Likelihood reclassification by an acoustic-based score in suspected coronary artery disease

医学 冠状动脉疾病 内科学 心脏病学 部分流量储备 计算机辅助设计 狭窄 接收机工作特性 试验前后概率 心绞痛 冠状动脉造影 诊断试验中的似然比 试验预测值 放射科 心肌梗塞 工程制图 工程类
作者
Laust Dupont Rasmussen,Simon Winther,Salma Raghad Karim,Jelmer Westra,Jane Kirk Johansen,Hanne Maare Søndergaard,Osama Hammid,Emelyne Sevestre,Yoshinobu Onuma,Mette Nyegaard,June Anita Ejlersen,Evald Høj Christiansen,Ashkan Eftekhari,Niels Ramsing Holm,Samuel Emil Schmidt,Morten Bøttcher
出处
期刊:Heart [BMJ]
卷期号:109 (16): 1223-1230 被引量:1
标识
DOI:10.1136/heartjnl-2023-322357
摘要

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 .
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