Simon Winther

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

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • S E Schmidt, Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark. sschmidt@hst.aau.dk.
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  • S Winther
  • B S Larsen, Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark.
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  • M H Groenhoej, 4 Department of Cardiology, Odense University Hospital, Odense, Denmark.
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  • L Nissen
  • J Westra
  • L Frost
  • N R Holm
  • H Mickley, 4 Department of Cardiology, Odense University Hospital, Odense, Denmark.
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  • F H Steffensen, Department of Cardiology, Lillebaelt Hospital Vejle, Denmark.
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  • J Lambrechtsen, Department of Cardiology, Svendborg Hospital, Valdemarsgade 53, DK-5700 Svendborg, Denmark.
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  • M S Nørskov, Acarix, Lyngby, Denmark.
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  • J J Struijk, Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark.
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  • A C P Diederichsen, 4 Department of Cardiology, Odense University Hospital, Odense, Denmark.
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  • M Boettcher

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.

Original languageEnglish
JournalThe international journal of cardiovascular imaging
Volume35
Issue11
Pages (from-to)2019-2028
Number of pages10
ISSN1569-5794
DOIs
Publication statusPublished - Nov 2019

    Research areas

  • Cost-effectiveness, Heart sounds, Non-invasive testing, Reclassification, Stable coronary artery disease, Ultrasensitive phonocardiography

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