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Evidence-Based Medicine 2005;10:182; doi:10.1136/ebm.10.6.182
Copyright © 2005 by the BMJ Publishing Group Ltd.
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Diagnosis

Third and fourth heart sounds had low sensitivity but moderate to high specificity for predicting left ventricular dysfunction.

Marcus GM, Gerber L, McKeown BH, et al. Association between phonocardiographic third and fourth heart sounds and objective measures of left ventricular function. JAMA 2005;293:2238–44.[Abstract/Free Full Text]

Q In patients referred for non-emergent left sided heart catheterisation, how accurate are the third (S3) and fourth (S4) heart sounds detected by computerised phonocardiography for predicting left ventricular dysfunction?

Clinical impact ratings IM/Ambulatory care *****{star}{star} Cardiology ******{star}

Key Words: heart sounds • phonocardiography • ventricular dysfunction (left)

The first 150 words of the full text of this article appear below.

METHODS
{ebmflochart.f1}Design: blinded comparison of S3 and S4 with B type natriuretic peptide (BNP) concentration, left ventricular end diastolic pressure (LVEDP), and left ventricular ejection fraction (LVEF) as reference standards.

{ebmglobe.f1}Setting: a university teaching hospital in the US.

{ebmpatient.f1}Patients: 90 patients (mean age 62 y, 61% men) who were referred for elective left sided heart catheterisation. Exclusion criteria included age <18 years and systolic pressure <90 mm Hg.

{ebmtestube.f1}Description of test: S3 and S4 were obtained from audioelectrocardiographic data generated by the Audicor System (Audicor, Inovise Medical Inc, Portland, OR, USA), with the audioelectrocardiographic leads attached to V3 and V4 positions and connected to a Marquette MAC 5000 (General Electric Healthcare Technologies, Waukesha, WI, USA).

{ebmgold.f1}Diagnostic standards: BNP concentrations measured using a membrane immunoflourescence assay (Biosite Inc, San Diego, CA, USA) with BNP concentrations >100 pg/ml specified as abnormal; LVEDP recorded using a 6F pigtail catheter and a fluid filled pressure . . . [Full text of this article]

Adrian F Hernandez, MD

Duke University Medical Center
Durham, North Carolina, USA






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