Assessment of remote digital auscultation for identifying significant aortic stenosis: A pilot study

Aortic stenosis (AS) is the most common valvular disease in the Western world. Technological advances, such as the TytoCare™ device, have introduced remote telemedicine-based cardiac auscultation. Its utility in diagnosing and grading AS remains unexplored. This study aims to evaluate the reliability of the TytoCare™ for assessing AS.

Sixty patients were classified by standard echocardiogram into three groups: significant AS (at least moderate AS; n=20), non-significant AS (aortic sclerosis or mild AS; n=20) and controls (n=20). Heart sounds were self-recorded using the TytoCare™ stethoscope. Fifteen blinded physicians - five each from primary care, internal medicine and cardiology - reviewed the recordings using standardized equipment and assigned diagnoses based on a categorical scale: 0=insufficient data, 1=normal, 2=mild AS and 3=at least moderate AS.

The study groups had comparable baseline characteristics, with a mean±standard deviation age of 72.6±9.1years. The correct response rate for significant AS was 85% (95% confidence interval [95% CI]: 80-88%), with both cardiologists and non-cardiologists achieving≥80%. In contrast, performance declined in non-significant AS (57%, 95% CI: 51-62%), but remained high in the control group (87%, 95% CI: 82-90%). Cardiologists outperformed other physicians, overall (P=0.029) and in significant AS cases (P=0.022), while no significant differences were found among non-cardiologists.

TytoCare™ demonstrated high reliability in the remote assessment of significant AS by both cardiologists and non-cardiologists. Its intuitive and user-friendly design enables self-application, even among older populations, emphasizing its potential as an effective screening tool for AS across diverse healthcare settings.