To Explore The Diagnostic Performance Of Acoustic Analysis Of Turbulent Murmur Caused By Coronary Artery Stenosis For Coronary Artery Disease

Objectives:To explore the diagnostic performance of the acoustic analysis method of turbulent murmur due to coronary artery stenosis and its potential clinical application value for diagnosing and treating coronary artery disease(CAD).Methods:Patients admitted to the cardiovascular department of the Sixth Medical Center of Chinese People’s Liberation Army General Hospital from September 2021 to June 2022 for elective coronary angiography were prospectively enrolled.We used the new digital electronic stethoscope to collect heart sounds before coronary angiography and stored them in the supporting acoustic analysis software.We used quantitative coronary angiography(QCA)as the diagnostic criteria to evaluate the diagnostic performance of the acoustic analysis method for CAD.Obstructive CAD was defined as the presence of≥50%stenosis of either coronary artery diameter shown by QCA,and severe obstructive CAD was defined as the presence of≥70%stenosis of either coronary artery diameter shown by QCA.Results:A total of 452 patients obtained complete QCA and heart sounds data.The final interpretation results of the acoustic analysis method were 310 cases of "abnormal" and 142 cases of "normal." The diagnostic performance of the acoustic analysis method is different under different cut-off values of coronary artery diameter stenosis.The best diagnostic performance is for coronary lesions with stenosis ≥ 50%.The sensitivity,specificity,PPV,NPV,and accuracy were 81.9%,70.4%,89.0%,57.0%,and 79.0%,respectively.The AUC value was 0.762.The sensitivity of the acoustic analysis method for single vessel disease of obstructive CAD was 86.6%,and the sensitivity for left anterior descending vessel disease was the best,at 90.7%.The sensitivity of the acoustic analysis method for simple coronary artery branch lesions was 66.7%.Subgroup analysis suggested that the acoustic analysis method had greater PPV for obstructive CAD in male patients and patients with hypertension or diabetes than in female patients and patients without hypertension and diabetes.In contrast,the NPV in female patients was more remarkable than in male patients.After dividing the subjects into two groups of low-risk and high-risk according to the simple prior probability model,the acoustic analysis method had a larger PPV for obstructive CAD in the high-risk group than in the low-risk group(92.9%vs.82.5%,P<0.05);The NPV low-risk group was more significant than the high-risk group(71.0%vs.43.8%,P<0.05),but the value was low;The AUC values were 0.767 and 0.756 in the low-risk and high-risk groups,respectively.The acoustic analysis method was more specific for severe obstructive CAD in the low-risk group than in the high-risk group(67.0%vs.45.4%,P<0.05),but the value was low;The NPV in the low-risk group was more significant than in the high-risk group(82.3%vs.60.3%,P<0.05);The AUC values were 0.754 and 0.643 in the low-risk and high-risk groups,respectively.Conclusions:The acoustic analysis method of turbulent murmur caused by coronary artery stenosis has different diagnostic performances under different cut-off values of coronary artery diameter stenosis.The best diagnostic performance is for coronary lesions with stenosis ≥ 50%.The overall diagnostic performance of the acoustic analysis method for obstructive CAD was moderate.The PPV of the acoustic analysis method for male patients,patients with hypertension or diabetes,and patients with a high risk of CAD was higher,up to 95.8%.The acoustic analysis method has the advantages of simplicity,low cost,safety,and radiation-free for the diagnosis and treatment of CAD,conforming to the current trend in the diagnosis and treatment of CAD,and is expected to play a significant role in the early screening,diagnosis,risk stratification,and prognosis assessment of CAD.