Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

Laust Dupont Rasmussen; Simon Winther; Salma Raghad Karim; Jelmer Westra; Jane Kirk Johansen; Hanne Maare Søndergaard; Osama Hammid; Emelyne Sevestre; Yoshinobu Onuma; Mette Nyegaard; June Anita Ejlersen; Evald Christiansen; Ashkan Eftekhari; Niels Ramsing Holm; Samuel Emil Schmidt; Morten Bøttcher

doi:10.1136/heartjnl-2023-322357

Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

Laust Dupont Rasmussen^*, Simon Winther, Salma Raghad Karim, Jelmer Westra, Jane Kirk Johansen, Hanne Maare Søndergaard, Osama Hammid, Emelyne Sevestre, Yoshinobu Onuma, Mette Nyegaard, June Anita Ejlersen, Evald Christiansen, Ashkan Eftekhari, Niels Ramsing Holm, Samuel Emil Schmidt, Morten Bøttcher

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

3 Citationer (Scopus)

Abstract

OBJECTIVE: Validation studies of the 2019 European Society of Cardiology pretest probability model (ESC-PTP) for coronary artery disease (CAD) report that 35%-40% of patients have low pretest probability (ESC-PTP 5% to <15%). Acoustic detection of coronary stenoses could potentially improve clinical likelihood stratification. Aims were to (1) investigate the diagnostic performance of an acoustic-based CAD score and (2) study the reclassification potential of a dual likelihood strategy by the ESC-PTP and a CAD score.

METHODS: Consecutive patients (n=1683) with stable angina symptoms referred for coronary CT angiography (CTA) underwent heart sound analyses by an acoustic CAD-score device. All patients with ≥50% luminal stenosis in any coronary segment at coronary CTA were referred to investigation with invasive coronary angiography (ICA) with fractional flow reserve (FFR).A predefined CAD-score cut-off ≤20 was used to rule out obstructive CAD.

RESULTS: In total, 439 patients (26%) had ≥50% luminal stenosis on coronary CTA. The subsequent ICA with FFR showed obstructive CAD in 199 patients (11.8%). Using the ≤20 CAD-score cut-off for obstructive CAD rule-out, sensitivity was 85.4% (95% CI 79.7 to 90.0), specificity 40.4% (95% CI 37.9 to 42.9), positive predictive value 16.1% (95% CI 13.9 to 18.5) and negative predictive value 95.4% (95% CI 93.4 to 96.9) in all patients. Applying the cut-off in ESC-PTP 5% to <15% patients, 316 patients (48%) were down-classified to very-low likelihood. The obstructive CAD prevalence was 3.5% in this group.

CONCLUSION: In a large contemporary cohort of patients with low CAD likelihood, the additional use of an acoustic rule-out device showed a clear potential to downgrade likelihood and could supplement current strategies for likelihood assessment to avoid unnecessary testing.

TRIAL REGISTRATION NUMBER: NCT03481712.

Originalsprog	Engelsk
Artikelnummer	heartjnl-2023-322357
Tidsskrift	Heart
Vol/bind	109
Nummer	16
Sider (fra-til)	1223-1230
Antal sider	8
ISSN	1355-6037
DOI	https://doi.org/10.1136/heartjnl-2023-322357
Status	Udgivet - 1 aug. 2023

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10.1136/heartjnl-2023-322357

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Rasmussen, L. D., Winther, S., Karim, S. R., Westra, J., Kirk Johansen, J., Søndergaard, H. M., Hammid, O., Sevestre, E., Onuma, Y., Nyegaard, M., Ejlersen, J. A., Christiansen, E., Eftekhari, A., Holm, N. R., Schmidt, S. E., & Bøttcher, M. (2023). Likelihood reclassification by an acoustic-based score in suspected coronary artery disease. Heart, 109(16), 1223-1230. Artikel heartjnl-2023-322357. https://doi.org/10.1136/heartjnl-2023-322357

@article{82de40c797364cb9b43c9340e7c4128c,

title = "Likelihood reclassification by an acoustic-based score in suspected coronary artery disease",

