Ambulatory Monitoring of Heart Sounds via an Implanted Device Is Superior to Auscultation for Prediction of Heart Failure Events

Abstract

Background: We compared the relationship between the third heart sound (S3) measured by an implantable cardiac device (devS3) and auscultation (ausS3) and evaluated their prognostic powers for predicting heart failure events (HFEs). Methods and Results: In the MultiSENSE study, devS3 was measured daily with continuous values, whereas ausS3 was assessed at study visits with discrete grades. They were compared among patients with and without HFEs at baseline and against each other directly. Cox proportional hazard models were developed between follow-up visits and over the whole study. Simulations were performed on devS3 to match the limitations of auscultation. We studied 900 patients, of whom 106 patients experienced 192 HFEs. Two S3 sensing modalities correlated with each other, but at baseline, only devS3 differentiated patients with or without HFEs (P < 0.0001). The prognostic power of devS3 was superior to that of ausS3 both between follow-up visits (HR = 5.7, P < 0.0001, and 1.7, P = 0.047, respectively) and over the whole study (HR = 2.9, P < 0.0001, and 1.4, P = 0.216, respectively). Simulation results suggested this superiority may be attributed to continuous monitoring and to subaudible measuring capability. Conclusions: S3 measured by implantable cardiac devices has stronger prognostic power to predict episodes of future HFEs than that of auscultation.

Multiparameter diagnostic sensor measurements during clinically stable periods and worsening heart failure in ambulatory patients

“…A separate analysis of the MultiSENSE study showed that device measured S3 was better able to predict heart failure decompensations than auscultation. 16 In the present analysis, the third heart sound has a significantly higher magnitude in patients experiencing an HF event, and crescendos on the day of admission.…”

Use of a novel implantable cardioverter‐defibrillator multisensor algorithm for heart failure monitoring in a COVID‐19 patient: A case report

“…The respiratory function began to improve in mid-April and was preceded by a decrease in the ICD-measured respiratory rate. These changes were accompanied by a reduction in the amplitude of S3, usually related to an improved diastolic function, 9,10 and an increase in the thoracic impedance, a sign of reduction in thoracic fluids. 11 Upon reaching adequate respiratory function and after verification of adequate hemodynamic compensation, the patient was discharged.…”

Integration of novel monitoring devices with machine learning technology for scalable cardiovascular management

“…Furthermore, microphone-based devices have been used to transform cardiac acoustic vibrations to biomedical signals in quantitative versions of the phonocardiogram 52 . Such devices can track respiratory rate, heart and lung sounds, and body motion or position, and might be superior to physical examination for predicting worsening HF 53 .…”