Going beyond blood pressure apps to digital health solutions in heart health, I stumbled upon this app called Heartscan. This app targets people with heart arrhythmia. It is a tool for patients, in use by many already, but it is also a diagnostic tool for doctors. Heartscan provides the user with something called seismocardiogram. It is a snapshot of the chest vibrations that originate from the heart’s mechanical activity. The technology is from the 1980s, but it now became accessible to any smartphone user. I talked to Michal Barodkin, the man behind the Heartscan app. Michal is an experienced health tech leader, with several successful projects in the industry and a personal interest in heart health.
Q1: Let’s start from the very basics. If you were to explain how seismocardiography works to a patient, how would you do it? And how would you describe it to a healthcare professional?
Let me start with an explanation to patients. Seismocardiography is a recording of how your chest vibrates. Not of all vibrations, this is very important, but only of those that are caused by your heart. Literally, by the mechanical activity of the heart.
It is called seismo – cardiography, to reflect the comparison with the seismic activity of the Earth, seismologists are those scientists engaged in prediction of earthquakes, imagine your heart as Earth, and it vibrates when it beats. These are the recordings we, engaged in seismocardiography, are interested in.
The seismocardiography was first introduced to clinical medicine in 1987 by two Italian researchers, Dr Zanetti, an earthquake seismologist, and Dr Salerno, a cardiologist. They used the technology employed in seismology to record the cardiac induced vibration from the surface of the body.
This technology, seismocardiography, allows very precise recordings of the heart’s mechanical activity, right down to the openings and closings of the heart valves.
To achieve such results, to exclude external interferences, to exclude recording of other vibrations from other muscles, from micro changes in the position of the patient’s body, precise sensors and complex calculations are required. That is why seismocardiography has not been widely used in the past. Its wide use has become possible only recently, with the development of technology in modern smartphones.
Q2: How is it technically possible that an iPhone-based meter does the same or more than in-house medical devices? And where is seismocardiography in comparison to other relevant technologies?
The recent development of micromechanical sensor systems has created this unique opportunity. The accuracy of the sensors in the average smartphone today reaches the level of scientific measuring equipment.
Recent lab-based data from clinical trials of other technologies has significantly lower accuracy, sampling frequency and a much higher noise level than we record with a regular smartphone today. The classic technology employed, electrocardiography, the ECG, has become widespread not because of its accuracy, but because of its simplicity.
For a long time there was no accessible hardware for recording heart vibrations with high enough accuracy. And it was already possible to use the electrical activity of the heart.
Independent scientific studies confirm that a seismic cardiogram is much more accurate in determining, for example, coronary heart disease than standard ECG and ultrasound and is comparable in accuracy to ECG and ultrasound of the heart under stress, when patients perform physical work during the measurement process. Moreover, for many patients, the stress of testing is already a health risk. Therefore, such studies are carried out only in well-equipped clinics where resuscitation is possible.
Q3: Please clarify further, where is seismocardiography in comparison to an electrocardiography?
A regular ECG is a recording of the heart’s electrical activity, not mechanical as we do with a seismocardiogram. Using ECG, healthcare professionals record and analyze the electric impulses controlled by the heart muscles.
Let me know give a very brief explanation to healthcare professionals, as you asked. They are welcome to contact me for further details, but to be very brief – seismocardiography is a recording of chest oscillations that are caused by the mechanical activity of the heart.
Such a recording is also a subject to interferences from movements, but it allows for more accurate diagnosis of some diseases at an early stage. Let’s say, we have a patient with a mild heart valve injury. This does not yet affect the impulses that control the muscles, but it does affect the movement of the heart already. With seismocardiography, and here I refer to results of further independent studies, it is possible to determine coronary heart disease with an accuracy higher than with ultrasound or with ECG.
Q4: A heart is often compared to an engine, while it is a muscle. Maybe this will help explain seismocardiography?
The heart is a very important part of our body, but comparing it with the engine of a regular car is not entirely correct. It is more accurate to compare the heart to a hydraulic pump.
We have all seen utility mini excavators used to carry out work in the city. The “heart” of the excavator is the hydraulic pump. The pressurized fluid transfers energy to all working tools and tracks. In the same way, the heart of our body is a pump that transfers energy to every organ. Only in the case of our body, energy is transmitted in the form of an oxidizer and fuel mixed in the blood, and not pressure.
Q5: Did you really get the idea when watching excavators doing road works?
In fact, it was exactly this way 🙂 I was working on a project for vibration diagnostics of motors and bearings, and got the idea for an app in seismocardiography, I was fond of coding since childhood. A two single-cylinder piston pump is a very close analogy of the heart from a physicist’s point of view.
Q6: I tried your app, it works well, and I got a very nice looking seismocardiogram. To be frank, I am not sure what exactly I can do with it. Perhaps you can explain what it is I as a patient can do, and what a doctor can do with a seismocardiogram done by your app?
Let me be very clear here. First about what you can do, then about what you cannot do. The app targets people with heart arrhythmia such as myself. Therefore, I will explain it from my own experience.
