疑似心肌梗死患者心音分析设备的诊断性能。

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

机构信息

Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany

Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Standort Hamburg/Kiel/Lübeck, Berlin, Germany.

出版信息

Open Heart. 2023 Mar;10(1). doi: 10.1136/openhrt-2022-002090.

DOI:10.1136/openhrt-2022-002090

PMID:36858602

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9980326/

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.

摘要

背景

由于只有一小部分胸痛患者患有心肌梗死（MI），因此安全排除 MI 非常重要。最近，一种用于排除冠状动脉疾病（CAD）的超灵敏麦克风进行舒张期心音分析（CADScorSystem）已经出现。在这项探索性研究中，我们旨在评估 CADScorSystem 在大型急诊部门中用于诊断 MI 的可行性。

方法

纳入因疑似 MI 而到急诊就诊的患者。对所有患者进行声学心音分析，并通过设备嵌入式算法计算自动 CAD 分数值，该算法还需要包含三个临床变量：年龄、性别和高血压的存在。患者还接受了连续的高敏肌钙蛋白 T 测量，以根据欧洲心脏病学会 0 小时/3 小时算法应用第三次通用心肌梗死定义评估最终诊断。考虑到不同的 CAD 分数截断值，计算了 MI 的诊断参数。

结果

在 167 名患者中，有 61.1%的患者可获得 CAD 分数。共有 8 名患者被诊断为 MI。在截断值<20 的情况下，CAD 分数的阴性预测值（NPV）为 90.7（78.4-96.3）。相应的阳性预测值（PPV）为 6.8（2.7-16.2）。对于调整后的 CAD 分数（年龄、性别、高血压），在截断值<20 的情况下，NPV 为 90.0（59.6-99.5），PPV 为 10.8（5.3-20.6）。