiber type. Regardless of age, decreased mechanical properties were universally observed for EDL fibers compared to soleus fibers.</div><div><em>Conclusion</em>: These findings highlight the potential of AFM to quantify transversal stiffness of the endomysium and have begun to better delineate the impacts of aging on the mechanical characteristics of skeletal muscle at single fiber resolution.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 5","pages":"Article 100908"},"PeriodicalIF":4.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical Cardioversion Outcome Prognosis: A Multivariate Multiscale Entropy Characterization of Atrial Activity in Persistent Atrial Fibrillation","authors":"Eva María Cirugeda Roldan ,&nbsp;Eva Plancha ,&nbsp;Victor M. Hidalgo ,&nbsp;Sofía Calero ,&nbsp;Jose Joaquín Rieta ,&nbsp;Raul Alcaraz","doi":"10.1016/j.irbm.2025.100905","DOIUrl":"10.1016/j.irbm.2025.100905","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) remains a significant cause of stroke, heart failure, and cardiovascular morbidity worldwide. Despite advancements in AF management, electrical cardioversion (ECV) remains the most commonly used technique for sinus rhythm (SR) restoration although presenting a limited success rate in the mid-term along with a high number of side-effects which can lead to an increase in patients health deterioration and, consequently, in healthcare costs. Hence, predicting ECV outcome in the mid-term remains a challenging task. Here, a new framework based on multivariate multiscale entropy (MMSE) characterization of atrial activity is proposed to improve ECV outcome prediction in the mid-term.</div></div><div><h3>Methods</h3><div>58 patients with persistent AF scheduled for ECV were considered. A 12-Lead standard ECG segment of 1.5 min duration prior to the first electrical shock was analyzed. The atrial activity (AA) is estimated from the 12-lead surface ECG using a QT segment removal algorithm based on QRS complex estimation and pattern recognition techniques. AA is characterized by means of multivariate extensions of traditional indices such as the amplitude of the fibrillatory waves and dominant frequency along with multivariate extensions of complexity measures as multivariate Sample Entropy and finally Multivariate Multiscale Entropy (MMSE). These indices were estimated over 12-lead ECG records from 58 ECV derived patients who were classified based on SR maintenance after 30-day follow up (mid-term evaluation). ECV prognosis was evaluated using ROC curves and Youden's Criteria for optimal threshold establishment. Performance was compared to that of unidimensional indices.</div></div><div><h3>Results</h3><div>Patients who maintained SR post-ECV exhibited distinct complexity patterns compared to those who relapsed into AF. Specifically, MMSE provided higher discriminant accuracy than traditional unidimensional indices. When considering only the limb leads in the analysis, the best performance was achieved, over 83% accurate classification of SR restoration in the mid-term (Se = 0.74, Sp = 0.85, <span><math><mi>p</mi><mspace></mspace><mo>≤</mo></math></span> 0.001). Additionally, the accumulated entropy and slope of the MMSE curves, offered robust predictors of ECV outcomes providing better balanced sensitivity and specificity ROC curves.</div></div><div><h3>Conclusions</h3><div>This work highlights the importance of multivariate approaches in AF characterization and provides a comprehensive framework for improving ECV outcome prediction, providing an increase in almost a 30% of correct predictions in the mid-term. Future research should explore the integration of these methods into clinical practice to optimize treatment strategies for AF patients and reduced healthcare costs.</div></div>","PeriodicalId":14605,"journal":{"name":"Irbm","volume":"46 5","pages":"Article 100905"},"PeriodicalIF":4.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}