The device underwent a feasibility and usability study in real-life clinical settings to validate user interaction and system performance.
Usability; Clinical setting; Feasibility
Clinical Evidence
Study Design
Population
Comparator
Key Endpoints
Feasibility & Usability Study; Observational/Usability study in clinical practice
Intended users (clinicians)
Not applicable for this study
Usability scoring (average score > 4 out of 5)
AI Performance
Output
Algorithm
Acceptance
Observed
Dev DS
Dev Readers
Test DS
Test Readers
Heart murmur classification
—
—
Specificity of 94% and Sensitivity of 91%
—
—
—
—
Indications for Use
The CardioSleeve System consisting of the CardioSleeve Front-End stethoscope with integrated ECG device, mobile heart sound and ECG recording application and the remote diagnostic heart murmur software is a decision support device intended to be used on a single patient to assist the qualified clinician in analyzing cardiac sounds and electrical signals for the identification and classification including of suspected murmurs. It is used to distinguish between normal/physiological and pathological heart murmurs by recording the acoustic signal of the heart and the ECG signal simultaneously and analyzing these signals. The acoustic heart signal is analyzed to identify specific heart sounds that may be present. Identified sounds include S1, S2, and suspected murmurs. CardioSleeve indicates whether or not a recorded heart sound contains a suspected heart murmur. The device must be used in a clinical setting by trained personnel with the prescribed accessories and all relevant patient information must be taken into consideration before a diagnosis is made. The interpretations of heart sounds offered by the CardioSleeve device are only significant when used in conjunction with physician over-read as well as consideration of all other relevant patient data. CardioSleeve is not intended to be a diagnostic device. It does not supersede the judgment of the clinician. The device is intended to aid the physician in the evaluation of heart sounds. The clinicians are responsible for reviewing and interpreting the results, along with the auscultatory findings and medical history, when making a referral decision. Caution: Federal (USA) law restricts this device to sale by or on the order of a clinician
Device Story
CardioSleeve is a decision support system for cardiac assessment; comprises a front-end stethoscope with integrated ECG, a mobile application, and remote diagnostic software. Device captures acoustic heart sounds (20Hz-500Hz) and 3-lead ECG signals simultaneously. Front-end recorder transmits data via Bluetooth to a mobile device; data is processed by a remote server-based algorithm. System identifies S1, S2, and suspected murmurs; provides classification of heart sounds as normal/physiological or pathological. Used by trained clinicians in clinical settings to aid evaluation; output displayed on mobile device for physician review. Does not replace clinical judgment; intended to support referral decisions and improve diagnostic efficiency.
Clinical Evidence
Bench testing and clinical validation performed. Software validation confirmed algorithm performance. Comparative study with predicate showed 70.8% accuracy. CAA algorithm validation demonstrated 91% sensitivity and 94% specificity. Pediatric population study validated murmur distinction using 1,568 high-quality heart sound recordings. Acoustic performance verified for 20Hz-500Hz range. Electrical safety met IEC 60601-1 standards.
Technological Characteristics
System includes front-end stethoscope with integrated ECG, mobile app, and remote server software. Connectivity via Bluetooth. Acoustic frequency response: 20Hz to 500Hz. Electrical safety: IEC 60601-1:2005. Software algorithm: Diagnostic Heart Murmur Algorithm (identical to K110704).
Indications for Use
Indicated for use by qualified clinicians in clinical settings to assist in the identification and classification of suspected heart murmurs in patients. Used to distinguish between normal/physiological and pathological murmurs by simultaneous recording and analysis of acoustic heart sounds and ECG signals. Not for use as a standalone diagnostic device; requires physician over-read.
Regulatory Classification
Identification
Manual stethoscope: A mechanical device used to project the sounds associated with the heart, arteries, and veins and other internal organs. Electronic stethoscope: An electrically amplified device used to project the sounds associated with the heart, arteries, and veins and other internal organs.
Special Controls
*Classification.* Class II (special controls). The device, when it is a lung sound monitor, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 870.9.
