Coronary artery disease risk reclassification by a new acoustic-based score

• Published in: The International Journal of Cardiovascular Imaging Vol. 35; no. 11; pp. 2019 - 2028
• Main Authors: Schmidt, S. E., Winther, S., Larsen, B. S., Groenhoej, M. H., Nissen, L., Westra, J., Frost, L., Holm, N. R., Mickley, H., Steffensen, F. H., Lambrechtsen, J., Nørskov, M. S., Struijk, J. J., Diederichsen, A. C. P., Boettcher, M.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-11-2019; Springer Nature B.V
• Subjects: Acoustics; Adult; Aged; Aged, 80 and over; Algorithms; Angiography; Audio data; Cardiac Imaging; Cardiology; Cardiovascular disease; Coronary Angiography; Coronary artery; Coronary artery disease; Coronary Artery Disease - classification; Coronary Artery Disease - diagnosis; Coronary Artery Disease - economics; Coronary Artery Disease - physiopathology; Coronary Stenosis - classification; Coronary Stenosis - diagnosis; Coronary Stenosis - economics; Coronary Stenosis - physiopathology; Coronary vessels; Cost Savings; Cost-Benefit Analysis; Decision Support Techniques; Diamonds; Female; Health Care Costs; Health risks; Heart diseases; Heart Sounds; Humans; Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Phonocardiography - economics; Phonocardiography - instrumentation; Predictive Value of Tests; Prognosis; Radiology; Reclassification; Reproducibility of Results; Retrospective Studies; Severity of Illness Index; Stenosis; Young Adult; Heart sounds; Stable coronary artery disease; Ultrasensitive phonocardiography; Non-invasive testing; Reclassification; Cost-effectiveness
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-019-01662-1

To determine the potential of a non-invasive acoustic device (CADScor®System) to reclassify patients with intermediate pre-test probability (PTP) and clinically suspected stable coronary artery disease (CAD) into a low probability group thereby ruling out significant CAD. Audio recordings and clinical data from three studies were collected in a single database. In all studies, patients with a coronary CT angiography indicating CAD were referred to coronary angiography. Audio recordings of heart sounds were processed to construct a CAD-score. PTP was calculated using the updated Diamond-Forrester score and patients were classified according to the current ESC guidelines for stable CAD: low < 15%, intermediate 15–85% and high > 85% PTP. Intermediate PTP patients were re-classified to low probability if the CAD-score was ≤ 20. Of 2245 patients, 212 (9.4%) had significant CAD confirmed by coronary angiography ( ≥ 50% diameter stenosis). The average CAD-score was higher in patients with significant CAD (38.4 ± 13.9) compared to the remaining patients (25.1 ± 13.8; p < 0.001). The reclassification increased the proportion of low PTP patients from 13.6% to 41.8%, reducing the proportion of intermediate PTP patients from 83.4% to 55.2%. Before reclassification 7 (3.1%) low PTP patients had CAD, whereas post-reclassification this number increased to 28 (4.0%) (p = 0.52). The net reclassification index was 0.209. Utilization of a low-cost acoustic device in patients with intermediate PTP could potentially reduce the number of patients referred for further testing, without a significant increase in the false negative rate, and thus improve the cost-effectiveness for patients with suspected stable CAD.