RT Journal Article
SR Electronic
T1 Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 928
OP 935
DO 10.1136/heartjnl-2017-311944
VO 104
IS 11
A1 Winther, Simon
A1 Nissen, Louise
A1 Schmidt, Samuel Emil
A1 Westra, Jelmer Sybren
A1 Rasmussen, Laust Dupont
A1 Knudsen, Lars Lyhne
A1 Madsen, Lene Helleskov
A1 Kirk Johansen, Jane
A1 Larsen, Bjarke Skogstad
A1 Struijk, Johannes Jan
A1 Frost, Lars
A1 Holm, Niels Ramsing
A1 Christiansen, Evald Høj
A1 Botker, Hans Erik
A1 Bøttcher, Morten
YR 2018
UL http://heart.bmj.com/content/104/11/928.abstract
AB Objective Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD.Methods We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography. If significant obstruction was suspected in any coronary segment, patients were referred to invasive angiography and fractional flow reserve (FFR) assessment. Heart sound analysis was performed in all patients. A predefined acoustic CAD-score algorithm was evaluated; subsequently, we developed and validated an updated CAD-score algorithm that included both acoustic features and clinical risk factors. Low risk is indicated by a CAD-score value ≤20.Results Haemodynamically significant CAD assessed from FFR was present in 145 (10.0%) patients. In the entire cohort, the predefined CAD-score had a sensitivity of 63% and a specificity of 44%. In total, 50% had an updated CAD-score value ≤20. At this cut-off, sensitivity was 81% (95% CI 73% to 87%), specificity 53% (95% CI 50% to 56%), positive predictive value 16% (95% CI 13% to 18%) and negative predictive value 96% (95% CI 95% to 98%) for diagnosing haemodynamically significant CAD.Conclusion Sound-based detection of CAD enables risk stratification superior to clinical risk scores. With a negative predictive value of 96%, this new acoustic rule-out system could potentially supplement clinical assessment to guide decisions on the need for further diagnostic investigation.Trial registration number ClinicalTrials.gov identifier NCT02264717; Results.