Diagnostic performance of coronary artery disease (CAD) prediction model (CAD-score system) based on phonocardiogram: A systematic review and meta-analysis

Miftah Pramudyo^1*Ahmad Faried¹Mohammad Rizki Akbar¹Dzulfikar Djalil Lukmanaul Hakim¹Agung Wahyu Setiawan²William Kamarullah¹

• ¹Padjadjaran University, Bandung, Indonesia
• ²Bandung Institute of Technology, Bandung, West Java, Indonesia

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 2x2 contingency table. Results A total of 4 studies involving 4050 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.