Abstract
Background: Although the fourth heart sound (S4) is thought to be associated with a stiff left ventricle, this association has never been proven. Recently, single-beat estimation of the end-diastolic pressure volume relationship (EDPVR) has been characterized (P = αVβ), allowing the estimation of EDPVR in larger groups of patients. We hypothesized that the S4 is associated with an upward- and leftward-shifted EDPVR, indicative of elevated end-diastolic stiffness. Methods and Results: Ninety study participants underwent acoustic cardiographic analysis, echocardiography, and left heart catheterization. We calculated α and β coefficients to define the nonlinear slope of the EDPVR using the single-beat method for measuring left ventricular end-diastolic elastance. In the P = αVβ EDPVR estimation, α was similar (P = .31), but β was significantly higher in the S4 group (5.96 versus 6.51, P = .002), signifying a steeper, upward- and leftward-shifted EDPVR curve in subjects with an S4. The intensity of the S4 was associated with both β (r = 0.42, P < .0001) and E/E′ ÷ stroke volume index, another index of diastolic stiffness (r = 0.39, P = .0008). On multivariable analysis, β remained associated with the presence (P = .008) and intensity (P < .0001) of S4 after controlling for age, sex, and ejection fraction. Conclusions: The S4 is most likely generated from an abnormally stiff left ventricle, supporting the concept that the S4 is a pathologic finding in older patients.
Original language | English (US) |
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Pages (from-to) | 431-436 |
Number of pages | 6 |
Journal | Journal of Cardiac Failure |
Volume | 14 |
Issue number | 5 |
DOIs | |
State | Published - Jun 2008 |
Funding
A.D.M. has received an unrestricted educational grant from Inovise Medical, Inc (Portland, OR). S.J.S. was supported by a Heart Failure Society of America Research Fellowship Award. A.D.M. was supported by a National Institute of Health Mentored Patient-Oriented Research Career Development K23 Award (RR018319-01 A1).
Keywords
- Phonocardiography
- echocardiography
- hemodynamics
- pathophysiology
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine