Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction
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Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction. / Lehmacher, Jonas; Neumann, Johannes T; Sörensen, Nils Arne; Goßling, Alina; Schmidt, Samuel Emil; Zeller, Tanja; Blankenberg, Stefan; Westermann, Dirk; Clemmensen, Peter M.
In: OPEN HEART, Vol. 10, No. 1, e002090, 03.2023.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction
AU - Lehmacher, Jonas
AU - Neumann, Johannes T
AU - Sörensen, Nils Arne
AU - Goßling, Alina
AU - Schmidt, Samuel Emil
AU - Zeller, Tanja
AU - Blankenberg, Stefan
AU - Westermann, Dirk
AU - Clemmensen, Peter M
N1 - © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/3
Y1 - 2023/3
N2 - BACKGROUND: As only a small proportion of patients with chest pain suffers from myocardial infarction (MI), safe rule-out of MI is of immense importance. Recently an ultrasensitive microphone performing diastolic heart sound analysis (CADScorSystem) for rule-out of coronary artery disease (CAD) has emerged. In this explorational study, we aimed to evaluate the feasibility of the CADScorSystem for diagnosis of MI in the setting of a large emergency department.METHODS: Patients presenting to the emergency department with suspected MI were included. Acoustic heart sound analysis was performed in all patients and automated CAD-score values were calculated via a device-embedded algorithm, which also requires inclusion of three clinical variables: age, sex and presence of hypertension. Patients additionally received serial high-sensitive troponin T measurement measurements to assess the final diagnosis according to third Universal Definition of Myocardial Infarction applying the European Society of Cardiology 0 hour/3 hours algorithm. Diagnostic parameters for MI, considering different CAD-score cut-offs, were computed.RESULTS: Of 167 patients, CAD-scores were available in 61.1%. A total of eight patients were diagnosed with MI. At a cut-off value of <20, CAD-score had a negative predictive value (NPV) of 90.7 (78.4-96.3). The corresponding positive predictive value (PPV) was 6.8 (2.7-16.2). For the adjusted CAD-score (age, sex, hypertension), at a cut-off value of <20, NPV was 90.0 (59.6-99.5) with a PPV of 10.8 (5.3-20.6).CONCLUSION: In this explorative analysis, a transcutaneous ultrasensitive microphone for heart sound analysis resulted in a high NPV analogous to the findings in rule-out of stable CAD in elective patients yet inferior to serial high-sensitivity cardiac troponin measurements and does not seem feasible for application in an emergency setting for rule-out of MI.TRIAL REGISTRATION NUMBER: NCT02355457.
AB - BACKGROUND: As only a small proportion of patients with chest pain suffers from myocardial infarction (MI), safe rule-out of MI is of immense importance. Recently an ultrasensitive microphone performing diastolic heart sound analysis (CADScorSystem) for rule-out of coronary artery disease (CAD) has emerged. In this explorational study, we aimed to evaluate the feasibility of the CADScorSystem for diagnosis of MI in the setting of a large emergency department.METHODS: Patients presenting to the emergency department with suspected MI were included. Acoustic heart sound analysis was performed in all patients and automated CAD-score values were calculated via a device-embedded algorithm, which also requires inclusion of three clinical variables: age, sex and presence of hypertension. Patients additionally received serial high-sensitive troponin T measurement measurements to assess the final diagnosis according to third Universal Definition of Myocardial Infarction applying the European Society of Cardiology 0 hour/3 hours algorithm. Diagnostic parameters for MI, considering different CAD-score cut-offs, were computed.RESULTS: Of 167 patients, CAD-scores were available in 61.1%. A total of eight patients were diagnosed with MI. At a cut-off value of <20, CAD-score had a negative predictive value (NPV) of 90.7 (78.4-96.3). The corresponding positive predictive value (PPV) was 6.8 (2.7-16.2). For the adjusted CAD-score (age, sex, hypertension), at a cut-off value of <20, NPV was 90.0 (59.6-99.5) with a PPV of 10.8 (5.3-20.6).CONCLUSION: In this explorative analysis, a transcutaneous ultrasensitive microphone for heart sound analysis resulted in a high NPV analogous to the findings in rule-out of stable CAD in elective patients yet inferior to serial high-sensitivity cardiac troponin measurements and does not seem feasible for application in an emergency setting for rule-out of MI.TRIAL REGISTRATION NUMBER: NCT02355457.
KW - Humans
KW - Heart Sounds
KW - Myocardial Infarction
KW - Coronary Artery Disease
KW - Hypertension
KW - Acoustics
U2 - 10.1136/openhrt-2022-002090
DO - 10.1136/openhrt-2022-002090
M3 - SCORING: Journal article
C2 - 36858602
VL - 10
JO - OPEN HEART
JF - OPEN HEART
SN - 2053-3624
IS - 1
M1 - e002090
ER -