Document Detail


Third heart sound and elevated jugular venous pressure as markers of the subsequent development of heart failure in patients with asymptomatic left ventricular dysfunction.
MedLine Citation:
PMID:  12727575     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To determine the independent prognostic value of a third heart sound (S(3)) and elevated jugular venous pressure in patients with asymptomatic left ventricular dysfunction. METHODS: We performed a post hoc analysis of 4102 participants from the Studies of Left Ventricular Dysfunction (SOLVD) prevention trial. In that trial, participants with asymptomatic or minimally symptomatic left ventricular dysfunction (New York Association class I or II, left ventricular ejection fraction < or =0.35, no treatment for heart failure) were allocated randomly to enalapril or placebo and followed for a mean (+/- SD) of 34 +/- 14 months. The presence of an S(3) and elevated jugular venous pressure was ascertained by physical examination at study enrollment. We used multivariate proportional hazards models to determine whether these physical examination findings were associated with the development of heart failure, a prespecified endpoint of the SOLVD prevention trial. RESULTS: At baseline, 209 subjects (5.1%) had an S(3) and 70 (1.7%) had elevated jugular venous pressure. Heart failure developed in 1044 subjects (25.5%). After adjusting for other markers of disease severity, an S(3) was associated with an increased risk of heart failure (relative risk [RR] = 1.38; 95% confidence interval [CI]: 1.09 to 1.73; P = 0.007) and the composite endpoint of death or development of heart failure (RR = 1.34; 95% CI: 1.09 to 1.64; P = 0.005). Elevated jugular venous pressure was also associated with these outcomes in multivariate models. CONCLUSION: The physical examination provides prognostic information among patients with asymptomatic or minimally symptomatic left ventricular dysfunction.
Authors:
Mark H Drazner; J Eduardo Rame; Daniel L Dries
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of medicine     Volume:  114     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-05-02     Completed Date:  2003-05-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431-7     Citation Subset:  AIM; IM    
Affiliation:
Heart Failure Research Unit, Donald W. Reynolds Cardiovascular Clinical Research Center, Dallas, Texas 75390, USA. mark.drazner@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Female
Heart Failure / diagnosis*,  physiopathology
Heart Sounds / physiology*
Humans
Jugular Veins / physiopathology*
Male
Middle Aged
Multivariate Analysis
Prognosis
Retrospective Studies
Risk Factors
Venous Pressure / physiology
Ventricular Dysfunction, Left / physiopathology*
Comments/Corrections
Comment In:
Am J Med. 2003 Apr 15;114(6):499-500   [PMID:  12727583 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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