Predicate Devices
Sensi with Diagnostic Heart Murmur Software (K110704)
{0}------------------------------------------------
# 510 (k) Summary 807.92(c)
# JUN 2 4 2013
### SPONSOR
Company Name: Company Address:
807.92(a)(1) Rijuven Corporation 624 Whispering Pines Drive Pittsburgh PA, 15238 +1 (301) 335-9163 +1 (412) 967-9393 Evens Augustin March 2, 2013
Telephone:
Fax:
Contact Person Summary Preparation Date:
### DEVICE NAME
807.92(a)(2)
Trade Name: Common/Usual Name:
Classification Name: Regulation Number: Product Code: Device Class:
CardioSleeve Electronic Stethoscope / Heart Sound Analyzer Electronic Stethoscope; Phonocardiograph 21 CFR 870.1875, 870.2390 DQD, DQC Class II
### PREDICATE DEVICE
807.92(a)(3)
Legally Marketed Equivalent Device
| Company | Product | 510(k) # |
|-----------------------------------------|------------------------------------------------|----------|
| Diacoustic Medical<br>Devices (Pty) Ltd | Sensi with Diagnostic<br>Heart Murmur Software | K110704 |
{1}------------------------------------------------
#### DEVICE DESCRIPTION 807.92(a)(4)
The CardioSleeve with Diagnostic Heart Murmur Application, (application identical to the FDA cleared Sensi with Diagnostic Heart Murmur Software-K110704), is a decision support device intended to acquire, record, and analyze heart sounds. It is used to distinguish between normal and pathological heart murmurs by recording the acoustic signal of the heart and the ECG signal simultaneously and analyzing these signals, and to acquire, record and display 3 Lead ECG signals for diagnostic support.
The complete system comprises of: a) Diagnostic Heart Murmur Algorithm (algorithm identical to the FDA cleared Diagnostic Heart Murmur Algorithm in K110704), that runs on a hosted server environment with Linux operating system, b) a mobile device software application that captures patient data, displays patient data and instructions for use and c) a stethoscope front-end recorder device with integrated ECG to acquire the acoustic and electrical heart signals. The CardioSleeve Front-end recorder device will interface via Bluetooth with the clinician's hand held mobile device.
#### DEVICE INDICATIONS FOR USE 807.92(a)(5)
The CardioSleeve System consisting of the CardioSleeve Front-End stethoscope with integrated ECG device, mobile heart sound and ECG recording application and the remote diagnostic heart murmur software is a decision support device intended to be used on a single patient to assist the qualified clinician in analyzing cardiac sounds and electrical signals for the identification and classification including of suspected murmurs. It is used to distinguish between normal/physiological and pathological heart murmurs by recording the acoustic signal of the heart and the ECG signal simultaneously and analyzing these signals. The acoustic heart signal is analyzed to identify specific heart sounds that mav be present. Identified sounds include S1, S2, and suspected murmurs.
CardioSleeve indicates whether or not a recorded heart sound contains a suspected heart murmur. The device must be used in a clinical setting by trained personnel with the prescribed accessories and all relevant patient information must be taken into consideration before a diagnosis is made.
The interpretations of heart sounds offered by the CardioSleeve device are only significant when used in conjunction with physician over-read as well as consideration of all other relevant patient data.
CardioSleeve is not intended to be a diagnostic device. It does not supersede the judgment of the clinician. The device is intended to aid the physician in the evaluation of heart sounds. The clinicians are responsible for reviewing and interpreting the results, along with the auscultatory findings and medical history. when making a referral decision.
Caution: Federal (USA) law restricts this device to sale by or on the order of a clinician
{2}------------------------------------------------
#### COMPARISON OF TECHNICAL CHARACTERISTICS 807.92(a)(6)
The CardioSleeve device features were directly compared with the FDA cleared Sensi with Diagnostic Heart Murmur Software, WelchAllyn Master Elite Stethoscope and the WelchAllyn Meditron Analyzer (K110704).
Synopsis of the comparison analysis:
- . Intended Use:
CardioSleeve and Sensi with Diagnostic Heart Murmur Software do have an equivalent intended use.
- . Indications for Use:
CardioSleeve and Sensi with Diagnostic Heart Murmur Software do have identical indications for use.
- . Composition
CardioSleeve and Sensi with Diagnostic Heart Murmur Software compromises equivalent functions system composition.
