【CIHFC2018】黄晶教授：心衰面部热像多中心临床研究

Early detection or immediatelymonitoring of the new or aggravated patients with HF is very important fortimely therapy

there is still lacing a fast,user-friendly, non-invasive methods to allow detection or monitoring of HF andideally cost-effective screening early

The lower body temperature (BT) maybe related with some poor physical general condition

Hypothermia could be a useful markerfor predicting worse prognosis in heart failure (HF) patients

Hypothermia could be a simple and useful markerfor predicting readmission,decreased time to rehospitalization and survival in HF patients

心衰导致心脏低输出量和交感兴奋，因而可能导致低体温和血流再分布

HFpatients with lowercardiac output 

highersympathetic-catecholamineand RAAS activity, which resulted in blood flowing reduction and redistribution

mightlead to hypothermiaand abnormal thermal distributions in peripheral tissue

Thecutaneous thermogram and temperature quantification canbe acquired quickly, noninvasively and contact free by an infrared thermal image

红外热像可快速获取人体二维温度分布状态

Thethermal distribution of the body surface is showed in a two-dimensional digitaltable or coded representing in gray-scale or color imaging according to thewavelength of the infrared radiation

红外热像可以灰阶或伪彩色显示

Second Affiliated Hospital of Chongqing Medical University      Jing HUANG MD

Fuwai Hospital, Chinese Acdemy of Medical Sciences                 Jian ZHANG  MD

Anzhen Hospital, The Capital Medical University                         Jianzeng DONG  MD

First Affiliated Hospital of Chongqing MedicalUniversity          Suxin LUO      MD

General Hospital of Jiangjing Distract, Chongqing                       Shiquan FU    MD

General Hospital of Chongqing Steel Company                           Henhua DAI   MD 

Theparticipants of thisstudy were screened from new admitted patients with suspected HF from November,2015 to August, 2017

N-terminalpro brain natriuretic peptide (NT-proBNP) or BNP, LVEF, SimpsomMethod

Diagnosisprocess of HF wasaccording to the guideline of ESC 2012

心衰患者也以EF和HYHA分级进行亚组分析，并申请临床试验注册

The patients in HF group further divided into HF with preserved ejection fraction (HFpEF) group (LVEF>40%) and HF with reduced ejectionfraction (HFrEF) group (LVEF≤40%)

also divided into Ⅰ-Ⅳ groups according to the New York Heart Function Assessment(HYHA) class

The Find-HF study was approved by the Institutional Ethics Committees of eachhospital, and registered in Clinical.Trials.gov. (NCT02672618)

用红外相机对所有患者进行面部温度采集，病房温度22-28°C

The facialthermograms in all patients were captured using an IRS camera

The camera uses an uncooled microbolometer focal plane array with a resolution of 384×288 pixels and a thermal sensitivity of 0.1 at 30 ℃

Thermography was collected at an appropriate distance, insuring that the margins of the face closed to the sampling frame of the image in the ordinary wards, and the room temperature was 22-28 ℃

meanfacial temperature （mFT）（平均温度）

temperaturestandard deviation （TSD）（温度标准差）

meaninner canthustemperature （mICT）（平均内眦温度）

meancheek temperature （mCT）（平均面颊温度）

Differencebetween mICT and mCT （DICC）（眦颊温度差）

Theincident of Monkey Face sign in HF patients was 60.4%

non-HF patients also presented Monkey Face Sign (19.5%)

the serious HF patients with higher incident of Monkey Face Sign, as in HFrEF(63.8%) and NYHA Ⅳ group (69.8%)

combined parameters of mFT, mCT, TSD, DICC and CTD, multivariate ROC curves with sensitivity of 75.3%, specificity of 62.8%, and value of area under curve (AUC) of 0.747 in discriminating HF from Non-HF patients 

The sensitivity, specificity and AUC value were 79.4%, 64.6% and 0.774 respectively in discriminating NYHA Ⅲ-Ⅳ from Non-HF patients 

while were72.2%, 71.3% and 0.776 respectively in discriminating HFrEF from Non-HF patients

The Find-HF Study is the first multicenter study to evaluate facial thermal distribution in HF patients based on a noninvasive IRTI

The main findings showed an appearance of hypothermia, increase of dispersion and abnormal facial temperature distributions in HF patients

The Monkey Face Sign on IRTI, revealed a characteristic of central thermal distribution on face, was more frequent in the HF patients

With combined-parameter of mFT, mCT, TSD, DICC and CTD, the sensitivity, specificity and AUC value were 66.1%, 73.2% and 0.752 respectively in discriminating HF from Non-HF patients, and were 79.3%, 73.2% and 0.825 respectively in discriminating HFrEF from Non-HF patients

Theinner canthus,  closed to the core temperature of the body, was less affected by the perfusion redistribution

内眦接近人体核心温度

Thecheek, is mainly reflecting peripheral circulation, and wasobviously decreased in the HF patients with perfusion redistribution

面颊温度较好反映外周循环

The results showed thatDICC was significantly higher in the HF patients

The FTDA between HF and Non-HFpatients was mainly in the cheek, supporting facial mCT as hypothermal value measurement in HF patients

We believe that the Monkey Face Signisn’t peculiar to HF patients and like to surmise it more related with sympathetic activity

我们认为，“猴脸”并不是心衰患者所特有的，更倾向于将其与交感神经活动联系起来。

thepresentnon-controlled, non-double-blinded and observational study limits its clinicalimportance, correlation between IRTI detection and prognosis on the HF patientsshould be researched next study

只是观察性研究，未反映动态变化

somefactors cansignificant interfere with the discrimination and analysis of IRTI, asvasoactive agents used, sweating condition, ambient temperature, etc., may leadto certain heterogeneities, which might negatively impact evaluation value for HF 

红外技术易受到药物、出汗、环境温度等影响

the data of two-dimension temperature and IRTI haven’t beenfull used still, further analytical method, such as machine learning etc., needto be explored to improve diagnostic value of the IRTI in detection of HF patients  

影像包括的信息尚未充分发掘

The Find-HF study showed a facial hypothermia,thermal dispersion increase and abnormal distributions in HF patients

FIND-HF研究揭示心衰患者存在的面部低温和分布离散现象

The facial thermal distribution evaluation may furtherexplore as a noninvasively and non-contact strategy for detection andmonitoring of new or aggravated HF patients in clinical practice

面部红外热像可进一步探索用于新发和加重的心衰患者的探测和监测