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

S E Schmidt, S Winther, B S Larsen, M H Groenhoej, L Nissen, J Westra, L Frost, N R Holm, H Mickley, F H Steffensen, J Lambrechtsen, M S Nørskov, J J Struijk, A C P Diederichsen, M Boettcher

Research output: Contribution to journalJournal articleResearchpeer-review

7 Downloads (Pure)

Abstract

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
Issue number11
Pages (from-to)2019-2028
ISSN1569-5794
DOIs
Publication statusPublished - Nov 2019

Fingerprint

Acoustics
Coronary Artery Disease
Coronary Angiography
Heart Sounds
Equipment and Supplies
Cost-Benefit Analysis
Pathologic Constriction
Databases
Guidelines

Cite this

Schmidt, S. E., Winther, S., Larsen, B. S., Groenhoej, M. H., Nissen, L., Westra, J., ... Boettcher, M. (2019). Coronary artery disease risk reclassification by a new acoustic-based score. The international journal of cardiovascular imaging, 35(11), 2019-2028. https://doi.org/10.1007/s10554-019-01662-1
Schmidt, S E ; Winther, S ; Larsen, B S ; Groenhoej, M H ; Nissen, L ; Westra, J ; Frost, L ; Holm, N R ; Mickley, H ; Steffensen, F H ; Lambrechtsen, J ; Nørskov, M S ; Struijk, J J ; Diederichsen, A C P ; Boettcher, M. / Coronary artery disease risk reclassification by a new acoustic-based score. In: The international journal of cardiovascular imaging. 2019 ; Vol. 35, No. 11. pp. 2019-2028.
@article{52363b1b0e2c47af8e0358a0a5cc2416,
title = "Coronary artery disease risk reclassification by a new acoustic-based score",
abstract = "To determine the potential of a non-invasive acoustic device (CADScor{\circledR}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.",
author = "Schmidt, {S E} and S Winther and Larsen, {B S} and Groenhoej, {M H} and L Nissen and J Westra and L Frost and Holm, {N R} and H Mickley and Steffensen, {F H} and J Lambrechtsen and N{\o}rskov, {M S} and Struijk, {J J} and Diederichsen, {A C P} and M Boettcher",
year = "2019",
month = "11",
doi = "10.1007/s10554-019-01662-1",
language = "English",
volume = "35",
pages = "2019--2028",
journal = "International Journal of Cardiovascular Imaging",
issn = "1569-5794",
publisher = "Springer",
number = "11",

}

Schmidt, SE, Winther, S, Larsen, BS, Groenhoej, MH, Nissen, L, Westra, J, Frost, L, Holm, NR, Mickley, H, Steffensen, FH, Lambrechtsen, J, Nørskov, MS, Struijk, JJ, Diederichsen, ACP & Boettcher, M 2019, 'Coronary artery disease risk reclassification by a new acoustic-based score', The international journal of cardiovascular imaging, vol. 35, no. 11, pp. 2019-2028. https://doi.org/10.1007/s10554-019-01662-1

Coronary artery disease risk reclassification by a new acoustic-based score. / Schmidt, S E; Winther, S; Larsen, B S; Groenhoej, M H; Nissen, L; Westra, J; Frost, L; Holm, N R; Mickley, H; Steffensen, F H; Lambrechtsen, J; Nørskov, M S; Struijk, J J; Diederichsen, A C P; Boettcher, M.

In: The international journal of cardiovascular imaging, Vol. 35, No. 11, 11.2019, p. 2019-2028.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Coronary artery disease risk reclassification by a new acoustic-based score

AU - Schmidt, S E

AU - Winther, S

AU - Larsen, B S

AU - Groenhoej, M H

AU - Nissen, L

AU - Westra, J

AU - Frost, L

AU - Holm, N R

AU - Mickley, H

AU - Steffensen, F H

AU - Lambrechtsen, J

AU - Nørskov, M S

AU - Struijk, J J

AU - Diederichsen, A C P

AU - Boettcher, M

PY - 2019/11

Y1 - 2019/11

N2 - 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.

AB - 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.

U2 - 10.1007/s10554-019-01662-1

DO - 10.1007/s10554-019-01662-1

M3 - Journal article

VL - 35

SP - 2019

EP - 2028

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

SN - 1569-5794

IS - 11

ER -