1. Likelihood reclassification by an acoustic-based score in suspected coronary artery disease.
- Author
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Rasmussen LD, Winther S, Karim SR, Westra J, Kirk Johansen J, Søndergaard HM, Hammid O, Sevestre E, Onuma Y, Nyegaard M, Ejlersen JA, Høj Christiansen E, Eftekhari A, Holm NR, Schmidt SE, and Bøttcher M
- Subjects
- Humans, Acoustics, Computed Tomography Angiography, Constriction, Pathologic, Coronary Angiography, Predictive Value of Tests, Probability, Coronary Artery Disease diagnostic imaging, Coronary Stenosis diagnostic imaging, Fractional Flow Reserve, Myocardial
- Abstract
Objective: Validation studies of the 2019 European Society of Cardiology pretest probability model (ESC-PTP) for coronary artery disease (CAD) report that 35%-40% of patients have low pretest probability (ESC-PTP 5% to <15%). Acoustic detection of coronary stenoses could potentially improve clinical likelihood stratification. Aims were to (1) investigate the diagnostic performance of an acoustic-based CAD score and (2) study the reclassification potential of a dual likelihood strategy by the ESC-PTP and a CAD score., Methods: Consecutive patients (n=1683) with stable angina symptoms referred for coronary CT angiography (CTA) underwent heart sound analyses by an acoustic CAD-score device. All patients with ≥50% luminal stenosis in any coronary segment at coronary CTA were referred to investigation with invasive coronary angiography (ICA) with fractional flow reserve (FFR).A predefined CAD-score cut-off ≤20 was used to rule out obstructive CAD., Results: In total, 439 patients (26%) had ≥50% luminal stenosis on coronary CTA. The subsequent ICA with FFR showed obstructive CAD in 199 patients (11.8%). Using the ≤20 CAD-score cut-off for obstructive CAD rule-out, sensitivity was 85.4% (95% CI 79.7 to 90.0), specificity 40.4% (95% CI 37.9 to 42.9), positive predictive value 16.1% (95% CI 13.9 to 18.5) and negative predictive value 95.4% (95% CI 93.4 to 96.9) in all patients. Applying the cut-off in ESC-PTP 5% to <15% patients, 316 patients (48%) were down-classified to very-low likelihood. The obstructive CAD prevalence was 3.5% in this group., Conclusion: In a large contemporary cohort of patients with low CAD likelihood, the additional use of an acoustic rule-out device showed a clear potential to downgrade likelihood and could supplement current strategies for likelihood assessment to avoid unnecessary testing., Trial Registration Number: NCT03481712., Competing Interests: Competing interests: SW acknowledges support from the Novo Nordisk Foundation Clinical Emerging Investigator grant (NNF21OC0066981). MB discloses advisory board participation for Novo Nordisk, AstraZeneca, Pfizer, Boeringer Ingelheim, Bayer, Sanofi, Novartis, Amgen, CLS-Behring and Acarix. The remaining authors have nothing to declare., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
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