Physiologic Basis for the Heart Sounds and Their Clinical Significance

Schwartz, Mortimer L.; Little, Robert C.

doi:10.1056/nejm196102092640606

Cited by 12 publications

(3 citation statements)

References 19 publications

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“…This responsive detection might have a possible application in peculiar patient subpopulations who would benefit from a chronic, non-invasive monitoring approach. Lastly, the digitalization of this hybrid technique will allow the quantification of acoustic parameters which could be of great diagnostic importance (Schwartz and Little, 1961) in an unbiased manner and, more importantly, independently of operator’s expertise (Mangione and Nieman, 1997) and propel new interest toward this non-invasive method.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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Background 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. Methods and Results 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 ( r 2 = 0.9583, p < 0.0001), PV diastolic filling time vs. AC perfusion time ( r 2 = 0.9686, p < 0.0001)]. Indexes of systolic and diastolic impairment correlated with quantifiable features of heart sounds [Tau vs. fourth heart sound Display Value ( r 2 = 0.2721, p < 0.0001) cardiac output vs. third heart sound Display Value ( r 2 = 0.0791 p = 0.0023)]. Additionally, acoustic cardiography diastolic time (AUC 0.675, p = 0.008), perfusion time (AUC 0.649, p = 0.024) and third heart sound Display Value (AUC 0.654, p = 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, p < 0.001). Conclusion 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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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“…This is consistent with the observations by Myhre et al (21), who found that peak negative RV dP/dt occurs an average of 60 ms before end ejection and that there is no RV isovolumic relaxation period. In humans, RV isovolumic relaxation is shorter than that in the LV: the pulmonary valve closes after the aortic valve (6,34,36) and the tricuspid valve opens before the mitral valve (15). Our results are consistent with the "hangout phenomenon" (measured by the time between the dicrotic notch values of RV and PA pressures), which is believed to occur because PA pressure is low and blood can flow easily into the pulmonary vascular bed because of its low resistance and high capacitance (36).…”

Section: Discussionmentioning

confidence: 99%

Assessment of right ventricular diastolic suction in dogs with the use of wave intensity analysis

Sun¹,

Belenkie²,

Wang³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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-Diastolic suction (DS) can be defined as that property of the ventricle by means of which it tends to refill itself during early diastole, independent of any force from the atrium. Although thought to be significant in the left ventricle (LV), DS in the right ventricle (RV) has received little attention, probably because of RV geometry. Our recent LV studies have shown that DS is related to both decreased elastance (i.e., , the relaxation time constant) and end-systolic volume (V LVES), thus reconciling the two mechanisms that have been used to explain the concept of DS. We hypothesized that RV DS would similarly depend on and V RVES. In six anesthetized open-chest dogs, aortic, RV, right atrial (RA), pulmonary arterial (PA), and RV pericardial pressure, tricuspid velocity, and PA flow were measured. VRVES was calculated by measuring distances between eight ultrasonic crystals. An empirical index of relaxation, Ј, and VRVES were manipulated by volume loading/caval constriction and isoproterenol/esmolol. We calculated the total energy (IWϪ) of the backward expansion wave generated during RV relaxation and that component causing DS [IWϪ(DS)]; i.e., the energy remaining after tricuspid valve opening. IWϪ [IWϪ(DS) also] was found to be inversely related to Ј and to VRVES {i.e., IWϪ ϭ Ϫ8.85 ⅐ e (Ϫ0.0423Ј) ⅐ e [Ϫ0.0665(%VRVES)] }. Thus, as for the LV, the energy of the backward-going wave generated by the RV during relaxation depends on both the rate at which elastance decreases and the completeness of ejection. Despite the thin wall and nonspherical shape of the RV, DS appears to be an important mechanism. diastole; hemodynamics; tricuspid valve; velocity; pressure THE UNIQUE CAPABILITIES of wave intensity analysis (WIA) could provide information regarding the dynamics and mechanisms of early right ventricular (RV) filling. Conceptually, diastolic suction (DS) is that property of the ventricle by which it tends to refill itself during early diastole, independent of any force from the atrium. Two apparently different types of mechanistic explanations have emerged. One is decreasing elastance; the other is the degree to which the ventricle empties (i.e., endsystolic volume) (11,12,19,22,38,42). Sabbah and colleagues (31, 32) indicated that RV early diastolic pressure is negative in both humans and dogs (perhaps reflecting RV DS) and that the RV can create a sucking effect during early diastole that may contribute to the filling process. Recently, our group clarified the mechanisms of left ventricular (LV) DS using WIA (41).The purpose of this study was to measure the energy associated with RV relaxation (I WϪ , see below) and to test the hypothesis that I WϪ depends on both the rate at which elastance decreases (Ј, an index of the exponential time constant of RV relaxation) and the completeness of RV emptying [RV end-systolic volume (V RVES )]. In particular, the energy associated with RV DS was identified as that component of I WϪ that remains after the opening of the tricuspid valve [I WϪ(DS) ]. METHODSExperimental ...

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“…It is therefore understandable that many of the authors (14,17,18,20,23,27,28,39,40,41,45,49,51,54) who observed presystolic gallop in hypertension had often perceived it for months, even years, without noticing simultaneous symptoms pointing to congestive heart failure. In the cases of Kincaid-Smith and Harlow (27), when blood pressure was reduced temporarily or lastingly during treatment, presystolic gallop vanished tem porarily or for good.…”

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confidence: 99%