Schmidt Samuel Emil, Madsen Lene Helleskov, Hansen John, Zimmermann Henrik, Kelbæk Henning, Winter Simon, Hammershøi Dorte, Toft Egon, Struijk Johannes Jan, Clemmensen Peter
Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 E4-213, 9220, Aalborg, Denmark.
Department of Cardiology, Hospital Unit West, Herning, Denmark.
Cardiovasc Eng Technol. 2022 Dec;13(6):864-871. doi: 10.1007/s13239-022-00622-6. Epub 2022 May 11.
Previous studies have observed an increase in low frequency diastolic heart sounds in patients with coronary artery disease (CAD). The aim was to develop and validate a diagnostic, computerized acoustic CAD-score based on heart sounds for the non-invasive detection of CAD.
Prospective study enrolling 463 patients referred for elective coronary angiography. Pre-procedure non-invasive recordings of heart sounds were obtained using a novel acoustic sensor. A CAD-score was defined as the power ratio between the 10-90 Hz frequency spectrum and the 90-300 Hz frequency spectrum of the mid-diastolic heart sound. Quantitative coronary angiography analysis was performed by a blinded core laboratory and patients grouped according to the results: obstructive CAD defined by the presence of at least one ≥ 50% stenosis, non-obstructive CAD as patients with a maximal stenosis in the 25-50% interval and non-CAD as no coronary lesions exceeding 25%. We excluded patients with potential confounders or incomplete data (n = 245). To avoid over-fitting the final cohort of 218 patients was randomly divided into to a training group for development (n = 127) and a validation group (n = 91).
In both the training and the validation group the CAD-score was significantly increased in CAD patients compared to non-CAD patients (p < 0.0001). In the validation group the area under the receiver-operating curve was 77% (95% CI 63-91%). Sensitivity was 71% (95% CI 59-82%) and specificity 64% (95% CI 45-83%).
The acoustic CAD-score is a new, inexpensive, non-invasive method to detect CAD, which may supplement clinical risk stratification and reduce the need for subsequent non-invasive and invasive testing.
既往研究观察到冠心病（CAD）患者低频舒张期心音增加。本研究旨在开发并验证一种基于心音的诊断性计算机声学CAD评分系统，用于CAD的无创检测。
对463例因择期冠状动脉造影而转诊的患者进行前瞻性研究。使用新型声学传感器在术前获取心音的无创记录。CAD评分定义为舒张中期心音10 - 90Hz频谱与90 - 300Hz频谱之间的功率比。由一个盲法核心实验室进行定量冠状动脉造影分析，并根据结果将患者分组：至少有一处≥50%狭窄定义为阻塞性CAD，最大狭窄在25% - 50%区间的患者为非阻塞性CAD，无冠状动脉病变超过25%的患者为非CAD。我们排除了有潜在混杂因素或数据不完整的患者（n = 245）。为避免过度拟合，将最终的218例患者随机分为用于开发的训练组（n = 127）和验证组（n = 91）。
在训练组和验证组中，CAD患者的CAD评分均显著高于非CAD患者（p < 0.0001）。在验证组中，受试者操作特征曲线下面积为77%（95%CI 63 - 91%）。敏感性为71%（95%CI 59 - 82%），特异性为64%（95%CI 45 - 83%）。
声学CAD评分是一种检测CAD的新型、廉价、无创方法，可补充临床风险分层并减少后续无创和有创检测的需求。
