| Implications of third heart sounds in patients with valvular heart disease. The Veterans Affairs Cooperative Study on Valvular Heart Disease. | |
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MedLine Citation:
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PMID: 1625735 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The presence of third heart sounds in patients with valvular heart disease is often regarded as a sign of heart failure, but it may also depend on the type of valvular disease. METHODS: We assessed the prevalence of third heart sounds and the relation between third heart sounds and cardiac function in 1281 patients with six types of valvular heart disease. RESULTS: The prevalence of third heart sounds was higher in patients with mitral regurgitation (46 percent) or aortic regurgitation (28 percent) than in those with aortic stenosis (11 percent) or mitral stenosis (8 percent). The left ventricular ejection fraction was significantly lower (P less than 0.001) when a third heart sound was detected in patients with aortic stenosis (0.38, vs. 0.56 in those without third heart sounds) or mixed aortic valve disease (0.40 vs. 0.55). However, the ejection fraction was only slightly lower in patients with mitral regurgitation and third heart sounds (0.51 vs. 0.57, P = 0.03). The pulmonary-capillary wedge pressure was higher (P less than 0.001) when a third heart sound was detected in patients with aortic stenosis (18.6 mm Hg, vs. 12.1 mm Hg in those without third heart sounds). There was no association between the wedge pressure and third heart sounds in patients with mitral regurgitation. The prevalence of third heart sounds increased with the severity of mitral regurgitation. CONCLUSIONS: In patients with mitral regurgitation, third heart sounds are common but do not necessarily reflect left ventricular systolic dysfunction or increased filling pressure. In patients with aortic stenosis, third heart sounds are uncommon but usually indicate the presence of systolic dysfunction and elevated filling pressure. |
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Authors:
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E D Folland; B J Kriegel; W G Henderson; K E Hammermeister; G K Sethi |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: The New England journal of medicine Volume: 327 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1992 Aug |
Date Detail:
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Created Date: 1992-08-13 Completed Date: 1992-08-13 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 458-62 Citation Subset: AIM; IM |
Affiliation:
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Research Services, Veterans Affairs Medical Centers, West Roxbury, Mass. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aortic Valve Insufficiency / physiopathology Aortic Valve Stenosis / physiopathology Heart Sounds* Heart Valve Diseases / physiopathology* Humans Mitral Valve Insufficiency / physiopathology Mitral Valve Stenosis / physiopathology Pulmonary Wedge Pressure Stroke Volume Ventricular Function, Left |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1992 Dec 17;327(25):1818-9
[PMID:
1435942
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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