Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification

Winther, Simon; Nissen, Louise; Schmidt, Samuel; Westra, Jelmer; Rasmussen, Laust Dupont; Knudsen, Lars; Madsen, Lene Helleskov; Johansen, Jane Kirk; Larsen, Bjarke Skogstad; Struijk, Johannes; Frost, Lars; Holm, Niels Ramsing; Christiansen, Evald Høj; Bøtker, Hans Erik; Bøttcher, Morten

doi:10.1136/heartjnl-2017-311944

Cited by 33 publications

(74 citation statements)

References 17 publications

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“…For detection of stable coronary artery disease (CAD), patients undergo risk stratification, non-invasive and invasive testing [1]. However, recent studies have demonstrated that as low as 6–10% of patients referred to non-invasive testing suffer from significant CAD [2–4]. A safe and low-cost rule-out test reducing the number of patients with non-obstructive CAD referred to non-invasive testing could therefore reduce costs and potential risk of complications.…”

Section: Introductionmentioning

confidence: 99%

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

Schmidt

Winther

Larsen

et al. 2019

Int J Cardiovasc Imaging

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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.Electronic supplementary materialThe online version of this article (10.1007/s10554-019-01662-1) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

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

Schmidt

Winther

Larsen

et al. 2019

Int J Cardiovasc Imaging

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“…To lower the overall mortality rate of CAD, a technology is required, which is inexpensive, easy to use, fast, reliable and accurate. As a result, a great interest in alternative techniques has been promoted to simplify the procedure of detecting CAD (for example recently a method has been suggested for detecting CAD using the sound of turbulent blood flow induced by coronary stenosis Schmidt et al, 2015; Winther et al, 2016, 2018; Thomas et al, 2017). Among them a technology using seismocardiography (SCG) for detecting CAD has the potential to fulfill these requirements.…”

Section: Introductionmentioning

confidence: 99%

Identifying Patients With Coronary Artery Disease Using Rest and Exercise Seismocardiography

Dehkordi

Bauer²,

Tavakolian

et al. 2019

Front. Physiol.

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Coronary artery disease (CAD) is the most common cause of death globally. Patients with suspected CAD are usually assessed by exercise electrocardiography (ECG). Subsequent tests, such as coronary angiography and coronary computed tomography angiography (CCTA) are performed to localize the stenosis and to estimate the degree of blockage. The present study describes a non-invasive methodology to identify patients with CAD based on the analysis of both rest and exercise seismocardiography (SCG). SCG is a non-invasive technology for capturing the acceleration of the chest induced by myocardial motion and vibrations. SCG signals were recorded from 185 individuals at rest and immediately after exercise. Two models were developed using the characterization of the rest and exercise SCG signals to identify individuals with CAD. The models were validated against related results from angiography. For the rest model, accuracy was 74%, and sensitivity and specificity were estimated as 75 and 72%, respectively. For the exercise model accuracy, sensitivity, and specificity were 81, 82, and 84%, respectively. The rest and exercise models presented a bootstrap-corrected area under the curve of 0.77 and 0.91, respectively. The discrimination slope was estimated 0.32 for rest model and 0.47 for the exercise model. The difference between the discrimination slopes of these two models was 0.15 (95% CI: 0.10 to 0.23, p < 0.0001). Both rest and exercise models are able to detect CAD with comparable accuracy, sensitivity, and specificity. Performance of SCG is better compared to stress-ECG and it is identical to stress-echocardiography and CCTA. SCG examination is fast, inexpensive, and may even be carried out by laypersons.

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“…Phonocardiography recordings were pooled from three different studies: AdoptCAD [5], BIO-CAC (NCT02913144), and Dan-NICAD [6,7] as shown in Table 1. Only one recording for each subject was included; in cases where more than one recording were available, the first recording was selected.…”

Section: Datamentioning

confidence: 99%

Autoregressive Whitening Filter for Detection of Coronary Artery Disease Based on Phonocardiography

Larsen¹,

Winther²,

Nissen³

et al. 2019

2019 Computing in Cardiology Conference (CinC)

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Background: Narrowing of the coronary arteries, which defines coronary artery disease (CAD), can be discovered through phonocardiography (PCG) analysis. Increased power of frequencies below 200 Hz in the diastole has been associated with CAD, and can be used to distinguish CAD from NonCAD patients. However, spectral roll off is steep (~40 dB/dec), and spectral leakage might mask the weak CAD-related signal. Methods: PCGs from 1168 subjects, 213 CAD and 955 NonCAD, were pooled from three studies. The average power spectral density (PSD) of diastole segments for NonCAD subjects was found, and an auto-regressive (AR) model of this PSD was constructed. The inverse of the corresponding filter was used for whitening. Results: A single iteration of whitening filtering was insufficient to make the PSD white for 5-1000 Hz. Two iterations of whitening filtering with an order of 6-10 were required to reach a plateau of maximal whitening with a spectral flatness measure close to 1 in the frequency band 5-1000 Hz. The whitening process revealed additional PSD differences between CAD and NonCAD subjects for the mid-diastole segment. Conclusion: Whitening of diastole PCG segments emphasized the difference between CAD and NonCAD patients.

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Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification

Cited by 33 publications

References 17 publications

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

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

Identifying Patients With Coronary Artery Disease Using Rest and Exercise Seismocardiography

Autoregressive Whitening Filter for Detection of Coronary Artery Disease Based on Phonocardiography

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