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

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  • Laust Dupont Rasmussen
  • Simon Winther
  • Salma Raghad Karim
  • Jelmer Westra
  • Jane Kirk Johansen, Stavanger University Hospital, Orthopedic Department, Regional Hospital Silkeborg, Silkeborg, Denmark.
  • ,
  • Hanne Maare Søndergaard
  • Osama Hammid
  • ,
  • Emelyne Sevestre, CORRIB Research Center for Advanced Imaging and Core Laboratory
  • ,
  • Yoshinobu Onuma, CORRIB Research Center for Advanced Imaging and Core Laboratory
  • ,
  • Mette Nyegaard, Department of Health Science and Technology, Danmarks Pædagogiske Universitet/Ålborg Universitet
  • ,
  • June Anita Ejlersen
  • Evald Christiansen
  • Ashkan Eftekhari, From the Department of Cardiology, Odense University Hospital, Odense, Denmark (P.T., K.N.H., H.S.H., A.J., K.T.V., L.O.J.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., E.H.C., L.T.); and Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (S.E.J., J.R.).
  • ,
  • Niels Ramsing Holm
  • Samuel Emil Schmidt, Department of Health Science and Technology
  • ,
  • Morten Bøttcher

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.


Original languageEnglish
Publication statusE-pub ahead of print - 6 Mar 2023

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