冠状动脉狭窄引起的湍流微杂音的声学分析方法对冠心病的诊断价值

Performance of Acoustic Analysis of Turbulent Murmurs Caused by Coronary Artery Stenosis in Diagnosing Coronary Artery Disease

目的:评估冠状动脉狭窄引起的湍流微杂音的声学分析方法对冠心病的诊断价值。方法:前瞻性纳入2021年9月至2022年6月于中国人民解放军总医院第六医学中心择期行冠状动脉造影的住院患者432例。在造影前使用电子听诊器采集心音数据。根据2019欧洲心脏病学会指南推荐使用的一种冠心病简单验前概率模型将患者分为低风险组和高风险组。以定量冠状动脉造影(QCA)为诊断标准,计算声学分析方法的灵敏度、特异度、阳性预测值、阴性预测值、准确度及AUC。结果:共有418例患者获得了完整的QCA和心音数据,低风险组166例,高风险组252例。以冠状动脉直径狭窄≥50%为临界值时,声学分析方法的灵敏度为82%,特异度为70%,阳性预测值为88%,阴性预测值为60%,准确度为79%,AUC为0.76;以冠状动脉直径狭窄≥70%为临界值时,声学分析方法的灵敏度为84%,特异度为47%,阳性预测值为58%,阴性预测值为77%,准确度为64%,AUC为0.65。根据简单验前概率模型分为两组后:当以冠状动脉直径狭窄≥50%为临界值时,声学分析方法在低风险组中的灵敏度和特异度分别为82%和70%,阳性预测值和阴性预测值分别为79%和74%,准确度为77%,AUC为0.76;在高风险组中的灵敏度和特异度分别为82%和71%,阳性预测值和阴性预测值分别为93%和46%,准确度为80%,AUC为0.76。当以冠状动脉直径狭窄≥70%为临界值时,声学分析方法在低风险组中的灵敏度和特异度分别为86%和53%,阳性预测值和阴性预测值分别为49%和88%,准确度为64%,AUC为0.70;在高风险组中的灵敏度和特异度分别为83%和41%,阳性预测值和阴性预测值分别为63%和66%,准确度为64%,AUC为0.62。结论:在住院患者中使用冠状动脉狭窄引起的湍流微杂音的声学分析方法诊断冠心病可能具有一定的诊断价值。当以冠状动脉直径狭窄≥50%为临界值时,无论在低、高风险组,声学分析方法诊断冠心病均具有较好的诊断性能;当以冠状动脉直径狭窄≥70%为临界值时,声学分析方法在低风险人群中识别冠心病可能具有较好的阴性预测价值。

Objectives:To evaluate the diagnostic performance of acoustic analysis of turbulent murmurs caused by coronary artery stenosis for coronary artery disease(CAD).Methods:A total of 432 inpatients undergoing elective coronary angiography at the Sixth Medical Center of People's Liberation Army General Hospital from September 2021 to June 2022 were prospectively enrolled.The electronic stethoscope was used to collect heart sounds before angiography.According to a simple pre-test probability model of CAD recommended by the 2019 European Society of Cardiology guidelines,patients were divided into low-risk and high-risk groups.Taking quantitative coronary angiography(QCA)as the diagnostic standard,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),accuracy,and AUC of acoustic analysis method were calculated.Results:Complete QCA and heart sounds were obtained from 418 patients.Among them,166 were in the low-risk group and 252 in the high-risk group.Taking coronary artery diameter stenosis≥50%as cut-off value,the sensitivity,specificity,PPV,NPV and accuracy of acoustic analysis method were 82%,70%,88%,60%and 79%,and the AUC value was 0.76.Taking coronary artery diameter stenosis≥70%as cut-off value,the sensitivity,specificity,PPV,NPV and accuracy of acoustic analysis method were 84%,47%,58%,77%and 64%,and the AUC value was 0.65.After dividing patients into two groups according to the simple pre-test probability model,the results were as follows.Taking coronary artery diameter stenosis≥50%as cut-off value,the sensitivity,specificity,PPV,NPV and accuracy of acoustic analysis method in the lowrisk group were 82%,70%,79%,74%and 77%,and the AUC value was 0.76;the sensitivity,specificity,PPV,NPV and accuracy in the high-risk group were 82%,71%,93%,46%and 80%,and the AUC value was 0.76.Taking coronary artery diameter stenosis≥70%as cut-off value,the sensitivity,specificity,PPV,NPV and accuracy of acoustic analysis method in the low-risk group were 86%,53%,49%,88%and 64%,and the AUC value was 0.70;the sensitivity,specificity,PPV,NPV and accuracy in the high-risk group were 83%,41%,63%,66%and 64%,and the AUC value was 0.62.Conclusions:Acoustic analysis of turbulent murmurs caused by coronary artery stenosis may have some value in diagnosing CAD in hospitalized patients.Taking coronary artery diameter stenosis≥50%as cut-off value,the acoustic analysis method has better diagnostic performance for diagnosing CAD in both low and high risk groups;taking coronary artery diameter stenosis≥70%as cut-off value,the acoustic analysis method may have good negative predictive value in detecting CAD in low-risk populations.