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Acoustic cardiography helps to identify heart failure and its phenotypes
Shang Wang1, Yat-Yin Lam, Ming Liu
1Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Insights
Acoustic cardiography accurately identifies heart failure (HF) and its phenotypes. This bedside technology aids in rapid diagnosis, particularly when echocardiography is unavailable.
Area of Science:
- Cardiology
- Medical Diagnostics
- Biomedical Engineering
Background:
- Increasing prevalence of heart failure (HF) due to aging populations necessitates improved diagnostic methods.
- Current diagnostic challenges include rapid identification and phenotyping of heart failure.
- Acoustic cardiography is explored as a potential non-invasive tool for HF diagnosis.
Purpose of the Study:
- To evaluate the accuracy of acoustic cardiography in identifying heart failure (HF).
- To assess the utility of acoustic cardiography in differentiating HF phenotypes (HFNEF and HFREF).
- To compare acoustic cardiography's diagnostic performance with echocardiography.
Main Methods:
- Three patient cohorts were studied: hypertension, HF with normal ejection fraction (HFNEF), and HF with reduced ejection fraction (HFREF).
- Acoustic cardiography parameters measured included S3 score, electromechanical activation time (EMAT), and systolic dysfunction index (SDI).
- Receiver operative characteristic (ROC) curves were employed to determine the diagnostic accuracy of acoustic cardiography parameters.
Main Results:
- EMAT/RR effectively differentiated HFNEF from hypertension (AUC=0.83), with specific thresholds showing high sensitivity and specificity.
- The Systolic Dysfunction Index (SDI) demonstrated strong performance in distinguishing HFREF from HFNEF (AUC=0.81).
- Acoustic cardiography parameters showed comparable diagnostic utility to echocardiographic measures like E/e' ratio.
Conclusions:
- Acoustic cardiography shows promise as a valuable bedside tool for heart failure diagnosis.
- This technology can aid in the rapid identification of HF and its distinct phenotypes.
- Acoustic cardiography offers a viable alternative or adjunct to echocardiography, especially in resource-limited settings.
Background:
The prevalence of heart failure (HF) is increasing as the population ages, but its rapid diagnosis and phenotype identification remain challenging. We sought to determine whether acoustic cardiography can accurately identify HF and its phenotypes.
Methods:
Three cohorts of patients were studied [94 with hypertension, 109 with HF and normal ejection fraction (HFNEF, EF ≥ 50%) and 89 with HF and reduced ejection fraction (HFREF, EF<50%)]. All participants received acoustic cardiography and echocardiography examinations. Acoustic cardiographic parameters included S3 score (probability that the third heart sound exists), electromechanical activation time (EMAT, interval from Q wave to the first heart sound; EMAT/RR is EMAT normalized by heart rate), and systolic dysfunction index (SDI, a combination of EMAT/RR, S3 score, QRS duration and QR interval). Receiver operative characteristic curves were used to determine diagnostic utility of acoustic cardiography.
Results:
EMAT/RR significantly differentiated HFNEF from hypertension (area under curve [AUC], 0.83; 95% confidence interval [CI], 0.77-0.89) with an EMAT/RR>11.54% yielded 55% sensitivity and 90% specificity. Similarly, an echo-measured E/e'>15 yielded 55% sensitivity, 90% specificity and 0.84 AUC in detecting HFNEF. Whereas SDI out-performed the other acoustic cardiographic parameters in differentiating HFREF from HFNEF (AUC, 0.81; 95% CI, 0.75-0.87), and an SDI>5.43 yielded 53% sensitivity and 91% specificity. The E/e' ratio had a similar diagnostic performance.
Conclusions:
Our study demonstrates that this bedside technology may be helpful in identifying HF and its phenotypes, especially when echocardiography is not immediately available.
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