Why the study?
Pre-test probability stratification for suspected obstructive CAD has remained suboptimal, leading to many normal diagnostic test results.
Does phonocardiogram using the CADScor system accurately detect the presence of CAD in patients with suspected obstructive CAD?
Meta-Analysis (n=4,050)
Does phonocardiogram using the CADScor system accurately detect the presence of CAD in patients with suspected obstructive CAD?
Effect estimate: AUC 0.79 (95% CI 0.75-0.82)
Phonocardiography using the CADScor system demonstrates high sensitivity (87%) but low specificity (35%), suggesting potential utility as a non-invasive rule-out tool for suspected CAD.
May support CADScor as a rule-out tool in suspected CAD; leaves open prospective validation against current diagnostics.
Introduction: Pre-test probability stratification of individuals with suspected obstructive coronary artery disease (CAD) has remained suboptimal for many years. Consequently, the majority of diagnostic tests used to rule out CAD exhibit normal results. An acoustic device capable of measuring micro bruits caused by stenosis-induced turbulence in the coronary circulation has showcased potential for stratifying CAD. The aim of this meta-analysis was to investigate the conceivable diagnostic value of phonocardiogram (PCG) in detecting the presence of CAD. Methods: We conducted a comprehensive search of PubMed, EuropePMC, and ScienceDirect for articles published through January 2025. Studies were eligible if they assessed the accuracy of PCG using the CADScor® system in predicting CAD and provided enough data to construct a 2 × 2 contingency table. Results: A total of 4 studies involving 4,050 patients were included for the final analysis. The pooled sensitivity and specificity were 87% (95% CI, 80%-92%) and 35% (95% CI, 21%-52%), respectively. The pooled positive likelihood ratio (PLR) was 1.34 (95% CI, 1.09-1.64) and the pooled negative likelihood ratio (NLR) was 0.37 (95% CI, 0.25-0.55). The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI, 0.75-0.82) in predicting CAD. Fagan's nomogram showed that the posterior probability of PCG with the CADScor® system for the detection of CAD was 19% when the CAD-score was above the cut-off value, and 6% in those with CAD-score below the cut-off value. Conclusion: Phonocardiography shows promise as a rule-out tool for patients with suspected CAD. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024550526, PROSPERO CRD42024550526.
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Pramudyo et al. (2025) conducted a meta-analysis in Suspected obstructive coronary artery disease (n=4,050). Phonocardiogram (CADScor system) vs. Invasive coronary angiography was evaluated on Area under the receiver operating characteristic curve (AUC) for predicting CAD (AUC 0.79, 95% CI 0.75-0.82).
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