The Cause and Clinical Significance of Diastolic Heart Sounds

Stefadouros, Miltiadis A.; Little, Robert C.

doi:10.1001/archinte.1980.00330160097035

Cited by 13 publications

(3 citation statements)

References 41 publications

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“…The auscultated S 3 and S 4 have long been used as clinical signs of heart disease, with diagnostic and prognostic importance. [2][3][4][5][6][7] However, the value of these physical findings has been diminished by reports of poor accuracy and interobserver reliability. 8,9 As an objective instrument that supplies measurable data, the phonocardiogram has traditionally been the criterion (gold) standard tool for the detection of ventricular gallop sounds.…”

mentioning

confidence: 99%

Association Between Phonocardiographic Third and Fourth Heart Sounds and Objective Measures of Left Ventricular Function

Marcus

Gerber²,

McKeown³

et al. 2005

JAMA

147

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ContextThe third (S 3 ) and fourth (S 4 ) heart sounds detected by phonocardiography are considered to represent the criterion standards of the gallop sounds, but their test characteristics have not been explored.Objective To determine the diagnostic test characteristics of the S 3 and S 4 for prediction of left ventricular dysfunction using a computerized heart sound detection algorithm.Design, Setting, and Participants Prospective study of 90 adult patients undergoing elective left-sided heart catheterization at a single US teaching hospital between August 2003 and June 2004. The mean age was 62 (SD, 13) years (range, 24-90 years) and 61 (68%) were male. Within a 4-hour period, participants underwent computerized heart sound phonocardiographic analysis, cardiac catheterization, transthoracic echocardiography, and blood sampling for assessment of an S 3 /S 4 , left ventricular end-diastolic pressure (LVEDP), left ventricular ejection fraction (LVEF), and B-type natriuretic peptide (BNP), respectively.Main Outcome Measures Diagnostic test characteristics of the computerized phonocardiographic S 3 and S 4 using markers of left ventricular function as criterion standards.Results Mean (SD) LVEDP was significantly elevated (18.4 [6.9] mm Hg vs 12.1 [7.3] mm Hg; PϽ.001), mean (SD) LVEF was reduced (49.4% [20.2%] vs 63.6% [14.8%]; PϽ.001), and median (interquartile range) BNP was elevated (330 [98-1155] pg/mL vs 86 pg/mL; PϽ.001) in those with an S 3 , S 4 , or both compared with patients without a diastolic heart sound. The sensitivities of these heart sounds to detect an elevated LVEDP, reduced LVEF, or elevated BNP were 41%, 52%, and 32% for an S 3 , and 46%, 43%, and 40% for an S 4 , respectively. For abnormal levels of the same markers of ventricular function, the specificities of the S 3 were 92%, 87%, and 92%, while the specificities of the S 4 were 80%, 72%, and 78%, respectively.Conclusions Neither the phonocardiographic S 3 nor the S 4 is a sensitive marker of left ventricular dysfunction. The phonocardiographic S 3 is specific for left ventricular dysfunction and appears to be superior to the moderate specificity of the phonocardiographic S 4 .

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mentioning

confidence: 99%

Association Between Phonocardiographic Third and Fourth Heart Sounds and Objective Measures of Left Ventricular Function

Marcus

Gerber²,

McKeown³

et al. 2005

JAMA

147

View full text Add to dashboard Cite

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“…Using acoustic cardiography on short recordings, detection of a third heart sound has been correlated to elevated LV end-diastolic pressure and reduced ejection fraction [21], and in emergency department patients with signs or symptoms of acute decompensated heart failure has been found to be specific for primary heart failure [22]. We found a hypertrophy [23], and with worse prognosis following myocardial infarction [24]. Detected by auscultation or phonocardiography in healthy persons, the prevalence of the S4 was as high as 73% and considered, by some, to be a normal result of aging [25,26] Second, acoustic cardiography measurements are not calculated for heart rates greater than 150 bpm, which has not been a problem in this study population.…”

