TY - JOUR
T1 - Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification
AU - Winther, Simon
AU - Nissen, Louise
AU - Schmidt, Samuel Emil
AU - Westra, Jelmer Sybren
AU - Rasmussen, Laust Dupont
AU - Knudsen, Lars Lyhne
AU - Madsen, Lene Helleskov
AU - Kirk Johansen, Jane
AU - Larsen, Bjarke Skogstad
AU - Struijk, Johannes Jan
AU - Frost, Lars
AU - Holm, Niels Ramsing
AU - Christiansen, Evald Høj
AU - Botker, Hans Erik
AU - Bøttcher, Morten
N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - 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.
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.
KW - Journal Article
KW - cardiac imaging and diagnostics
KW - coronary artery disease
KW - Prospective Studies
KW - Computed Tomography Angiography/methods
KW - Humans
KW - Middle Aged
KW - Coronary Stenosis
KW - Male
KW - Acoustics/instrumentation
KW - Heart Sounds/physiology
KW - Coronary Artery Disease/diagnosis
KW - Point-of-Care Systems
KW - Sensitivity and Specificity
KW - Female
KW - Coronary Angiography/methods
UR - http://www.scopus.com/inward/record.url?scp=85047239228&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2017-311944
DO - 10.1136/heartjnl-2017-311944
M3 - Journal article
C2 - 29122932
SN - 1355-6037
VL - 104
SP - 928
EP - 935
JO - Heart
JF - Heart
IS - 11
ER -