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Coronary artery disease can be detected by an advanced sound analysis from the coronary circulation

Session Poster session 1

Speaker Simon Winther

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : S Winther (Aarhus,DK), L Nissen (Herning,DK), J Westra (Aarhus,DK), JK Johansen (Silkeborg,DK), NH Holm (Aarhus,DK), M Bottcher (Herning,DK), SE Schmidt (Aalborg,DK), L Dupont (Herning,DK), BS Larsen (Aalborg,DK), L Frost (Silkeborg,DK), HE Botker (Aarhus,DK)

Authors:
S. Winther1 , L. Nissen2 , J. Westra1 , J.K. Johansen3 , N.H. Holm1 , M. Bottcher2 , S.E. Schmidt4 , L. Dupont2 , B.S. Larsen4 , L. Frost3 , H.E. Botker1 , 1Aarhus University Hospital, Skejby - Aarhus - Denmark , 2Regional Hospital West Jutland, Department of Cardiology - Herning - Denmark , 3Regional Hospital Central Jutland, Department of Cardiology - Silkeborg - Denmark , 4Aalborg University, Department of Health Science and Technology - Aalborg - Denmark ,

On behalf: DAN-NICAD study group

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 189-190

Background: Stratification of patients with suspected coronary artery disease (CAD) and a low to intermediate likelihood of CAD remains a challenge. New risk stratifications algorithms are needed to reduce unnecessary advanced diagnostic test. A new acoustic system relying on advanced sound analysis from the coronary circulation obtained by a simple stethoscope like device may serve as a rule-out device of CAD. The aim in this study was to investigate prediction of CAD severity in patients with a low to intermediate likelihood of CAD.

Methods: We included 1675 patients (male: 49% mean age 57±9 years) with a low to intermediate likelihood of CAD referred for coronary CTA. If severe stenosis was suspected in any coronary segments at the coronary CTA, patients were randomized 1:1 to either CMRI or MPS. CAD severity was classified on patient level according to Non-CAD: coronary artery calcium score (CACS) = 0 and no plaque, mild CAD: CACS≥0 and plaque with 1–29% diameter stenosis, moderate CAD: CACS≥0 and plaque with 30–49% diameter stenosis and severe CAD: CACS≥0 and plaque with ≥50% diameter stenosis. A coronary vessel was categorized as diseased when a ≥50% diameter stenosis was present.

CAD-score was recorded in all patients. The CAD-score combines acoustic features and clinical risk factors. Low risk is indicated by a CAD-score value ≤20. The algorithm was developed using recordings from 711 patients from previous studies and a trainings cohort of 589 patients from the present study. The remaining 1086 patients were used as the validation cohort.

Results: CAD-score was successfully analyzed in 1464 (87%) patients. The performance of the CAD-score algorithm in the training and validation cohorts did not differ.

In the entire cohort, the CAD-score differed between CACS groups, disease severity and number of vessel disease (Figure). Diagnostic performance of severe CAD at coronary CTA evaluated by receiver operating characteristic curve showed an accuracy of 69% (CI: 66% - 73%). Sensitivity, specificity, PPV and NPV for CAD-score value ≤20 were 73% (CI: 68% to 78%), 56% (CI: 53% to 59%), 33% (CI: 29% to 36%), and 88% (CI: 85% to 90%). In patients with severe CAD at coronary CTA, CAD-score was significant lower for patients without vs. with a perfusion defect at CMRI or MPS, 27±12 vs 31±12 (p<0.05)

Conclusion: The new acoustic risk stratification score was associated not only with the presence but also the severity of CAD in patients with a low to intermediate likelihood of CAD.

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