ArticleEuropean heart journal. Imaging methods and practice2026
Diagnostic performance of combined biomarkers and phonocardiography vs. the 2024 ESC risk factor-weighted clinical likelihood model for detecting coronary artery disease.
Article in European heart journal. Imaging methods and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: Non-invasive rule-out of coronary artery disease (CAD) using phonocardiography (CADScor©System) has been introduced as an alternative to the calculation of clinical risk-scores in populations with low-to intermediate CAD-likelihood. This study aims to (i) evaluate the diagnostic performance of the CADScor©System in a population with an intermediate CAD-likelihood and (ii) investigate whether a combined strategy of selected biomarkers and use of the device improves diagnostic accuracy compared to the 2024 ESC risk factor-weighted clinical likelihood (RF-CL) model. Methods and results: A total of 167 patients with symptoms suggesting CAD and scheduled for coronary computed tomography angiography (CCTA) or elective invasive coronary angiography (ICA) were prospectively enrolled. Blood samples and heart sound recordings, obtained with the CADScor©System, were performed within 24 h before scheduled examinations. A resulting score (CADScore) ranging from 0 to 99 determined the risk of CAD. Diagnostic performance was calculated as sensitivity, specificity, negative predictive value, and positive predictive value. Diagnostic accuracy incorporating cardiovascular biomarkers was assessed using AUC-ROC analysis. Bootstrap validation ( Conclusion: The CADScor©System is a reliable non-invasive test method for ruling out obstructive CAD in a population with intermediate disease prevalence, characterized by high sensitivity (93.8%) and negative predictive value (90.0%). Bootstrap validation confirmed the stability of diagnostic performance estimates across all methods. While incorporation of hs-TnI as a predictor for obstructive CAD did not significantly improve diagnostic accuracy beyond the CADScore alone, Net Reclassification Index analysis revealed modest improvements in patient classification. Decision curve analysis demonstrated complementary clinical utility patterns between both models. The 2024 ESC RF-CL model remains a strong primary approach for risk stratification, while CADScore offers excellent rule-out capability. Trial registration number: EK 21-012-0221.
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