- . Physical Properties
CardioSleeve with Front-end unit and Diagnostic Heart Murmur Software, and Sensi with Diagnostic Heart Murmur Software, the WelchAllyn Master Elite Stethoscope and the WelchAllyn Meditron Analyzer share equivalent physical characteristics (K110704).
- . Technology Characteristics
CardioSleeve consists of a front-end recorder device with a Bluetooth interface connected to a standard acoustic stethoscope recording both the acoustic heart sound and/or ECG signal. The Sensi consists of an electronic stethoscope and ECG recorder connecting to a PC by means of a USB interface for recording of acoustical body sounds.
CardioSleeve and Sensi with Diagnostic Heart Murmur Software are using identical heart murmur analysis algorithm.
CardioSleeve and Sensi with Diagnostic Heart Murmur Software are using equivalent user interface properties.
#### SAFETY AND EFFECTIVENESS
### 807.92(b)
A comprehensive list of verification and validation testing was performed in accordance to Rijuven's Design Control procedures.
Software validation was performed for all aspects of the CardioSleeve System and Software. The graphical user interface and usability were compared to the predicate devices.
Validation of the CardioSleeve was performed to ensure that the CardioSleeve system consistently fulfills its intended use and the needs of the user. A clinical software validation was performed to insure the performance of the software algorithm.
{3}------------------------------------------------
| 1 | Biocompatibility Testing | CardioSleeve material presented no<br>issues of biocompatibility |
|---|---------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 2 | Electrical Safety Testing | The CardioSleeve meets the<br>requirements of IEC 60601-1: 2005 +<br>CORR. 1 (2006) + CORR. 2 (2007). |
| 3 | Feasibility & Usability Study | Intended users performed usability<br>validation within real life clinical<br>settings.<br>On average all users scored the<br>usability of the CardioSleeve Software<br>more than 4 out of 5. |
| 4 | Comparative study between<br>FDA approved CardioSleeve<br>and Sensi system | CardioSleeve and Sensi achieve<br>comparable accuracy of 70.8% |
| 5 | Design verification of a CAA<br>algorithm | Specificity of 94% and Sensitivity of<br>91% |
| 6 | Validate algorithms used to<br>distinguish between functional<br>and pathological heart murmurs<br>in the pediatric population. | 1568 heart sounds were accepted to<br>meet the criteria of good quality and<br>match the recorded pathological<br>conditions |
| 7 | Verification of the acoustic<br>performance of the<br>CardioSleeve front-end | The CardioSleeve Front-End perform<br>favorably, in responding to heart<br>sound frequency of 20hz to 500hz |
### CONCLUSION
### 807.92(b)(3)
Based upon the indications for use, technology characteristics and safety and performance testing, it is the conclusion of Rijuven that the CardioSleeve device consisting of the CardioSleeve Front-End stethoscope and ECG device, mobile heart sound recording application and the remote diagnostic heart murmur software is as safe and effective as the predicate devices and raises no new issues of safety and effectiveness.
{4}------------------------------------------------
#### DEPARTMENT OF HEALTH & HUMAN SERVICES
Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" around the perimeter. Inside the circle is a stylized symbol that resembles a person with outstretched arms.
June 24, 2013
Public Health Service
Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002
Rijuven Corp Mr. E.J. Smith Regulatory Consultant 1468 Harwell Ave. Crofton, MD 21114 US
Re: K131287
> Trade/Device Name: Cardiosleeve Regulation Number: 21 CFR 870.1875 Regulation Name: Electronic Stethoscope / Heart Sound Analyzer Regulatory Class: Class II Product Code: DQD, DQC Dated: May 9, 2013 Received: May 9, 2013
Dear Mr. E.J. Smith:
We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA), You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.
If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.
Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must
{5}------------------------------------------------
Page 2 - Mr. E.J. Smith
comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.
If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fdagov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, Misbranding by reference to premarket notification (21CFR Part 807.97), For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/MedicalDevices/Safety/ReportalProblem/default.htmfor the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.
You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638 2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.
