TY - JOUR
T1 - Physiology of the Third Heart Sound
T2 - Novel Insights from Tissue Doppler Imaging
AU - Shah, Sanjiv J.
AU - Marcus, Gregory M.
AU - Gerber, Ivor L.
AU - McKeown, Barry H.
AU - Vessey, Joshua C.
AU - Jordan, Mark V.
AU - Huddleston, Michele
AU - Foster, Elyse
AU - Chatterjee, Kanu
AU - Michaels, Andrew D.
N1 - Funding Information:
Dr. Michaels received an unrestricted educational grant from Inovise Medical, Inc. (Portland, OR). Dr. Shah is supported by a Heart Failure Society of America Research Fellowship Award.
PY - 2008/4
Y1 - 2008/4
N2 - Background: The third heart sound (S3) is thought to be caused by the abrupt deceleration of left ventricular (LV) inflow during early diastole, increased LV filling pressures, and decreased LV compliance. We sought to determine whether the ratio of early mitral inflow velocity to diastolic velocity of the mitral annulus (E/E') could confirm the proposed mechanism of the S3. Methods: A total of 90 subjects underwent phonocardiography, echocardiography, tissue Doppler imaging, and left-sided heart catheterization. Results: Phonocardiography detected an S3 in 21 patients (23%). Subjects with an S3 had lower ejection fraction (P = .0006) and increased E deceleration rate (P < .0001), E/E' (P < .0001) and filling pressures (P < .0001). The phonocardiographic S3 confidence score correlated with E/E' (r = 0.46; P < .0001) and E deceleration rate (r = 0.43, P = .0001). Of the echocardiographic variables, only E/E' was independently associated with the S3 confidence score (P = .009), independently of invasively determined LV filling pressures (P = .001). Conclusions: The most important determinants of the pathologic S3 are an increased deceleration rate of early mitral inflow, elevated LV filling pressures, and abnormal compliance of the myocardium as measured by tissue Doppler imaging.
AB - Background: The third heart sound (S3) is thought to be caused by the abrupt deceleration of left ventricular (LV) inflow during early diastole, increased LV filling pressures, and decreased LV compliance. We sought to determine whether the ratio of early mitral inflow velocity to diastolic velocity of the mitral annulus (E/E') could confirm the proposed mechanism of the S3. Methods: A total of 90 subjects underwent phonocardiography, echocardiography, tissue Doppler imaging, and left-sided heart catheterization. Results: Phonocardiography detected an S3 in 21 patients (23%). Subjects with an S3 had lower ejection fraction (P = .0006) and increased E deceleration rate (P < .0001), E/E' (P < .0001) and filling pressures (P < .0001). The phonocardiographic S3 confidence score correlated with E/E' (r = 0.46; P < .0001) and E deceleration rate (r = 0.43, P = .0001). Of the echocardiographic variables, only E/E' was independently associated with the S3 confidence score (P = .009), independently of invasively determined LV filling pressures (P = .001). Conclusions: The most important determinants of the pathologic S3 are an increased deceleration rate of early mitral inflow, elevated LV filling pressures, and abnormal compliance of the myocardium as measured by tissue Doppler imaging.
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U2 - 10.1016/j.echo.2007.06.007
DO - 10.1016/j.echo.2007.06.007
M3 - Article
C2 - 17658724
AN - SCOPUS:41249084539
SN - 0894-7317
VL - 21
SP - 394
EP - 400
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 4
ER -