TY - JOUR T1 - Third and fourth heart sounds had low sensitivity but moderate to high specificity for predicting left ventricular dysfunction. JF - Evidence Based Medicine JO - Evid Based Med SP - 182 LP - 182 DO - 10.1136/ebm.10.6.182 VL - 10 IS - 6 A2 - , Y1 - 2005/12/01 UR - http://ebm.bmj.com/content/10/6/182.abstract N2 - 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.OpenUrlCrossRefPubMedWeb of Science 
 
 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 ★★★★★★☆ 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. Setting: a university teaching hospital in the US. 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. 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 V … ER -