abstract = "OBJECTIVE: Validation studies of the 2019 European Society of Cardiology pretest probability model (ESC-PTP) for coronary artery disease (CAD) report that 35%-40% of patients have low pretest probability (ESC-PTP 5% to <15%). Acoustic detection of coronary stenoses could potentially improve clinical likelihood stratification. Aims were to (1) investigate the diagnostic performance of an acoustic-based CAD score and (2) study the reclassification potential of a dual likelihood strategy by the ESC-PTP and a CAD score.METHODS: Consecutive patients (n=1683) with stable angina symptoms referred for coronary CT angiography (CTA) underwent heart sound analyses by an acoustic CAD-score device. All patients with ≥50% luminal stenosis in any coronary segment at coronary CTA were referred to investigation with invasive coronary angiography (ICA) with fractional flow reserve (FFR).A predefined CAD-score cut-off ≤20 was used to rule out obstructive CAD.RESULTS: In total, 439 patients (26%) had ≥50% luminal stenosis on coronary CTA. The subsequent ICA with FFR showed obstructive CAD in 199 patients (11.8%). Using the ≤20 CAD-score cut-off for obstructive CAD rule-out, sensitivity was 85.4% (95% CI 79.7 to 90.0), specificity 40.4% (95% CI 37.9 to 42.9), positive predictive value 16.1% (95% CI 13.9 to 18.5) and negative predictive value 95.4% (95% CI 93.4 to 96.9) in all patients. Applying the cut-off in ESC-PTP 5% to <15% patients, 316 patients (48%) were down-classified to very-low likelihood. The obstructive CAD prevalence was 3.5% in this group.CONCLUSION: In a large contemporary cohort of patients with low CAD likelihood, the additional use of an acoustic rule-out device showed a clear potential to downgrade likelihood and could supplement current strategies for likelihood assessment to avoid unnecessary testing.TRIAL REGISTRATION NUMBER: NCT03481712.",

keywords = "atherosclerosis, coronary artery disease, diagnostic imaging, Predictive Value of Tests, Constriction, Pathologic, Humans, Probability, Acoustics, Computed Tomography Angiography, Coronary Artery Disease/diagnostic imaging, Coronary Angiography, Coronary Stenosis/diagnostic imaging, Fractional Flow Reserve, Myocardial",

author = "Rasmussen, {Laust Dupont} and Simon Winther and Karim, {Salma Raghad} and Jelmer Westra and {Kirk Johansen}, Jane and S{\o}ndergaard, {Hanne Maare} and Osama Hammid and Emelyne Sevestre and Yoshinobu Onuma and Mette Nyegaard and Ejlersen, {June Anita} and Evald Christiansen and Ashkan Eftekhari and Holm, {Niels Ramsing} and Schmidt, {Samuel Emil} and Morten B{\o}ttcher",

note = "Funding Information: The study was supported by the Health Research Fund of Central Denmark Region, Aarhus University Research Foundation and by an institutional research grant from Acarix, Denmark. Funding Information: SW acknowledges support from the Novo Nordisk Foundation Clinical Emerging Investigator grant (NNF21OC0066981). MB discloses advisory board participation for Novo Nordisk, AstraZeneca, Pfizer, Boeringer Ingelheim, Bayer, Sanofi, Novartis, Amgen, CLS-Behring and Acarix. The remaining authors have nothing to declare. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

month = aug,

day = "1",

doi = "10.1136/heartjnl-2023-322357",

language = "English",

volume = "109",

pages = "1223--1230",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "16",

}

Rasmussen, LD , Winther, S , Karim, SR , Westra, J, Kirk Johansen, J, Søndergaard, HM, Hammid, O, Sevestre, E, Onuma, Y, Nyegaard, M, Ejlersen, JA, Christiansen, E, Eftekhari, A, Holm, NR, Schmidt, SE & Bøttcher, M 2023, 'Likelihood reclassification by an acoustic-based score in suspected coronary artery disease', Heart, bind 109, nr. 16, heartjnl-2023-322357, s. 1223-1230. https://doi.org/10.1136/heartjnl-2023-322357

Likelihood reclassification by an acoustic-based score in suspected coronary artery disease. / Rasmussen, Laust Dupont ; Winther, Simon ; Karim, Salma Raghad et al.
I: Heart, Bind 109, Nr. 16, heartjnl-2023-322357, 01.08.2023, s. 1223-1230.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

AU - Rasmussen, Laust Dupont

AU - Winther, Simon

AU - Karim, Salma Raghad

AU - Westra, Jelmer

AU - Kirk Johansen, Jane

AU - Søndergaard, Hanne Maare

AU - Hammid, Osama

AU - Sevestre, Emelyne

AU - Onuma, Yoshinobu

AU - Nyegaard, Mette

AU - Ejlersen, June Anita

AU - Christiansen, Evald

AU - Eftekhari, Ashkan

AU - Holm, Niels Ramsing

AU - Schmidt, Samuel Emil

AU - Bøttcher, Morten

N1 - Funding Information: The study was supported by the Health Research Fund of Central Denmark Region, Aarhus University Research Foundation and by an institutional research grant from Acarix, Denmark. Funding Information: SW acknowledges support from the Novo Nordisk Foundation Clinical Emerging Investigator grant (NNF21OC0066981). MB discloses advisory board participation for Novo Nordisk, AstraZeneca, Pfizer, Boeringer Ingelheim, Bayer, Sanofi, Novartis, Amgen, CLS-Behring and Acarix. The remaining authors have nothing to declare. Publisher Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023/8/1