Section: Methodsmentioning

confidence: 67%

Assessment of Cardiac Function and Prevalence of Sleep Disordered Breathing using Ambulatory Monitoring with Acoustic Cardiography – Initial Results from SWICOS

Bauer¹,

Arand²,

Radovanović

et al. 2018

JHC

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The aim of this study was to assess the use of ambulatory acoustic cardiography during the initial data collection of the longitudinal study of a rural population in Switzerland (n=297, mean age 48.9 ±16.5 years, 57% female). Ambulatory acoustic cardiography non-invasively can assess sleep disordered breathing (SDB) and provides markers of left ventricular systolic and diastolic dysfunction. The percentage of the third heart sound detected during sleep decreased significantly across age groups (age < 40 years, 40-60 years, > 60 years) for both genders (males, p=0.04; females, p=0.02). The percentage of a fourth heart sound detected exhibited an increasing trend for both genders with age suggesting increased diastolic dysfunction with aging. Mean electromechanical activation time (EMAT) during sleep was within the normal range across age groups and both genders (male 93.7 ± 11.6 ms, female 94.6 ± 13.0 ms), and did not vary significantly with age. A large proportion of subjects had a high likelihood of sleep disordered breathing (17.6%). Baseline characteristics categorized by SDB severity indicate increasing age, male gender and being overweight (BMI ≥ 25) to be associated with greater SDB severity. Acoustic cardiography findings categorized by SDB severity reveal increased nocturnal non-dipping heart rate, presence of atrial fibrillation, prolonged QRS duration and QTc interval, increased percentage of fourth heart sound detected, and longer EMAT to be significantly associated with greater SDB severity. Overall, acoustic cardiography detected a very low prevalence of systolic dysfunction, age-related increases in diastolic dysfunction and a moderate prevalence of sleep disordered breathing.

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“…The auscultated S 3 and S 4 have long been used as clinical signs of heart disease with both diagnostic and prognostic importance. 18–23 However, the value of these physical findings has been diminished by reports of poor accuracy and a large degree of interobserver variability 24,25 . In addition, it has been well documented that physician physical examination skills have deteriorated and are not emphasized during training as much as they once were 26 .…”

Section: Heart Sounds and Systolic Time Intervalsmentioning

confidence: 99%

The Utility of Heart Sounds and Systolic Intervals Across the Care Continuum

Peacock

Harrison

Maisel

2006

Congestive Heart Failure

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Acoustic cardiography is an exciting, new, easy-to-use, modernized technology that incorporates already proven techniques of phonocardiography. Application of acoustic cardiography to clinical practice can improve diagnosis and management of heart failure patients. Its clinical use should help address some of the need for robust, inexpensive, and widely accessible technology for proactive heart failure diagnosis and management. Acoustic cardiographically recorded measurements have been correlated with both cardiac catheterization and echocardiographically determined hemodynamic parameters. Heart sounds captured by acoustic cardiograms have proven to assist clinicians in assessing dyspneic patients in the emergency department by utilizing the strong specificity of an S3 for detecting acute decompensated heart failure. Acoustic cardiography offers a cost-efficient, easy-to-use method to optimize the devices used in cardiac resyncronization therapy. The rapidly and easily obtainable information gathered by acoustic cardiography should foster its more widespread use in diagnosis and treatment of heart failure, including cardiac resyncronization therapy device optimization.

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The Cause and Clinical Significance of Diastolic Heart Sounds

Cited by 13 publications

References 41 publications

Association Between Phonocardiographic Third and Fourth Heart Sounds and Objective Measures of Left Ventricular Function

Association Between Phonocardiographic Third and Fourth Heart Sounds and Objective Measures of Left Ventricular Function

Assessment of Cardiac Function and Prevalence of Sleep Disordered Breathing using Ambulatory Monitoring with Acoustic Cardiography – Initial Results from SWICOS

The Utility of Heart Sounds and Systolic Intervals Across the Care Continuum

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