Several years ago, I myself had a problem with heart rhythm disturbances. Unusual sensations in the chest, tremors, freezing. It was incomprehensible and the unknown was frightening. My grandfather died of a heart problem at the age of 57, so heart issues are very important to me.
When I visited specialists or even went to an emergency, all indicators and parameters, and results of lab tests were normal. Only one experienced doctor, a cardiologist, was able to give the correct diagnosis based on the description and prescribe pills that solved the problem.
Q7: Is it when you decided to develop this app, HeartScan?
Yes, the next time I felt the same sensations in my chest, I already knew what it was, but I couldn’t imagine how my heart behaved at such moments.
It was at this point that I had a prototype application for diagnosing defective bearings and was able to record data from my chest. I didn’t really believe in the results.
Imagine my surprise after analyzing the data, when I was able to determine not only the main phases of my heart, but also highlight the clear moments of the opening and closing of the heart valves.
Q8: To come back to what a patient and a doctor can do with your app, I understand that the app is for the people with heart arrhythmia, but what exactly and when, in what life situations, will they be able to do with your app?
With my app, people with heart arrhythmia will be able to ‘take a photo’ of the mechanical activity of their heart on the spot, right when they experience the symptoms of arrhythmia.
Imagine, you feel this freezing sensation in your chest. You can place your iPhone to your chest, and in one minute get something that is close and in many ways better than an electrocardiogram. The heart arrhythmia will in most cases stop before you can reach a doctor or even before you can be measured by an emergency personnel. But when you get to see your doctor, you can show it to her or him. Also, in an emergency.
Q9: By the way, how many people in the world live with heart arrhythmia?
I do not have one number, there are several types of heart arrhythmia. The most common type, atrial fibrillation (AF) is estimated to affect almost 60 million people worldwide (2019).
Q10: And what about the doctors? How can they use your app?
It is basically a diagnostic tool. It takes one minute to use. Currently, the patient has to lie down for one minute. In the next version, it will not be required.
Based on the conclusions of the analysis of the seismocardiogram, the cardiologist can determine the type of arrhythmia that the patient had at the time of measurement.
This helps a lot with temporary rhythm disturbances. In the situation that I described, I felt strange sensations in my chest, but when visiting the doctor or an ER, all was found normal. Using our program allows the doctor to see how the heart moves during or right after those unpleasant sensations that people with heart arrhythmia know, the freezing sensation in the chest or tremors that people feel.
Users will get an opportunity to study their health, and doctors will get a tool to reduce appointment time by easing diagnostics.
Also, the doctors are getting the ability to do remote monitoring, for example, in the postoperative period. My app provides a unique opportunity to monitor the patient’s heart condition without the need to use equipment and medical personnel.
This opens up new opportunities both for patients and for doctors. Now about what you cannot do, at least for now.
Q11: Yes, what about the limitations?
As of today, we do not yet have the right to inform users about detected problems, even if they are clearly seen. Having received the result, it is challenging for an untrained user to draw conclusions. Therefore, we have provided for exporting the results in a form convenient for the doctor.
Also, we are not currently a certified medical device. However, according to a survey among cardiologists, and multiple comparisons in measurement sessions, the seismocardiogram, when presented to a doctor, can reduce the doctor’s time and ease diagnostics.
Q12: Even with these limitations, it sounds very impressive. What are your further plans with this?
Today, our application is used by tens of thousands users every month. This shows not only the clinical potential but a potential for widespread adoption. As an early-stage startup, we focus on improving technology and expanding our user base.
Our immediate goal is to launch collaborations with healthcare professionals and researchers to validate the app and to improve its capabilities through clinical trials. We are already negotiating with several government backed US corporations to commence cooperation.
To support these efforts, we are fundraising. The funds will be used on R&D, and registration as a medical device. Also, we have a comprehensive education strategy in our vision, to target users and HCPs.
Our goal is to make seismocardiography accessible to everyone who has a smartphone. After all, every new user is a step towards our dream of saving a million lives.
When we read or listen to reviews from users whom we were able to help, it encourages us to move even faster. Our team of cardiologists and cardiac surgeons and data scientists who develop methods for analyzing signals are people as passionate as I am.
As a founder, I firmly believe that our journey is not only about ensuring heart health, it is also about creating a strong, sustainable business model that can support our mission.
With every step forward, we strive to demonstrate the enormous potential of our technology, not only as a tool to save lives, but also as an innovative solution that represents an attractive investment opportunity in the health technology sector.
Q13: In your opinion, what is needed for adoption of seismocardiography?
Obtaining certificates is not enough for mass adoption. Also, there are established technologies and practices in place. We aim to obtain funding and to generate revenue, to spend it on educating users and spreading awareness of the technology’s availability among healthcare professionals.
Seismocardiography is a method that is available to everyone, at any time, in any place. To obtain information about the work of the heart, you only need a smartphone.
My dream is to save a million lives with the help of seismocardiography. And this allows our team to move forward every day.