Sincerely yours,
# Bram D. Zuckerman -S
Bram D. Zuckerman, Ph.D. Director Division of Cardiovascular Devices Office of Device Evaluation Center for Devices and Radiological Health
{6}------------------------------------------------
# Indications for Use
#### 510(k) Number (if known):
#### Device Name: CardioSleeve
#### Indications For Use:
The CardioSleeve System consisting of the CardioSleeve Front-End stethoscope with integrated ECG device. mobile heart sound and ECG recording application and the remote diagnostic heart murmur software is a decision support device intended to be used on a single patient to assist the qualified clinician in analyzing cardiac sounds and electrical signals for the identification and classification including of suspected murmurs. It is used to distinguish between normal/physiological and pathological heart murmurs by recording the acoustic signal of the heart and the ECG signal simultaneously and analyzing these signals. The acoustic heart signal is analyzed to identify specific heart sounds that may be present. Identified sounds include S1, S2, and suspected murmurs.
CardioSleeve indicates whether or not a recorded heart sound contains a suspected heart murmur. The device must be used in a clinical setting by trained personnel with the prescribed accessories and all relevant patient information must be taken into consideration before a diagnosis is made.
The interpretations of heart sounds offered by the CardioSleeve device are only significant when used in conjunction with physician over-read as well as consideration of all other relevant patient data.
CardioSleeve is not intended to be a diagnostic device. It does not supersede the judgment of the clinician. The device is intended to aid the physician in the evaluation of heart sounds. The clinicians are responsible for reviewing and interpreting the results, along with the auscultatory findings and medical history, when making a referral decision.
Caution: Federal (USA) law restricts this device to sale by or on the order of a clinician
Prescription Use X
AND/OR
Over-The-Counter Use (21 CFR 801 Subpart C)
(Part 21 CFR 801 Subpart D)
(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)
Concurrence of CDRH, Office of Device Evaluation (ODE)
Bram D. Zuckerman 2013.06.24 16:58:04 -
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Learn the FDA Browser
Two short videos show you everything — or skip straight to the written tutorial if you'd rather read. You can reopen this any time from the Tutorial button in the top bar.
Part 1 — Search, results, and everyday workflows 16 min
Part 2 — Embeddings: the galaxy map 3 min
1. Search: exact and fuzzy
Type a phrase like "coronary artery calcification" into the search box. You get two kinds of results. Exact results match the literal phrase — prefix searches work ("coronary artery calcificati") but suffix searches do not. Fuzzy results match on the meaning and intent of your phrase rather than the exact words, and are sorted by relevance score. Hover over the Exact or Fuzzy badge on any row to see exactly why it matched.
Use the checkboxes above the results to narrow: SaMD keeps only software-only devices, AI / ML keeps only devices with AI.
Exact vs. fuzzy search: what's the difference?
Exact matches on the literal phrase (prefix search works, suffix does not). Fuzzy matches on the meaning and intent of the phrase rather than the exact words. Hover over the badge on any row to see why it matched.
You search "coronary artery calcification" and want only software devices with AI. What two filters do you apply?
Narrow by SaMD (software-only devices), then narrow by AI/ML (devices with AI).
2. The results table
Scroll right in the results table. The intended use is extracted for you — no need to open the PDF. The device story gives a high-level snapshot of what the device does and how it's used. The AI Performance sub-table shows each output name, acceptance criteria, observed values, and development/test dataset descriptions — the same format Innolitics uses for regulatory strategy outputs, and the fastest high-level fingerprint of an AI device. It is AI-generated but has been very reliable in practice.
Where do you find a device's intended use without opening the PDF?
Scroll right in the search results table. The intended use column is extracted for you; no need to dig into the 510(k) summary PDF.
What does the AI Performance sub-table show, and why is it useful?
Output name, acceptance criteria, observed values, development dataset description, and test dataset description. It's the same format we use for regulatory strategy output and Fast 510(k) input, and the fastest high-level fingerprint of an AI device. AI-generated but reliable in practice.
3. Judging fuzzy relevance
Fuzzy results trail off in relevance as you scroll. Use three signals to decide how far down to go: the fuzzy badge explanations, the intended use column, and whether your target output (e.g., Cobb angle) still appears in the AI Performance sub-table. Once it stops appearing, you're past the relevant zone. A top hit with a low score (~0.4) and a stretched explanation is a hint the closest predicates are far away — the project may be headed for De Novo. Note the fuzzy search is a pattern match: it doesn't handle negation ("not") well, and hardware devices can appear — filter by SaMD/AI ML to cut them.
