A study by the American College of Cardiology (ACC) is the first to use an artificial intelligence (AI)-based system to predict incidences of coronary artery disease (CAD) by analysing voice markers. Cardiology fellow Dr. Jaskanwal Deep Singh Sara said that the autonomic nervous system, which regulates the voice box and vital aspects of the cardiovascular system, may play a role.

For the new study, Dr. Sara and other researchers recruited 108 participants who were referred for a coronary angiogram (an X-ray imaging procedure used to assess the condition of the heart’s arteries). Participants were also asked to record three 30-second voice samples using the US-based Vocalis Health smartphone application. For the first sample, participants read from a prepared text; for the second sample, they were asked to speak freely about a positive experience; and for the third, they were asked to speak about a negative experience.

The Vocalis Health AI algorithm then analysed the participants’ voice samples, picking out features such as frequency, amplitude, pitch, and cadence, based on a training set of over 10,000 voice samples collected in Israel. These features were catagorised into a single score, expressed as a number between -1 and 1 for each individual: one-third of participants had a high score, and two-thirds had a low score.

In the two years that followed, those with a high voice biomarker score, 58.3% reported visiting the hospital for chest pain or suffered acute coronary syndrome (a type of major heart problem that includes heart attacks). This score was compared with 30.6% of those with a low voice biomarker score. Participants with a high voice biomarker score were also more likely to have a positive stress test or be diagnosed with CAD during a subsequent angiogram.

As mentioned earlier, it is possible that the voice could provide clues about how the autonomic nervous system is functioning, and by extension, provide insights into cardiovascular health. Voice analysis could be a powerful screening tool in identifying patients who may benefit from closer monitoring for CAD-related events – this approach could be particularly useful in remote health care delivery and telemedicine/telehealth.

“Telemedicine is non-invasive, cost-effective and efficient and has become increasingly important during the pandemic,” said, Dr. Sara. “We’re not suggesting that voice analysis technology would replace doctors or replace existing methods of health care delivery, but we think there’s a huge opportunity for voice technology to act as an adjunct to existing strategies.

“Providing a voice sample is very intuitive and even enjoyable for patients, and it could become a scalable means for us to enhance patient management.”

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Coronary artery disease (CAD) was reported as the top cause of death in much of the developed world – in Malaysia in 2019, over 16,300 victims made up 15% of medically-certified deaths, according to national statistics, and proper management of CAD depends on the appropriate use of revascularisation techniques – Malaysian patients can now finally opt for a better, safer and more advanced treatment solution with a newly-available diagnostic tool.

Known as Intravascular Ultrasound (IVUS) technology, the tool uses sound waves to generate detailed imaging of the heart blood vessels and provides cross-sectional views of the affected artery. This gives doctors important information on the nature of blockages or compositions within one’s heart; the IVUS technology also ensures practitioners are able to develop the right treatment plans for patients.

Read also: New option for treatment of Coronary Artery Disease

“This is a big step forward for cardiology in Malaysia. As doctors, we always want to offer our patients treatment solutions that give them the most promising outcome. To do so, we need to know as much information about the condition as we can,” said Datuk Dr. Tamil Selvan Muthusamy, Consultant Cardiologist at Cardiac Vascular Sentral Kuala Lumpur (CVSKL), Malaysia. Datuk Dr. Tamil Selvan has performed more than 100 IVUS-guided procedures at CVSKL.

IVUS is proven to be more effective in treating CAD: an extensive study involving 1,448 patients with recurring blockages after undergoing stent procedure (also known as target vessel failure or TVF) found that only 6.6% of patients who underwent IVUS-guided procedures had TVF; it is a significantly lower number than the 10.7% patients who did not use IVUS for their procedures.

This data emphasises IVUS’s capabilities to help reduce the chances of TVF by almost half, and stands to improve the long-term results of angioplasty with stent implantation. 

“IVUS is an important tool to help doctors achieve better procedural results,” added Datuk Dr. Rosli Mohd Ali, Consultant Cardiologist at CVSKL. Datuk Dr. Rosli has also performed over 100 IVUS-guided procedures in CVSKL.

“With IVUS, doctors can get a clear look of the final stent expansions, reduce the chances of post-procedure complications thus achieving better long-term outcomes as shown innumerous studies.  It helps to minimise the need for subsequent interventions. [Most] importantly, we are able to provide higher assurance and confidence to our patients,” Datuk Dr. Rosli said.