Document Detail

Association of the fourth heart sound with increased left ventricular end-diastolic stiffness.
MedLine Citation:
PMID:  18514937     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although the fourth heart sound (S4) is thought to be associated with a stiff left ventricle, this association has never been proven. Recently, single-beat estimation of the end-diastolic pressure volume relationship (EDPVR) has been characterized (P = alphaV(beta)), allowing the estimation of EDPVR in larger groups of patients. We hypothesized that the S(4) is associated with an upward- and leftward-shifted EDPVR, indicative of elevated end-diastolic stiffness. METHODS AND RESULTS: Ninety study participants underwent acoustic cardiographic analysis, echocardiography, and left heart catheterization. We calculated alpha and beta coefficients to define the nonlinear slope of the EDPVR using the single-beat method for measuring left ventricular end-diastolic elastance. In the P = alphaV(beta) EDPVR estimation, alpha was similar (P = .31), but beta was significantly higher in the S(4) group (5.96 versus 6.51, P = .002), signifying a steeper, upward- and leftward-shifted EDPVR curve in subjects with an S(4). The intensity of the S(4) was associated with both beta (r = 0.42, P < .0001) and E/E' / stroke volume index, another index of diastolic stiffness (r = 0.39, P = .0008). On multivariable analysis, beta remained associated with the presence (P = .008) and intensity (P < .0001) of S(4) after controlling for age, sex, and ejection fraction. CONCLUSIONS: The S(4) is most likely generated from an abnormally stiff left ventricle, supporting the concept that the S(4) is a pathologic finding in older patients.
Sanjiv J Shah; Kenta Nakamura; Gregory M Marcus; Ivor L Gerber; Barry H McKeown; Mark V Jordan; Michele Huddleston; Elyse Foster; Andrew D Michaels
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-05-27
Journal Detail:
Title:  Journal of cardiac failure     Volume:  14     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-02     Completed Date:  2008-09-22     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-6     Citation Subset:  IM    
Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
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MeSH Terms
Aged, 80 and over
Cross-Sectional Studies
Heart Sounds*
Heart Ventricles / physiopathology
Middle Aged
Multivariate Analysis
Stroke Volume
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography
Grant Support
K23 RR018319-04/RR/NCRR NIH HHS; RR018319-01 A1/RR/NCRR NIH HHS

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