How do you judge how far down fuzzy search results to go?
Use the relevancy signals: the fuzzy badge explanations, the intended use column, and whether the target output (e.g., Cobb angle) still appears in the AI Performance sub-table. Once it stops appearing, results are trailing off in relevancy.
4. Device detail page: chat and citations
Click a device name to open its detail page: device facts on the left, a chat window on the right. Ask something like "Describe the training data". The answer carries little citation bubbles — click one to jump to the highlighted passage in the source PDF, so you can verify every AI answer against the document. There's also a Download PDF button for sharing.
How do you verify an AI chat answer on the device detail page?
Click the citation bubbles to jump to the relevant highlight in the source document.
Reading rule for every project: how many summaries do you read in full?
At least the three most relevant 510(k) or De Novo summaries, in full. After that, use targeted chat questions to confirm your memory quickly. The tool supports this professional habit — it doesn't replace it.
5. Side-by-side comparison
Select multiple rows in the results table (aim for under ~10), then open the PDF Viewer tab. Ask one question — it goes to all selected devices in parallel, each with citations. This is the fastest way to compare and contrast devices: training data, PCCP scope, how they handled adding new scanners, and so on.
What does the side-by-side PDF viewer mode do?
Select multiple devices, open the PDF viewer tab, and ask one question (e.g., "Describe the training data"). It queries all selected devices simultaneously with citations, so you can compare and contrast quickly.
6. Collections
With rows selected, go to the Collections tab and create a labeled collection (e.g., "Cobb Angle Project"). Reload that selection any time — before a client call, pull up the collection and ask questions across all of its devices at once.
How do you save a set of selected devices for later use?
Select the rows, go to the Collections tab, and create a labeled collection (e.g., "Cobb Angle Project"). You can reload the selection anytime and carry it into the PDF viewer and other tabs that support selections.
7. Product codes and the regulations tree
Click a product code in the results to jump to it in the regulations tree — identification text, sibling product codes, and devices you can open in a PDF viewer on the right. Click a regulation number to see its identification, special controls, and related product codes. You can also search by product code or regulation number at the top of the tree. Always read the special controls if any exist for your device — it broadens your search and sharpens pre-kickoff research.
What can you do from the regulations tree view?
Browse product codes and regulation numbers, read the identification text and special controls, browse sibling product codes, open device PDFs on the right, and search by product code or regulation number at the top of the tree.
8. Chart view
Click Show Chart and segment by regulation number (or product code) to see which regulations dominate your result set. Clicking a regulation takes you into the regulations tree. Great for spotting that most matches are, say, hardware laparoscopic devices — a cue to go back and filter.
How do you see which regulations dominate a search result set?
Click "Show Chart" and segment by Regulation Number. Clicking a regulation takes you to the regulations tree.
9. The predicate graph
Open the Predicates tab for a family-tree view of predicate relationships. Click a node to trace its parents and children; selections from search carry over pre-selected. Commonly predicated devices are worth reading — a lot of people predicated them for a reason. The visual lineage is also handy on client calls, e.g. to show how a predicate family evolved and justify why your predicate still holds.
In the predicate graph, why are commonly predicated devices worth reading?
A lot of people predicated them for a reason. Clicking a node traces parents and children, and selections from search carry over pre-selected.
10. Embeddings: the galaxy map
The Embeddings tab plots every matching document in a 2-D "galaxy map" where semantically similar devices cluster together. Hover or click clusters to explore, and let AI label the clusters for you. Embeddings beat product codes for grouping: two devices can carry different product codes (LLZ vs. QIH) yet do the same thing — the embedding captures the meaning of the intended use and device story. This is also exactly how retrieval-augmented generation (RAG) works under the hood, and it makes a great visual on client calls.
Try it yourself
Head to the search page and work through a few of these AI/ML fuzzy searches to build intuition: perivascular fat on CT · aortic valve calcification opportunistic screening on noncontrast CT · breast cancer prediction on digital pathology slides · autism detection · gestational age prediction · a hearing aid that can also detect a pulse · foundation model based analysis of ECG · large language models · penetration test. Watch how the relevance scores, intended use, and AI Performance tables tell you when results stop being meaningful.