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

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 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 ★★★★★☆☆ Cardiology ★★★★★★☆


Embedded ImageDesign:

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.

Embedded ImageSetting:

a university teaching hospital in the US.

Embedded ImagePatients:

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.

Embedded ImageDescription 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 V …

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  • For correspondence: Dr Andrew D Michaels, University of California San Francisco Medical Center, San Francisco, CA USA. andrewm{at}

  • Source of funding: National Institutes of Health Mentored Patient-Oriented Research Career Development Award.