DESCRIPTION
Acoustic cardiography (e.g., AUDICORŪ TS system, AUDICORŪ 200S) is a non-invasive procedure that simultaneously records the electrical and acoustical aspects of the heart. By integrating the acoustic and electric properties, acoustic cardiography is intended to enhance the diagnostic ability of simple auscultation in the diagnosis of heart failure and for the optimization of cardiac resynchronization therapy (CRT) hemodynamic parameters for individuals with a CRT device.
Acoustic cardiography utilizes three inputs - a single EKG lead from two standard electrodes, and two audio sensors placed at the usual V3 and V4 positions on the chest. These three channels synchronously record electrical and audio information. The audio information is processed using wavelet signal processing techniques and a diagnostic algorithm that filters out extraneous noise and uses time-frequency analysis to objectively define the heart sounds and the intervals between sounds. An analogue visual display of the audio data is then displayed and paired with the electrical data from the EKG recording. Numerous parameters can be obtained from the acoustic cardiography output:
S3 strength - a quantitative measure of the intensity of the S3 heart sound, which is an abnormal sound that is associated with systolic dysfunction
Left ventricular systolic time (LVST) - the interval between mitral valve closure and aortic valve closure. This length of the LVST has been correlated with changes in ejection fraction
Electromechanical activation time (EMAT) - the interval between the onset of the QRS complex and the closure of the mitral valve. EMAT is the main parameter that is used to optimize CRT therapy by choosing the interval that optimizes cardiac output
POLICY
Acoustic cardiography for the diagnosis of heart failure is considered investigational.
Acoustic cardiography for the optimization of cardiac resynchronization therapy (CRT) hemodynamic parameters is considered investigational.
Acoustic cardiography for the treatment of all other conditions/diseases is considered investigational.
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ADDITIONAL INFORMATION
Since the lack of any well-designed randomized controlled trials addressing acoustic cardiography for the diagnosis of heart failure, for the optimization of CRT hemodynamic parameters, and for the treatment of all other conditions/diseases, no conclusions can be drawn regarding the effect on net health outcomes.
When used to optimize CRT settings, several studies report that acoustic cardiography has a high correlation with the doppler echocardiography. No studies have demonstrated that acoustic cardiography is superior to echocardiography for this purpose, and therefore there is no evidence that acoustic cardiography improves outcomes when used for optimization of CRT therapy.
SOURCES
Bertini, M., Delgado, V., Bax, J. J., & Van de Veire, N. R. (2009). Why, how and when do we need to optimize the setting of cardiac resynchronization therapy? Europace, 11 (Suppl. 5), v46-57.
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2011). Acoustic cardiography (2.02.27). Retrieved August 1, 2011 from BlueWeb. (10 articles and/or guidelines reviewed)
Dillier, R.,Kobza, R., Erne, S., Zuber, M., Arand, P., & Erne, P. (2010). Noninvasive detection of left-ventricular systolic dysfunction by acoustic cardiography in atrial fibrillation. Cardiology Research and Practice, 2011, 1-7. (Level 3 Evidence - Industry sponsored)
Erne, P. (2008). Beyond auscultation--acoustic cardiography in the diagnosis and assessment of cardiac disease. Swiss Medical Weekly, 138 (31-32), 439-452.
Kosmicki, D. L., Collins, S. P., Kontos, M. C., Zuber, M., Kipfer, P., Attenhofer Jost, A., et al. (2010). Noninvasive prediction of left ventricular systolic dysfunction in patients with clinically suspected heart failure using acoustic cardiography. Congestive Heart Failure, 16 (6), 249-253.
U. S. Food and Drug Administration. (2005, February). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K043074. Retrieved July 22, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf4/K043074.pdf.
U. S. Food and Drug Administration. (2007, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070136. Retrieved July 22, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K070136.pdf.
U. S. Food and Drug Administration. (2008, September). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K073545. Retrieved July 22, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K073545.pdf.
Zuber, M., & Erne, P. (2010). Acoustic cardiography to improve detection of coronary artery disease with stress testing. World Journal of Cardiology, 2 (5), 118-124. (Level 4 Evidence - Independent study)
Zuber, M., Kipfer, P., & Attenhofer Jost, A. (2007). Usefulness of acoustic cardiography to resolve ambiguous values of B-type natriuretic peptide levels in patient with suspected heart failure. The American Journal of Cardiology, 100 (5), 866-869. (Level 3 Evidence - Independent study)
Zuber, M., Toggweiler, S., Roos, M., Kobza, R., Jamshidi, P., & Erne, P. (2008). Comparison of different approaches for optimization of atrioventricular and interventricular delay in biventricular pacing. Europace, 10 (3), 367-373. (Level 4 Evidence - Independent study)
ORIGINAL EFFECTIVE DATE: 12/10/2011
MOST RECENT REVIEW DATE: 12/10/2011
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