Acoustic-based systems for the evaluation of coronary artery disease: A systematic literature review

Coronary artery disease (CAD) remains one of the primary causes of morbidity and mortality worldwide. Acoustic-based systems offer the prospect of a rapid, noninvasive method to diagnose and stratify risk in patients with suspected CAD.

We conducted a systematic review to assess the diagnostic accuracy, cost-effectiveness, and feasibility of acoustic-based systems for CAD risk stratification and diagnosis. Eligible studies published from 1980 to 2025 were retrieved from MEDLINE, Embase, and ClinicalTrials.gov. We included articles that compared acoustic-based systems to standard-of-care non-acoustic tools for CAD diagnosis, such as invasive angiography or coronary computed tomography angiography. Data on sensitivity, specificity, negative predictive value, positive predictive value, cost, and outcomes were extracted.

We identified 32 studies examining a range of acoustic-based systems, including digital stethoscopes and advanced acoustic cardiographs. Most systems demonstrated high sensitivity and strong negative predictive values, suggesting they can serve as reliable rule-out tools for CAD. Preliminary cost analyses suggest that acoustic-based systems could reduce unnecessary imaging and lower resource use, particularly for low- to intermediate-risk patients. Limited evidence also points to a possible role in prognostication when acoustic scores are combined with clinical data.

Acoustic-based systems appear promising as non-invasive, rapid, and potentially cost-effective methods for diagnosing and stratifying risk in patients with suspected CAD. Further large-scale research is necessary to refine these technologies, improve implementation, and evaluate clinical outcomes across diverse populations.