Y1 - 2023/8/1

N2 - OBJECTIVE: Validation studies of the 2019 European Society of Cardiology pretest probability model (ESC-PTP) for coronary artery disease (CAD) report that 35%-40% of patients have low pretest probability (ESC-PTP 5% to <15%). Acoustic detection of coronary stenoses could potentially improve clinical likelihood stratification. Aims were to (1) investigate the diagnostic performance of an acoustic-based CAD score and (2) study the reclassification potential of a dual likelihood strategy by the ESC-PTP and a CAD score.METHODS: Consecutive patients (n=1683) with stable angina symptoms referred for coronary CT angiography (CTA) underwent heart sound analyses by an acoustic CAD-score device. All patients with ≥50% luminal stenosis in any coronary segment at coronary CTA were referred to investigation with invasive coronary angiography (ICA) with fractional flow reserve (FFR).A predefined CAD-score cut-off ≤20 was used to rule out obstructive CAD.RESULTS: In total, 439 patients (26%) had ≥50% luminal stenosis on coronary CTA. The subsequent ICA with FFR showed obstructive CAD in 199 patients (11.8%). Using the ≤20 CAD-score cut-off for obstructive CAD rule-out, sensitivity was 85.4% (95% CI 79.7 to 90.0), specificity 40.4% (95% CI 37.9 to 42.9), positive predictive value 16.1% (95% CI 13.9 to 18.5) and negative predictive value 95.4% (95% CI 93.4 to 96.9) in all patients. Applying the cut-off in ESC-PTP 5% to <15% patients, 316 patients (48%) were down-classified to very-low likelihood. The obstructive CAD prevalence was 3.5% in this group.CONCLUSION: In a large contemporary cohort of patients with low CAD likelihood, the additional use of an acoustic rule-out device showed a clear potential to downgrade likelihood and could supplement current strategies for likelihood assessment to avoid unnecessary testing.TRIAL REGISTRATION NUMBER: NCT03481712.

AB - OBJECTIVE: Validation studies of the 2019 European Society of Cardiology pretest probability model (ESC-PTP) for coronary artery disease (CAD) report that 35%-40% of patients have low pretest probability (ESC-PTP 5% to <15%). Acoustic detection of coronary stenoses could potentially improve clinical likelihood stratification. Aims were to (1) investigate the diagnostic performance of an acoustic-based CAD score and (2) study the reclassification potential of a dual likelihood strategy by the ESC-PTP and a CAD score.METHODS: Consecutive patients (n=1683) with stable angina symptoms referred for coronary CT angiography (CTA) underwent heart sound analyses by an acoustic CAD-score device. All patients with ≥50% luminal stenosis in any coronary segment at coronary CTA were referred to investigation with invasive coronary angiography (ICA) with fractional flow reserve (FFR).A predefined CAD-score cut-off ≤20 was used to rule out obstructive CAD.RESULTS: In total, 439 patients (26%) had ≥50% luminal stenosis on coronary CTA. The subsequent ICA with FFR showed obstructive CAD in 199 patients (11.8%). Using the ≤20 CAD-score cut-off for obstructive CAD rule-out, sensitivity was 85.4% (95% CI 79.7 to 90.0), specificity 40.4% (95% CI 37.9 to 42.9), positive predictive value 16.1% (95% CI 13.9 to 18.5) and negative predictive value 95.4% (95% CI 93.4 to 96.9) in all patients. Applying the cut-off in ESC-PTP 5% to <15% patients, 316 patients (48%) were down-classified to very-low likelihood. The obstructive CAD prevalence was 3.5% in this group.CONCLUSION: In a large contemporary cohort of patients with low CAD likelihood, the additional use of an acoustic rule-out device showed a clear potential to downgrade likelihood and could supplement current strategies for likelihood assessment to avoid unnecessary testing.TRIAL REGISTRATION NUMBER: NCT03481712.

KW - atherosclerosis

KW - coronary artery disease

KW - diagnostic imaging

KW - Predictive Value of Tests

KW - Constriction, Pathologic

KW - Humans

KW - Probability

KW - Acoustics

KW - Computed Tomography Angiography

KW - Coronary Artery Disease/diagnostic imaging

KW - Coronary Angiography

KW - Coronary Stenosis/diagnostic imaging

KW - Fractional Flow Reserve, Myocardial

UR - http://www.scopus.com/inward/record.url?scp=85152460509&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2023-322357

DO - 10.1136/heartjnl-2023-322357

M3 - Journal article

C2 - 36878672

AN - SCOPUS:85152460509

SN - 1355-6037

VL - 109

SP - 1223

EP - 1230

JO - Heart

JF - Heart

IS - 16

M1 - heartjnl-2023-322357

ER -

Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

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