Relationship of the Third Heart Sound to Transmitral Flow Velocity Deceleration

Manson, Abigail L.; Nudelman, Scott P.; Hagley, Michael T.; Hall, A.F.; Kovács, Sándor J.

doi:10.1161/01.cir.92.3.388

Cited by 40 publications

(26 citation statements)

References 14 publications

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“…These sounds have their maxima in the frequency range 80-120 Hz, whereas this study shows that the main frequency content of the third heart sound is in the range of 10-100 Hz. This finding is consistent with other studies that found the main third heart sound frequency content to be below 60 Hz (EWING et al, 1984;LONGHINI et al, 1988;AGGIO et al, 1990;GLOVER et al, 1992;MANSON et al, 1995;EL-ASIR et al, 1996).…”

Section: Discussionsupporting

confidence: 93%

“…A third heart sound in adults indicates systolic heart failure (ABDULLA et at., 1981;AGGIO et at., 1990;GLOVER et al, 1992;KONO et al, 1993;MANSON et al, 1995). if a simple method exists that can objectively identify and characterise the third heart sound or exclude it, it will be of great value both for the patient and also, economically, for society.…”

Section: Discussionmentioning

confidence: 99%

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Detection of the third heart sound using a tailored wavelet approach

Hult

Fjallbrant

Wranne

et al. 2004

Med. Biol. Eng. Comput.

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The third heart sound is normally heard during auscultation of younger individuals but disappears with increasing age. However, this sound can appear in patients with heart failure and is thus of potential diagnostic use in these patients. Auscultation of the heart involves a high degree of subjectivity. Furthermore, the third heart sound has low amplitude and a low-frequency content compared with the first and second heart sounds, which makes it difficult for the human ear to detect this sound. It is our belief that it would be of great help to the physician to receive computer-based support through an intelligent stethoscope, to determine whether a third heart sound is present or not. A precise, accurate and low-cost instrument of this kind would potentially provide objective means for the detection of early heart failure, and could even be used in primary health care. In the first step, phonocardiograms from ten children, all known to have a third heart sound, were analysed, to provide knowledge about the sound features without interference from pathological sounds. Using this knowledge, a tailored wavelet analysis procedure was developed to identify the third heart sound automatically, a technique that was shown to be superior to Fourier transform techniques. In the second step, the method was applied to phonocardiograms from heart patients known to have heart failure. The features of the third heart sound in children and of that in patients were shown to be similar. This resulted in a method for the automatic detection of third heart sounds. The method was able to detect third heart sounds effectively (90%), with a low false detection rate (3.7%), which supports its clinical use. The detection rate was almost equal in both the children and patient groups. The method is therefore capable of detecting, not only distinct and clearly visible/audible third heart sounds found in children, but also third heart sounds in phonocardiograms from patients suffering from heart failure.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Detection of the third heart sound using a tailored wavelet approach

Hult

Fjallbrant

Wranne

et al. 2004

Med. Biol. Eng. Comput.

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“…Presence of S3 is associated with steeper pressure rise during rapid filling wave portion of LV pressure tracing as well as increased LV chamber stiffness . Modelling studies of cardiohemic vibratory system imply presence of vibrations due to blood‐pool deceleration in all hearts . With stiffer ventricles, restrictive early filling and shorter and sharper decelerations in HF, these vibrations are believed to assume sufficient enough energy in the audible range to be heard with a stethoscope .…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic monitoring of cardiac status using heart sounds from an implanted cardiac device

Thakur

Swanson

et al. 2017

ESC Heart Failure

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AimThe aim of this study was to evaluate the haemodynamic correlates of heart sound (HS) parameters such as third HS (S3), first HS (S1), and HS‐based systolic time intervals (HSTIs) from an implantable cardiac device.Methods and resultsTwo unique animal models (10 swine with myocardial ischaemia and 11 canines with pulmonary oedema) were used to evaluate haemodynamic correlates of S1, S3, and HSTIs, namely, HS‐based pre‐ejection period (HSPEP), HS‐based ejection time (HSET), and the ratio HSPEP/HSET during acute haemodynamic perturbations. The HS was measured using implanted cardiac resynchronization therapy defibrillator devices simultaneously with haemodynamic references such as left atrial (LA) pressure and left ventricular (LV) pressure. In the ischaemia model, S1 amplitude (r = 0.76 ± 0.038; P = 0.002), HSPEP (r = −0.56 ± 0.07; P = 0.002), and HSPEP/HSET (r = −0.42 ± 0.1; P = 0.002) were significantly correlated with LV dP/dtmax. In contrast, HSET was poorly correlated with LV dP/dtmax (r = 0.14 ± 0.14; P = 0.23). In the oedema model, a physiological delayed response was observed in S3 amplitude after acute haemodynamic perturbations. After adjusting for the delay, S3 amplitude significantly correlated with LA pressure in individual animals (r = 0.71 ± 0.07; max: 0.92; min: 0.17) as well as in aggregate (r = 0.62; P < 0.001). The S3 amplitude was able to detect elevated LA pressure, defined as >25 mmHg, with a sensitivity = 58% and specificity = 90%.ConclusionsThe HS parameters such as S1, S3, and HSTIs measured using implantable devices significantly correlated with haemodynamic changes in acute animal models, suggesting potential utility for remote heart failure patient monitoring.

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“…S3 auscultation has been used for noninvasive assessment of left ventricular dysfunction for over a century . By defining S3 more generally as an acoustic wave and not limited to an audible sound, it can be stated that all hearts generate S3 resulting from halting of early diastolic filling, and S3 becomes audible only for hearts with sufficiently abrupt filling in a favorable acoustic environment and with a trained listener. This is supported by the findings of this study, where all subjects had a distinct and electronically measurable infrasonic S3, regardless of clinician audibility.…”

Section: Discussionmentioning

confidence: 99%