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Clinical Trial
. 2023 Mar;10(1):e002090.
doi: 10.1136/openhrt-2022-002090.

Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction

Jonas Lehmacher  1   2 , Johannes T Neumann  3   2   4 , Nils Arne Sörensen  3   2 , Alina Goßling  3 , Samuel Emil Schmidt  5 , Tanja Zeller  3   2 , Stefan Blankenberg  3   2 , Dirk Westermann  2   6 , Peter M Clemmensen  3   7
Affiliations
Clinical Trial

Diagnostic performance of a device for acoustic heart sound analysis in patients with suspected myocardial infarction

Jonas Lehmacher et al. Open Heart. 2023 Mar.

Abstract

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.

Keywords: acute coronary syndrome; chest pain; coronary artery disease; myocardial infarction.

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Conflict of interest statement

Competing interests: JL is grant-recipient of a not project related grant by the Ernst und Bertha Grimmke Stiftung SB has received honoraria from Abbott Diagnostics, Siemens, Thermo Fisher and Roche Diagnostics and is a consultant for Thermo Fisher. DW reports personal fees from Bayer, Boehringer-Ingelheim, Berlin Chemie, Astra Zeneca, Biotronik and Novartis. PMC received honoraria/reports personal fees from Abbott, Acarix, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Eli-Lilly, Evolva, Fibrex, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Regado, Sanofi, Searle and Servier.

Figures

Figure 1
Figure 1
Displays the flow of patients in the study, including reasons for exclusion; version 2=unadjusted CAD-score; version 3.1=adjusted CAD-score (CAD-score version 3.1) adjusted for gender, age and sex. BACC, biomarkers in acute cardiac care; CAD, coronary artery disease.
See this image and copyright information in PMC

References

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