The Austin Flint Murmur and the
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            Wave of the Apexcardiogram in Aortic Regurgitation

Parker, Elizabeth; Craige, Ernest; Hood, William P.

doi:10.1161/01.cir.43.3.349

Cited by 36 publications

(7 citation statements)

References 16 publications

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“…An Austin-Flint rumble is a specific finding for severe AR. 289,290 In many patients with more mild to moderate AR, the physical examination will identify the regurgitant lesion but will be less accurate in determining its severity. When the diastolic murmur of AR is louder in the third and fourth right intercostal spaces than in the third and fourth left intercostal spaces, the AR likely results from aortic root dilatation rather than from a deformity of the leaflets alone.…”

Section: Diagnosis and Initial Evaluationmentioning

confidence: 99%

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

916

259

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Section: Diagnosis and Initial Evaluationmentioning

confidence: 99%

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

916

259

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“…We have first described the temporal coincidence of the onsets of systolic upstrokes and, in part, also of the diastolic nadirs of apex and left ventricu lar pressure tracings using simultaneous high-fidelity trac ings during diagnostic heart catheterization [17,18]. Fur ther, it has been found by many authors that relative A wave height parameters correlate significantly not only with left ventricular end-diastolic pressure [34,[36][37][38] but also with internally derived indices of end-diastolic pressure-volume relation [20,39]. According to all these findings the apex tracing represents the only hitherto available noninvasive method which reflects left ventricu lar pressure changes.…”

Section: Monolas Types Of Diastolic Dysfunction During Handgripmentioning

confidence: 99%

Clinical Value of Types of Exercise-Induced Diastolic Abnormalities in Patients with Myocardial Disease

Manolas¹

1993

Am J Noninvas Cardiol

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It has recently been demonstrated that the handgrip-apexcardiographic test (HAT) represents a low-level (40% of maximal voluntary contraction) isometric stress test of short duration (2 min) by which one can assess early occurring silent left ventricular diastolic abnormalities in coronary patients. The aim of this study is to determine the pattern of these exerciseinduced diastolic abnormalities and to assess its potential diagnostic as well as prognostic significance in patients with various myocardial disease states. HAT was performed in 242 healthy subjects and 155 patients; 15 patients with previous infarction without symptoms (group 1), 40 patients with prior infarction and angina pectoris (group 2), 74 patients with typical angina pectoris without infarction (group 3), and 26 patients with congestive heart failure (group 4). As index of compliance served the relative A wave to the total height (A/H) of apexcardiogram, and as indices of relaxation the total apexcardiographic relaxation time (TART) and TART corrected for the duration of diastole (TARTI). The following three types of handgrip-induced changes of these diastolic indices were observed: (1) the compliance (C)-type, which was present when A/H increased during and/or after handgrip >21 % (= largest individual value in controls); (2) the relaxation (Retype being present when TART during handgrip >TART at rest >143 ms or/and TARTI <0.14 (= lowest individual value in controls), and (3) the mixed (RC)-type which is defined by the presence of both the criteria of R- and C-types. These 3 types showed a different distribution in the four groups of patients. The C-type was predominant in groups 2 and 4 (73 and 58%, respectively), whereas in group 3 all three types showed a similar distribution (C-type: 31%, R-type: 27% and RC-type: 34%). In contrast, in group 1 the C-type was absent and the R- as well as RC-types were rare (13 and 7%, respectively). During a clinical follow-up period of 20 ± 2 months, patients with C-type of dysfunction had a less favorable outcome (7% deaths, 6% new infarctions and 4% acute lung edema). According to our present data derived from HAT in patients with myocardial disease, it can be concluded that: (1) three different types of diastolic abnormalities are present during isometric stress; (2) there is a different distribution of these patterns depending on the presence of previous infarction, angina pectoris or heart failure, and (3) the C-type is probably associated with the worst long-term prognosis. Thus, this study introduces the 3-type concept of exercise-induced diastolic abnormalities and demonstrates their potential diagnostic and prognostic significance in clinical practice.

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“…9 2) The systolic upstroke time (SUT), measured from the onset (C point) to the protosystolic summit (E point) of the upstroke of the apex tracing, as shown in figures I and 3. In the absence of sharp C and/or E points the SUT can accurately be measured by the use of the first derivative of the ACG as the time from the point where dA/dt ascends from the zero line to the point where it reaches this line again after having reached its maximal peak(s),12 as demonstrated in figure 2.…”

Section: Analysis Of the Simultaneous Tracingsmentioning

confidence: 99%

Comparison between apexcardiographic and angiographic indexes of left ventricular performance in patients with aortic incompetence.

Manolas¹,

Krayenbuehl²

1978

Circulation

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Left ventricular (LV) apexcardiogram (ACG) and its first derivative (dA/dt) was obtained in 104 normal subjects and 34 patients with chronic aortic incompetence (AI). In the patients with AI the ACG was recorded simultaneously with LV pressure (tipmanometer). The systolic upstroke time (SUT), the time to peak dA/dt (t-dA/dt) and the a wave percentage amplitude (a/H) of the ACG was measured. In normal subjects SUT averaged 99 +/- 17 (SD) msec. In 17 patients with AI and normal ejection fraction (EF) (group 1) SUT was within normal limits; in 17 patients with AI and decreased EF (group 2) it was prolonged (142 +/- 19 msec) (P less than 0.001). The SUT was closely correlated with EF (r = 0.85) and less with contractile indexes derived from pressure curves. The indexes t-dA/dt and a/H were not significantly different in groups 1 and 2; they were weakly correlated only with the time to peak rate of LV pressure rise (r = +0.56) and the LV end-diastolic pressure (r = +0.59), respectively. These results demonstrate the superiority of SUT over the other apexcardiographic parameters. The measure provides another means of noninvasive assessment of the LV performance in patients with AI.

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The Austin Flint Murmur and the a Wave of the Apexcardiogram in Aortic Regurgitation

Cited by 36 publications

References 16 publications

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Clinical Value of Types of Exercise-Induced Diastolic Abnormalities in Patients with Myocardial Disease

Comparison between apexcardiographic and angiographic indexes of left ventricular performance in patients with aortic incompetence.

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