Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction
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 e...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/1/e002090.full |
| _version_ | 1797772380517433344 |
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| author | Dirk Westermann Tanja Zeller Stefan Blankenberg Samuel Emil Schmidt Alina Goßling Jonas Lehmacher Johannes T Neumann Nils Arne Sörensen Peter M Clemmensen |
| author_facet | Dirk Westermann Tanja Zeller Stefan Blankenberg Samuel Emil Schmidt Alina Goßling Jonas Lehmacher Johannes T Neumann Nils Arne Sörensen Peter M Clemmensen |
| author_sort | Dirk Westermann |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T21:51:02Z |
| format | Article |
| id | doaj.art-40bed71822dd46e98e65189cf1b5a01c |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-03-12T21:51:02Z |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-40bed71822dd46e98e65189cf1b5a01c2023-07-26T02:20:06ZengBMJ Publishing GroupOpen Heart2053-36242023-02-0110110.1136/openhrt-2022-002090Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarctionDirk Westermann0Tanja Zeller1Stefan Blankenberg2Samuel Emil Schmidt3Alina Goßling4Jonas Lehmacher5Johannes T Neumann6Nils Arne Sörensen7Peter M Clemmensen8Klinik für Kardiologie und Angiologie, Universitats-Herzzentrum Freiburg Bad Krozingen Standort Freiburg, Freiburg, GermanyDepartment of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, GermanyDepartment of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Health Science and Technology, Aalborg Universitet, Aalborg, DenmarkDepartment of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, GermanyDepartment of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, GermanyDepartment of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, GermanyDepartment of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, GermanyDepartment of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, GermanyBackground 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.https://openheart.bmj.com/content/10/1/e002090.full |
| spellingShingle | Dirk Westermann Tanja Zeller Stefan Blankenberg Samuel Emil Schmidt Alina Goßling Jonas Lehmacher Johannes T Neumann Nils Arne Sörensen Peter M Clemmensen Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction Open Heart |
| title | Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction |
| title_full | Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction |
| title_fullStr | Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction |
| title_full_unstemmed | Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction |
| title_short | Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction |
| title_sort | diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction |
| url | https://openheart.bmj.com/content/10/1/e002090.full |
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