| Objective:This study plans to determine the feasibility and validity of modern electronic stethoscope for diagnosing coronary artery stenosis,by analyzing heart sounds data in patients undergoing coronary angiography and comparing it with coronary angiography results.Methods:First,this prospective research enrolled hospitalized patients intending to undergo coronary angiography,and patients undergone coronary angiography after collected heart sounds data using acoustics electronic stethoscope pre-operation.Then,we blinded evaluated whether heart sound waveform figures exist diastolic characteristic murmurs or not and whether coronary artery had lesions and the location,degree,scope,nature of the diseased vessels,and further compared the relationship between characteristics of coronary artery lesions and characteristic murmurs in cardiac auscultation in order to evaluate the feasibility and validity of electronic stethoscope in diagnosing coronary artery stenosis.At the same time,we collected heart sound data of some patients after percutaneous coronary intervention,and compared the changes of heart sound waveform figures preoperative and postoperative.Results:A total of 320 patients were included and 100%completed the heart sound data collection,and eventually generated 311 analyzable heart sound data.Coronary angiography showed,the incidence of stenosis>50%of any coronary artery was 78.13%(243 cases),and that of stenosis≥70%of any coronary artery was 63.34%(197 cases).This study found that whether taken branching lesions into account,with the aggravation of the degree of coronary artery stenosis,the positive rate of heart sound waveform figure increased and the negative rate decreased.When taken 30%,50%and 70%of the maximum stenosis of any vessel diameter as the cut-off values,in the identification of coronary artery stenosis,electronic stethoscope diagnostic accuracy was 0.71-0.74,sensitivity was 0.61-0.79,specificity was 0.66-0.79,positive predictive value was 0.77-0.94,negative predictive value was 0.37-0.67,positive likelihood ratio was 2.226-3.310,negative likelihood ratio was 0.328-0.401.When the maximum diameter of any vessel stenosis≥95%,the sensitivity(0.81)and negative predictive value(0.89)were increased,but the diagnostic accuracy(0.53-0.54),specificity(0.45)and positive predictive value(0.29-0.31)were significantly decreased.In this study,there were 2 cases of single vessel lesions with diameter ≤2.5mm,and the stenosis degree was≥70%in both cases,1 case of heart sound waveform figure was positive,and the other one was negative.Further studied on single-vessel and multi-vessel coronary artery lesion,found that,in single-vessel lesion,electronic stethoscope had the best sensitivity to identify the stenosis of left main coronary artery and left anterior descending artery,followed by right coronary artery and the worst is branch vessel and left circumflex artery.Diagnosis of main coronary artery stenosis by electronic stethoscope was better than coronary artery branch stenosis.Diagnosis of single-vessel multi-places coronary lesions by electronic stethoscope was better than single-vessel single-place coronary lesions.When the degree of coronary stenosis≥50%,the electronic stethoscope had similar diagnostic performance in single-vessel and multi-vessel lesions.When the degree of coronary artery stenosis≥70%,the diagnostic performance of electronic stethoscope in single-vessel coronary artery lesion was better than multi-vessel coronary artery lesion.Finally,this study analyzed the changes of diastolic heart murmurs in 10 patients accepted PCI,the results showed that diastolic heart murmurs disappeared in 6 patients and decreased in 4 patients compared with that before PCI.Conclusion:The diastolic murmurs detected by electronic stethoscope before coronary intervention is coming from coronary artery stenosis,and the electronic stethoscope has good application value in the recognition of diastolic murmurs produced by coronary artery stenosis. |
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