S3 Detection as a Diagnostic and Prognostic Aid in Emergency Department Patients With Acute Dyspnea

2013 ACCF/AHA Guideline for the Management of Heart Failure

“…Both BNP and NT-proBNP are useful for the identification or exclusion of acutely decompensated HF in dyspneic patients, 247,249,250,718,719 particularly in the context of uncertain diagnosis. [720][721][722] Other options for diagnostic evaluation of patients with suspected acutely decompensated HF, such as acoustic cardiography, 723 bioimpedance vector monitoring, 724 or noninvasive cardiac output monitoring 725 are not yet validated. ACS is an important cause of worsening or new-onset HF.…”

Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims

“…Over the past decade processes for satisfying regulatory requirements have gone through rigorous review and are now well developed. 3,83,170,221 In extreme cases, when a patient's decision making capacity is expected to be so impaired as to impede the consenting process, exception from informed consent may be necessary. Exception from informed consent requires significant resource allocation to obtain community input regarding the trial, but allows inclusion of patients who otherwise could not be enrolled.…”

Fluid-Volume Assessment in the Investigation of Acute Heart Failure

“…In patients who had a right heart catheterization, the use of acoustic cardiography predicted a PCWP C15 mmHg (c-stat 0.76) [5]. The Heart Failure and Audicor Technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) trial investigated the use of acoustic cardiography S3 in 995 dyspneic patients and found that for acoustic cardiography the S3 had a sensitivity of 40.2 % and a specificity of 88.5 % [6]. Although it has low sensitivity, acoustic cardiography S3 was not found to change the diagnostic accuracy for AHF [6].…”

“…The Heart Failure and Audicor Technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) trial investigated the use of acoustic cardiography S3 in 995 dyspneic patients and found that for acoustic cardiography the S3 had a sensitivity of 40.2 % and a specificity of 88.5 % [6]. Although it has low sensitivity, acoustic cardiography S3 was not found to change the diagnostic accuracy for AHF [6]. In the subset of patients with slightly to moderately raised brain natriuretic peptide (BNP) (between 100 and 499 pg/mL), acoustic cardiography improved the accuracy of AHF diagnosis from 47 to 69 % [7].…”