AUTHOR=Luciani Marco , Saccocci Matteo , Kuwata Shingo , Cesarovic Nikola , Lipiski Miriam , Arand Patricia , Bauer Peter , Guidotti Andrea , Regar Evelyn , Erne Paul , Zuber Michel , Maisano Francesco 

TITLE=Reintroducing Heart Sounds for Early Detection of Acute Myocardial Ischemia in a Porcine Model – Correlation of Acoustic Cardiography With Gold Standard of Pressure-Volume Analysis

JOURNAL=Frontiers in Physiology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2019.01090

DOI=10.3389/fphys.2019.01090

ISSN=1664-042X

ABSTRACT=<sec><title>Background</title><p>Acoustic cardiography is a hybrid technique that couples heart sounds recording with ECG providing insights into electrical-mechanical activity of the heart in an unsupervised, non-invasive and inexpensive manner. During myocardial ischemia hemodynamic abnormalities appear in the first minutes and we hypothesize a putative diagnostic role of acoustic cardiography for prompt detection of cardiac dysfunction for future patient management improvement.</p></sec><sec><title>Methods and Results</title><p>Ten female Swiss large white pigs underwent permanent distal coronary occlusion as a model of acute myocardial ischemia. Acoustic cardiography analyses were performed prior, during and after coronary occlusion. Pressure-volume analysis was conducted in parallel as an invasive method of hemodynamic assessment for comparison. Similar systolic and diastolic intervals obtained with the two techniques were significantly correlated [Q to min dP/dt vs. Q to second heart sound (<italic>r</italic><sup>2</sup> = 0.9583, <italic>p</italic> &lt; 0.0001), PV diastolic filling time vs. AC perfusion time (<italic>r</italic><sup>2</sup> = 0.9686, <italic>p</italic> &lt; 0.0001)]. Indexes of systolic and diastolic impairment correlated with quantifiable features of heart sounds [Tau vs. fourth heart sound Display Value (<italic>r</italic><sup>2</sup> = 0.2721, <italic>p</italic> &lt; 0.0001) cardiac output vs. third heart sound Display Value (<italic>r</italic><sup>2</sup> = 0.0791 <italic>p</italic> = 0.0023)]. Additionally, acoustic cardiography diastolic time (AUC 0.675, <italic>p</italic> = 0.008), perfusion time (AUC 0.649, <italic>p</italic> = 0.024) and third heart sound Display Value (AUC 0.654, <italic>p</italic> = 0.019) emerged as possible indicators of coronary occlusion. Finally, these three parameters, when joined with heart rate into a composite joint-index, represent the best model in our experience for ischemia detection (AUC 0.770, <italic>p</italic> &lt; 0.001).</p></sec><sec><title>Conclusion</title><p>In the rapidly evolving setting of acute myocardial ischemia, acoustic cardiography provided meaningful insights of mechanical dysfunction in a prompt and non-invasive manner. These findings should propel interest in resurrecting this technique for future translational studies as well as reconsidering its reintroduction in the clinical setting.</p></sec>